An ongoing challenge for most health enterprise IT departments is the existence of multiple picture archiving and communication systems (PACS) within the organization. These proprietary silos present a barrier to physician access to imaging studies and thus stymie collaboration and consultation. They also create inefficient duplication of effort by IT staff and, due to the long process involved in changing a PACS, slow adoption of new imaging technology.
To overcome these challenges, Utah’s Intermountain Healthcare made the decision to create a vendor-neutral archive.
The technical solution
According to Marc Probst, Intermountain’s CIO and vice president of information systems, the healthcare system partnered with Dell and Siemens Healthcare to implement an enterprise-wide archive designed to manage data from all PACS, facilitate access to imaging data and improve clinical care. The solution has three components:
- Clinical data-management layer that has the capability of aggregating data for each patient from all PACS, HIS and specialized imaging applications. For the initial Intermountain solution, the data-management layer aggregates data from radiology and cardiology imaging systems.
- Clinical archival layer that includes on-site and cloud deployment options that can be used independently or as a hybrid. Intermountain chose a hybrid deployment with both on-site and cloud-managed storage.
- Clinical collaboration portal for easy access, secure sharing and integration of clinical data across a variety of platforms. It allows diagnosing physicians to use the PACS reader of their choice when viewing images and allows integration with the EMR for easy access by attending physicians. Intermountain’s implementation of this layer is still in progress.
The initial installation, which completed final testing in April, aggregates data from radiology and cardiology and stores five years of data onsite in the active archive, using two Dell PowerEdge R720XD servers and two Dell EqualLogic storage devices, the FS7620 and the PS6510, along with Dell Force10 4810 switches. Intermountain will also have cloud storage at Siemens and Dell data centers for a highly redundant system that facilitates fast disaster recovery.
Intermountain will migrate nearly half a petabyte of data from existing PACS storage to a mix of on-site storage and cloud storage. Going forward, all new images, approximately 1.6 million radiology files and 350,000 cardiology files annually, will be stored locally for five years and also uploaded to cloud storage.
Intermountain Healthcare has 22 hospitals and 180 clinics, in addition to its own insurance company. The need to share patient data across platforms was growing, which led the Intermountain team to search for a common storage platform that would allow wider, easier access for system physicians and integration with other data across the enterprise.
“We’ve had PACS in our facilities for the past 15 years, and the number and variety of systems was growing,” says Intermountain CIO Marc Probst. “Radiology, cardiology, all the ‘-ologies’ have a digital platform, and it seemed silly to have separate archives for each system.”
The Intermountain team decided to go with an outside vendor for their storage solution. “We’ve got 1,100 IT staff, and we’ve done a lot of our own in-house solutions,” Probst says. “But medical image storage is growing rapidly and requires dedicated staff to maintain it. It made sense to go with a vendor who has expertise in the area, rather than to create an in-house solution.”
Neutrality, dependability were key selection criteria
“We did a lot of planning before we selected our vendor,” Probst says. “And we went through an extensive selection process.”
True neutrality was the first criteria in Intermountain’s selection hierarchy.
“We were not super-keen on the idea of using a vendor linked to proprietary imaging systems. We wanted a truly ubiquitous platform that would work well with all image types, from a vendor without any other agenda,” Probst says. “We also wanted proven technology, though in 2010, the technology was still pretty new. And we wanted a company that would stand behind their product and [would] be there over the long haul.”
After a lengthy selection process, Intermountain chose a partnership with Siemens Healthcare and Dell to implement an image-archiving solution using Dell hardware. Siemens had provided the system’s cardiology PACS, so it was a proven partner, Probst says, and the Dell technology brought the neutrality that Intermountain was looking for.
“Siemens does sell imaging systems, but the fact that they were partnered with Dell was a big factor in the decision,” Probst says. “Dell doesn’t sell medical imaging systems, so we felt confident that their technology would provide the neutral platform we needed.”
Careful planning, knowledge of existing system came first
Planning for the new system began in 2010, and continued throughout 2011, after the Siemens/Dell team was selected. Implementation began in 2012.
“You have to be realistic about the timing,” Probst says. “The decision should be made strategically, not in a rush because your PACS system is failing. The planning takes time. And you need patience in the implementation process. The technology is relatively new, and it doesn’t always work the way you think it will. And it will take longer than you think it will. But if you work with your vendor, you will end up with a solid product.”
Because Intermountain’s IT staff had developed much of the system that was currently in place, they had a thorough understanding of the technology and its capabilities. That, according to Probst, was the key to making the transition work smoothly.
“You have to know how the existing system works to integrate it with the new archive,” says Probst. “You need to be thoroughly familiar with the technical interface – the various readers currently being used by the clinical staff, as well as the nuances of the image formats. Even though all of the systems use a DICOM format, there is still a lot of variation in the formats.”
For Intermountain, with its wealth of IT expertise in house, the implementation was not a big project, Probst says. “It wasn’t a huge event. We didn’t delay or halt any other projects to get this done. It was just one of many things that were happening. We had a bridging team, four to five people who worked with Dell to implement the system.”
Seamless new technology for clinicians
One big advantage of the new system, according to Probst, is that clinicians won’t be required to learn a new interface. As the images are brought into the archive, they are standardized into a common format that allows them to be read using any reader.
“The physicians can keep using whatever reader they are comfortable with. This will give them some additional flexibility in bringing on new technology,” says Probst. “Because implementing a new PACS is a long process, we didn’t allow the physicians to make those changes very often. Now, if they want to bring in something new, we don’t have to make huge changes. If there is a new reader that offers clinical advantages, we can integrate that pretty easily without adding a new layer of complexity that a full PACS implementation would require.”
The new system will also make it possible to integrate more images into the system’s electronic medical records, improving access for attending physicians as well as diagnosing physicians. And sharing images between Intermountain and other healthcare providers will be easier.
“This will allow us to share images with the University of Utah hospitals and clinics or any other provider, and that has got to be better for patients,” Probst says.
“The decision should be made strategically, not in a rush because your PACS system is failing. The planning takes time. And you need patience in the implementation process.”
Solution works for small hospitals, too
“We have a lot of in-house talent and experience, but with the increasing hardware requirements for image storage and the need to manage that storage, working with a partner made sense,” Probst says. “They were able to bring in experts and manage the project with us. It’s a solution that would also work well with small hospitals or health systems. Even though Intermountain is a complex system, with complex use cases and demands, the implementation was rapid and relatively easy. A less complex system would be implemented even faster. They would get the same advantages, just on a different scale.”
Partner, patience and planning
Making the transition to a unified, vendor-neutral image archive comes down to three factors, according to Probst: partner, planning and patience.
“You have to pick a good partner, you have to know your system thoroughly and plan the transition carefully, and you have to have patience,” Probst says. “Transitions are tough. But you will get a good solution if you are patient and work with and learn from your vendor partner.”
For more information about Intermountain Healthcare’s transition to an enterprise-wide image archiving solution from Siemens and Dell, contact Geoff Duke at firstname.lastname@example.org.
About the Author
Karen Branz is a freelance journalist specializing in healthcare and technology issues. For more on Dell: www.rsleads.com/306ht-203