Healthcare institutions struggle with the pros and cons of digital image management on a large scale and for high stakes. One issue is that although image storage doesn’t take up actual physical real estate and is relatively inexpensive, there’s a temptation to store, and keep indefinitely, every image from every patient encounter in every department.
Trent Conwell, director of IT for Sentara Healthcare, calls it the “out of sight, out of mind” problem, and it presents a number of challenges. In addition to increasing storage costs, from an IT perspective, “the more images you include in your archive, the slower and more complicated the processes of moving any individual image back and forth become,” says Conwell.
By Adam Blair
Enterprise imaging platform addresses explosive growth in digital image volumes.
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Healthcare institutions struggle with the pros and cons of digital image management on a large scale and for high stakes. One issue is that although image storage doesn’t take up actual physical real estate and is relatively inexpensive, there’s a temptation to store, and keep indefinitely, every image from every patient encounter in every department.
Trent Conwell, director of IT for Sentara Healthcare, calls it the “out of sight, out of mind” problem, and it presents a number of challenges. In addition to increasing storage costs, from an IT perspective, “the more images you include in your archive, the slower and more complicated the processes of moving any individual image back and forth become,” says Conwell.
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He speaks from experience; Sentara Healthcare, based in Norfolk, VA, went digital with its radiology images back in 2002 and saw its image storage requirements first grow and then accelerate, alarmingly. In addition to incremental growth from seeing more patients, Sentara has also grown institutionally by creating partnerships with other healthcare facilities, with the result that the company now includes 12 hospitals, more than 100 medical groups, and clinics in both Virginia and northeast North Carolina. The addition of these entities also meant adding a variety of different PACS, which led to “more complexity, because each PACS has its own individual silo of image storage,” notes Conwell.
Reducing costs and the complexity and variations among different departments and facilities were the key motivating factors for Sentara’s adoption of an enterprise imaging solution. The company began implementing the platform from Mach7 Technologies in May 2014, with deployments in cardiology and podiatry planned this fall, with other departments to follow soon afterward.
Drawbacks Of Packaged PACS
This deployment wasn’t Sentara’s first attempt to address image management and storage issues arising from explosive growth. Initially, the solution was to add storage to the existing PACS for departments needing an image storage solution. “This worked well, for a while, from a back-end storage viewpoint, but not always from a workflow and operational perspective,” Conwell notes.
The arrival of vendor-neutral archive technology around 2008 seemed like it would solve some of the integration, interoperability, and storage challenges Sentara was facing. However, the vendor landscape at that time consisted of packaged solutions that bundled together storage, image management, and image viewing. “Vendors probably thought a unified solution would make for easier implementations,” says Conwell. “But the problem for us was that the solutions were costly, the savings they produced were negligible, and they didn’t offer any real clinical benefits. We tried, not once, but twice, to formulate a business case for this type of solution, but we weren’t able to do it.”
By 2012, however, the vendor landscape was changing, with technology companies offering components of their solutions separately. This development on the supplier side coincided with Sentara’s decision to centralize procurement of its digital data storage as a way to cut costs. By carving out these costs from the business case for enterprise imaging, Conwell took another step toward creating a compelling argument for an enterprisewide solution.
4 Pillars Supporting Enterprise Imaging
The business case had to be solid, since Conwell and his team needed to first convince both the VP of IT and Sentara’s CIO of the value of enterprise imaging. Then, they needed to sell the concept to the company’s decision makers and to users in the organization.
Conwell and his team identified four points to support the business case:
- Storage Savings: These can be derived by storing fewer images, which usually requires either modification of clinician routines or use of image compression technologies. Clinicians tend to want to keep every image in perpetuity. However, for a variety of reasons, IT, corporate, and legal departments generally want to limit the number of images that are stored. As a compromise, Sentara has planned for image compression. Sentara and Mach7 performed image compression studies with input from Sentara’s physicians to ensure that the compression rate produced images that were of diagnostic quality, “but that also provide us savings in storage space and ultimately in dollars,” says Conwell.
