Moving Toward the Top of Its KLAS
Consolidating Storage for Savings
A Snapshot of Synapse PACS
Teaming Up on Single Solution for Security
Super Solution

Moving Toward the Top of Its KLAS

Executives from Ramsoft Inc, Toronto, are delighted that their company recently jumped up six spots from last year to receive the No. 2 ranking in the PACS (Ambulatory) market segment in the “2008 Top 20 Best in KLAS Awards: Software & Professional Services” report.

Ramsoft recently debuted the company’s latest PowerServer 4.6.

“We are thrilled to have leapt past so many other vendors to achieve our No. 2 ranking,” said Vijay Ramanathan, Ramsoft president and CEO. “This is reflective of our growth and maturity into an industry-leading vendor.”

News of this achievement came after the debut of the company’s latest PowerServer 4.6, which contains several key upgrades to the RIS and PACS software. Designed for functionality and flexibility, the upgraded product includes features that speed image load times, enable optimized breast imaging tools, and improve overall performance.

“The Ramsoft product, especially the 4.6, is really focused on being the product that can manage your information, as well as do all the triggers and corrections,” said Greg Smith, eastern regional sales manager.

Smith said one of the biggest problems for radiologists has been the naming scheme. Doctors who write in “head CT” run into problems when hanging protocols are made for “CT of the head.” “Ramsoft has developed triggers to allow common naming schemes or fill in the location,” Smith said. “The router, which is the basis of everything we built in the beginning, is now becoming a major tool for vendors with customers who need to have a fine-tuned manipulation of information. They need this information correctly distributed in the format that they want.”

The product also boasts fast image loading, as a result of smarter management of computer and memory resources. With the intelligence to predict which study will be needed next, the upgraded PowerServer allows images to be preloaded in advance and therefore increase overall productivity. A rules-based auto study delete capability allows users to define rules that permit disk-cleaning activities based on markers such as “study age,” “body part,” “status,” “last access,” and others.

Ramsoft has designed the PowerServer to work efficiently with a customer’s existing hardware and network infrastructure. Addressing scalability needs, the company enables customers to buy the system, lease it, or do a hosted version. Smith points out that users can start out at the level that they are using today, or below so they can have more manageable numbers.

Among the targeted avenues for development, teleradiology, and final reads are particular areas of focus for the company, according to Smith. Furthermore, Ramsoft is concentrating on offering mammography as both a stand-alone reading station and Web-based.

Its workstation supports four monitors instead of the traditional two, allowing radiologists to view mammography, breast MRI, and breast ultrasound images simultaneously using any color monitor and any 5 MP black/white monitor configuration. It adheres to Hologic and iCAD specifications, and it is fully integrated with MagView.

Additionally, the technology integrates with billing systems via HL-7, and it incorporates built-in and up-to-date CPT or ICD-9 codes to avoid double entry and billing errors. With the HL-7, the RIS/PACS solution is capable of exporting patient demographics, such as insurance information, and current CPT/ICD-9 codes for accurate billing.

—Elaine Sanchez

Consolidating Storage for Savings

As health care institutions integrate the databases from their various departments and facilities with large enterprise systems, they often neglect to consolidate their data storage. “Many facilities have medical data stored in separate silos that don’t talk to each other. These multiple storage area networks are exorbitantly expensive,” said Amy Beaubien, PACS administrator for Manatee Healthcare System Inc, based in Bradenton, Fla.

Consolidating storage can help to save a facility significant dollars while preserving clinician processes. Faced with increasing the storage capacity for its cardiology PACS applications, Manatee decided that rather than implement a storage solution that would be vendor-specific to the cardiac application, it would install a system that could store data from not only the cardiac PACS, but also the radiology PACS and general network data.

The savings realized in the acquisition price alone with this decision was in excess of $200,000. “There is a huge economic component to consolidated storage area networks that the medical communities are failing to recognize and capture,” Beaubien said.

Service Solution

The Manatee Healthcare System includes Manatee Memorial Hospital, Lakewood Ranch Medical Center, and Lakewood Ranch Imaging Center. Together, the three sites perform more than 160,000 radiology examinations annually. All share an enterprise PACS system from Sweden’s Sectra that was installed about 4 years ago.

Because the system was purchased through Philips Healthcare, in Andover, Mass (which held rights to the product at the time), Manatee also purchased Philips-associated storage products, creating yet another disparate and expensive system used only for radiology. Cardiology and the general network had their own separate systems; none of them communicated with the others.

