Collaborative Picture Archiving & Communication System (PACS) Project SISU Medical Systems July 17, 2006

“I have traveled the length and breadth of this country and talked with the best people, and I can assure you that data processing is a fad that won't last out the year.” The editor in charge of business books for Prentice Hall, 1957

Acronyms & Definitions PACS – Picture Archiving Communication System. Defined as a system that enables the capturing, storage and retrieval of digital images. SAN – Storage Area Network. Defined as a high-speed sub-network of shared storage devices. HCIS – Health Care Information System. RIS – Radiology Information System

Overview of SISU Non-profit information technology consortium for hospitals & clinics. Currently 14 members throughout Minnesota. Shared technology and I.T. staff. SISU is NOT a vendor!

Typical Rural Radiology Environment The patient’s perspective: May have to wait for a radiologist consult while image is couriered to the radiologist. In general, is at the mercy of delays related to the physical media being shuttled between multiple locations. Patient may be transferred as an end result.

Typical Rural Radiology Environment From the radiologist’s perspective: Delay in reading films in emergency situations. Difficulty in meeting customer expectations.

Typical Rural Radiology Environment From the hospital / clinic perspective: Stuck in the middle between the patient and the radiologist. Images not always where they are needed, when they are needed resulting in inefficiencies. Costs associated with film, storage, courier services, etc.

Every healthcare organization could build its own PACS solution, but… they would miss the opportunity to share the risks and costs associated with maintaining common elements of a PACS environment. they would need to build their own methodology for connecting the radiologist to their site. the radiologist would likely have multiple means of accessing multiple locations and need to learn multiple PACS environments. the radiologists would likely miss the opportunity to share resources such as on-call duty with other radiologists.

“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” Sir Winston Churchill

Network Configuration Medical Facility Network Configuration Modalities Diagnostic Workstations Clinical Workstations Image Cache / DICOM Broker / Web Access HCIS / RIS Radiologist Office T-1 or better N S A Centralized Archive System VPN Radiologist Home Internet VPN VPN

Shared PACS Network - Current Status Seven hospitals have already purchased jointly from our selected vendor: Grand Rapids, Crosby, Aitkin, Ely, Bigfork, Deer River, Detroit Lakes. Five hospitals are in the process of installing computed radiography in preparation for PACS. This project was assisted by a joint state grant. These hospitals include Grand Marais, Cook, Cloquet, Moose Lake, and Mora. Integrating our healthcare information system with the PACS for five of our facilities. This interface will: Pass ADT information to the PACS. Pass radiology order information to and from the PACS. Allow the users to call up an image from within our enterprise medical record system. Pass transcription to the PACS.

Shared PACS Network – The Future Four additional hospitals are evaluating and preparing to purchase PACS technology - Cook, Cloquet, Mora, Hastings, Hutchinson and Moose Lake. Likely begin the integration between our healthcare information system and the PACS for the remainder of the hospitals. Continue enabling access to HCIS / PACS environment by remote radiologists & physicians.

Advantages of Working Collaboratively Negotiated pricing with our PACS vendor. Shared hardware costs. Reduced maintenance costs. Reduced interface costs through standardization. Data resides in at least two locations at all times allowing member sites to go film-less. Reduced pricing on computed radiography (CR). Ability to contract jointly for radiology services.

Examples of Shared Expenses Centralized Long-term Archive: Hardware Licensing Maintenance Potential savings in “like” modality interfaces. Savings in “like” HCIS vendor interfaces. Shared information technology staffing for archive and network maintenance. Shared internet / VPN access expenses. Reduced on-going training expenses through shared vendor training sessions and sharing of expertise with other members.

Current PACS Configuration Medical Facility Current PACS Configuration Modalities Diagnostic Workstations Clinical Workstations HCIS / RIS Image Cache Server DICOM Broker Web Access Server N S A Centralized Archive System Less Resilient Lower Cost Highly Resilient Higher Cost

Even Lower Cost Configuration Medical Facility Even Lower Cost Configuration Modalities Diagnostic Workstations Clinical Workstations HCIS / RIS Image Cache Server DICOM Broker Web Access Server N S A Centralized Archive System Less Resilient Lower Cost Highly Resilient Higher Cost

Sisu Medical Systems / Solutions Thank You! Sisu Medical Systems / Solutions 5 W 1st St, Suite 200 Duluth, MN 55802 (218) 529-7900 (218) 529-7920 / Fax www.SisuNet.org