A Two-Tier Solution

June 24, 2011
Memorial Hospital found it takes two vendors to handle imaging properly — one for PACS and one for storage. Not satisfied with accepting the boiler

Memorial Hospital found it takes two vendors to handle imaging properly — one for PACS and one for storage.

Not satisfied with accepting the boiler plate storage solution offered with McKesson's PACS solution, Steve Huffman, director of IT at Memorial Hospital in South Bend, Ind. challenged the software company to partner with IBM and come up with a uniquely designed solution. The non-profit, 526-bed regional referral center went live with IBM's tiered storage solution and McKesson's PACS last November. HCI's Stacey Kramer learns about the processes and challenges involved in the implementation of both solutions from Steve Huffman.

I see that you were previously using an "in-house" PACS system, when did you know you were hitting the ceiling as far as its functionality?

PACS systems change very frequently and new functionalities come out all the time. Our existing PACS system worked fine, but we were hitting a support limit. We've had our previous system for five years, so we needed to either upgrade to the newest and greatest version, which was essentially a forklift upgrade, or replace it. In the end, we opted to replace it.

What was the rationale behind replacing the system rather than just upgrading the existing technology?

It was costly. I mean, literally it was a forklift upgrade. It was a fairly substantial software change, and so the question came up, 'If it's that big of a change, should we look at other products in the market?'

Can you tell me about the process you went through to select IBM, why did you select IBM over EMC?

We're an IBM shop, so the majority of our data center is IBM. We do have EMC and it's a great product, but what we challenged McKesson with is to partner with IBM and Memorial to come up with the configuration that we had, which in the end, they did.

I want to make sure that it doesn't come across that Memorial doesn't like EMC products, because we're an EMC customer as well, and it works very well. For our support needs, IBM just felt more solid from a disaster recovery standpoint. The solution IBM had at the time had a much stronger disaster recovery solution that we're now implementing and we felt a lot more comfortable with the IBM product for this solution.

Why did you choose to create a storage solution and not just go with the initial system offered by McKesson?

At the most rudimentary level, PACS is keeping electronic images for radiologists and referring physicians in an organized, easy to retrieve electronic warehouse. McKesson or any other PACS vendor provides a boiler plate storage solution, which is what McKesson does. We went back to challenge them, along with IBM, to come up with an IBM storage solution for McKesson PACS.

It was a challenge getting over that first hurdle of getting those organizations to work together to a great solution.

Did you ever consider going with another PACS vendor?

In the very beginning of the reevaluation process, we looked at a number of different vendors, but we went through what I would refer to as Memorial's normal process of vendor selection. It just wasn't a, 'McKesson offers it, so we're going to buy it from McKesson'.

Do you have a long-term strategy for having images from your PACS flow into an electronic medical record system?

The eventual strategy is to have a medical record and have all necessary medical information housed in that electronic medical record. There's a million integration points that any hospital would say 'boy I wish that would integrate better.'.We, as every hospital does, just continue to plug through those integration points. The long term strategy is to have those images tied into electronic medical records.

As far as your PACS system, will it be used across for radiology, cardiology, pathology and other medical specialties?

The PACS system is utilized for any image that's taken at Memorial. So it's leveraged across all the specialties and even medical offices on campus and off have access to get in through our system to get those images at their office.

Why is it important to keep physicians happy, in terms of giving them access to images in varying formats?

A physician doesn't like to wait, and if I'm the patient I don't want my physician to wait either. So it's getting reliable, accurate information to the physician in any way that he can get it, whether it's in his office whether it's in his P.J.'s at three in the morning so that he doesn't have to drive in. Also, the ER doctor can look at it online if he needs to for some sort of reference point.

Do you have any advice to others facilities looking to implement a PACS and storage solution?

The only thing that I might say is the conversion of all the old images off the old system and new system is taking a long time, but we communicated that way up front. We took timing and estimates that said, you know, it may take eight months to a year depending on how many types of access field systems for old images haven't been converted, but we'll get them over there. But every now and again a physician questions the speed of the access; 'Why do I have to go to the old system?' Well, it's because it's not converted yet. It's very, very old images. That's not really a thorn; it's more of just an annoyance that we knew was going to be there.

Would you say that the implementation is entirely completed?

No, I don't think that it's ever really complete, because you've always got new radiology equipment coming in that you have to bolt on to it. You always have somebody who wants access to it. The core is complete, everybody is very happy with it, and it's just a continual roll out, probably forever.


Tiered Solutions Rising

Marc Deary

"In this day and age, the integration piece is definitely going to be a no brainer. The concern would be inside the storage, making sure that both vendors are committed to expandability. A lot of times they may not have planned properly for the growth. There's a lot of new technology out there, with multi-sized CT, and everybody's pushing images to PACS now. The bigger concerns are more on workflow planning pro-expandability sizing.”—Marc Deary, senior project manager at First Consulting Group

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