Enterprise Image Management Makes the Grade

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 - Nurse

For many sites, PACS is an enterprise—rather than radiology department—investment. The enterprise approach packs a powerful punch. It delivers cost-savings, efficiencies and improved care. But as PACS extends throughout the enterprise—either to separate campuses or to other “ologies” beyond radiology—it can grow more complicated. Depending on the project, the enterprise may need to consider and develop or revamp interfaces, enterprise patient identifiers, network connections, legacy equipment and more. This month, Health Imaging & IT visits a few sites that have taken PACS to enterprise level to learn more about the benefits and best practices.

Interfaces optimize performance

Memorial Hermann Baptist Beaumont Hospital in Beaumont, Texas, is an enterprise success story. This 247-bed community hospital deployed Philips Healthcare iSite PACS and Xcelera Cardiology in 2006. At the time, the hospital’s image management needs were fairly pressing. For starters, the hospital was experiencing rapid growth. And, as a rural provider, the hospital aimed to become a complete healthcare system via a telemedicine program with Houston-based Hermann Hospital.

The key elements of the hospital’s enterprise solutions include PACS, the cardiology information system and key interfaces between the departmental systems and its hospital information system (HIS) and radiology information system (RIS). The HIS interface allows clinicians to access HL7 data such as patient demographics and lab results and DICOM images in a single session. The clinical module is very popular among referring physicians, says Director of Medical Imaging Chuck Self. In fact, the radiology department has grown its business from 75,000 studies annually to 130,000 exams since deploying iSite two years ago.

Self credits the successful implementation to a robust test process. After installing a test server, Philips worked with the hospital’s IT and administrative teams to map HL7 information and develop necessary interfaces. The IT department also installed a separate LAN for the radiology department so its traffic did not interfere with other hospital operations.

In addition to the LAN and PACS server, the hospital configured workstations to meet the unique needs of various user groups. On the floors, it converted enterprise 17-inch, flat-panel display systems into image review stations. The ER viewing solution is a bit beefier with 20-inch, 2 megapixel (MP) displays, and cardiac surgeons use mobile carts with dual 20-inch, 2MP displays to view cardiac cath images, cine loops and complete studies and review echo studies in the OR. Radiologists use a two monitor configuration that pairs a 21-inch, grayscale 3MP flat-panel for review of most images with a 20-inch color system for HIS, ultrasound, nuclear medicine and 3D applications. Other IT infrastructure includes a gigabit network backbone with gigabit switches for radiology modalities and cardiovascular systems.

One of the most powerful benefits of the approach, says Self, is that a hospital can realize cost-savings almost immediately after deployment. 

Voices of Experience

If the site needs an enterprise solution, look for a complete package that meets the needs of radiology and cardiology, says Coffee Health Group's Birt

Do your homework, says Self of Memorial Hermann Baptist Beaumont Hospital. Sites can estimate storage requirements by converting analog volume into gigabytes and terabytes and adding projected growth. Make sure that inter-site connections can support rapid transfer of images.

Avoid the lengthy RFP, says Bayhealth's Walczak. It can morph into a monster and add to everyone's workload. Each vendor under consideration must create a document that responds to the RFP, and then hospital staff must review all proposals. Generally, long RFPs correlate with long responses. Instead, develop a request for a solution that focuses on key components of the desired future state and asks vendors to share a plan for taking the hospital from point A to point B.

Determine which areas can benefit from enterprise image management. These include subspecialty review, central ER reading and referring physicians, particularly those who practice at multiple locations. Include all users ("customers") in the selection process; the committee should represent the needs of cardiologists, radiologists and technologists, says Birt.

Enterprise-lite

The operative word in Bayhealth Medical Center’s enterprise solution is trim. The Dover, Del.-based medical center consists of two acute-care hospital and 10 imaging centers. Its image management goals focused on an enterprise solution that avoided hefty bandwidth requirements. The health system’s answer is GE Healthcare Centricity PACS-IW.

Centricity PACS-IW fits our bandwidth and storage infrastructure, says CIO Dave Walczak. At the same time, Walczak admits IT concerns should play second fiddle to the needs of end-users during the PACS selection process. That is, PACS should add value to technologists and radiologists via logical, intuitive workflow. In addition to keeping its bandwidth and storage budget under control, Bayhealth Medical Center has maximized productivity across the radiology department and boasts turnaround time under 24 hours for 95 percent of its studies; most are complete within one to two hours, and inpatient STAT results are often reported before the patient returns to his room.

