Cloud Storage Is The Solution For Outpatient Center

By Katie Wike, Contributing Writer

When a large outpatient center needed more space for archives but wasn’t able to expand its datacenter footprint, it turned to the cloud for storage options.

Zwanger-Pesiri Radiology (ZPRAD) is one of the largest outpatient centers in the country by volume. The organization provides advanced imaging tests for residents of Long Island, NY. Radiology is a field which revolves around images, and ZPRAD quickly learned its old archive solutions were not meeting the storage and sharing needs of the organization. In addition, the organization recognized that having the latest-emerging health technology could help achieve a higher level of care and create a competitive advantage. Thus, the search for a new storage solution began.

Unreliable And Costly Image Storage
ZPRAD’s previous storage solution, a traditional production clinical in-house PACS and tier-one, tier-two storage solution with remote tape storage deep archive, provided unreliable image retrieval and retention. It was prone to data loss and corruption of tape media and disks. As a large practice, ZPRAD created more than 1 TB worth of new data each week, which needed to be protected and stored in a reliable system.

The PACS solution was a distributed model and required on-site storage for each site to store and forward every radiology study to the core for archiving. A typical remote-site buildout included HP 2x servers clustered with HP MSA P2000 G3 storage at each location and EMC CLARiiON at the core for centralized image management and archiving. The cost for each of these sites exceeded $60,000, not including the cost of adding capacity to the archive in the core to accommodate the additional study volume. This cost also did not include supporting infrastructure such as cabinets, racks, cable management, network, firewall, UPS, and backup devices. It required close to 20 FTEs, multiple consultants, and vendors for support.

“It has always been difficult for organizations operating in high-priced real estate markets such as New York to secure adequate datacenter space to properly size and scale the required computing power necessary to run a business,” explained Anthony Ervolino, senior system engineer at ZPRAD. “Many times IT departments are forced to make do with undersized space and inadequate power and cooling. These lead to unplanned business interruptions due to outages and oversubscription of utilities/HVAC. Therefore, it is always on the minds of IT managers to select high-density solutions, outsourced solutions, or private clouds to manage datacenter sprawl.”

Moving Into The Cloud
ZPRAD needed to find a cost-effective way to archive its growing collection of digital images. The organization also needed a way to store images and data without monopolizing expensive real estate.

“We recognized that in order to cooperate in the health exchanges and share images on demand with other entities, we needed to adopt a more available and always-online solution without expanding our datacenter footprint,” said Ervolino.

With many new names in the VNA (vendor neutral archive) market, there were a lot of options for the transition to the medical imaging cloud. However, as Ervolino put it, “This is not an area you would want to experiment with.”

Because of that, ZPRAD selected Dell’s VNA (i.e., Dell Unified Clinical Archive or Dell UCA) as the solution. Originally, the organization planned to use Dell VNA only as an archiving solution. However, the IT department quickly saw its potential to share studies with ZPRAD’s partners, health exchanges, and referring physicians EMRs.

Space-Free Storage And Sharing
Ervolino says the integration process was typical, taking about six months to implement. Once the installation was complete, it was quickly followed by a testing sequence between the vendors and ZPRAD, which took about one month.

Dell VNA was integrated with the existing PACS system in order to retrieve and share studies without interrupting the PACS DICOM. “Traditionally any queries for DICOM data retrieval went to our PACS system and placed an I/O (input/ output) burden on the system. This traffic would compete for I/O with our radiologist and clinical practice. With VNA, we can now bypass the PACS for prior exams and go directly into VNA for access,” says Ervolino. “This removes the workload from PACS, reserving more I/O for our radiologist for reading current studies making a better reading workflow experience.” Some prior exams, such as CT scans, MRIs, ultrasounds, and mammograms are required to be kept for several years or longer, and radiologists use VNA to access the files.

“The VNA allows us to remain nimble and responsive to the ever-changing healthcare space and allows us to extend our archive repository to various partners without impacting the performance or security of our production PACS,” adds Ervolino. Because the VNA is a separate system (from PACS), ZPRAD can place it in a DMZ (protected isolated firewall zone) and create access rules for HIE, RHIO, and Partners to access data only on the VNA and not on the PACS. This minimizes exposure of hacking into PACS. It also minimizes any impact that a breach, virus, or malware attempt would have.

While the ZPRAD staff was pleasantly surprised to find they could use the Dell VNA to share studies in addition to archiving images, they were also pleased to gain the ability to predict costs from the installation. “The other main benefit we experienced was a predictable cost as we penetrated new and unpredictable markets. We paid only for what we used and ensured we didn’t waste capital on unknown storage needs,” explained Ervolino. Dell VNA provides ZPRAD with a predictable cost model for growing the practice without increasing its datacenter footprint.

“As we expand operations into new territories, we’re often unsure of the amount of market share we stand to win, especially when we face competition from other established radiology groups, outpatient centers, and hospitals,” Ervolino adds.

Today, ZPRAD has 11 FTEs (compared to the previous 20) supporting the PACS system — six RIS\PACS telephone support professionals, one network consultant, one systems engineer, one security consultant, and two PACS\ RIS administrators.

“Of the 360 hours per week, 80 of those hours were from dedicated FTEs who managed storage and backups of the archive system. This represents a savings of over $200,000 per year on FTEs alone,” explains Ervolino. “We did not remove these jobs but repurposed the staff for project work.”