An enterprise archive offers a number of advantages, including patient care benefits, cost savings, and the ability to facilitate HIPAA compliance, according to a presentation at the recent PACS 2006: Digital Healthcare Information and Management Systems (DHIMS) conference in San Antonio.
Since implementing its enterprise archive, Inland Imaging of Spokane, WA, has seen dramatic improvements in patient care, improved security, increased efficiency of sharing medical images across the enterprise, and overall lower costs due to economies of scale, according to Jon Copeland, Inland's chief information officer.
Copeland discussed the practice's experience with its enterprise archive during a talk at the March PACS 2006 conference, sponsored by the University of Rochester School of Medicine and Dentistry.
Inland Imaging has an inter-enterprise PACS configuration, which handles archiving of studies from sites located in three states using a single PACS database. It's a highly complex PACS environment that includes multiple RIS networks, Copeland said.
More than 20 different entities, including competitors of Inland Imaging, send exams for archiving on its iSite PACS network (Philips Medical Systems, Andover, MA), with over 200 attached modalities.
Inland Imaging has a zero-downtime policy; 100% of the exams -- images only -- go to the institution's business continuation server (BCS), which has instant failover capability, Copeland said. And disaster recovery is handled by its service provider in San Jose.
The practice also maintains a "warm" site created with the BCS, which provides access to reports for the past three months and an active RIS for the diagnostic imaging centers and other RIS customers, according to Copeland. "We also use this for our scheduled downtime," he said.
To prevent disasters, Inland performs constant monitoring of interface engines, processes, devices, and networks, Copeland said. Network monitoring and tools and process monitors are also employed.
The enterprise archive allows for a single patient enterprise timeline for all entities who participate in the enterprise archive, he said.
"The caregivers really appreciate this," Copeland said. For example, "every surgeon in Spokane operates in three different hospitals in two completely different systems. For them to be able to have a single medical image archive is a big benefit to them and has really paid off for us."
The archive also facilitates seamless patient consults across enterprises, and collaboration enables better decisions, he said. Radiologists are happier and 30% more efficient, and referring physicians are also pleased, according to Copeland.
The enterprise archive yields lower costs as well. With all previous studies on a single archive, there is much less transferring of film or CD/DVD media between organizations, according to Copeland.
Non-Inland Imaging customers are charged a per-exam fee to store their exams on the archive. Cost reductions gained via economies of scale are passed on to customers, and PACS costs have dropped by 29% since 2001, he said.
Inland Imaging has also found that it needs fewer staff overall per exam, according to Copeland.
Supporters and detractors
Supporters of implementing an enterprise archive have included anyone directly involved in patient care, system users, IT staff, and larger medical centers and hospitals that are affiliated with smaller referring hospitals, Copeland said.
Detractors for implementing an enterprise archive include nonparticipants and factors such as vesting in other systems, a lack of business organizational structure to support cooperation across entities or the enterprise, and a lack of established, consistent policies for the enterprise and inter-enterprise systems and patient data management.
"We end up spending a lot of time analyzing and merging patients, because they do have multiple identifying factors," Copeland said.
The enterprise archive approach has also facilitated HIPAA compliance, allowing for a single point of patient image management, access, and control, he said.
Inland is being challenged, though, with patient management issues, including managing an enterprise master patient index (EMPI) and dealing with duplicate patients, and is working on a community policy on privacy and patient management.
"But at least we can identify (the duplicate patients)," Copeland said. "We've got everybody on one PACS."
In addition, logging and tracking is better with a single archive, according to Copeland. But, "you got to have a very robust security model underneath your PACS database or a tightly integrated RIS/PACS environment so that you can prevent access," he noted.
The enterprise archive offers improved patient care, improved security and patient ID management, and efficient sharing of images across the enterprise or inter-enterprise, Copeland concluded. For Inland, it has also brought lower costs due to economies of scale, and generally happier system users.
Drawbacks of an enterprise archive include the need to manage an EMPI, cross-identifying patients as they move from one system to another, more complex overall system management, and more difficult upgrades due to the impact on more users. Interfaces also get more complicated, and system stability becomes essential, he said.
By Erik L. Ridley
AuntMinnie.com staff writer
April 10, 2006
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