• May 2008 FEATURE ARTICLES •
PACS/RIS/Imaging: Case History
Moving Pictures
A Minnesota imaging company upgrades its RIS and PACS for streamlined workflows that facilitate sustained growth.
Radiological imagery is a critical and often
lifesaving component of the healthcare system with doctors using
MRI, CT scans, nuclear medicine, X-rays, mammograms and bone
density exams to diagnose frequently disguised diseases and
injuries. What if all stakeholders in the healthcare system
could be connected through a single digital communications
infrastructure to share information, collaboratively treat
patients, and, at the same time, save costs? Doctors and
technology specialists at the Center for Diagnostic Imaging
(CDI) shared that vision; one they started to put into practice
in 2002, when the clinic set forth on a high-growth path that
came to fruition in the past year.
CDI, based in Minneapolis, with 750 employees
nationwide, is a pioneer in outpatient diagnostic imaging,
interventional radiology procedures and therapeutic pain
management. Kenneth Heithoff, M.D., a leading spinal
radiologist, founded CDI in 1981 at a time when private
outpatient imaging providers were in much demand by patients but
difficult to find. As CDI expanded across the country, Heithoff
steadily guided its growth, determined to provide each patient
with exceptional individual care and superior national
resources.
When the company first embarked on this expansion plan, it had 15 clinics and its affiliated physicians read 189,000 exams, representing 24 million digital images. Today, CDI has 45 centers spread coast-to-coast from Florida to Washington with physicians reading 287,000 exams, representing 38 million digital images.
As the imaging center broadened its
geographic reach, Heithoff, his executive management, and CDI’s
IT staff realized there was an opportunity for the medical
center to become more efficient and cost-effective by
streamlining its radiology images. "As we grow, we need to
ensure our systems and network can place the highest value on
exam consultation between specialists," says CDI Chief
Information Officer Steve Fischer.
Infrastructure Upgrade and Expansion
To continue to fuel its growth, CDI had to
optimize its ability to acquire, manage and store images across
a national imaging archive environment. To accomplish this, the
team embarked on the daunting challenge of upgrading CDI’s
systems infrastructure to a single radiology information system
(RIS) coupled with an open architecture picture archive and
communication system (PACS) that would allow best-of-class
reading workstations to be deployed.
The initial step was to select a RIS that
would support this vision. RISLogic was selected and
implemented. "We could not afford downtime, misdirected traffic,
or an unreasonable number of servers on our network," says CDI
Infrastructure Architect James Keller. "We want our referring
physicians to have the ability to stream images and view reports
online, instantly, anytime, anywhere."
Within a year, CDI had expanded to 24 centers
nationally and decided to select and implement a PACS solution
that would provide a vendor-neutral, open environment that would
not restrict the use of best-of-class reading and computer-aided
diagnosis solutions. An additional requirement was to provide an
archiving infrastructure that would support the transparent
migration of archived images to new storage technology as it
became available.
To establish an effective PACS infrastructure
and image workflow capability for its widely dispersed
enterprise, CDI turned to Cisco Systems and its partner, Acuo
Technologies. CDI first talked to Cisco in part because of the
networking company’s leadership and investment in Connected
Imaging systems. Cisco Connected Imaging solutions facilitate
information sharing so physicians can interpret, diagnose and
collaborate across geographic boundaries to treat patients.
Results
In creating this national imaging
infrastructure, CDI’s goals were multifold: to use Connected
Imaging to provide secure and efficient image archiving and
access, improve productivity, support collaboration and reduce
costs throughout the imaging workflow. CDI also wanted to send
images securely and quickly across the network to caregivers
inside and outside their facilities, while also cutting the
costs associated with film transport and storage.
By implementing the system, CDI is able to
facilitate timely and accurate interpretation of images as
doctors, clinicians and specialists — even in different
locations around the country or the world — share images and
diagnoses without worrying about system capacity. The system
design enabled CDI to lower the costs and complexities of its
infrastructure environment while supporting mission-critical
imaging services, overall providing a highly reliable, available
and secure platform. Since the architecture is modular and
adaptable, the medical center can align its national expansion
plans with its infrastructure deployments.
Perhaps the most important benefit to CDI
came from having a communications system that could change and
grow at a moment’s notice, enabling new capabilities for more
effective diagnostic communications, clinician mobility,
streamlining business processes, fueling growth and improving
profitability. "The Cisco and Acuo solutions have allowed us to
deliver more and better services to our physicians with the
minimum number of servers," says Keller. "As a result, we have
created a fully functional heterogeneous medical archive, while
at the same time servicing more patients and reducing CDI’s cost
per exam."
CDI’s Network Engineering Manager Jerry
Allard sees a strong correlation between the network solution
and those benefits. "As we add new partnerships and imaging
centers, we can either add to the existing regional facility or
create a new regional facility," says Allard. "We can do this
just by scaling our capacity and performance in conjunction with
the number of supported imaging centers."
Unprecedented National Growth
When the center first embarked on this
expansion plan, it had 15 clinics and its affiliated physicians
read 189,000 exams, representing 24 million digital images.
Today, CDI has 45 clinics spread coast-to-coast from Florida to
Washington with physicians reading 287,000 exams, representing
38 million digital images. This growth has required CDI to
establish a distributed PACS network, with Cisco and Acuo at its
foundation.
"The addition of clinics leverages the IT
infrastructure, effectively spreading costs over more exams,
thereby reducing the cost per exam," explains Fischer.
"Consistent and timely delivery of quality results in a
cost-effective manner is how recurring business is garnered."
According to Fischer, CDI’s ability to
increase access to care and services by providing concise,
specialized clinical information to referring physicians is
critical to continued growth. That information includes
obtaining the expert advice of sub-specialists located anywhere
on their PACS network through the use of advanced technology.
"For example, an extremity radiologist reads only extremity
exams and is an expert in their interpretation. Additionally,
through our peer review program, geographically dispersed
sub-specialized radiologists can review cases and compare notes,
thereby continually improving reads and refining the scanning
protocols to obtain the best results," says Fischer.
Center for Diagnostic Imaging has been able to continue its
growth path while sustaining operational effectiveness across
its existing communication networks. The vision exemplified by
the group’s leadership has resulted in an award-winning
implementation of enterprise PACS for delivering the most
cost-effective imaging services while improving the quality of
healthcare by having specialists review complex cases without
geography as a barrier.