Trends in Storage Requirements

According to a new study from Frost and Sullivan entitled Data Storage Management Markets for US Healthcare Settings, data storage management solutions may play a key role in helping health care facilities meet the Health Insurance Portability and Accountability Act deadline for security compliance. The report reveals that revenue in the data storage management markets in health care totaled $845.2 million in 2004 for storage hardware solutions, and projects the total to reach $1.33 billion in 2008. The research data show that investment in PACS, EMR, and computerized physician order entry (CPOE) solutions are expected to be among the top areas of focus for the increase in IT spending in the market. Demand for high storage requirements is expected to come from medical images, patient records, and hospital administration-related data. The study states that health care data is increasing by more than four times every 2 years.

–A. Murti

Slammer and Blaster, Begone!

Network security is a mission-critical activity in every department as even a film-based department needs a working network for the RIS and printers, said Charles Suitor, MS, MD Anderson Cancer Center, Houston, who presented the paper “Beyond Patching: Implementation of Robust Security Architecture Supporting Diagnostic Imaging,” at the 2004 meeting of the Radiological Society of North America (RSNA). While many organizations seek to protect their networks with the latest security patches, imaging modality and PACS vendors frequently lag in their ability to provide the latest patches as they have to ensure that they will not adversely affect the operation of the system. For the past 4 years, MD Anderson Cancer Center radiology department has used a multi-tiered integrated security strategy designed to limit vulnerability of the most mission-critical department equipment to external computer virus threats. Whereas it is commonplace in many departments to have the modality workstations and the administrative PCs on the same network, MD Anderson is using network segmentation to separate those devices into different sub-networks and to limit conversation between them using internal firewalls to ensure that the average secretary’s PC is not connected to the network used by the modalities. (Suitor also suggested using proxy servers as an alternative to network segmentation to keep Internet traffic away from the modalities.) Intrusion detection software is also used. E-mail is scanned for known virus threats, and suspicious attachments are blocked. Access to commercial e-mail services such as Hotmail and Yahoo is also blocked within the department. The institution treats faculty and staff computers that access the network by a virtual private network as internal devices and requires the most current virus protection software and remote computer firewall protection. Suitor recommended studying the ISO 17799 Standard for Information Security, developed in Great Britain, the most widely recognized standard for information security in the world.

–C. Proval

Cannot Cost Justify PACS? Read On

Many have tried and failed to cost justify picture archiving and communications systems using strictly hard cost savings within the typical 5-year ROI window normally used for medical technology: the average 12-18 month ROI for IT is considered unattainable. In presenting “Cost Justification for PACS: Realized Return on Investment in 3.5 Years” at the 2004 RSNA meeting, M.B. Morgan, MD, reported that the University of Pittsburgh health care system achieved ROI for PACS in the shorter time frame, but cautioned that the results were based on savings for a large academic institution with 19 community and specialty hospitals, and that the experience of a smaller organization with a lower study volume and smaller percentage of cross-sectional imaging likely would be quite different. The health system transitioned to a second-generation PACS beginning in 1999, and the results of this study are based on costs and savings beginning then and continuing over the next 4 years. The PACS, which featured an ASP financial model, required an initial capital investment of $13.5 million, including infrastructure, PACS, and modality-specific costs, and operating expenses of $11.2 million over 4 years. Branstetter et al used a figure of $20 to represent the cost of generating and supporting each study, similar to that calculated for other large hospital systems and the value most likely to change for smaller hospitals. System-wide, the provider was doing 1.15 million studies per year. With the introduction of PACS, film costs per case dropped 72% at the academic site and 46% across the system. Annual savings were calculated by using the following formula: film cost savings = volume (1.15 million) x film cost per case ($20) x % filmless. When that figure reached the amount spent on the system, it was determined that the system achieved its breakeven point at 3.5 years (28.5% per year). With savings increasing as both filmlessness and volume increased, the researchers emphasized that smaller sites probably do not achieve the same results. The authors emphasized that they encountered many unexpected costs involved with PACS installation. These costs, most notably the cost of upgrading existing equipment, are often excluded from traditional PACS cost analyses.

–C. Proval

Using IT to Reduce Radiological Error

In a provocative session at the recent RSNA, Ron Arenson, MD, UCSF chair of radiology, identified sources of radiological error using an acronym he called PERFECT AIMS, provided examples in each error category, and then called on his IT-savvy copresenters (Ramin Khorasani, MD, Brigham & Women’s Hospital, Boston; Curtis Langlotz, MD, University of Pennsylvania, Philadelphia; and David Channin, MD, Northwestern University, Chicago) to suggest how IT could provide a solution.

Khorasani maintained that the use of intelligent computerized physician order-entry systems that deliver content and specific decision support can help ensure that the correct test is ordered. “We don’t need to focus on products – there will be a lot of those in the next few years – we need to focus on process. Preapproval is required in order to order your test,” he asserted.

Langlotz looked toward structured reporting to improve the clarity of radiology reports by using consistent terminology. “For instance, radiologists use 14 different terms for interstitial edema,” he noted. Citing the 2001 Naik et al paper from the American Journal of Roentgenology, Langlotz said, “What they found was that referring physicians overwhelmingly prefer structured reporting.”

Channin saw solutions in system interoperability promoted by the Integrating the Healthcare Enterprise (IHE) initiative. “The problem we have is the health care information management processes are complex, involving multiple, heterogeneous systems,” he said. “There is no one vendor who can do them all, so all of the information systems must interact. There is a lot of wiggle room that has crept into the standards so you have to define the choreography of any action: That’s what IHE is all about. IHE has solved 14 problems in radiology.”

Below are listed the sources of error (spelling out the acronym PERFECT AIMS) identified by Arenson:

  • Patient misidentification (perform procedure on wrong patient, give wrong patient contrast, read imaging for wrong patient, transportation mixes up patients).
  • Equipment (electric shock and excessive radiation).
  • Reading error (wrong diagnosis leading to wrong therapy, chasing incidental findings leading to more invasive tests, poor patient history).
  • Falls (patient faints in bathroom).
  • Environmental factors (uneven floor, difficult doors, elevator door too fast, unstable chairs, hit by car crossing street, auto accident due to sedation).
  • Communication/miscommunication (cryptic wet readings, resident interpretations at night, curbside consults, poorly constructed reports).
  • Test (performing right test on wrong patient, performing the wrong test for the indication).
  • Allergy (contrast reactions).
  • Injection (contrast reactions).
  • Metal (infusion pump flies off gurney into magnet, scissors fly from nurse’s hand and she tries to catch them, malfunction of devices such as pacemakers).
  • Side (mixing up right and left).

–C. Proval