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For other articles and previous issues click here. July 19, 2004 Navigating
Mini-PACS Options Including future growth potential and compatibility in your planning often allows a mini-PACS to grow with your needs. As PACS technology marches toward full integration, an emerging trend toward implementing enterprisewide PACS for many different modalities and facility types has some observers calling into question the future of the highly popular mini-PACS configuration. That trend, however, fuels the hesitation many smaller and medium-sized facilities feel over going digital. These facilities, including many smaller hospital radiology departments, reading groups, and stand-alone imaging centers, face a crucial decision that will affect their business for years to come: Should they install a traditional mini-PACS to handle precisely what they need right now and wrestle with larger integration issues down the road? Or should they take on the cost and complexity of an enterprise PACS with a full range of features that currently amounts to overkill but may better serve long-term needs? Configuring Mini-PACS The third configuration, which seems on the verge of becoming a de facto definition of mini-PACS, enables imaging departments with a limited number of modalities (eg, one CT and one MRI) and only two or three workstations to go completely filmless but still network interactively, whether using a Web server or another Internet connection. Affordable Expansion It’s this last apparently infinitely extendable configuration that for many imaging centers seems to embody simultaneously both the carrot and the stick. This concept of a minimalist-enterprise PACS holds the potential for wide-ranging functionality and the promise of easy, swift integration of future applications and network nodes; at the same time, it often seems to mean an immediate steep capital outlay coupled with the need to quickly reorganize workflow and retrain virtually everyone. Defining Differences PCCG helps buyers understand what’s most applicable
for them by categorizing PACS solutions not only on the basis of
space storage requirements and exam volume but also according to
the type of facility, number of radiologists, and where they prefer
to read, says PCCG vice president and consultant Christie Hentschl.
With those needs determined, eventual plans for Web communications,
teleradiology, and/or RIS/HIS (health information system) integration
can be anticipated more realistically. In general, the main differences between a mini-PACS and its hospitalwide cousin are size and RIS/HIS capabilities. An enterprise PACS requires a RIS element to integrate patient data and administration tracking, and usually HIS support as well. The typical stand-alone mini-PACS configuration uses the same rule-based DICOM routing automation for receiving, archiving, and distributing exams as an enterprise PACS. Both automatically direct and track images among modalities and locations, including diagnostic viewing stations and short-, mid-, and long-term storage servers. While some define mini-PACS as a configuration that relies on manual archiving and image control in which the administrator typically assigns images to a reading station and moves images into long-term archives as needed, Posner cautions that a true “mini-PACS should not be confused with homegrown, self-imposed PACS solutions” that simply use a workstation to receive, send, and back up DICOM files manually. New Solutions Of course, you may want to departmentalize some of your information on an institutional level, adds Posner, for which a mini-PACS installation is clearly best tailored. That doesn’t lessen the need for intercommunications, whether via the Web or an internal network. “Let’s say you have five facilities,” Hentschl says. “You want to be able to isolate exams by tech, by radiologist, [or] by facility. But a radiologist reading for five hospitals, no matter what the size, should be able to see any patient record from any facility and any patient report from any modality.” Market Trends and User Needs Focus instead on full DICOM and Health Level 7 (HL7) compliance that will ease integration issues when they arise. Doing so, Hentschl advises, prevents small- and medium-sized users from “tying themselves to a less than best-of-breed PACS they really don’t care for [because] they feel they’re buying into the future RIS.” Many smaller and midsized imaging center administrators
are swayed by the recent wave of mergers among several RIS and PACS
companies, adds Posner. “If you go to just one manufacturer,
you’re missing a good overview of what the [total] market
