Image Management: The Online Option

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Online image management solutions offer a novel paradigm in the crowded PACS market. Under some online arrangements, the vendor assumes the bulk of the IT and storage burden, which can make for a smoother PACS implementation and upgrade process. The model works well in many types of settings including community hospitals and multi-site imaging enterprises. It can serve as a comprehensive or departmental solution depending on the needs of the site. In others, the online approach reduces the cost and burden of client server architecture to provide universal access to images across and beyond the enterprise. This month, Health Imaging & IT visits a few sites that have discovered the benefits of tapping into online image management.

Propelled out of the dark ages

“Yavapai Medical Center [in Prescott, Ariz.] resided in the dark ages at the turn of [the 21st] century,” admits RIS/PACS Administrator John Munday. Labor-intensive manual image management processes ruled at the small facility. Images were pushed to a teleradiology system, and radiologists dialed in to access images. A failure of the teleradiology system proved to be a blessing in disguise.

Radiology staff happened to meet InSite One Inc. at an Arizona Hospital Association meeting. The company shared its ASP model with Yavapai leadership. Essentially, InSite One proposed to store digital studies, convert analog images to a digital format and install black boxes to output digital studies on each older system that did not transmit digital data. The company also enabled radiology information system (RIS) functionality and worklist reading by storing all studies.

Yavapai Medical Center realized an immediate cost savings with the approach. “When we started storing digital images, the medical center did not have a place to store the data or a budget to purchase critical IT infrastructure,” says Munday. InSite One offered a budget-friendly option by providing the primary onsite archive and two redundant offsite archives in Connecticut and Phoenix. The dual redundant archives serve as the disaster recovery mechanism for the medical center.

The next big bang coincided with the PACS deployment in 2005. “Converting to PACS is usually a painful process with radiology working in two worlds during the transition: soft-copy current files and hard-copy historical images. Because we had more than two years of historical digital files, we were able to go filmless overnight,” says Munday.

The “install and forget” ASP model is a good fit for Yavapai Medical Center. Today, the center completes 112,000 imaging studies annually and stores radiology and cardiac catheterization lab datasets in the 6 terabyte (TB) archive. The IT oversight and management burden is comparably light; InSite One proactively monitors the medical center’s storage needs. When the archive approaches the high water mark, an InSite One representative simply phones Munday to make arrangements to increase storage, sparing the PACS administrator the burden of monitoring storage.

Tapping into the benefits of standardization

Universal Health Services, Inc. (UHS), a publicly owned hospital system headquartered in King of Prussia, Penn., aimed for standardization among its 23 geographically dispersed acute-care hospitals when it turned to online image management. The rationale was two-pronged, says Bruce Marcolongo, manager, information services. “[With a standard system], we could better drive PACS functionality with the vendor and also leverage our internal user group to develop imaging tips and address support issues.”

UHS selected GE Healthcare Centricity IW, and in the last two years, deployed the web-centric system in eight facilities. In addition to meeting its initial goals, UHS has realized additional benefits. “We’ve avoided the limitations of client-server based architecture and implemented a fully web-centric system to provide immediate access to images throughout and beyond our hospitals,” explains Marcolongo. Consequently, UHS hospitals running Centricity IW report improved turnaround time and lower costs. The cost savings are multi-faceted. Legacy client-server PACS carried licensing and upgrade costs as well as higher maintenance bills. Centricity IW, on the other hand, offers a volume-based model. If imaging volume remains flat at 100,000 studies annually at one site, PACS costs stay fixed. But if volume increases to 120,000 studies at another site, the hospital pays more and also profits more with