Managing the Flow in Radiology

Pack Up Your Old PACS
Modern Architecture a Must for Multisite Practice
Data Encryption High Priority for QStar Healthcare

Pack Up Your Old PACS

Hard to believe, but it could be time to replace—or upgrade—that pricey picture archiving and communication system (PACS) you purchased just a few years ago. At Iowa Health System, officials had an adequate system in place, but with an upgrade and data migration in the works, they determined the time was right for a reevaluation.

Tom Coppa, infrastructure architect at Iowa Health System, knew his customers wanted clinical features and workflow enhancements that were just not possible with his current vendor. Web features, ease of access, and reliability were also on a wish list that began to take shape in February 2009. With millions of dollars set aside to upgrade Iowa Health System’s 13 hospitals (and 30-plus additional outreach locations), the decision took 5 months.

San Francisco-based McKesson Corp had cultivated a relationship with Coppa and Iowa Health System in 2008, and that ultimately paid dividends in July 2009 when Iowa officials decided to go with the Fortune 500 giant. Far from being averse to change, Coppa reports that the majority of radiologists were relieved and eager to try out the new bells and whistles. “Radiologists participated in the selection process and saw all of the systems we had evaluated,” Coppa said. “McKesson put in place an aggressive training program before the ?go live.’ They placed their best trainers right next to the radiologists, over their shoulders, for multiple days.”

Full buy-in from radiology fostered a quicker-than-average 45-day transition for seven affiliates as of December 9. That’s about 8 weeks for a sizable portion of the system that does about a million studies a year, supporting more than 60 radiologists and several hundred users—both in the hospital as well as referring physicians. The entire project, from contract signature to “go live” of the last facility, will be 4 months.

From the beginning, Coppa says there was a large emphasis on clinical features and enhancements to workflow, integration with other products, and inclusion of specific capabilities in the base package. For example, advanced mammography reading, announced by McKesson at the recent RSNA, was one of many factors in choosing the new PACS. “Several of the reasons [for switching to the new PACS] revolved around architecture—things such as scalability and centralization,” Coppa said. “But we also looked at the disaster recovery capability and business continuance capability. Just 18 months ago, Cedar Rapids endured floods, so we were concerned about disaster and its effect on data centers and delivering health care.”

Coppa calls migration the unsung hero of the entire implementation. McKesson was able to seamlessly transition a massive amount of digital information to the new PACS. “It was about 3.5 million studies, which is nearly 200 million images and 60 terabytes of data,” Coppa said. “The migration began at the same time we prepared for our first go live. Migration continued through the go live, taking what was traditionally measured in years and measuring it in months. The full data migration will complete in less than 6 months. McKesson and the partners inside of the architecture allowed us to map out a plan to migrate and go live simultaneously.”

The entire transformation provided a solution that helped the Iowa Health System build strategically for the future. Additional benefits such as reducing power and cooling requirements fostered better results while using fewer resources.

After expending the time, money, and effort to make a PACS switch, Iowa Health System hopes to increase productivity and physician satisfaction. Ultimately, McKesson’s

considerable resources and expertise earned them the right to deploy their Horizon Medical Imaging? PACS at hospitals and clinics throughout Iowa. Iowa clinicians will take advantage of advanced communications capabilities that make real-time worklist reviews possible. The system also makes physician and radiologist consultations easier, regardless of whether participants are down the hall or across the state.

Iowa Health System is now live on the new PACS solution in six of the seven regions it serves, including Des Moines, Quad Cities, Fort Dodge, Sioux City, Waterloo, and Dubuque. Bill Leaver, president and CEO of Iowa Health System, expects the new system will improve workflow and, most importantly, patient care. “When this project is fully complete, our physicians and radiologists will have fast, easy access to their files, images, and results virtually anywhere and anytime,” Leaver said. “Our goal is to provide the best health care possible to the communities we serve. With the new PACS in place, our physicians will be able to make care decisions much faster.”

“Our team remains focused on providing IT solutions that transform the way health care leaders like Iowa Health System distribute and share medical images and information region-wide,” added Rod O`Reilly, president, Medical Imaging Group, McKesson Provider Technologies. “As Iowa Health System [the state’s first and largest integrated health system] completes its switch to Horizon Medical Imaging and anticipates system growth and expansion, its medical teams are well positioned to provide the best-informed patient care today and far into the future.”

—Greg Thompson

Modern Architecture a Must for Multisite Practice

The long sought after ability to seamlessly integrate a modern PACS/RIS with electronic medical records (EMR) is becoming increasingly common. With the help of Rochester, NY-based Carestream Health Inc, medical practices such as Crystal Run Healthcare are on the forefront of this mini-revolution.

JoAnn Linder

After conducting imaging exams, radiologists at Crystal Run do their readings using Carestream Health’s RIS/PACS. Initial reports are immediately transferred to the EMR where radiologists approve them, and those reports become viewable by referring physicians.

Officials at Crystal Run Healthcare, a Middletown, NY, practice with 180 physicians and almost a dozen facilities, selected the CARESTREAM RIS/PACS primarily for its modern architecture and its ability to interface with a variety of other systems. “The CARESTREAM clinical data archive is a vendor-neutral archiving solution,” said JoAnn Linder, marketing director, Healthcare Information Solutions, Carestream Health. “We will archive anybody’s files, and it doesn’t matter if you have the GE MRI or someone else’s CT. Our clinical data archive allows all of those modalities to be saved.”