Complicating matters a bit at the time of Manatee’s installation, rights to sell the Sectra PACS reverted back to Sectra, which decided to keep them and sell the system itself. Although Philips has serviced Manatee’s Sectra PACS since the installation, the health care organization decided to transition the maintenance agreement to Sectra and include the data migration to the new storage system. “The device—a CLARiion from EMC Corporation [Hopkinton, Mass]—is closer to Sectra’s normal configuration and a lot more cost-efficient,” Beaubien said.

The new system will provide shared storage for the cardiology PACS, radiology PACS, and the general network. Features include FDA approval, redundancy, and self-healing mechanisms, which contribute to the benefits of single-system management.

Centralized Storage

Centralized storage offers economies of scale that do not impact workflow. Image retrieval has always been quick on the Sectra system. “If we do our job well, the data migration transition will be completely invisible to radiologists,” Beaubien said.

She expects that the installation, from concept to implementation, will be completed over 2 years. The team took about 8 months to plan, purchase, and prepare; installation is currently under way. “We’ve had many people look at the project from different perspectives to make sure we are doing it right,” Beaubien said. These professionals include clinicians, clinical engineers, and information technology specialists from both Sectra and the facilities.

Clinicians know what they want in terms of features and performance, but they don’t often understand the technology infrastructure. People with technical backgrounds can assist clinicians to ensure that a technology is appropriate, cost-efficient, and state-of-the-art. They can also make sure that the system will integrate with others, helping to capitalize on its value.

Manatee has already saved money with the decision to purchase a system for centralized data storage. Beaubien added, “We demand high availability, integration with our other software vendors, and an efficient workflow for all radiology examinations to help facilitate the utmost quality in patient care. We look forward to working with Sectra, and fully anticipate they will meet and even exceed all of our PACS expectations.”

—Renee Diiulio

A Snapshot of Synapse PACS

Jim Morgan got his start in the industry in 1993 at Loral Medical Imaging Systems’ engineering department, developing one of the first PACS products on the market. Since then, he has served in multiple positions within engineering and marketing specifically for PACS. For the past 5 years, he has worked for Fujifilm, where he is director of marketing, network systems. Axis Imaging News recently spoke with Morgan about the company’s recent developments to its Synapse PACS.

Fujifilm’s Synapse PACS is one of the industry’s first completely Web-based solutions.

IE: What features can users enjoy from Synapse PACS, and what makes it unique from other PACS available in the market?

Morgan: Synapse represents a family of products dedicated to informatics. Synapse PACS is a pioneer in the industry as one of the first to be completely Web-based, offered as software only, universal user-interface, and multisite capabilities. Customers appreciate the user interface for its simplicity, robust radiologist toolset, and image processing capability inherent to the application. IT departments are attracted to the openness of the application, hardware vendor independence, and ability to virtualize the infrastructure for lowered total cost of ownership and fault tolerance.

IE: Recently, your company announced the acquisition of Empiric Systems. How do the companies complement each other, and how will Empiric add to your current offerings?

Morgan: The former Empiric organization is fully integrated into Fujifilm. The information system portfolio of products is extremely synergistic to Synapse PACS—sharing many of the core strengths of a fully Web-based product and a history of innovation. Our combined products offer radiology departments a comprehensive solution.

IE: What were the steps involved in integrating Fujifilm’s Synapse PACS and Empiric’s Encompass.NET RIS?

Morgan: Our partnership with the former Empiric organization began more than 2 years ago. With multiple joint clients, we have developed a combined solution that offers all the functionality expected by radiologists, technologists, and referring physicians. We have adapted our market strategy, product road maps, and support organizations to meet the needs of our customers. The acquisition allows us to continue this path and expand both our market presence and product portfolio in other information domains.

IE: What direction is the health care IT market headed and what developments can we expect to see this year?

Morgan: Health care IT plays a significant role in decreasing costs and improving patient care. Health care providers are facing increased regulation and decreased reimbursements. Automation is required to do more with better outcomes. Health care providers need the ability to focus on patient care, which will occur only with increased use of information systems that eliminate unnecessary tasks. Electronic medical records play a significant role in tying together all patient information to eliminate diagnostic procedure duplication due to unavailability of prior results. Patients will become the owner of their medical records, and the industry will provide the secure systems to make them easily transportable between caregivers.

—E. Sanchez

Teaming Up on Single Solution for Security

With the abundance of scans being performed by health care providers, many are facing the difficult task of keeping images easily accessible to an entire team of clinicians while at the same time ensuring that the images are securely backed up in the event of a hardware catastrophe. Due to the complexities involved, most providers have separate solutions for PACS and backup. However, PACS leader McKesson announced at RSNA an agreement with Iron Mountain to combine McKesson’s Horizon Medical Imaging PACS with Iron Mountain’s Digital Record Center image archival solution.

