Rising imaging volume calls for single storage solution

Like other healthcare systems, Mercy Health Partners faces enormous challenges related to explosive growth in both the volume and the size of imaging exams. Our seven hospitals represent 21 discrete radiology, cardiology, and pathology imaging systems, each with a dedicated storage solution.

These departments and their clinical users rely upon IT staff to maintain fast, reliable access to imaging studies, along with disaster recovery. We didn't need a crystal ball to see that the demands of maintaining these disparate systems would rapidly outpace our personnel and financial resources.

Three years ago, we determined that a centralized storage architecture was the best way to support our current and future imaging needs.

We began this ambitious project at our primary local data center at St. Vincent Mercy Medical Center, a regional referral and teaching hospital in Toledo. In addition to serving its host hospital, this data center also serves our new Regional Heart & Vascular Center across the street and three additional hospitals in the area: St. Charles Mercy, St. Vincent Mercy Children's, and St. Anne Mercy. Most of our PACS-based radiology images were already archived on RAID at these sites, but we used our storage management software to migrate cardiology data from CD/DVD storage devices to the primary archive.

SYSTEMWIDE PATIENT ID NUMBERS

Our primary data center currently manages 450,000 imaging studies from cardiology and PACS for all four hospitals. The originating site for each study can be determined by its site identification number. We solved the problem of creating systemwide identification by activating our hospital information system's capability to assign a unique corporate identification number to each patient. We essentially operate parallel systems because we also maintain each hospital's medical record number to facilitate local access to existing files.

Images are transmitted from the Regional Heart & Vascular Center and three Toledo-area hospitals to our primary data center via a wide area network. These imaging studies are then delivered in real-time via a dedicated 1-Gb fiber optic network to a fully redundant secondary data center at St. Charles Mercy Hospital, 13 miles away in Oregon, OH. In the event of a disaster, we will use the backup data center to provide user access to our entire database of images.

DISASTER RECOVERY

One of our key objectives for establishing centralized storage management was to facilitate access in the event of a disaster. The only way to deliver radiology services during an emergency is to have both the information and the processing power available to serve these records to staff and clinicians. Our current configuration with redundant data centers is designed to deliver access to medical imaging records in the event of a disaster, both to meet Health Insurance Portability and Accountability Act regulations and to satisfy the needs of patients and physicians.

Now that we have established centralized management of PACS and cardiology studies at our four largest hospitals, we are in the process of adding pathology studies from these hospitals as well. We are also integrating PACS and cardiology studies from three additional remote hospitals. We have just linked PACS images from Mercy Hospital in Tiffin, OH, into our architecture and will soon add PACS studies from Mercy hospitals in Willard and Defiance, OH. Cardiology images will be next, followed by pathology.

As part of this process, we are installing PACS for the first time at two of the three rural hospitals and have upgraded our network connections to 15 and 20 MB/sec to provide acceptable response times for all three facilities.

We store data both locally and in our primary and secondary data centers for 18 to 24 months and then retain information for the length of time required for each type of study. We plan to take advantage of our storage management platform's clinical information life cycle management capabilities to govern where data reside as they age. A multidisciplinary committee is creating storage plans for each type of exam: pediatric, general radiography, cardiology, oncology, mammography, and others.

AUTOMATED DATA MANAGEMENT

The storage management software will determine the type of imaging study or data by "reading" the header information and applying these instructions to the study. If our needs change, we can adjust our storage plans, and the software will apply these revised plans to both current and existing records. This type of automated management is important because it eliminates time-consuming manual processes by our IT staff. It also ensures that data and images are maintained online during periods of peak use and transferred to near-line or offline storage during periods when access is unlikely to be needed.

We did not work with a consultant on this project, but we did retain project management services from Carestream Health, our storage management software vendor. The project team's knowledge, gained from implementations at other institutions, was invaluable as we worked together to design a storage architecture that would support multiple applications and facilities and would allow scalability for growth.

A centralized storage architecture and network delivers many benefits. Our institution benefits from more efficient use of personnel and equipment resources, clinicians benefit from faster and more reliable information access, and patients benefit from the ability of specialists to view their imaging exams and help make a diagnosis or recommend appropriate treatment.

For example, we support after-hours radiology reads at our main sites and facilitate nighthawk services for the remote sites. Physicians and radiologists at the rural hospitals can also seek consultations with specialists and review the imaging studies immediately and simultaneously.

Two years into this project, we are pleased with our progress and our results. While we did consider the financial investment required by this implementation, our driving force was the cost we would face if we did not undertake it. Maintaining dozens of separate imaging and information management systems would place an untenable financial burden on our institution in the coming years. Our current solution not only solves our immediate need to establish cost-effective, centrally managed storage, it also delivers added benefits in the form of built-in disaster recovery and enterprise-wide clinical access to imaging studies.

Mr. Albin is chief information officer, and Mr. Borer is director of technical services, both at Mercy Health Partners in Toledo, OH.

Challenge:

Create a cost-effective centralized storage archive for PACS,
radiology, and cardiology systems at seven hospitals
Solution:
Centralized storage archive with specialized management software
Benefits:
Enterprise-wide access to patient images
Reduced management/maintenance duties for IT staff
Built-in disaster recovery
Support for remote reading by radiologists, specialists