Sponsored by an educational grant from GE Healthcare and HP
Case Study: Memorial Sloan-Kettering Cancer Center | New York, N.Y.
Memorial Sloan-Kettering Cancer Center in New York City epitomizes the large-scale filmless radiology enterprise. The cancer center was an early PACS adopter and first deployed digital image management in 1998. Today, the center completes more than 305,500 imaging studies annually at its five main locations and is virtually filmless. Nearly 150 radiologists read images for Memorial Sloan-Kettering. PACS pervades the enterprise. One hundred imaging systems feed images into the PACS. The center houses about 70 diagnostic radiology workstations and 400 PACS workstations. Plus, nearly 9,000 personal computers are equipped with web-viewing capabilities. All told, PACS represents a tremendous IT maintenance and management responsibility for this enterprise focused on cancer diagnosis, treatment and monitoring.
Memorial Sloan-Kettering aims to streamline RIS/PACS processes with the implementation of an integrated GE Healthcare Centricity RIS/PACS. “RIS and PACS were developed independently, but it is important to bring the two systems together,” says Peter Kijewski, PhD, attending physicist and PACS project director. The integrated model can bring significant IT efficiencies including streamlined support and reduced costs.
The cancer center first considered replacing its RIS with an integrated model in 2002, but decided to put the project on hold because the desirable information systems did not offer synergy with Centricity PACS at the time.
Fast forward to 2006. GE acquired IDX Systems Corporation. Centricity RIS-IC offered synergy and integration with Centricity PACS, and Memorial Sloan-Kettering decided to deploy the new RIS. The goal is to merge all functional components into a single system, including embedded voice recognition to minimize the requirements for moving data between systems and interfacing various systems. The implementation is a work in progress, but ideally, RIS-driven workflow will direct the navigation and events within the system.
An IT boon
The new integrated RIS/PACS is expected to deliver significant benefits at Memorial Sloan-Kettering Cancer Center. All users benefit from the upgrade, but the primary payoff is in terms of IT infrastructure and support, says Kijewski.
“There will be one instance of each patient and exam, which means users won’t need to pass through multiple systems to complete a case. There will be one user interface for both RIS and PACS,” adds Kate Lynch, radiology IT & PACS manager. Currently, radiologists primarily interact with the PACS interface, viewing all reports and images in PACS and completing dictation via a PACS-integrated, but separate, voice recognition system. An embedded dictation system with voice recognition will lead to improved workflow, enabling radiologists to access lab interfaces to enhance the protocoling process and providing more flexible worklists. Technologists, who use both systems in their daily workflow, will no longer need to move between the RIS and PACS to complete cases and verify images.
IT maintenance and support needs should drop with the streamlined system, says Lynch, freeing staff to work on other projects. Consider, for example, business continuity. In the current environment, IT must provide high availability and disaster recovery for three distinct systems: RIS, PACS and voice recognition. “When the functions are integrated into a single system, we can transition to a single support infrastructure for major radiology applications,” explains Kijewski. Take a look, too, at the center’s dictation application. It requires three distinct onsite production servers in the computer room and then an additional three mirrored servers for business continuity at the offsite location.
IT also requires test systems. PACS needs three test systems: a test system for current production, a test system for the next software upgrade and a test system for a planned major forklift upgrade for improved capacity and compatibility with RIS/PACS. An integrated RIS/PACS/voice solution streamlines the server burden and frees up real estate in the computer room.
The new configuration should