Hospital IT systems that talk to each other improve efficiency, enhance patient safety, and save money.

Could health care reform have the unintended consequence of increasing wait times at your hospital’s emergency department? It could, if a 7% increase in emergency department wait times (which is above the national norm) in Massachusetts is anything to go by.

Rand Corporation’s Arthur L. Kellerman, MD, told the Associated Press last summer that “More people will have coverage and will be less afraid to go to the emergency department if they’re sick or hurt and have nowhere else to go. ? We just don’t have other places in the system for these folks to go.”1

If emergency department wait times could increase between 2005 and 2007 in Massachusetts—considered the model for federal health care reform—what could this mean for your hospital’s emergency department? Or, indeed, other departments throughout your hospital? What can you do to plan ahead?

For one thing, you can focus on being more efficient with your current resources—starting with making sure that your various IT systems can “talk” to each other, which can help your physicians deliver efficient patient care while keeping an eye on any possible patient safety issues.

Image Access and Patient Safety

For insight, look no further than Dan West, director of imaging informatics at St Thomas Hospital, a 541-acute bed hospital in Nashville, Tenn. He needed to come up with a solution to this problem: The cardiologists at his hospital didn’t have access to radiology images and radiologists didn’t have access to cardiology images. This presented a particular challenge to his facility because, typically, a third of its patients are cardiology patients.

Because the IT systems within the radiology and cardiology departments couldn’t “talk” to each other, there could be delays in the delivery of patient care and potential patient safety issues because physicians were forced to toggle back and forth between two different departmental systems. For example, a physician could possibly be viewing images from two different patients, which can—if undetected—result in a patient receiving the wrong diagnosis.

A “De-siloed” Image Archive

Dan West of St Thomas Hospital stands near Merge ECM, which supports his hospital?s approach to high availability and consolidation of medical images.

Given this dilemma, West was presented by his hospital’s chief medical officer with this assignment: “De-silo” the hospital’s imaging environment. Success would mean that physicians could access a wide variety of medical images—whether those images had originated in the radiology, cardiology, or pathology departments.

With Merge ECM (Enterprise Content Manager), St Thomas Hospital now has a robust, “de-siloed” storage environment across the radiology, cardiology, and pathology departments. The hospital’s implementation of Merge ECM kicked off in January 2004 and was determined a success across all five of the hospital’s campuses within 18 months.

From a technical standpoint, Merge ECM is designed so that all DICOM studies are in the same repository—with the same database—and the same front-end viewer. That being the case, HL7 messages from the EHR interface engine can be parsed for the individual “‘ologies” to separate the studies based on order number—but the most efficient method requires that DICOM studies be archived in the storage environment, regardless of the modality that produced those studies.

While West’s team once managed five separate storage area networks (SANs), they’ll soon have to manage one. And that means his team can now focus on the next phase of this project, which is to store all DICOM studies sent from any DICOM-compliant imaging modality within Merge ECM by the end of the year.

According to Merge, this consolidated archive enables physicians to view the entire “multi-ology” patient imaging record from a single viewer. Further, this shared common storage environment enables St Thomas Hospital to match patient data so that physicians can be confident that they’re always making comparisons based on images that are associated with the right patient.

A Single, Long-term Archive

Because Merge ECM also provides replicated content management capabilities, West feels confident that his facility has a solid disaster recovery program in place.

“It’s not simply mirrored storage architecture but a fully replicated architecture,” he said. “All vendors can provide mirrored storage. But only in a replicated environment, such as Merge offers, where if one replicated peer goes down, can you still run the entire enterprise environment on the surviving peer.”

Merge ECM provides application-level replication, which, says Scott Hoch, product director, enterprise at Merge Healthcare, Milwaukee, means that “these images are replicated at the software level; this provides more flexibility than you’ll find when data is replicated at the storage level.”

