Images Anywhere, Anytime: Web-based PACS & RIS/PACS

nline Radiology, based in Riverside, Calif., has experienced record volumes each month for the past few years and grew 30 percent in 2007. The organization is on track to grow 40 percent this year. The practice provides service to customers across the country at more than 100 facilities, and for several hundred modalities and PACS solutions. Hundreds of emergency cases come in every night, requiring immediate, appropriate prioritization. The right study has to be matched to the right radiologist—someone credentialed in the originating state as well as that specialty and modality—and then redistributed to the facilities efficiently and accurately. O A proven track record To manage the operation as well as the rapid growth, Online Radiology implemented a new PACS, Centricity PACS-IW from GE Healthcare, earlier this year. A long-time user of TeleRIS from ThinAir Data Corp., the PACS purchase was contingent on integration between the two products. The companies had successfully integrated the two systems for other organizations, says Jesse Salen, director of technology, so “we knew that there’s already a proven track record.” TeleRIS lets Online Radiology perform all the study prioritization and distribution automatically. The integration with PACS allows radiologists to provide preliminary and final reads over the Web for their many customers, wherever they are, all using the same PACS graphical user interface for all of the accounts, on a single centralized worklist, regardless of the HIS/RIS/PACS used at the client facilities. Online Radiology is on its third-generation PACS, so they knew what they wanted and needed. “The GE PACS allows us to integrate and we can grow with it,” says Daniel Brasell, vice president of operations. “It was necessary to bring on a PACS that can handle what we were doing and what we will be doing in the future.” Once customers send images securely over a VPN to PACS, Online Radiology monitors the receiving of studies. The image viewing software accepts DICOM images from all modalities, either directly from the modality or from a facilities’ PACS. Customers have access to ThinAir’s TeleRIS and their own account, where they can view workflow, status of cases and more, says Brasell. The organization created a user-friendly, Web-based case management graphical user interface (GUI) that is used on both ends. Customers can log in through secure, encrypted authentication and view cases in real-time at any point. The system shows when an Online Radiology radiologist is interpreting a case and lets users view reports as they are created. ments is a robust, redundant, powerful backend system. Salen says since he joined Online Radiology about a year ago, he has been systematically standardizing operations on Dell equipment and infrastructure. The GE PACS is running on a series of Dell servers—two clusters of 2950s and individual 2950s and 1950s for backup/test servers, all with various configurations of RAM and processors. “All of our servers are running with dual power supplies,” he says, to provide an additional measure of high availability. Standardizing on Dell allows Salen to easily and conveniently add to the setup whenever necessary, enable access to more affordable prices and just one number to call if anything goes wrong. Technological advances mean the hardware is more powerful with more memory and better processing power. “There are noticeable differences as far as speed,” says Salen. “We need that to run the software.” In fact, the practice purposely overspec’d the hardware which means the software runs exceptionally fast. The main servers offer quadruple redundancy with full loadbalancing to keep the data moving. Online Radiology also offers fully redundant optical WAN connections on multiple vendor’s circuits, and redundant switches. The practice moved its servers and network to a more robust data center to provide the most reliable and un-interrupted service possible. That move increased available bandwidth and includes use of two disaster recovery sites, if necessary. “We are very optimistic about the new data center move as it will help us ensure that we provide near 100 percent uptime to our customers. As we provide medical service to many level 1 trauma centers, we understand how key this uptime is,” says Salen. Before standardizing on Dell, Online Radiology typically stored only a few weeks’ worth of images. The newer setup now allows the practice to store images for six months or more. That helps with running quality assurance checks as well as improving efficiency in cases that require comparisons to prior studies. “There are definitely efficiencies there,” says Salen. The last word Aside from the double-digit growth in volume that Online Radiology has already experienced, the practice is now reading studies that contain more images than ever before. “As far as actual images processed, we’re probably experiencing about 60 percent growth,” Salen says. The GE-ThinAir integration is scaleable with Online Radiology’s growth, an important consideration. The investment was well worth it, Salen says: “but we’d be going out of business without it. We wouldn’t be able to read all our images.” Another consideration, according to Salen, is choosing a PACS vendor that will accommodate your workflow. “Don’t let a vendor tell you what your workflow should be,” he says. Online Radiology’s past PACS vendors were not willing to integrate with the ThinAir TeleRIS, but “GE has been really flexible as far as making their system work with our workflow.” ■ Robust and redundant The other component of successfully running these software ele- HealthImaging.com Images, Anywhere, Anytime: Web-Based PACS & RIS/PACS | Health Imaging & IT 11 http://HealthImaging.com

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