Safe and Sound with InSite One
Getting on the Grid
Virtual Storage, Real Savings
Archiving Software Relieves IT Headaches

Safe and Sound with InSite One

For health care facilities located in the Hurricane Belt, disaster recovery is crucial. So when NCH Healthcare System of Naples, Fla, went searching for an archiving solution, it wanted to make sure that it could depend on the technology in the event of unplanned downtime.

“We wanted to be able to essentially pick right up and start running again if something were to happen locally to our on-site storage, whether it’s a technical problem or something more catastrophic, like we lose our data center,” said Deanna Myli, assistant director, radiology.

NCH, which operates two hospitals and four imaging centers in a 26-mile radius, chose the InDex® archive from InSite One. The company introduced the newest version of the product during November’s meeting of the Radiological Society of North America and recently began offering the updates to customers.

The enhanced features of InDex 6.0 focus on networked resources that allow for data management strategies in enterprises of any size, as well as the ability to connect with referring physicians. Using IHE defined XDS protocols, the new release boasts the ability to archive and manage clinical data that is accessible independent of the PACS or viewing application platform.

According to InSite One, major features include the upgrade of InDex web with a new thin client for referring physicians, performance enhancements on managed non-DICOM archive solutions with disaster recovery, upgrade of InDex Services to support the XDS document source, an HL7 driven workflow to enhance local access, and flexibility in financing with the ASP or licensed-service model. At the Healthcare Information and Management Systems Society meeting in April, the company reported that the 6.0 release enables the bridging of multiple PACS and reconciling of multiple patient identifiers into a single internal patient-centric archive.

InSite One’s InDex proved to be a sound decision for NCH. Praising the solution’s cost-saving appeal, Myli pointed out another big benefit. “I’m sure real estate everywhere is very expensive, so as we push everything over into a digital format, we don’t need to maintain warehouses, the staff to pull the film, or transportation to take the films back and forth,” she pointed out.

Myli said prior to the InDex installation, the health care provider resided in a film-based world that made it difficult to retrieve priors. InSite, on the other hand, provides NCH with 18 months of local on-site storage. Although the health care system just recently switched PACS, the transition was seamless because all of the images were already on InSite One, therefore avoiding a time-consuming data migration, Myli said.

Another big draw for Myli is InSite’s support staff. “They call me before I realize something is wrong on our side,” she said.

In addition to the 6.0 release, InSite recently shared another major announcement: its InDex Archive has reached a new milestone.

Specifically, the company noted that more than 33 million studies are included in the single object repository. This figure represents approximately 4.5% of the diagnostic imaging patient population in 2008. The active repository includes cardiology, radiology, mammography, and other non-x-ray images, and it is used as an on-demand storage model in a growing number of states.

“The growth that InSite One has experienced is due to the market’s increased confidence level in a storage service provider model,” said Mitchell Goldburgh, senior vice president, InSite One. “Our operating budget model resonates well during these capital preservation times as the continued need for protection of vital health care data grows.”

—Elaine Sanchez

Getting on the Grid

DiCOM grid Inc’s Medical Image Storage and Communication (MISTC) Service is designed with the future in mind. The system, which Tom Gibbs, vice president of sales and marketing, refers to as “PACS 2.0,” is aimed at any radiologic service from the smallest imaging center to the largest enterprise-based practice.

Because storage demands are increasing by about 10% to 25% per year, electronic file archiving is starting to mimic its paper-based cousin by becoming unwieldy and eating up precious practice real estate with banks of servers replacing file cabinets. The Phoenix-based company partnered with Nirvanix to create a system that solves this problem by removing the burden of both having to maintain a server system filled with electronic files and having the expense of a PACS system.

For radiology services—large or small—that can’t spare the resources to purchase a dedicated PACS system, the subscription-based MISTC Service allows them to use existing resources to implement it. The DICOM imaging studies are collected from the point of origin, from either a PACS or DICOM modality—such as a CT or MRI via a MISTC access node.

The node is designed to determine which physician ordered the study and everyone who must read it from the radiologist to the referring physician to consulting clinicians. The study is “pushed” to these physicians as encrypted data via the public Internet and can be uploaded for review. A series of viewing tools that are compatible with all the various modalities are part of the MISTC package. For enterprises that already have a PACS system in place, the company will install a device that looks a bit like a standard cable box to allow the interchange of data.

Studies can be viewed only by authorized users, so the Service is fully HIPAA compliant. “The control of access is a big part of the [MISTC Service],” Gibbs said.

Once the study is viewed and the case resolved, the radiologist can then archive it as long as it’s needed on a DiCOM grid/Nirvanix server. If the study is needed in the future, the radiologist can locate it using a search function and then upload it again.

Coupled with the Service’s unique pricing structure, which ranges from $99 to $499 per month subscription and $1.50 to $6 per study upload price, the system is a kind of iTunes for PACS. And like iTunes, the cost of the study is a one-time price. Additional uploads of the same study are free. DiCOM grid also offers MISTC DR (Disaster Recovery), a cost-effective second copy of all studies stored at a remote server.

With the government deadline for implementing electronic medical records just around the corner, the MISTC Service could be a cost-effective solution for even the smallest radiology service.

