Italian hospitals give ASP-based RIS a try

Radiologists at two hospitals in Pisa, Italy, are testing an application service provider solution for their institution-wide radiology information system. Reports generated in any one of the five radiology departments at Santa Chiara Hospital and Cisanello Hospital are transferred 300 km to a central archive near Rome. The ASP vendor has also assumed responsibility for daily maintenance and technical support of the hospitals' RIS.

The switch to an ASP-based solution was made early this year after radiologists in Pisa decided to replace their technologically obsolete 10-year-old RIS and promote better integration between the hospitals' separate radiology departments. Doctors considered software solutions from five vendors before opting for the remotely hosted RIS.

"We chose the RIS that offered the best technical solution and was most favorable economically," said Dr. Davide Caramella, an associate professor of diagnostic and interventional radiology at the University of Pisa. "When we compared quotes for this solution as a hosted RIS and an ASP-based RIS, the second was much more favorable."

Onsite system deployment began in May. Hardware installation in the departments of university radiology, neuroradiology, and emergency radiology at Santa Chiara Hospital and in the departments of hospital radiology and advanced imaging at Cisanello Hospital took 20 days. A total of 150 radiology staff also underwent a five-hour training program, a process that took 320 hours to complete.

Operation of the RIS started at the beginning of June, and over 30,000 reports were archived during the first three months. Digital signatures are used to authenticate reports prepared in the radiology departments. A multilevel firewall protects communication with the remote archive, which receives reports via a 2-MBit/sec HDSL line.

"You don't really realize that you are accessing a distant server," Caramella said. "The only moment you appreciate that it is not local is when you first log in, which takes a few seconds."

Network connections have been made to 67 clients, half of which have voice recognition installed. Work list management is being introduced for 23 DICOM-compatible modalities, including seven ultrasound units, five digital x-ray units, and 11 cross-sectional (CT and MR) scanners.

Implementation of the ASP-based RIS has not been entirely problem-free, however. Radiologists continue to experience difficulties accessing reports archived in their former RIS, so they have kept the old system "alive" for the time being, Caramella said. Service disruption has also occurred, most notably in September, when a primary server crash left both hospitals without a RIS for three and a half hours. But the system survived Italy's national power blackout during the evening of Sept. 28, thanks to backup electrical generators serving Santa Chiara's emergency radiology department and the ASP center.

"I receive plenty of telephone calls from colleagues asking me what we think about this solution, and I have to be honest," Caramella said. "I point out the advantages, but also the problems we have seen. We are still in the experimental stage, at least in Italy, and there are still some minor details that have to be worked out."