All the data (typically DICOM) can be stored on Carestream Health’s clinical archive, but other crucial elements can also be salted away. “You can store Word documents, JPEG files, and photographs—perhaps a picture of a burn or a mole—that clinicians may want to look at,” added Linder. “The clinical data archive stores all of this in a patient-centric way. That means the architecture can image-enable the EMR. Your EMR can link to this archive, and you can access all of this information.”

If radiology practices can work more efficiently, it stands to reason they will also boost productivity and save money. The CARESTREAM PACS PowerViewer performs automatic registration among differing volumetric studies to deliver faster and more accurate comparisons of multiple data sets over time.

It does this directly within the standard viewer, so radiologists do not need to switch to different applications or workstations. “This capability allows comparison of data sets from different modalities in different planes and renditions (such as MPR, MinIP) and eliminates time-consuming manual or semiautomatic processes currently used to set up studies for comparison,” said Linder. “Time is money, and being able to read these large exams quickly enables greater productivity and higher ROI for hospitals and radiologists. Our new RIS also boosts reading productivity with voice-driven commands and several methods for faster, more automated reporting.”

?”The CARESTREAM PACS offers advanced functionality and ease of use that improve productivity for both our radiologists and physicians,” said Greg Spencer, MD, Crystal Run’s chief medical officer. “Our radiologists were particularly impressed with the PowerViewer’s ability to immediately deliver automatic registration and matching of volumetric data for enhanced reading of these complex exams.”

Additional features such as the company’s SuperPACS? Architecture saves money by enabling radiologists in any on-site or remote location to read from a global worklist that serves all sites within a health care system. This unified global worklist enables a cross-site, collaborative workflow for efficient subspecialty reading. “One of the key reasons we selected the newest generation RIS/PACS from Carestream Health was its modern architecture and its ability to interface with a variety of other systems, including enabling bidirectional information exchange with our EMR,” added Miguel Hernandez, director of IT, Crystal Run Healthcare. “This RIS/PACS was clearly designed from the ground up to function smoothly in a modern multivendor, multisystem environment.”

Using what Carestream Health calls tunneling technology, studies are communicated to radiologists on demand, and don’t require prefetching or prearchiving to a central location. This workflow replaces the need for on-site readings, while also eliminating situations where radiologists in some locations develop reading backlogs of several hours, while other radiologists sit idle.

Additional perks that attracted Crystal Run include a color-coded display in the RIS that tracks each patient’s status. Factors such as wait time and flexible scheduling parameters are also considered when assessing the needs of each modality and exam room.

—Greg Thompson

Data Encryption High Priority for QStar Healthcare

With patients taking more control of their medical records, this sensitive data needs a higher level of protection. QStar Healthcare, Mary Esther, Fla, has just released its new SntryDICOM and DICOM Publisher, which should be just the trick to protect data both in and outside the radiology department.

Steve Tongish

The SntryDICOM is a vendor-neutral storage solution with a fully compliant DICOM 3.0 interface. The storage solution allows radiology departments to archive images hierarchically, and it can be used for the entire life cycle of the image. Because of its resiliency, there is little need for disruptive and costly image migration, and it can be used to share images between workstations—no matter where the PACS system is being used. “The idea is that the archive sits there and can be accessed [when the image is needed],” said Steve Tongish, global marketing director. “This should mitigate the need for a knee-jerk migration every time there’s a new PACS implementation.”

QStar’s vendor-neutral approach gives customers the flexibility to implement the PACS system that best fits their needs with the confidence that they will be able to access the images no matter when they were produced and at a moment’s notice. The SntryDICOM system has a license fee structure based on capacity of storage.

SntryDICOM has the additional benefit of storing data in whatever media is most appropriate for the department, ranging from disk to tape to optical storage options. The company also employs a 3-2-1 storage best practice model. This best practice calls for the creation of three copies on two different media with one copy off-site on removable media (eg, a disc or tape). This method is crucial in cases of a full-scale disaster to allow for data retrieval and recovery.

The company’s DICOM Publisher is an on-demand copying software that allows radiology departments to “print” a copy of an image on a CD, DVD, or Blu-Ray disc. A DICOM-compliant image can be printed anywhere from the network for both internal and patient use.

Images can be produced directly from the modality, the server, or a workstation. DICOM Publisher comes in both “Standard” and “Lite” versions. Both can produce DICOM-compliant images, but the Lite version does not offer the option for file encryption or other advanced functionality found in the Standard version.

While vendor neutrality and ease of use make SntryDICOM and DICOM Publisher attractive options for use in the increasingly complex world of the modern radiology department, security is also a byword that administrators and patients have on the tips of their tongues. The company offers two forms of encryption for the images coming from SntryDICOM and burned by the DICOM Publisher onto removable media, including a unique media password or PIN, or through a trusted third party using a public key infrastructure (PKI) for images shared internally or released to a patient. According to the company, QStar Healthcare is the only organization offering both options. Tongish noted that this level of encryption is already very common in Europe, and is becoming more common in the United States.

—C.A. Wolski