Matt Van Vranken, COO

Is using a single vendor to provide hospital-wide image management-in effect, putting all your eggs in one basket-a good idea? Matt Van Vranken, COO at Brigham and Women’s Hospital, Boston, thinks that it is. He says, “We’ve taken the approach that it makes no sense whatsoever to have to support separate radiology and cardiology picture archiving and communications systems (PACS).”

The 702-bed teaching hospital is one of the cornerstones of Partners HealthCare, an integrated health care delivery system established in 1994. Partners HealthCare also includes Massachusetts General Hospital, Boston; Newton-Wellesley Hospital, Newton, Mass; Faulkner Hospital, Jamaica Plain, Mass; and Dana-Farber Cancer Institute,? North?Shore Medical Center, McLean Hospital, Spaulding Rehabilitation Hospital Network, and Partners Community Healthcare, Boston.?It serves some 5,000 referring physicians within 50 km of Boston, including 1,000 who are contracted to Partners HealthCare and make up Partners Community HealthCare, Inc.

While Van Vrenken remains convinced that the decision that he helped make some 4 years ago to put enterprise-wide image management under a single umbrella is the right one, he is willing to admit that there is a bit of risk to this approach. Nonetheless, he says, “Quite frankly, we think that our Agfa PACS, which has recently been expanded from radiology to embrace cardiology and other hospital departments that use diagnostic imaging, is going to continue to evolve, and will eventually mirror an application service provider model. In that scenario, I would hope to be able to shift the risk to the vendor, having that company provide a digital environment in which our costs would not exceed our traditional analog costs. We anticipate that the vendor will be able to figure out how to deal with the technology curve.”

Brigham and Women’s Hospital, created by the 1980 merger of three of Boston’s oldest and most prestigious hospitals, has taken a unique approach to image storage.

“We’ve tried to break down the traditional walls,” Van Vranken says. “When our cardiology department said that it needed a system to store and retrieve images, I told them that rather than creating a new island of information, we would see if there was a way we could do it in conjunction with radiology, and that’s what we have done. We are also going to do it in endoscopy, and we are evaluating whether we can store pathology images. We want to be in such a position that, when physicians need to access diagnostic information, they don’t have to toggle back and forth between two systems,” he continues. “There are some institutions that now have something as bizarre as side-by-side work stations because they have independent systems that manage these data.”

Van Vranken is well aware of the ongoing turf battles between radiologists and cardiologists, and he feels that they will continue. “I think we are going to see more of them, rather than fewer,” he states, “and I think that they will spill over into surgical suites-as they are doing right now-as the interventional radiologists get more aggressive. We’ve seen our carotid volume drop because interventional radiologists are putting stents in carotid arteries.”

To smooth out problems between the radiology and cardiology departments in imaging storage and retrieval, Brigham and Women’s Hospital has created a central support group under Ramin Khorasani, MD, a radiologist who was instrumental in getting the radiology PACS up and running in September 1998. Khorasani is medical director for multidisciplinary PACS. “He is a major ambassador for this enterprise-wide system,” Van Vranken says.

Brigham and Women’s Hospital’s radiology department has become almost completely digital over the past several years. “I can’t think of another institution that is more digital,” Van Vranken says. The remaining analog systems are the mammography units and a few radiography rooms. “As they reach obsolescence, we are converting them to digital systems,” Van Vrenken notes.

In the cardiology area, Brigham and Women’s Hospital recently upgraded three of its five cardiac catheterization laboratories and installed 11 diagnostic workstations, along with the necessary software to link them to the acquisition hardware and the main PACS archive. “Our cardiologists are thrilled with our ability to manage this information,” Van Vranken says.

One special feature of the PACS is a quality-control filter. This lets a technologist compare information from the radiology information system and the imaging modalities to verify that images and demographic information come from the same patient. This is done before the data enter the PACS for distribution, archiving, and reading by a consulting radiologist.

The state-of-the-art PACS at Brigham and Women’s Hospital and an older Agfa PACS at Massachusetts General Hospital are linked by the Partners HealthCare Information System, an intranet whose foundation is a platform of some 40,000 personal computers running Windows? NT. The Partners HealthCare Information System connects all Partners HealthCare affiliates and their referring physicians, and allows them to exchange data with one another.

Since 1998, Partners HealthCare has budgeted $71 million to deploy its information systems network, and it is spending about $30 million annually on its maintenance and upgrading, plus some $10 million per year on new capital equipment. At completion, Brigham and Women’s Hospital expects that it will have invested about $5 million in its multidisciplinary PACS.

Richard B. Elsberry is a contributing writer for Decisions in Axis Imaging News.