can offer you.” Solid Foundation Whatever vendor(s) you select, look for systems that adhere to the highest-level IHE (Integrating the Healthcare Enterprise) guidelines governing DICOM and HL7 interexchange compliance. DICOM compatible is a meaningless marketing term; demand full DICOM compliance for all services you’ll require. While scalability is the major buzzword among large, all-inclusive companies, if you purchase a mini-PACS from one company expecting to expand it with equipment from another firm, it’s critical to ensure your data can be migrated to the new standard. Or, better, says Primo, “be certain right from the beginning that your mini is based on open standards so that subsequent communication between systems is seamless.” That proviso applies not only when adding PACS workstations and modalities but also when networking your original mini-PACS with RIS and HIS. “The idea of going from small to large should be based on what you can afford this year and what savings can be gained by going to PACS,” says Cornell. “For example, at Medina [Ohio] General Hospital, we sold the mini-PACS to the radiology department, but now cardiology is going to use [that] storage device instead of buying a separate one. They’re looking at an enterprisewide solution [with] SAN [Storage Area Network] technology [and] everything stored online. One server will be radiology, another server will be cardiology, another server could be electronic medical records [EMRs], one will be laboratory, and so on.” If you concentrate on backbone connectivity and hardware infrastructure, he says, “it’s almost like building a house from the foundation up and enlarging it as you can afford to. You may start out with a smaller infrastructure with smaller applications [initially] defined as mini-PACS, but you’re really looking at the endgame of total EMR for all areas … in an integrated workflow.” Buying for the Future Today’s shortage of radiologists offers great opportunity to take on additional reading, he adds. “You may have a radiologist at one site … able to access images from many other centers, or from home, so the efficiency of radiologists at one location increases dramatically. The ability to read virtually anywhere [and virtually 24 hours a day] becomes a very functional option.” — J. K. Bucsko is a freelance healthcare and technical writer and editor based in Westville, N.J. Planning Well Ahead for Mini-PACS Expansion This month, AMI plans to integrate a bone densitometer as well as scheduling and billing for the new machinery. Within the next five years, Robert R. Brown, MD, says he also plans to add ultrasound and at least one additional remote office. PACS Administrator David Itkin projects that by year-end, the system will handle some 2,500 MRIs and 4,000 CTs annually. The AMI installation uses the Siemens MagicView VE40 PACS with a Plasmon Enterprise D-Series Jukebox containing 2 terabytes of storage as 100 disks (200 sides). PACS/RIS integration and modular scalability was the key selling point for Brown. He says the MagicView was chosen as much for its RIS as PACS capabilities. “If I had thought this was going to be it, it would just be an expensive piece of software. But [the MagicView] certainly allows growth [and] it was affordable. It’s easy to add to the PACS or the RIS so you can have multiple offices [with] one central control.” Even in its present minimal configuration, the system supports remote viewing via Siemens’ MagicWeb interface. An active link at AMI’s Web site enables referring physicians to access patient studies online and allows Brown to both receive outside consultations and perform readings at home or on the road. “Adding a new office location will be almost as easy as expanding within existing space,” says Brown. Just as important to Brown as the technical details was the ease of dealing with a single vendor. “[It] simplified practice start-up. For somebody who’s starting out, it’s kind of daunting to deal with different companies for different machines,” he says. The center also uses a Siemens Somatom MDCT and Symphony Tesla MRI, and, based on previous experience with the company, Brown says, “To have everything [from] Siemens meant … having the security that the one company would be able to help me if I did encounter problems. The integration of the machinery and software systems has been much easier with this one vendor.” — JKB
Initially, the physicians were reluctant to move to PACS, partly because of the expected expense; they prefer spending money on employees rather than equipment. That’s one reason Copeman chose to work with PCCG: “[I found many] of the bigger companies can’t customize to your needs, whether you’re small or big.” Instead, Copeman says, he particularly appreciated PCCG’s responsiveness to his group’s individual requirements. “[They] matched product to volume perfectly. With the right product, even a small practice can go digital without a quarter-million-dollar cost.” The PCCG installation uses a Web-based dedicated PACS server to integrate two Hewlett-Packard Agilent 5500s, each with two workstations. With 1 terabyte of storage, Copeman finds the system’s vast capacity as valuable as its speed because it’s enabled the group to completely eliminate “a huge volume” of other media, with associated hardware and costs. He estimates that “it should be six years before we have to dump the hard disk”—even better, the system allows automatic archiving to DVD “as we move through the month … all [our] studies are already backed up. If a patient wants a copy of their [exam] now, we just shoot one and hand them a CD almost before they leave. And if we want to look at any study, we can just pull it up on the server—no retrieving tape or rewinding.” Remote reading capabilities from virtually any location
also helped convince the physicians to take the plunge into full
digital. Plans include adding electronic medical record capabilities
within the next few months and eventually implementing RIS. “People
feel like they’re not big enough to go digital, but that’s
[a mistake]. Whether you’re doing 40 studies a month or 10,000
a year, [working with the right company] can help,” says Copeman.
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