Feature | May 07, 2008 | Mary Beth Massat

Max Your PACS via Central, Virtualized Storage

Centralized storage, virtualization and enterprise-wide policy are key to ‘maxing’ your PACS.

Every hospital and imaging center wants to maximize capital equipment and technology investments in today’s cost-constrained healthcare market. Lowering reimbursement and rising costs require hospitals to maximize utilization of existing equipment and technology.
So what can hospitals do? One answer is to look at maximizing their storage investment across multiple departments and information systems. There is no doubt the data explosion in healthcare threatens the operating structure of many hospitals and specifically, radiology departments. The volume of data generated by multislice CT, high-field MRI and full-field digital mammography, for example, require facilities to look deeper at storage solutions and data management strategies.
Centralize your storage
Storage is a key area where facilities can maximize their PACS and IT investment. As hospitals continue to feel the pain of PACS data migration, more sites are embracing the concept of DICOM storage versus “PACS” storage. The concept is to create a central DICOM storage repository that is not native to any one IT solution, such as PACS.
An enterprise-wide storage management policy lets facilities maximize storage technology across a broad range of imaging from all “ologies.” Rather than having silos of information storage, hospitals can invest in a central data repository that facilitates the distribution of imaging studies throughout the enterprise, including those from: radiology, cardiology, visible light (endoscopy, laproscopy, arthroscopy, etc.), pathology, opthalmology and even otolaryngology (ear, nose and throat).
An inherent advantage in a central data repository is the facilitation of information into an electronic medical record. Gary Wendt, M.D., MBA, enterprise director of medical imaging and vice chair of informatics at the University of Wisconsin – Madison, addressed this point during his DHIMS 2008 lecture on Enterprise versus Departmental Storage Solution. Dr. Wendt noted that “moving the vision of radiology DHIMS to other clinical departments with common archive and distribution mechanism will allow you to improve the effectiveness of your clinical team with a single point of image display, improve patient care with a more integrated record and improve the speed of clinical care.”
One answer to centralized storage is to look at outsourcing storage management services. At Yavapai Regional Medical Center, John Munday, PACS administrator, built his PACS implementation around his outsourced storage management solution. Since 2001, Yavapai has used InSiteOne’s InDex Online to store images, first from the facility’s teleradiology solution, then RIS and PACS. When Munday’s department installed a RIS in 2003 and PACS in 2005, a primary requirement for both systems was the ability to interface with InDex Online.
For Munday, it is important that the hospital’s image archive is not attached to the PACS. “InSiteOne helped prepare us for the transition to PACS,” said Munday. “With their service, we already had two years of images stored, so we were able to go filmless the same day our PACS went live.” The creation of a DICOM archive also eliminates proprietary storage at the PACS level, which will facilitate any future migration to a new PACS, which facilitates sending images to other facilities in the area.
Storage and PACS - package deal
The wave of PACS and archive services has drawn the attention of IT giants like Hewlett Packard (HP) and IBM. HP recently entered into a deal with Iron Mountain to offer mid-sized hospitals and imaging centers a service for protecting and storing diagnostic images. The service includes Iron Mountain’s new Digital Record Center for medical images, a disaster recovery and long-term archiving service that is powered by the HP Medical Archive solution (MAS). The service delivers on-demand access to diagnostic images, and assists healthcare organizations meet compliance with federal laws for handling patient data and reduce long-term storage costs.
As a managed service, the Digital Record Center for Medical Images provides secure, off-site, back-up protection without requiring hospitals and imaging centers to set aside storage systems, data center space, staff and capital investments. This helps medical institutions reduce their storage costs and allows them to redirect resources to clinical operations.
IBM introduced its Grid Medical Archive Solution (GMAS) storage solution, which it offers as a storage option with Siemens Medical Solutions’ PACS syngo and Soarian platform. The package includes IBM’s GMAS storage system designed to speed up workflow, leverage high availability and interoperability with PACS, and offer the enterprise scalability, security and automated disaster recovery. IBM and Siemens implemented this solution at HealthAlliance Hospital, a member of UMass Memorial Health Care, which sought to improve its workflow across its radiology and emergency departments, surgery, physician practices, remote locations and finance department.
Taking the storage and PACS in another direction is Candelis’ ImageGrid RIS/PACS Appliance. Candelis integrated the two components by extending from the ImageGrid the RIS/PACS capabilities. The Web-based end-to-end digital image management appliance is designed for budget-conscious regional or community hospitals as well as diagnostic imaging centers.
