Managing the Flow in Radiology

Health Care Disaster Recovery Is ?Uniquely Complex?

With the fifth anniversary of Hurricane Katrina marked by grim fanfare and endless analysis, and recent reports of serious cyber attacks making headlines throughout the world, thoughts of disaster recovery are undoubtedly forefront in the minds of radiologists and administrators alike. And they should be. A new white paper from BridgeHead Software notes that disaster recovery for health care is “uniquely complex.” Add to that the fact that health care data comprises nearly a third of all computer data in the world, then the problem is something else altogether: staggering.

The unique complexity for health care data comes from the fact that it isn’t all the same. According to BridgeHead Software’s free white paper, the data comes in varied data types—structured, unstructured, and semi-structured—that are commonly generated by both clinical and administrative departments.

But, according to BridgeHead CEO Tony Cotterill, all data isn’t created equal and there are things that administrators can do as long as they understand the nature of their data.

The solution involves a number of steps. First, reducing the data by deduplication can help. Compressing data is also a possibility; however, for imaging files found in a PACS system, this can be tricky. Cotterill says that the maximum compression allowed is usually 30%, and this could compromise the detail in these files.

Ominously, Cotterill says that there is no way to back up the huge amounts of data on a daily basis. At first glance, this would seem to be a doomsday scenario—with administrators hoping against hope that a disaster doesn’t occur.

However, there is a practical solution and Cotterill’s BridgeHead has it. The company’s BH MediSafe uses a combination of a traditional backup and archive to fully protect data and improve the recovery process in the event of outage, corruption, or loss. The solution protects health care information by analyzing whether it is “static” (unlikely to be accessed or changed) or “dynamic” (regularly accessed or changed), then protecting it accordingly. Since it selectively moves static data into a fully protected archive, the traditional backup of the dynamic content is optimized and data recovery at both the file and the system level is vastly improved, according to the company.

This dynamic versus static data is the key to protecting data, says Cotterill, who notes that about 85% of patient data, including imaging files, are static. “When 85% of data is static—never changes and is never accessed—now you’re just playing with 15% of your data,” he said.

He also noted that most disasters, such as Katrina, cause losses at the file level, which means that the lion’s share of data can be recovered with only the most recent data unrecoverable. “Think of it this way—an archive is granular and a backup is a whole wall,” he said.

Cotterill says that a disaster recovery plan has to be comprehensive and include both an archive and a backup with secondary storage in a geographic area far away from the enterprise.

And, most important, it has to be tested and monitored. He said that he knows of enterprises that never tested their systems and, when a disaster did occur, discovered that the backup and archiving systems had not been utilized properly. The key, when putting in a disaster recovery plan, is that it is thoroughly tested and maintained, so when an event occurs—be it a natural or man-made disaster—the work of imaging patients doesn’t stop in its tracks.

—C.A. Wolski

At Long Last: Pleased with His PACS

Choosing a new PACS system is already tough, but discerning hyperbole from reality can make it even tougher. “A salesman will tell you anything they think you want to hear to get the sale,” said Jonathan S. Dorn, MD, owner of Meridian Teleradiology, Merritt Island, Fla.

Dorn has learned the hard way in a long radiology career that has seen the relatively primitive beginnings of teleradiology first hand. And despite the high-tech trappings of today’s modern systems, he believes that old-fashioned human integrity is the most important feature when deciding on which PACS to purchase.

After struggling with what he calls a “middle of the road” PACS, Dorn relied on Ken Trotman, president of Radical Radiology, to find a new system. Dorn and Trotman finally settled on RamSoft’s PowerServer, a software package that collects client studies into a universal worklist. From that worklist, reports are generated and automatically faxed or e-mailed to ordering physicians and facilities, or they are made available via a Referring Physician Portal. In addition, a number of clients are provided with long-term archival of studies both on-site and off-site using RamSoft Gateway’s archive capabilities, as well as Meridian Teleradiology’s redundant PowerServers.

With additional offices in Birmingham, Ala, Meridian Teleradiology provides preliminary and final interpretation services 24 hours a day, 7 days a week, for all major modalities to a client base across a large geographic area. It’s a major undertaking that requires exceptional training and the responsiveness to promptly solve technical issues.

Most companies will make these promises, but will they keep them? That is the question that only reputation and track record can answer. “The most important thing is that hopefully the guy selling to you has honor,” said Dorn. “From there, I have basically three things [to say]: 1) Talk to somebody who has the software; 2) Don’t go dirt cheap, because it is so expensive in the end; and 3) Look for service, service, and service, and deal with an honest, reliable vendor—and know that honesty can be hard to find.”

Efficient software has improved patient care and made the job more enjoyable for Meridian physicians. “The system helps me keep my teleradiologists, because they don’t get fed up and say, ‘I don’t want to do this anymore,'” said Dorn.

“They spend more time looking and less time manipulating.”

Radical Radiology, Meridian’s technology backbone, manages the fully redundant LAN/WAN network infrastructure, including Web hosting, image management, and report distribution services—all with an uptime percentage of 99.9%. The RamSoft PowerServer efficiently and securely routes patient studies to appropriate/qualified reading radiologists. “The cases can be readily pulled down, so they don’t have to twiddle their thumbs,” added Dorn. “We find that most of our clients that already have a PACS in place use our RamSoft PACS more than they use their own.”

—Greg Thompson