Month: September 2007

Take the Archive Out of PACS

Those of you that have been following my recent posts on the subject of PACS-Neutral Archive might find it useful to visit the HIMSS or Emageon web sites to access a webinar delivered today to an audience of 70+ members of HIMSS.

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The seminar covered the subject of Tag Morphing and explained how some very common problems faced by Health Systems today can be resolved by deploying a PACS-Neutral Archive; problems such as the sharing of a single archive among multiple dissimilar PACS, and the elimination of future data migrations. The Emageon web site offers the visitor the option of downloading a collection of white papers that describe the concept of PACS-Neutral Archive and Tag Morphing in more detail.

Check it out.

Is new Stark Exemption an Opportunity?

I came across an article in Imaging Economics titled “Surveys Show Paper Legacy Tough to Shake”

What caught my eye was the second paragraph statement “A new Stark exception allows hospitals to donate health information technology in the form of an EMR to private physicians.”

I was wondering if the definition of “EMR” could be extended to radiology web viewer? Is this possibly a mechanism for providing the necessary hardware (PC), software and connectivity services to the referring physician office to get them to stop requesting paper and film?

The article is worth reading as it explains why “more than 50% (hospitals) continue to print and distribute paper lab and imaging reports.” This does not come as a surprise to me, but it occurs to me that if so many hospitals are still printing paper radiology reports, a similarly large number must also be distributing hardcopy images.

Clearly the success of a Radiology PACS depends on turning off a large percentage of hardcopy and getting the referring physicians to access images and reports from their offices electronically. I have long argued that the cost of providing a suitable PC and basic connectivity services is more than paid for by the value of the hardcopy. Many clients were concerned about the Stark implication. Is this exception an opportunity?

The article goes on to explain that 62% of hospital executives surveyed in February said their organization had no plans to donate technology. “They’re waiting to see how the government changes the landscape. How will it affect their nonprofit standing, that kind of thing.” Once again, I think this is a shortsighted point of view. The continued printing of hardcopy films is certainly affecting their bottom line. Why not take advantage of this opportunity to legally equip their referring physicians with a much less expensive method to access images and reports?

Separating Storage from the PACS is Good First Step

I was browsing today when I came upon an all too brief article that appeared in HealthCare Informatics in August, 2007. The title of Stacey Kramer’s article is A Two-Tier Solution, and the first sentence states that “Memorial Hospital found it takes two vendors to handle imaging properly – one for PACS and one for storage.”

According to the article, Memorial Hospital decided to combine a McKesson PACS with “IBM’s tiered storage solution”. Unfortunately the article provides no real information on the actual configuration, or any explanation as to why this was the ideal combination.

Without any detail, I am left to speculate that this is merely an example of the customer requiring the PACS vendor to substitute the customer’s favorite storage solution for the storage solution originally proposed by the PACS vendor. If this is the case, this is hardly a breakthrough.

If in fact, “IBM’s tiered storage solution” was their GMAS configuration featuring Bycast’s potent Information Lifecycle Management software, that would be a significant upgrade over the typical PACS configuration that features direct attached storage, but once again, hardly a breakthrough.

There is no evidence to suggest that there is a separate data Directory on this separate storage solution, and that the data is in any way being managed independently of the PACS application. Bottom line, the McKesson PACS still controls the study data, and years from now, when Memorial Hospital decides to replace this PACS with another PACS, they will have to migrate all of that study data through the McKesson PACS and through the new PACS, even if this migration is right back to the same IBM storage solution.

Choosing a separate Storage Solution was a good First Step, but the next step would have been to interface the McKesson PACS to a PACS-neutral Archive. There are a number of PACS-neutral Archive software applications that could utilize the same IBM storage solution, but in this case, the study data would be controlled by the PACS-neutral Archive and not the McKesson PACS application. The study data would not have to be migrated downstream, when the McKesson PACS is replaced.

The good news is that it is never to late to build a PACS-neutral Archive, and pro-actively migrate the study data to this archive long before the data migration task gets that much bigger and much more expensive.

I have written several White Papers on the subject of Pro-active Data Migration and PACS-neutral Archives. The papers are too lengthy to publish on this web site, but they are freely available to anyone forwarding an email request.

PACS for the Smaller Organization

Over the last several months a number of posts have shown up on auntminnie.com and pacs-admin@yahoogroups.com asking readers opinions on some of the smaller PACS solutions in the market. I assume that most of these questions are being posed by members of small imaging operations performing less than 40,000 procedures per year who assume that they can only afford the relatively inexpensive PACS solutions offered by the small vendors. In the past, this was probably the case, but that is no longer the case.

Today, several of the biggest vendors in the PACS market, creators of the really big and fully featured PACS, have achieved a scaling feature that allows them to offer effectively the same fully featured PACS at a price point within reach of even the smaller imaging operation.

These vendors have achieved this scaling by reducing the number of servers in the cluster, without eliminating robustness or reliability. They have retained the basic display features, including hanging protocols, but made many of the more advanced display features (like 3D) line item extra-cost options, so they can be added for a modest license fee if needed. They have made many of the professional services that were automatically included in the big system, line item options in the scaled down package. The site that can follow directions and set up their own modality interfaces, complete their RIS interface on their own, and perform their own network testing can save some money.

Perhaps the best feature of this new generation of scaled down PACS is that their upside potential is not artificially limited. If the study volume suddenly jumps by 100%, the small system can be expanded to accommodate growth, without a wholesale exchange of hardware or a whole new tier of software licensing. The user truly pays for only what they need, and only as they need it.

In this scenario, there is no reason for the smaller imaging organization to risk an investment in a fragile company and purchase a bargain-basement PACS with limited features and limited support. It is now possible to afford the economical version of the same PACS being used by the big boys.