Centralizing all of this data onto a single, long-term archive can help health care executives with a keen eye on their bottom line. “It’s more cost-effective to have all of your data existing on a consolidated archive in a vendor-neutral way,” said Hoch. “Over time, departmental imaging solutions will be replaced. With Merge ECM, migrating data [from those solutions] won’t be required.”

According to Hoch, CIOs have been very responsive to Merge ECM’s proven track record—the solution has been operational and available for more than 10 years, and the knowledge gained from more than 300 successful deployments is very valuable. “Radiologists and other physicians have been most receptive to the system’s proven performance, meaning that the solution can handle more than 1,000 concurrent users at the same time, so that physicians and other health care personnel can be productive and efficient as their facilities continue to grow,” said Hoch.

Thin-client Access to Medical Images

If your goal is to provide your radiologists with access to nuclear medicine studies on the same workstation or from their homes, Jackson Memorial Hospital, a 1,550-bed facility in Miami, provides some valuable lessons learned.

According to Mike Georgiou, PhD, a physicist at Jackson Memorial Hospital, the challenge was that radiologists once had to walk over to the nuclear medicine department in order to access SPECT/CT images, echocardiograms, and other images not native to the practice of radiology.

That walk from the radiology department to the nuclear medicine department also meant a possible delay in the delivery of patient care and perhaps even suboptimal care if radiologists couldn’t easily draw comparisons between two different types of exams—since nonradiology exams weren’t available for viewing within the hospital’s Philips iSite PACS.

A Smart Solution

With Thinking Systems’ ThinkingWeb™ thin-client server solution, physicians now have enterprise-wide and remote access to the complete suite of clinical applications on any computer with Internet access through Philips iSite Enterprise. Running on server-side computing technology, ThinkingWeb is available via a residential DSL or cable modem connection. With this solution, clinicians also have access to advanced image review tools for all modalities, including, for example, nuclear cardiology processing and image fusion.

In addition, Thinking Systems’ Modality Broker™ and the clinical application suites from Thinking Systems function as plug-ins within the hospital’s PACS system to provide physicians with access to nonradiology images with the appropriate applications, such as PET/CT images, SPECT/CT fusion, and nuclear cardiology quantification analysis.

Key to providing physicians with the tools they need is delivering on a thin-client solution that provides physicians with easy, location-independent access. According to Xiaoyi Wang, PhD, president and co-CEO at Thinking Systems, St Petersburg, Fla, a physician often needs remote access—perhaps from home or while in the emergency department—where they would prefer to have a robust tool set in order to make accurate interpretations and diagnoses.

While Jackson Memorial Hospital’s challenge was a rather complicated one, the combined thin-client/plug-in solution itself was relatively straightforward and the implementation—which included extensive testing—took less than 2 weeks. Wang attributes the timely implementation to the company’s experience integrating with all of the major radiology PACS solutions.

According to Georgiou, the Modality Broker solution allows their radiologists to view nuclear medicine images appropriately and efficiently on their PACS system.

Cost Savings and Efficiency Improvements

Hospitals often realize significant cost savings and efficiency improvements with ThinkingWeb, according to Wang. This thin-client solution enables physicians to view images from any computer on the network and eliminates costs associated with per workstation software licensing and dedicated computer hardware.

For patients, this combined thin-client/plug-in solution means that their physicians have access to radiology images and other medical images, which translates to more efficient diagnoses.

According to Wang, image acquisition systems for nuclear medicine haven’t evolved a great deal in the last 15 years, so many hospitals have outdated equipment and their radiologists and cardiologists are at a disadvantage, since they are working on older, legacy systems.

“Major radiology PACS vendors have a solution that caters primarily to radiology. Several of [those vendors] partner with us to provide a solution that [offers] easy access to images from outside the discipline of radiology,” said Wang.

Aine Cryts is a contributing writer for Axis Imaging News.


  1. Health overhaul may mean longer ER waits, crowding. Washington Post. July 2, 2010.