“Today, many health care providers are battling exploding storage volumes while trying to comply with regulations to implement effective disaster recovery systems. To meet their needs, McKesson’s Medical Imaging group has partnered with Iron Mountain to deliver a single solution for archiving images securely off-site and protecting them from disaster,” said George Kovacs, director, product marketing, Medical Imaging Group, McKesson Provider Technologies. “Iron Mountain’s reputation as a leader in enterprise-storage-as-a-service and disaster recovery, combined with McKesson’s leadership in medical imaging solutions, makes this service an ideal choice for customers who want to reduce costs and mitigate risks.”

Ken Rubin, senior vice president of strategic alliances for Iron Mountain, added, “Through this agreement, hospitals and imaging centers receive one solution capable of both secure backup and recoverability in the event of disaster and quick access to their patient records. By using a managed service, these institutions can better protect and preserve vital patient data and redeploy resources previously spent on in-house storage to patient care.”

McKesson’s Horizon Medical Imaging PACS is the flagship component of the company’s popular PACS solution. It features clinical series mapping, adaptive image loading, intelligent and individualized workflow, as well as “report from anywhere” capabilities with the goal of streamlining workflow and breaking down interdepartmental communication barriers.

Iron Mountain’s Digital Record Center mitigates hardware or software disaster by continually and automatically backing up studies off-site—all while running quietly in the background. It also is managed as a “pay as you go” service so that hospitals and imaging centers pay only for what they need with the option of increasing storage capacity if business grows. By outsourcing this service, Rubin estimates that these centers can save between 20% and 50% of what it would cost themselves.

“Hospitals and imaging centers of every size can benefit from this service,” Rubin said. “While smaller and mid-size organizations appreciate both the service’s archiving and disaster recovery capabilities [equally], larger hospitals gravitate toward the service more for its disaster recovery capabilities that they have difficulty doing themselves.”

—Ed Wilson

Super Solution

Carestream Health debuted at this year’s RSNA its first-ever SuperPACS Architecture, designed to integrate multivendor, multisite PACS solutions. The new architecture will work with preexisting PACS resources and will be available for order in the second quarter of 2009. It is the first of its kind to offer a single integrated workstation with advanced visualization tools combined with a global worklist.

“Health care providers around the world need the ability to manage disparate radiology solutions at multiple locations without replacing existing RIS/PACS systems,” said Diana L. Nole, president, digital medical solutions, Carestream Health. “This new infrastructure will also enable health care facilities to share patient information and enhance collaboration among clinicians. Ultimately, this platform is intended to help improve the quality of patient care while simultaneously boosting productivity and resource utilization.”

One of the main features of the SuperPACS Architecture is its ability to deliver a single global worklist that covers both on-site and off-site radiologists (including routing to specialists), balancing workflow among them. The radiologists can then access remotely a list of unread exams from various hospitals and centers.

Joe Maune, worldwide business manager, Healthcare Information Solutions, Carestream Health, explained this potential. “Radiologists often travel to multiple sites to provide reading services, and smaller facilities or those in rural areas often have limited access to radiologists. In cases where exams are being read remotely, most radiologists must check separate worklists for each institution and use multiple systems with differing interfaces and commands.

“The SuperPACS Architecture will communicate with each RIS and PACS platform through a local node. This grid infrastructure will collect patients’ and study information from each RIS and PACS database to create a centralized and synchronized virtual database,” Maune continued. “The new virtual database is designed to allow patient content to be readily accessed by authorized clinicians at any location from any system.”

The architecture accommodates multiple patient identifications using IHE PIX profiles. This allows the radiologists to link the new, unread exam back to the patient’s history and prior exams from multiple centers. Carestream expects this architecture to be useful anywhere scans are taken or where radiologists practice, including hospitals and health care enterprises, regional health networks, single- and multi-site imaging centers, reading groups, and teleradiology services.

“Response to our announcement at RSNA was extremely positive,” Maune said. “Radiology and hospital administrators—especially those with limited access to on-site radiologists—are eager to access a central radiology resource for prompt reading and reporting. Radiology and teleradiology groups are equally enthusiastic because this model allows them to serve multiple facilities from a single PACS workstation with a global patient worklist, integrated advanced tools, and a familiar user interface.”—Ed Wilson

—E. Wilson