- Physician Adoption Of The Technology: By opting for the eUnity enterprisewide image viewing solution from Client Outlook, Sentara was able to encourage physician buy-in by providing users with a standardized clinical viewing tool set across the various PACS used by radiology and cardiology, as well as future non- PACS images in ultrasound, pathology, endoscopy, etc., “regardless of what type of image or the location it was stored in,” says Conwell. Common access to various image types, located in previously siloed storage areas, was a significant factor influencing physician buy-in.
- Simplifying Business Continuity And Record-Keeping: The various pockets of image storage around the Sentara organization made business continuity planning complex, time-consuming, and costly. However, the ability to “get all the images into a single archive/storage platform will simplify our ability to replicate that platform, creating a true business continuity model regardless of either image type or source,” says Conwell.
- Blueprint For Integrating Individual PACS: Sentara’s growing network of healthcare organizations and facilities meant the company had been dealing with as many as eight different PACS, creating considerable management complexity and high costs. An enterprise image platform not only addressed these issues, but “if we partner with another organization, we now have a ‘cookbook’ for integrating their PACS,” says Conwell.
Stringent Selection Process
These leverage points were part of Sentara’s road map for an imaging strategy solution, developed in concert with Ascendian Healthcare Consulting. The final choice of Mach7 Technologies rested not only with the vendor’s technology but also on its performance during the selection process.
“We brought each finalist into the office and asked them to design a system for Sentara on the spot, that day,” says Conwell. “We gave them a white board and marker along with a diagram of the Sentara organization. We wanted to find out, first, which vendors had sent us people who really knew the product and also which ones were agile and nimble enough to think on their feet.”
The process worked well. “This was the point where the vendors really separated themselves from one another,” reports Conwell. “These are the kinds of things it’s difficult to determine from a written RFP.”
After nearly three months of internal lobbying for the project, Conwell and the IT team got the go-ahead to proceed in February 2014. System design began in May, after Conwell and his team had procured the necessary hardware to meet the needs of the design, and the system was functional and ready for integration and testing in August.
Ability To Pivot With Changing Conditions
The vendor’s industry knowledge has also come in handy during the implementation process. During the summer, Sentara discovered that it would not be able to synchronize the Mach7 database with its current radiology PACS vendor’s database. Sentara had been unaware that the PACS vendor was performing updates that would have made it impossible to perform the necessary synchronization within Sentara’s original schedule.
“We discussed our options with Mach7 and decided to put this portion of the implementation on hold until the PACS vendor provided a solution that we could implement to keep us in synch,” says Conwell. Instead of being stymied, however, “we decided to go down another path until the situation was remedied, so we went into cardiology as our initial implementation, to be followed by podiatry.”
Conwell notes that to achieve this large-scale, enterprisewide integration, “you have to know more than you realize about your own systems.” With Mach7 Technology, Client Outlook, and Ascendian Healthcare’s outside perspective coupled with technical and industry knowledge, vendors “help you understand your own environment. They’re there not just to implement your product, but also to educate you about your current system and also how it will all fit together.”
Healthcare institutions struggle with the pros and cons of digital image management on a large scale and for high stakes. One issue is that although image storage doesn’t take up actual physical real estate and is relatively inexpensive, there’s a temptation to store, and keep indefinitely, every image from every patient encounter in every department.
He speaks from experience; Sentara Healthcare, based in Norfolk, VA, went digital with its radiology images back in 2002 and saw its image storage requirements first grow and then accelerate, alarmingly. In addition to incremental growth from seeing more patients, Sentara has also grown institutionally by creating partnerships with other healthcare facilities, with the result that the company now includes 12 hospitals, more than 100 medical groups, and clinics in both Virginia and northeast North Carolina. The addition of these entities also meant adding a variety of different PACS, which led to “more complexity, because each PACS has its own individual silo of image storage,” notes Conwell.
