HIMSS: Enterprise imaging project tops 1,200 terabytes
LAS VEGAS—Cleveland Clinic is building an enterprise imaging repository that allows physicians to visualize everything that happens to the patient, including radiology images, tissue pathology, digital photos and more, according to Louis M. Lannum, director of enterprise imaging at Cleveland Clinic, who detailed the organization’s progress toward an enterprise repository during a Feb. 21 session at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

The six-year odyssey started with a radiology roadmap that included a vendor neutral archive and has mushroomed to approximately 20 departments and a 650-terabyte spinning disk data center, which is replicated off-site.

“Imaging is no longer a radiology silo,” Lannum said. “The most important thing we did was to set up an imaging council group that meets once a month to review all imaging strategies in Cleveland Clinic.”

The leaders have recognized and positioned imaging as a shared strategic resource. “Our strategy is no image left behind.” Lannum and colleagues devised a plan to identify and capture images regardless of the source and divided imaging data into five categories: DICOM PACS, non-DICOM PACS, standalone DICOM acquisition devices, standalone non-DICOM devices and image-based reports.

The strategy is comprised of three related parts: an enterprise model, a longitudinal imaging record and cloud-based storage.

“Workflow is extremely important. In order to understand workflow across departments, we built a model that can be applied across departments and accounts for acquisition, management, reporting, storage and visualization,” Lannum said.

Data storage or data repository?
An imaging repository differs from storage, said Lannum. “Storage is just another layer of storage area network. A repository has its own database and is independent of all systems that feed it.”

Cleveland Clinic is placing image viewers at the repository level as part of its strategy to enable viewing of all images from the EMR.

The project has extended across the enterprise and engaged women’s health, ophthalmology, ambulatory endoscopy, anesthesiology, anatomical pathology, orthopedic surgery, emergency medicine and cardiology. “The list of departments continues to grow,” said Lannum.

The expansion has inflicted growing pains. “We are quickly running out of storage space.” The problem has prompted a move to cloud-based storage as well as an analysis of image retrieval as part of a comprehensive effort to reduce the footprint of the data center.

Cleveland Clinic’s analysis has shown that legacy images from more than three years ago are accessed less than 5 percent of time and after four years retrieval drops to less than 1 percent. However, policies dictate that images must be held seven years. Intelligent, cloud-based storage could help the clinic tame its ever-expanding data center.

For more about enterprise image management please read “No Image Left Behind” in Health Imaging.