Picture Archiving and Communications Systems (PACS)PACS Technology Helps Doctors Get the Picture — Making it Easier for Hospitals to Archive and Retrieve Patient Information

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2CDW Helps Healthcare Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Healthcare Providers Deal with Changing Technology . . . . . . . . . . . . . . . . . . . . . . . . . 3Planning a PACS Solution for Your Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Best Practices: Things to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Diagram: Anatomy of a PACS Infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Balancing Your Storage Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6A Unified PACS Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Servers: ProLiant BL20p and BL40p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Workstations: HP Workstation xw8200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Monitors: Planar Dome C3i-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Multi-Function Printer: HP LaserJet 4345xs mfp . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Storage Area Network: HP StorageWorks Modular Smart Array 1500 cs. . . . . . . . . . . . . . . . 7Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

published in association with ZIFF DAVIS

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CDW Helps Healthcare Providers

In recent years, technology has become an increasingly integral part of the operations within healthcare organizations. Advances in technology are providing better forms of treatment, as well as more efficient ways to manage and access patient data. The end results for the healthcare providers have been faster turnaround of patients, reduced operational costs and increased profits. For patients, this has led to improved quality of care, fewer errors in diagnosis and treatment and better protection of their privacy.

To attain these benefits, healthcare organizations must have the proper technology in place. This means properly installing sufficient hardware and software to support these processes and ensuring that all of the components work together.

“ We are experiencing a

massive infusion of IT

in healthcare and the

effect will be profound.”

Gary Reed, President

Integration Resources, Inc.

From “The Future of PACS 2004

and Beyond,” Radiology Today

(November 2001)

Executive Summary

Rapid advancements are quickly changing the face of healthcare, with new technologies allowing organizations to manage and access patient data more efficiently. Before your healthcare organization can take advantage of these new technologies, you’ll first have to plan and properly implement a tightly integrated technology infrastructure.

CDW’s specialists understand the needs of today’s healthcare providers and the problems IT departments face as they plan, purchase and implement new systems. To help ease the process, CDW has partnered with brand-name vendors that offer the latest solutions for the medical field. Whether your goal is to rollout a medical imaging system, provide mobile access to patient data, adhere to HIPAA requirements or install an integrated system that does all of the above, CDW’s specialists can help you plan and choose the solutions that will best meet your organization’s needs while staying within your budget.

41%

83%

1999 2002

Sites with PACS Budget

$743,000

$2,100,000

1999 2002

Average PACS Budget

8%

16%

28%

1998 2000 2002

Filmless Diagnosis

According to the 2001 PACS Market Summary Report published by the IMV Medical Information Division, the percent of high-volume medical imaging sites that included PACS in their budget more than doubled from 1999 to 2002.

The same 2001 PACS Market Summary Report showed that the average budget for PACS at each site tripled from 1999 to 2002.

According to IMV’s 2002/03 PACS Census Market Summary Report, the number of high-volume imaging sites that performed filmless primary diagnosis more than tripled from 1998 to 2003.

Data is based on the IMV Medical Information Division’s “2001 PACS Market Summary Report” and “2002/03 PACS Census Market Summary Report.” IMV Medical Information Division’s ongoing census of high-volume medical imaging sites is based on responses from sites with 200 or more beds, and a sampling of sites with 100 to 199 beds.

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The PACS Advantage

• Instant access to patient information, allowing hospitals to offer more efficient service to patients

• Real time access to images, such as X-rays, leads to better healthcare and fewer medical errors

• Fast distribution of patient files to multiple physicians, allowing doctors to collaborate in real time, even from thousands of miles away

• Share information across systems, allowing all patient data to be linked and readily accessed

• Audit trails help ensure patient information remains private by tracking who accesses which files and when

• Film-less environment means no need to buy, develop and store film

• Archive data without the space, cost, staff and maintenance concerns associated with large archives of paper files and film

• Images don’t deteriorate with age

• Easily backup data for disaster recovery

• Meet regulations set by the Health Insurance Portability and Accountability Act

Healthcare Providers Deal with Changing Technology

Hospitals have long faced the difficult challenge of managing patient information. They’ve had to maintain large archives of medical files, insurance records, X-ray film and other documents. Not only does this require a substantial amount of archival space, but it causes logistical problems.

Gathering all the information related to a single patient takes a lot of effort. Consider, for example, when a single patient visits his doctor. Standard charts and medical records may be kept in one location, while X-rays are stored in another. When a patient comes in for an appointment, staff members must gather the relevant files and deliver them to the doctor. If, for instance, the patient had recently visited another facility (an emergency room, perhaps), any relevant data that was collected at that visit (such as X-ray images) will have to be messengered over to the patient’s regular doctor ahead of time.

The result is that doctors don’t have fast access to patient information, and collaborating with other doctors and specialists is difficult because physical files may have to be shipped hundreds or even thousands of miles away.

