Start-up firm pursues long-term image archiving

February 2, 2000

As was the case with film-based radiology, the growing adoption of digital imaging is creating a need for long-term storage of a different sort. The concept of off-site data warehouses for electronic medical images is not new; Emerald Archiving offers a

As was the case with film-based radiology, the growing adoption of digital imaging is creating a need for long-term storage of a different sort. The concept of off-site data warehouses for electronic medical images is not new; Emerald Archiving offers a number of digital image conversion and archiving services, and Wam!Net continues to refine its Internet-based long-term image-storage service (SCAN 4/28/99).

But a newcomer to this business, InSite One, is taking a new approach with its service model. The Wallingford, CT-based company debuted InDex (Internet DICOM Express), its version of off-site image storage and management, at the 1999 RSNA meeting in November. InDex works in conjunction with any PACS and information system to provide on-demand access to DICOM images residing either locally or at a storage facility that is linked via the Internet or a virtual private network to the hospital’s network.

InSite takes a three-tiered approach to image archiving through InDex. A RAID-based proxy server linked with the PACS resides in the radiology department, and each image that is generated automatically goes into that server and is kept there for two to six weeks, depending on usage needs. The first time the image goes into the proxy server, a duplicate is sent immediately to InSite’s nearline warehouse in Connecticut, where it is stored on a DVD server. In addition, a third image is stored offline at a third location in the Midwest.

“Our patented model (covers) the use of the proxy server in the facility to store images in a facility online,” said Rick Friswell, chairman and CEO of InSite. “The key for us is the hardworking proxy server on-site.”

All image transmission to these storage facilities is done via the Internet or a hospital’s intranet using a 3:1 JPEG compression algorithm and 128-bit military-grade encryption protocols to ensure image security. Other security measures include firewalls, filtering, digital signatures, and access control technologies.

InSite also takes a unique approach to pricing. All equipment is installed and maintained by the company under a flat rate charged for a seven-year contract to the InDex service. Customers are billed on a monthly basis at $3.65 per study for every image stored during the first year and 24¢ per study per year for each year after that. The model is based on an estimated study size of 25 megabytes, which InSite anticipates will be the average size. If the average size is much larger, for cardiograms for example, the company may consider a differential charge.

“The pricing is based on the fact that, in the first year, images will be experiencing their heaviest use,” Friswell said. “We have developed use algorithms by modality and a formula to optimize the on-site/online storage configuration to maximize utilization for the customer. Our objective is to make the pricing structure simple so the facility can budget in the cost.”

InDex is still in beta testing at Hartford Hospital, the largest medical care facility in Connecticut, but the company plans to go live this quarter and have its first contract relationships up and running by April. In addition, InSite is pursuing strategic alliances with several PACS vendors, the first of which should be announced in the second quarter. Despite some initial reactions to the InDex as a competitive rather than complementary product, most PACS vendors see the value in InDex as a sensible add-on for enterprise-wide PACS, according to Friswell. The firm also plans to offer InDex via direct sales.

“And then there is HIPAA (Health Insurance Portability and Accountability Act), which will require hospitals in the next two years to have a disaster recovery and redundancy plan in place,” he said. “So a warehouse alternative and storage component will have to be part of their strategy.”

Another potential avenue for this service relies on a miniPACS modeling strategy. InSite has put together a miniPACS model for facilities that do not have the funds to invest in an enterprise-wide PACS but are looking for digital image management capabilities. The company is already in negotiations with various Internet browsing and workstation companies to support this service.