The World Class Digital Enterprise

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WellStar Health System is a rapidly growing hospital system located in the northwest suburbs of Atlanta. It includes five hospitals: Kennestone, Cobb, Douglas, Paulding and Windy Hill and represents the largest not-for-profit hospital system in Georgia. Kennestone Hospital is the largest hospital in the system with 500 beds, but business is brisk, particularly in medical imaging, at all of our sites. Six imaging centers support the system's mission: to deliver world class healthcare.

WellStar Health System offers comprehensive medical imaging services with the latest solutions, including multiple MRI units and multislice CT scanners as well as a fixed-site PET scanner. The system has embraced the data-intensive volumetric approach to multislice CT data; Kennestone Hospital has become a 3D center of excellence with a 3D lab to facilitate the approach. Approximately 12 CT angiographies per day are assimilated at the Kennestone lab, representing a significant amount of data transfer. CT will continue to dominate the medical imaging landscape and drive data increases as WellStar deploys four 64-slice scanners throughout the system by the end of the year.

Bone densitometry, mammography, ultrasound, fluoroscopy, general radiography and nuclear medicine round out the medical imaging services within the enterprise. Current annual imaging procedure volume stands at 600,000 procedures; 45 radiologists provide medical imaging interpretation services for a large physician referral base.

The high medical imaging volume across multiple sites translates into a tremendous need to deliver images to the right place at the right time. Simultaneously, WellStar struggles with the issue that confronts most 21st century healthcare enterprises: how to manage the ever-increasing image data load. Currently, our system pushes 50 gigabytes (GB) of data into the Agfa IMPAX PACS daily - for a total annual data load of 18 terabytes (TB). And our plan to soon deploy 64-slice scanners further accelerates the need for a comprehensive and proactive data management plan.

Digital roots

By the end of the 1990s, it became apparent that image volume had outpaced hospital capacity at Kennestone Hospital. The hospital frequently encountered numerous medical imaging scheduling conflicts and could not consistently and adequately meet the needs of the ER and inpatient population while simultaneously providing high-quality outpatient imaging services. The solution was to open two nearby, off-site, all-digital imaging centers to provide outpatient medical imaging services. Agfa's IMPAX and CR 75.0 and CR 25.0 computed radiography systems served as the imaging cornerstones of the new ventures.

The new centers were a success on multiple levels. WellStar has taken the position that improvements in patient care should drive digital implementations; however, there are returns on the investment, which is an added benefit. At WellStar, IMPAX facilitates patient care improvements in a number of ways:
  • Images can be sent to radiology specialists no matter where they are located; this provides the highest quality interpretation. If a patient at one of the smaller imaging centers requires an expert neuroradiology consult, the study can be transmitted immediately to the appropriate specialist for interpretation.

  • Films are no longer lost, eliminating unnecessary retakes and delays in diagnostic decisions.

  • Immediate image access and availability for attending physicians enables more timely review and patient treatment.
WellStar realized a quick return on investment with its decision to implement Agfa's digital solutions. The all-digital centers do not contain processors, film chemistry or a film archive, which provides significant savings in architectural engineering and construction fees.

Finally, IMPAX and CR 75.0 and CR 25.0 enabled a total transformation of workflow for radiologists and technologists. Images are almost immediately available at radiologist workstations, which yield a significant improvement in turnaround time. Relevant priors are available from the archive in less than a minute. In the film era, it took hours and even days to retrieve relevant priors as some films were located in an offsite storage facility. Immediate availability of relevant priors also improves patient care as radiologists may not render a final decision without viewing relevant priors in some cases. Technologists' workflow is more streamlined as the need to transport film from point A to point B and back again is eliminated.

The success of the initial digital deployment laid the groundwork for an enterprise digital conversion. The next phase entailed bringing a third imaging center into the digital environment, and over the last three years our remaining imaging centers and five hospitals have been converted, relying on IMPAX and CR 75.0 and 25.0 as the backbone of the conversion.

WellStar Health System recently completed our entire digital integration. An enterprise digital implementation can be an enormous undertaking that requires integration of multi-modality, multi-vendor and DICOM-compatible and legacy equipment. IMPAX seamlessly accomplished the integration of all modalities across the enterprise.

The IT infrastructure

WellStar had set its sights on digital medical imaging in the 1990s. Consequently, our IT department developed a plan to facilitate PACS deployment and digital integration across the enterprise. The final elements of the plan included laying OC-3/fiber network to a few of the remote imaging centers to increase bandwidth and enable 100 megabit/second image transfer speed. WellStar scaled the local RAID at each hospital and imaging center to store images for one year. This secures 75 to 90 percent of relevant priors, driving performance improvement and fast retrieval while limiting bandwidth consumption.

Selecting an enterprise digital partner

There are scores of PACS vendors willing to sell an enterprise image management and distribution solution; however, developing an enterprise solution is an intricate process. Multi-site systems like WellStar Health System are large, complex operations. It is necessary for the PACS vendor to expertly integrate legacy and multi-vendor modalities, and with complex storage and IT arrangements and stay ahead of technical developments in imaging modalities. Thus, it is critical that the PACS vendor offer experience with enterprise implementations, as well as the various, often smaller components, such as imaging centers. This narrows the field considerably. Agfa stands out as one vendor that has successfully completed a number of very large enterprise solutions, all the while keeping an eye on the small details. In fact, its track record of successful enterprise systems led WellStar to select Agfa as its digital solutions provider. It proved to be a wise choice as IMPAX has been a patient care, financial and workflow success across the WellStar enterprise.

Bob Mandler is Director of Radiology at WellStar Health System.