Secure, scalable DICOM data archive with full disaster recovery

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2. Questions ?
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presentation. Submit your questions
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3. Application Service Provider: ASP
• Secure, scalable DICOM data archive with full
disaster recovery
• Turnkey offsite solution
• Price per procedure model
• Obsolescence protection from hardware and
software as an expendable cost
• Data are redundantly backed up at several remote
data centers
• Images are immediately available to radiologists,
specialists, and referring physicians

4. Diagnostic Imaging Services - New Orleans
• Survived Hurricane Katrina
• Due to ASP, PACS and offsite archive
were secure
• No electronic images were lost
• Five free-standing radiology facilities
• 115,000-120,000 imaging procedures
each year

5. University of Washington Medical Center - Seattle
• 450-bed hospital
• 9 neighborhood clinics
• 100 outpatient facilities
• 210,000 imaging procedures annually
• Top 10 medical centers in the U.S.
— U.S. News and World Report
• Teaching hospital for University of
Washington School of Medicine

6. Rush-Copley Medical Center – Aurora, Ill.
• 183-bed community hospital
• Implemented ASP when it went online
with PACS six years ago
• Member of Rush-System for Health
• 120,000 imaging procedures each year
• Physician base of 500

7. UW Medical Center:
Webcast Presenters
• William Shuman, MD, FACR
Professor and Vice Chairman of
Radiology, and Director of Radiology
• Gene Hoefling
Administrative Director, Radiology
• Andy Strickland
Director of Imaging Informatics

8. Rush-Copley Medical Center:
Webcast Presenters
• Dennis DeMasie
Vice President and CIO
• Tom Markuszewski
Director of Imaging
• Bob Bruecker
PACS Administrator

9. Diagnostic Imaging Services:
Webcast Presenters
• Anthony Gettys
CEO
• Kathy Rabalais
Director of Clinical Services and IT
• Andrew LeBlanc
IT Consultant
• Keith Robichaux
PACS Administrator

10. Q & A Session
Please submit your questions by
typing them in the “Ask A Question”
box in the right of your console.

11. UW Medical Center: Facility Overview
• Harborview Medical Center – trauma
and burn center
• Children’s Hospital & Regional Medical
Center
• Veteran’s Administration Puget Sound
Health System
• 13 primary care clinics around the city
• 2 specialty clinics

12. UW Medical Center: Technology Portfolio
• 64-Slice CT
• 1.5 and 3 Tesla MR
• Digital mammography
• 4D ultrasound
• Nuclear medicine
• PET/CT
• Interventional radiology
• PET/CT and CT in radiation therapy for IMRT
therapy planning

13. Reasons for Going with ASP
• Filmless for seven years
• Gradually extended PACS into the
enterprise and expanded network
• Required a better archiving solution
• Prior to ASP, used optical disc and
then migrated to content addressed
storage

14. UW Medical Center: ASP Benefits
• Cost-effective savings
• Factor of safety and disaster recovery
• Data are backed up at several offsite
locations
• UW located near:
- Volcano: Mt. Rainier
- Earthquake fault
- Tsunami zone
• Expense of having a safe backup system is a
fraction of what a minimal disaster would
cost

15. UW Medical Center: PACS Archive
• PACS archive = 30 Terabytes
• Expected to reach 50 TB in a couple years
• 25 TB online for short-term storage
• Previously used optical disc for disaster
recovery, but it was too limited for growth
• Went to spinning disc, RAID technology
• Needed a third tier storage strategy
• Looked into ASP solution

16. UW Medical Center: Disaster Recovery
• Three copies of every exam are sent at
acquisition time:
- One copy of images goes to short-term,
on-site storage
- Second copy goes to server that sends
images to ASP via VPN to Chicago where
stored in another spinning RAID device
- Third copy kept on other ASP site in
California

17. UW Medical Center: Benefits of ASP
• Ability to continue business even if the
entire hospital is destroyed in an
earthquake
• Archive is online
• Simple implementation – only need to
provide a network connection to ASP
center
• Can run 150 MB per second over the
internet through a VPN

18. UW Medical Center: Choosing ASP
• Decision driven by escalating data
sets – 64-slice CT
• Started looking at ASP two years ago
• Key as move into next-generation
imaging systems with larger data
volumes
• Outgrew local archive