The value of PACS increases with use, and Bayhealth Medical Center lures referring physicians to PACS via an interface with McKesson Corporation Physician Portal that allows access to financial information, lab and radiology results, medications, nursing documentation and educational content via hyperlinks.

The other secret to enterprise success is an adequate network. Bayhealth Medical Center added redundancy and a 100 megabit connection to the desktop with gigabit switches within its hospitals. Imaging centers have network solutions tailored to their needs. Small sites that complete only a few x-rays daily use T1 lines; larger centers in the city limits rely on a fiber optic gigabit Ethernet leased from the city. Other sites use 10 megabit or T3 lines.

The mega-enterprise

“Enterprise image management is more than numbers. It describes a strategy for image dissemination and management,” opines Lou Lannum, administrator, radiology informatics at The Cleveland Clinic Foundation in Ohio. The Cleveland Clinic uses Siemens Medical Solutions syngo Imaging as a single image management umbrella for its 27 sites that complete 2 million exams annually. The solution makes 100 terabytes (TB) of imaging data available to every physician at every site.

The benefits of the approach are significant. The clinic truly taps into sub-specialty expertise. For example, every head CT is read by a neuroradiologist regardless of where the image originated. “We treat MR and CT resources as enterprise resources, which delivers easier, faster scanning,” says Lannum. In addition, every ER across the enterprise is connected to two primary reading points to provide streamlined workflow for all off-hours emergency studies. Referring physicians can view patient images from any site regardless of location and host HIS.

Enabling rapid access across a large enterprise requires significant IT planning. Cleveland Clinic uses a regional approach to the network with each region housed in a sonnet ring. Regional servers for local storage deliver fast image viewing at the point of acquisition. Images reside in a central archive.

Another IT challenge came in the form of multiple hospital information systems. The Cleveland Clinic sites use different HIS and each assigns a local patient number. The enterprise approach, however, requires a global patient number. Cleveland Clinic developed a unique patient identifier to standardize patients across the enterprise. “An enterprise identifier can be a complex undertaking,” cautions Lannum. The challenges of the enterprise patient identifier extend beyond complexity; some legacy systems may not be able to accommodate an enterprise identifier.

From island to enterprise

Coffee Health Group, a Florence, Ala.-based health system comprised of two hospitals and an imaging center, first deployed PACS in 2003. The health group’s initial digital image management solution also included a mini-PACS for echo, cath lab and EKG images. The group, which completes 146,000 radiology studies and 52,000 cath, echo and EKG studies annually, found the specialized solutions didn’t quite meet its needs.

Ultimately, Coffee Health Group selected ScImage PicomEnterprise PACS to lnk radiology and cardiology images and deployed the new system in June 2007, explains PACS Administrator Philip Birt.

The health system realized cost and workflow benefits immediately after the transition. All physicians, including radiologists and cardiologists, can review both radiology and cardiology images from their offices or home. An interface with the HIS provides access to lab results via PicomEnterprise, too. Because storage islands cost more than a central approach, Coffee Health Group saw an immediate drop in its storage costs. Plus, it’s easier to manage one archive than two separate ones, says Birt.

The health group’s IT infrastructure, new PCs running Microsoft Windows XP, a gigabit fiber connection between facilities and 100 megabit internal connections, more than sufficed for the new PACS.

Making the transition

Nassau University Medical Center in East Meadow, N.Y., deployed AMICAS Vision Series PACS as a departmental solution in February 2004. Now, the trauma center is taking PACS to the enterprise level. “We need a central location for all images and high availability for all images,” explains PACS Administrator David Ramsbotham.

The first target for the enterprise project is surgical ultrasound. The medical center purchased new vascular ultrasound systems for its OR suites. On the IT side, the PACS administrator added a new surgical ultrasound category to the worklist to enable surgeons to manage exams orders.

The medical center plans to gradually grow its enterprise system. Because surgical ultrasound is a low volume procedure, the move does not require a hefty infusion of IT infrastructure. The long range plan calls for wrapping a departmental cardiology solution into the enterprise system.

Building excellence

PACS grows in complexity as it grows outside of radiology and into the enterprise. On the other hand, the benefits of digital management also grow as it extends into the enterprise. Consider:

  • An enterprise system can make sub-specialty expertise universally available.
  • The enterprise can configure the system to provide physicians with access to other key patient data such as lab results, nursing documentation and patient demographics.
  • Enterprise PACS provides a solid foundation for telemedicine and remote ED review.
  • The enterprise approach eradicates expensive islands of images held in mini-PACS.