ASP: The Answer for Images - Offsite, Secure, Now

With continued procedural growth and study volume, the aging of digital imaging exams and ever-increasing demand for complex 3D image sets in MR and CT, the proliferation of digital images has created a challenge shared by today’s radiology and IT directors, as well as CIOs addressing image management from an enterprise level. A recent Frost and Sullivan PACS report pegged the national volume of archived radiology images at 13 Petabytes (PB) or 13,046 Terabytes (TB) with growth in the double digits.

From not being able to predict hardware and software storage costs, to the increased strain of securing physical space, some data centers are in great need of upgrading and simplification. Healthcare facilities continually need to find ways to increase archive capacity with slim capital budgets, usually resulting in a drain of human and economic capital that could otherwise be invested in higher return activities. And as more departments such as cardiology and pathology add to the imaging profile, facilities can expect that the need for a better archive solution will not go away any time soon.

Managing images offsite

Secured Storage Providers offer a new way to manage archived images and exams in a remote data center. As storage prices have decreased over time, imaging facilities and hospitals can place more of their pertinent case volumes—for example, a patient who will have multiple visits per year—on-line for quick reading access.  Long gone are the days of needing to keep a small amount of short-term storage and having to pre-fetch historical exams with studies dates only a few months old. 

Remote DICOM hosting services allow IT departments to take advantage of long-term storage technologies today. Using either dedicated network circuits or existing VPN internet technology, hospitals and imaging centers can establish secure links to transmit patient images on a pay-per-exam model, thereby converting a once costly capital investment into a monthly payment from their operating budgets. This means that sites no longer have to plan for archive obsolescence, migrate old data, battle for real estate, or engage in any other type of management activity involved in the maintenance of the PACS archive solution. And because internet technologies and bandwidths have improved, there is no minimum procedure volume threshold that a site needs to meet for this to be a financially viable decision.

Dollars and sense

Healthcare facilities ultimately have to choose between the creation of their own PACS DICOM archive or remotely hosting their data, and it is important for them to have a clear understanding of how the timing of cash flows impact their decision. Because a storage service provider can offer a predictable monthly payment based upon an exam volume commitment, institutions can free up cash that would normally be tied up in a capital purchase. When discounting the future cash flow of a smooth, operational payment versus a saw-tooth capital expenditure back to today’s dollar, the majority of institutions come out financially ahead by choosing the outsourced DICOM service. 

Not only do IT departments receive the latest storage technologies today with a storage service provider, but they also receive inherent security and disaster recovery benefits by choosing to remotely host their archive data. HIPAA compliance policies are easily met, with most vendors providing at least two copies of patient images as part of the solution. And because data centers are typically built with the intention of serving many industries, physical and network security levels derived from financial institutions are usually present.  This is where comparison to an onsite archive truly becomes an academic exercise of comparing apples to oranges. Most sites will not be able to reproduce the size, scale, or inherent advantages that a remote facility can, from redundant networking components, highly available applications, instantaneous capacity expansion, and back ups for the back-up power generators, to name a few.

The ins and outs of ASP

Centricity Application Service Provider (ASP) offers an outsourced and truly scalable DICOM archive solution for radiology and cardiology exams. Hosting Centricity Enterprise Archive and Centricity Web software applications, users can take advantage of the same feature functionality with an improved economic cost structure. Supported by dedicated IT and software engineering teams, changes in hardware technology and software applications are implemented at the data centers, providing obsolescence protection. And with a pay-per-exam model, institutions can match costs to revenues for better-managed cash flow.

With two data centers (and the option to expand to seven others) separated by 1,700 miles, the offering includes inherent disaster recovery planning to sites that are in need of geographical protection of their patient data. With the ability to serve as a DICOM archive, there is another option to plan for growth with peace of mind. On-line storage facilitates quick access to images, supported by dedicated network circuits. And with the introduction of VPN internet connection technologies, there are no minimum procedure volumes required to make ASP a financially viable option. 

All system and network components at the data centers are designed to run in an N+1 (or high availability) design, such that a hardware failure does not result in outages or reduced performance. Each layer is modular and can easily scale horizontally and run in active/passive (such as database servers and network equipment) or in load-balanced (for application and web servers) mode. And because each is a Tier IV data center, customers can be assured of more than adequate building, network, and power security to keep their operations running.

Self Healing Systems verifies proper working of each application and web server. If a server falls outside an operating parameter, the server is disabled on the load balancer and notification is sent to the operations team for break-fix analysis.

This month Health Imaging & IT takes a closer look at three facilities that utilize Centricity ASP in tandem with their Centricity PACS.

The University of Washington Medical Center in Seattle, a 450-bed teaching hospital, is part of a group that also includes approximately nine neighborhood clinics, and more than 100 outpatient facilities. UW Medical Center—which performs about 215,000 imaging procedures annually—ranks among the Top Ten medical centers in the United States as rated by U.S. News & World Report.

Diagnostic Imaging Services located in the greater New Orleans area is comprised of a group of five free-standing radiology facilities that together perform between 115,000 and 120,000 imaging procedures each year. Thanks to ASP, in the aftermath of Hurricane Katrina in August 2005, the facility’s PACS and archived images were secure. Not one electronic image was lost.

Rush-Copley Medical Center is a 183-bed community hospital in Aurora, Ill., that implemented ASP when it went online with PACS six years ago. The facility, which is a member of the Rush-System for Health, completes about 120,000 imaging procedures each year with a physician base of about 500.