19. Rush-Copley: Why ASP?
• Driver: Avoid capital expense
• ASP: Expense it as you use it
• Don’t need hospital technical staff to
manage storage – vendor provides
resources
• Frees up CIO to focus on hospital’s
business and clinical needs
• Certified disaster recovery

20. Rush-Copley: ASP Lessons Learned
• Maximize resources to focus on
strategic operations
• Do a site visit prior to implementing
ASP
• Be sure vendor is thorough
• No HIPAA or JCAHO issues
• No concern with upgrades
• Looking to add cardiology ASP next

21. Rush-Copley: ASP Lessons Learned
• Logical solution for disaster-recovery
• Three layers of backup with ASP
• Turnkey solution at 2 offsite locations
• Invisible solution to the organization
from a hardware cost and manpower
cost
• ASP vs. onsite storage – pick ASP

22. Rush-Copley: ASP Benefits
• RAID – 4TB
• Store 2-3 years of images in short-term
storage
• ASP: Long-term storage is infinite
• Never run out of space
• Pay only for storage that is used
• Issue of storage is invisible, concerns
and problems are in the background

23. Rush-Copley: User Experience
• No data migration issues
• No questions, because there are no
problems
• User feedback: Out of site, out of mind
– the system always works
• Images are always available under all
circumstances

24. Rush-Copley: User Experience
• ASP means images and problems are
out of sight, out of mind
• No hardware and software
obsolescence
• No change in platforms to worry about
• No data migration costs

25. DIS: Overview
• 110,000 imaging procedures a year
• 5 facilities located throughout the
metropolitan New Orleans area –
Metairie and Marerro, La.
• Women’s center performs 20,000-
25,000 mammography procedures per
year
• 100-150 open MRI procedures on a
monthly basis

26. DIS: Benefits of ASP
• Created numerous efficiencies from a
radiologist’s standpoint
• Improved radiologist workflow
• Better use of radiologists’ time
• Able to store images at an offsite
location for a minimal fee

27. DIS: Katrina and Beyond
• When Katrina hit, the storage of images was
not a concern because ASP safely stored
information offsite
• After the storm, opened each clinic
individually
• Able to retrieve images and operate as
normal, as if the storm had never
happened
• Within 6-7 months after reopening, DIS
was back to pre-Katrina imaging volume

28. DIS: Katrina and Beyond
• Once reopened, patients were happy to
get images they needed
• Continuity of care for patients
• Referring physicians were glad too

29. DIS: The Disaster Plan
• June 2005: Review disaster plan with personnel
• August 2005: Activated disaster plan
• Katrina was imminent, had to shut down
• Before closing, made sure all modality-specific
exams had gone to ASP
• Images were stored offsite in Chicago and California,
as well as in short-term storage in New Orleans
• Went smoothly
• Confident in double back-up
• Able to retrieve data when they returned or wherever
they set up a workstation to work from

30. DIS: After Katrina
• After setting up a workstation, they were
able to read digital mammography exams
quickly
• Patient data and reports were fully secure
and safe through ASP
• ASP allowed us ‘one less worry’

31. DIS: Factors to Consider for ASP
• Strategic advantage – allowed us to recover
quickly from a disaster
• Disaster Recovery – data are maintained no
matter what happens locally
• Got PACS back online 3 weeks after Katrina
• Gave referring physicians access via web
• Convenience – technologists don’t have to
retrieve tapes
• Instant access to images
• All data were maintained, nothing was lost

32. Webcast Presenters
• William Shuman, MD, FACR • Anthony Gettys
Professor and Vice Chairman CEO
of Radiology, and Director of • Kathy Rabalais
Radiology
• Gene Hoefling Director of Clinical Services
and IT
Administrative Director, • Andrew LeBlanc
Radiology
• Andy Strickland IT Consultant
Director of Imaging Informatics • Keith Robichaux
• Dennis DeMasie PACS Administrator
Vice President and CIO • Andy Vranesic
• Tom Markuszewski GE Healthcare
Director of Imaging • Vijay Tanjore
• Bob Bruecker GE Healthcare
PACS Administrator

33. Thank You
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