Virtualization optimizes power
One key area that offers a simplified approach is virtualization of the data center. Virtualization of both servers and storage enables scalability and accessibility without crippling the bottom line. Consolidation allows organizations to restructure their IT infrastructure for the purpose of reducing costs and improving control by optimizing the resource requirements. Fewer servers and software licenses, lower power and cooling costs, smaller data center footprints and greater productivity by healthcare IT teams are some of the obvious benefits to a sound virtualization strategy. Less infrastructure maintenance means more business innovation. According to James Coffin, vice president of Dell Healthcare and Life Sciences, IT departments spend around 70 percent of their IT budget on ongoing operations and maintenance, which leaves only 30 percent for driving new initiatives.
Coffin points to a good example of this with Sun Healthcare Group, an organization that reduced the footprint of its data center by 56 percent and expects to reduce total cost of ownership by 50 percent over the next three years. This allows Sun Healthcare to focus on bigger, strategic priorities while getting even better performance from its IT infrastructure.
It's important to have a strategy that looks at how to keep data secure for indefinite periods while making it accessible when it's needed.
Digital dashboard monitors progress
Another issue is the utilization of information to make better purchasing decision. The growth of “digital dashboards” opens a new realm of information-based decision-making tools for administrators. Are they getting the biggest bang from their buck when it comes to modality utilization? Is information technology helping radiology departments maximize efficiency and productivity or creating new barriers?
PACS is just the first step to electronics-based informatics, pointed out Paul J. Chang, M.D., FSIIM, professor and vice-chairman of radiology informatics, medical director of pathology informatics, University of Chicago School of Medicine and medical director, enterprise imaging at the University of Chicago Hospitals, at the recent DHIMS 2008 conference. “Improved patient throughput is not sufficient,” he said. The real goal is information throughput by re-engineering workflow processes to leverage the electronic infrastructure. Dr. Chang also noted that facilities must move beyond just shutting off film to the elimination of paper. Electronic-based information systems and tighter integration among these are key requirements for a paper-less workflow.
Digital dashboards, the administrative arm of PACS, provide information that can be used to help re-engineer radiology workflow to improve efficiency, Dr. Chang explained. Specifically, he demonstrated improved report turnaround and improved dictation times with integrated dashboards. Information that details workflow and helps identifies bottlenecks can improve efficiency by helping administrators address issues that may remain unseen to the human eye, but uncovered through data reporting tools such as digital dashboards.
In fact, Pam Moseley, director of radiology informatics at Rochester General Hospital (Rochester, NY), uses her RIS/PACS to maximize equipment utilization, identify the need, or lack thereof, for new imaging equipment and to reorganize workflow throughout the department. “There is so much information in the RIS/PACS,” she said. “I can generate reports to know what is going on at any time throughout the radiology department.”
For example, Moseley can determine exactly how often each modality room is used, including the type of studies, volume, staffing, including nurses, and report turn-around times. She credits Carestream’s RIS/PACS for giving her the ability to create new reports on-the-fly. The system interfaces with Crystal Links, a report creation program, to generate reports by accessing the RIS/PACS database. Reports that Moseley has created since joining Rochester General four years ago include: productivity, exam volume, room utilization, referring physician volumes, daily billing, cashier reports for co-pays and even failed faxes. “Everything is a domino effect, but if you can look at all the reports together, you can see the big picture,” said Moseley.
Three examples ring true for Moseley on the value of advanced reporting capabilities. When she first started, the facility was considering a new nuclear medicine camera based on the feedback of clinicians. What she uncovered by tapping into the RIS/PACS database is that the real problem was scheduling. “Service records also showed that our third machine was 40 percent idle,” she said. In some cases, patients required both a NM and CT exam and the department could schedule these studies together.
Likewise, after purchasing a third CT, the hospital entertained buying a fourth. “We found out that we could fit more patients into CT if we increased the patient preparation area,” she explained. This allowed patients to be prepped outside of the CT room, resulting in a higher utilization level of the existing CT systems.
Patient wait times were also long. After generating another custom report, Moseley was able to determine that the department needed another diagnostic X-ray room. With the ability to generate any type of report, Moseley can view the entire department to “see how all the pieces go together and look at the big
picture, not just one room’s utilization.” She calls it “the perfect ROI.”

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