Radiological imagery is a critical and often lifesaving component of the healthcare system with doctors using MRI, CT scans, nuclear medicine, X-rays, mammograms and bone density exams to diagnose frequently disguised diseases and injuries. What if all stakeholders in the healthcare system could be connected through a single digital communications infrastructure to share information, collaboratively treat patients, and, at the same time, save costs? Doctors and technology specialists at the Center for Diagnostic Imaging (CDI) shared that vision; one they started to put into practice in 2002, when the clinic set forth on a high-growth path that came to fruition in the past year.

CDI, based in Minneapolis, with 750 employees nationwide, is a pioneer in outpatient diagnostic imaging, interventional radiology procedures and therapeutic pain management. Kenneth Heithoff, M.D., a leading spinal radiologist, founded CDI in 1981 at a time when private outpatient imaging providers were in much demand by patients but difficult to find. As CDI expanded across the country, Heithoff steadily guided its growth, determined to provide each patient with exceptional individual care and superior national resources.

When the company first embarked on this expansion plan, it had 15 clinics and its affiliated physicians read 189,000 exams, representing 24 million digital images. Today, CDI has 45 centers spread coast-to-coast from Florida to Washington with physicians reading 287,000 exams, representing 38 million digital images.

As the imaging center broadened its geographic reach, Heithoff, his executive management, and CDI’s IT staff realized there was an opportunity for the medical center to become more efficient and cost-effective by streamlining its radiology images. “As we grow, we need to ensure our systems and network can place the highest value on exam consultation between specialists,” says CDI Chief Information Officer Steve Fischer.

Infrastructure Upgrade and Expansion

To continue to fuel its growth, CDI had to optimize its ability to acquire, manage and store images across a national imaging archive environment. To accomplish this, the team embarked on the daunting challenge of upgrading CDI’s systems infrastructure to a single radiology information system (RIS) coupled with an open architecture picture archive and communication system (PACS) that would allow best-of-class reading workstations to be deployed.

The initial step was to select a RIS that would support this vision. RISLogic was selected and implemented. “We could not afford downtime, misdirected traffic, or an unreasonable number of servers on our network,” says CDI Infrastructure Architect James Keller. “We want our referring physicians to have the ability to stream images and view reports online, instantly, anytime, anywhere.”

Within a year, CDI had expanded to 24 centers nationally and decided to select and implement a PACS solution that would provide a vendor-neutral, open environment that would not restrict the use of best-of-class reading and computer-aided diagnosis solutions. An additional requirement was to provide an archiving infrastructure that would support the transparent migration of archived images to new storage technology as it became available.

To establish an effective PACS infrastructure and image workflow capability for its widely dispersed enterprise, CDI turned to Cisco Systems and its partner, Acuo Technologies. CDI first talked to Cisco in part because of the networking company’s leadership and investment in Connected Imaging systems. Cisco Connected Imaging solutions facilitate information sharing so physicians can interpret, diagnose and collaborate across geographic boundaries to treat patients.

Results

In creating this national imaging infrastructure, CDI’s goals were multifold: to use Connected Imaging to provide secure and efficient image archiving and access, improve productivity, support collaboration and reduce costs throughout the imaging workflow. CDI also wanted to send images securely and quickly across the network to caregivers inside and outside their facilities, while also cutting the costs associated with film transport and storage.

By implementing the system, CDI is able to facilitate timely and accurate interpretation of images as doctors, clinicians and specialists — even in different locations around the country or the world — share images and diagnoses without worrying about system capacity. The system design enabled CDI to lower the costs and complexities of its infrastructure environment while supporting mission-critical imaging services, overall providing a highly reliable, available and secure platform. Since the architecture is modular and adaptable, the medical center can align its national expansion plans with its infrastructure deployments.

Perhaps the most important benefit to CDI came from having a communications system that could change and grow at a moment’s notice, enabling new capabilities for more effective diagnostic communications, clinician mobility, streamlining business processes, fueling growth and improving profitability. “The Cisco and Acuo solutions have allowed us to deliver more and better services to our physicians with the minimum number of servers,” says Keller. “As a result, we have created a fully functional heterogeneous medical archive, while at the same time servicing more patients and reducing CDI’s cost per exam.”

CDI’s Network Engineering Manager Jerry Allard sees a strong correlation between the network solution and those benefits. “As we add new partnerships and imaging centers, we can either add to the existing regional facility or create a new regional facility,” says Allard. “We can do this just by scaling our capacity and performance in conjunction with the number of supported imaging centers.”

Unprecedented National Growth

When the center first embarked on this expansion plan, it had 15 clinics and its affiliated physicians read 189,000 exams, representing 24 million digital images. Today, CDI has 45 clinics spread coast-to-coast from Florida to Washington with physicians reading 287,000 exams, representing 38 million digital images. This growth has required CDI to establish a distributed PACS network, with Cisco and Acuo at its foundation.

“The addition of clinics leverages the IT infrastructure, effectively spreading costs over more exams, thereby reducing the cost per exam,” explains Fischer. “Consistent and timely delivery of quality results in a cost-effective manner is how recurring business is garnered.”

According to Fischer, CDI’s ability to increase access to care and services by providing concise, specialized clinical information to referring physicians is critical to continued growth. That information includes obtaining the expert advice of sub-specialists located anywhere on their PACS network through the use of advanced technology. “For example, an extremity radiologist reads only extremity exams and is an expert in their interpretation. Additionally, through our peer review program, geographically dispersed sub-specialized radiologists can review cases and compare notes, thereby continually improving reads and refining the scanning protocols to obtain the best results,” says Fischer.

Center for Diagnostic Imaging has been able to continue its growth path while sustaining operational effectiveness across its existing communication networks. The vision exemplified by the group’s leadership has resulted in an award-winning implementation of enterprise PACS for delivering the most cost-effective imaging services while improving the quality of healthcare by having specialists review complex cases without geography as a barrier.