Streamlining Imaging in the Growing Enterprise

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 Southern Ohio Medical Center (SOMC) in Portsmouth, Ohio, a 235-bed community hospital, is at a crossroads. It aims to become the leading medical center in the region and strives to provide appropriate, high quality, timely and cost-effective service. Its imaging department is top-notch. The primary-care hospital provides a full range of diagnostic imaging procedures, including digital mammography, PET/CT and digital radiography. SOMC was an early PACS adopter, deploying Agfa HealthCare IMPAX PACS in 1998, leveraging an EMC information infrastructure. It also uses Agfa HealthCare’s TalkStation and Agfa HealthCare’s RIS. Radiography solutions include Agfa HealthCare computed radiography and DXS systems and Shimadzu Mobile DaRT for wireless digital portable radiography.

Currently, SOMC and its two satellite imaging centers complete 170,000 studies annually. Its volume, however, is expected to increase substantially over the next several years as the medical center is undertaking a $100 million project that will expand its cardiac and vascular services and add about 100 patient beds. The project coincides with three enterprise imaging initiatives, reports RIS/PACS Administrator Howard Stewart.

The projects over the next two to three years include implementing Agfa IMPAX 6.0 PACS, merging cardiology into the overall IT infrastructure and adding a physician portal. SOMC initiatives are designed to streamline workflow for both radiologists and clinicians, improve access to data and simplify IT management. “It will bring significant changes to the cardiology department and also benefit radiology,” predicts Stewart. 

Distributed PACS delivers

SOMC has begun implementing IMPAX 6.0, and expects to complete the project in three to six months. The upgrade is a distributed PACS application rather than a client-server model. “Many vendors want to tie imaging data to specific workstations and equipment. IMPAX 6.0 moves away from that model,” explains Stewart.

Although the SOMC radiology department uses IMPAX, its cardiac cath lab relies on a different archiving system. Physicians must use contained workstations to retrieve and view cardiac cath imaging data. This model does not facilitate optimal physician workflow or a coordinated patient care model. In fact, the opposite is true. The workstation model can restrict physician workflow, impede flexibility and hamper clinical decision-making and the speed of patient care.

“IMPAX 6.0 infuses PACS throughout the enterprise by providing licensing based on concurrent users,” Stewart says. It will allow SOMC to deliver coordinated patient care, a key factor as the hospital moves forward with its expansion project. “Cardiologists need to interact with cardiac surgeons, pulmonologists and other clinical specialists. They need to view a wide variety of imaging data including cath results, CT images and calcium scores,” continues Stewart. IMPAX 6.0 allows users to access the full complement of patient imaging data from a single workstation. Ultimately, it gives physicians the tools and data they need to make well-informed clinical decisions in minimal time, without disrupting workflow.

Distributed image management dovetails nicely with the second SOMC initiative—tying cardiology into the overall IT infrastructure. “Our goal is for physicians to access the data they need at the point of care; data should be available at the physician workpoint—not tied to specific workstations,” explains Stewart, “Data should be accessible by mobile physicians who no longer work from a single location.”

The portal payoff

SOMC has used a homegrown portal for several years; however, the system has several limitations. That is, it does not provide access to live data such as patient monitoring and, in addition, it requires physicians to complete multiple log-ins. “Our vision is a one-stop shop for physicians,” says Stewart. Once SOMC implements a physician portal like Agfa Enterprise Clinical Dashboard, physicians will log onto the portal once to access all pertinent patient information including imaging and lab reports. The portal also will provide access to imaging programs and allow physicians to update reports. It meets the common twin goals of improving patient care and physician workflow.

Enterprise advice

Selecting a PACS vendor is a bit like marriage. It is a long-term commitment fraught with change, challenges and growing pains. SOMC selected wisely with its initial radiology implementation and has benefited from a well-conceived implementation. Stewart offers some advice for his colleagues:

  • Find out if the vendor is willing to accommodate requests that fall outside of the normal product line. For example, at the time of the initial PACS implementation SOMC had decided on gigabit Ethernet rather than proprietary network connections. Agfa agreed to the modification.
  • Look into interface design. At the time of implementation, SOMC required an interface between its PACS and its previous RIS and HIS. The medical center realized that interface represented a significant IT challenge that fell outside the normal scope of is IT department, so it asked PACS vendors to include interface design in the project quote. Agfa complied and accepted responsibility for PACS/RIS/HIS connectivity, removing a hefty project from the already stretched IT department.
  • Carefully consider the archive. “The archive needs to be your top concern,” Stewart says. “It is your data and your business.” As the nerve center of the enterprise, the archive needs to be reliable and cost-effective. Avoid models that require a licensing fee for every device that connects to the database and move as far away from physical data as possible. “SOMC has never lost image data stored on the RAID.” A solid relationship with information infrastructure supplier EMC Corporation combined with a commitment to reliability, efficiency and cost-effectiveness drive the success of the SOMC archive.

Growing pain-free (almost)

In many locations, healthcare is a growing business that needs to serve more customers (patients) while optimizing its clinical staff and maximizing its investments. Business growth is never completely painless, but it can be achieved in a relatively pain-free model through careful planning and beneficial partnerships. The solid relationship between SOMC, Agfa HealthCare and EMC Corporation combined with proactive planning and careful investments in enterprise digital imaging solutions, lays a sound foundation for business growth, excellent and well-informed patient care and streamlined workflow across the enterprise.

The Storage Connection

Southern Ohio Medical Center employed an unusual strategy when it deployed Agfa HealthCare IMPAX PACS in 1998. "We worked backwards and started with storage when we deployed PACS," says Howard Stewart, PACS administrator. The rationale for the decision was straightforward. "The systems and configuration used for image storage set accessibility for all users," explains Stewart.Initial storage was fairly basic and consisted of a Magneto Optical Drive (MOD) jukebox archive. In 2000, the medical center surveyed the storage landscape and started to implement EMC Corporation information infrastructure solutions. Over the next two years, SOMC continued to see rapid growth in imaging volume and storage needs. In addition, its jukebox neared capacity, and the health system realized its storage needs would continue to escalate. SOMC was ripe for an upgrade.

In 2002, SOMC began to fully transition to EMC solutions, starting with an EMC Symmetrix storage area network (SAN) before implementing EMC Centera content addressed storage (CAS) for worm-compliant archiving and CLARiiON network attached storage (NAS) for cache data.

The systems have proven to be both cost-effective and reliable. "The transition seemed expensive at first," admits Stewart, "but EMC made it very easy to upgrade from Symmetrix to newer models. After analyzing the various options, we realized the cost of ownership of EMC solutions is actually less than the MOD model." Plus, the system is highly reliable, a benefit not realized with primitive storage systems. In addition to high reliability, the EMC cache/archive model readily accommodates growth and offers fast image retrieval. Finally, both systems are mirrored at an offsite location to provide a redundant PACS archive supporting HIPAA and Joint Commission regulations.

The information infrastructure at SOMC not only meets current needs, but provides a robust storage framework for future needs. Centera and CLARiiON provide the necessary scalability for a $100 million expansion and enterprise storage model that wraps "ology" images such as cardiology and pathology into the archive.

Storage and enterprise image management go hand in hand. An enterprise strategy cannot succeed without a sound storage strategy. Designing and implementing a scaleable, robust and compliant enterprise archive returns hefty dividends—including rapid image retrieval, reduced storage overhead and streamlined management.