—C.A. Wolski

Virtual Storage, Real Savings

As the Cardiac Care Group’s imaging data began to grow larger, the solo physician practice in Cape Coral, Fla, determined that it was working with the right vendor, but the wrong archiving solution.

Anthony Giordano, the practice’s director of operations, explained that the initial solution he purchased from Iron Mountain Digital was ideal and affordable when he started small, but as the files moved from megabytes to terabytes of information, it got too expensive.

That’s when Giordano took the opportunity to sign up as a beta client for the company’s new Virtual File Store (VFS) solution, a cloud-based archiving solution designed to help enterprises securely and cost-effectively manage their data. Cardiac Care Group has since gone live with the technology.

The technology arm of Iron Mountain Inc, Iron Mountain Digital designed the Virtual File Store to offer secure, long-term storage of inactive data from off-site centers. In doing so, the company says that the solution greatly reduces the investment in an expensive, on-site storage infrastructure and supports regulatory and compliance initiatives.

“More than ever, companies are struggling to keep pace with rapid data growth and increased regulatory demand, often retaining enormous amounts of data ‘just in case’ they need it down the road,” said John Clancy, president of Iron Mountain Digital. “Given that 50% to 60% of corporate data is inactive, storing all that data in house is not a sustainable storage strategy for companies today that are faced with storage and shrinking IT budgets. The enterprise-class Virtual File Store service directly addresses this problem by freeing up precious storage resources, while ensuring inactive data is secure and easily accessible.”

The Virtual File Store service is integrated with existing infrastructure and fits into the monthly operating budget; therefore, no large capital investment is required. Other major benefits include a reduced total cost of ownership that eliminates ongoing system investments or maintenance challenges. Ideal for Giordano, the solution offers scalability to adjust to business needs. Additional capacity is readily available in the event of short-term storage spikes, long-term structural changes, and expanding digital file archives.

“Large files can grow everyday, and we needed something off-site especially due to the fact that we’re in a hurricane zone,” Giordano said. “We knew that we needed a local backup that could grow with our needs. They provided us with the local server here that my server is copied to, which we manage. It is a good idea for the client to be able to manage the pieces they want to store from their system onto the VFS local server.”

With the VFS, Giordano said the group is paying under a thousand dollars for their archiving, compared to the thousands it had previously shelled out for the original solution. This difference amounts to big savings for a smaller practice that performs 2,400 imaging exams a year, Giordano points out.

The Virtual File Store offers virtually unlimited storage capacity and can be integrated with a company’s existing storage infrastructure to migrate inactive files over the VPN network to Iron Mountain’s redundant data centers.

Authorized users can retrieve files on-demand via a secure Internet connection anywhere they have access to the Web. As the newest addition to the company’s Storage-as-a-Service portfolio, the Virtual File Store leverages the scalability of that particular framework to manage large volumes of inactive digital data, therefore reducing overall storage expenses.

As a beta client and customer, Giordano has given Iron Mountain feedback for future releases of the software. He hopes that one day he will be able to receive information about what is being archived on a live basis. “It’s important for me, as the end user or CIO, to know my data, the size of it, what went over, what was successful,” he explained. “It’s one thing for them to tell me it matches the grid; it’s another thing for me to see it on a daily basis. I want to make sure that it is growing and get a better feeling that I know that what I have here locally is what they have off-site.”

—E. Sanchez

Archiving Software Relieves IT Headaches

In conversations with its customers and other PACS users, BridgeHead Software pinpointed the range of challenges these individuals and businesses face.

“Number one is the difficulty of accessing data from disparate PACS systems,” said Charles Mallio, vice president of business development and corporate marketing at BridgeHead Software. “Many hospital groups have inherited different PACS systems through acquisition and merger activity or because individual modalities work with separate systems.”

Providing clinicians with centralized access to PACS data that is sourced on disparate systems, the company’s PACStore product aims to efficiently utilize existing investments. BridgeHead Software recently announced the latest version of the product.

The solution incorporates a fully featured DICOM storage class server and HL7 interface, creating a central repository for imaging data with a single point of access. This data is automatically repositioned between different IT storage tiers during its lifetime, in order to minimize storage costs. It also permits Web-based access to DICOM images when primary PACS systems are unavailable.

“DICOM also allows us to address another issue that users come up against—lack of investment protection when changing PACS providers,” Mallio said. “Because of our use of DICOM, when an organization chooses to replace existing PACS systems, they’re no longer locked in to a particular PACS vendor. They will still be able to access all the historical medical images from our DICOM store—no costly migration or integration required.”

Further commenting on cost savings, Mallio continued, “PACStore is designed to help reduce the accelerating storage hardware costs and management burden imposed on health care organizations by having to retain and protect PACS medical image data over the long term. The system aggregates data from hospitals’ various PACS systems and from other modalities and automatically moves this data onto the appropriate storage media based on how available it needs to be.”

Another area of concern for PACS administrators is disaster recovery, Mallio said. These users may not have invested in backup for PACS because backing up the large amount of data poses a problem. One of PACStore’s features is its ability to maintain multiple copies of the image data repository simultaneously in multiple locations. “So it’s self-protecting and does away with the need for frequent backups,” Mallio said. “In fact, it enhances business continuity because if a disaster makes it difficult to access data from one location, then clinicians can access it from another.”

—E. Sanchez