Advances in technology are quickly changing this. Over the past decade, health organizations have witnessed new solutions that can drastically improve the way they handle information and treat patients — and ultimately improve the quality of patient care. Administrative services have been streamlined, allowing doctors to treat patients in better, more efficient ways. Thus, patient records are more complete and readily available to doctors, which allows for a faster turnover of patients. This, in turn, makes patients happier, as well as healthcare organizations; the faster the turnover, the greater the profit. However, the most important factor in these technology advances and the move to electronically stored data, is the controlled data access keeping patient files more secure.

One of the most innovative changes has been in how hospitals handle image data. With a Picture Archiving and Communications System (PACS), images such as X-rays and ultra-sounds can be produced, stored and viewed digitally. Information is readily accessible throughout an entire organization over the network, eliminating the obstacles that typically slow down patient treatment.

Meanwhile, many of the costs and inconveniences involved with film are becoming a thing of the past. In a traditional, film-based environment, a radiologist relies heavily on support staff — darkroom personnel, film library clerks, clinicians, messengers — who develop, archive and distribute the film X-rays. But in a PACS environment, these images are stored electronically, along with other patient information, and can be retrieved instantly by doctors, whether they’re down the hall or in another state.

There are a number of inherent advantages when dealing with digital images. For starters, there is no worry about errors during film processing and, unlike film, digital X-rays won’t be damaged. And radiologists can easily zoom into a specific part of an image, add annotations and e-mail files to an associate. Files can even be accessed by physicians in multiple locations at the same time, allowing them to collaborate in real time.

While a PACS system may seem like an expensive investment, all the efficiencies add up to big savings. The Journal of Digital Imaging reported that in 1999 healthcare facilities with PACS systems in place had average revenues of about three times as much as organizations that weren’t using PACS. Since then, the cost benefits have only improved, as equipment has gotten better and cheaper. Hard drive space is far less of an issue, standard PCs can easily tie into PACS networks and bandwidth has gotten more plentiful.

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Integration may sound obvious, but making it happen can be difficult. Healthcare providers typically rely on a large variety of IT systems, software and medical equipment. You’ll need to integrate all this technology — everything from server-based databases that store patient health records to specialized equipment like Radiology Information Systems (RIS) that are used for capturing X-rays.

There are many standards and protocols at play, and a well-integrated infrastructure will require compatibility across the board. Not all equipment is compatible, so up-front planning is essential. According to SCAR (Society for Computer Applications in Radiology), poorly integrated IT systems often lead to decreased productivity in organizations when a PACS solution is first implemented. And, keep in mind that much of the imaging equipment in your PACS network must be compliant with DICOM (Digital Imaging and Communications in Medicine) standards.

Plan for future technology changes. Systems get faster, new equipment is released and the amount of data an organization must store and access on a daily basis increases. Such a core solution should be flexible so it can grow and adapt to your organization’s needs. Starting with a solid foundation — meaning a well-integrated system that hasn’t merely been cobbled together — will provide the most seamless upgrade paths. Planning well now can save an organization a lot of time and money in the future.

“ The PACS installation

will require coordination

among multiple vendors

and specialists within the

institution.”

From “10 Tips for PACS Planners,”

Imaging Economics (October 2003)

Best Practices: Things to Consider

Every business wants to serve its customers to the best of its abilities, and maintaining a healthy technology infrastructure is a key factor in achieving this goal. However, when it comes to healthcare providers, problems with technology, such as interruptions in connectivity, can literally mean the difference between a patient’s life and death. With the stakes so high, it is essential that healthcare organizations have truly reliable systems in place.

When designing a technology solution for a healthcare organization, you have to make sure that every piece of hardware can sufficiently handle the demands being placed on it. There are some key points you should consider.

Understand your organization’s needs. Map out the organization’s current workflow so you know what kind of expectations and demands your organization will have and can better see how a PACS system will effect its daily operations. A PACS solution can place a heavy burden on system resources.

Radiologists alone rely heavily on image data for diagnosing and treating patients. And now other specialists, such as cardiologists, are moving into the digital domain. Your PACS system may need to support X-Rays that are stored as digital images, ultrasounds that are stored as digital video files and MRI scans that can be used to render 3-D models of organs.

Evaluate the amount of image data your organization produces, because these types of image files are large and can overload a network that isn’t prepared for the resulting traffic. A PACS solution will only pay off if it provides fast, reliable access to patient information.

Planning a PACS Solution for Your Organization

The benefits of a PACS solution are fairly obvious. But with these improvements come certain obstacles and concerns. The infrastructure will require suitable workstations, a fast network and ample storage. All the systems throughout the network will need interoperable standards. Security will be critical, ensuring patient data is kept secure from intruders and system failures. And, of course, implementing and maintaining a PACS solution will place an increased demand on the IT department.

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When planning your PACS infrastructure, be sure to communicate with the vendors and make sure they understand your current and future needs. This will allow them to help you find the products that will fit best, meet your organization’s needs and provide the scalability that will be essential in years to come. It will also help if you can facilitate communication among vendors, since the PACS network will consist of equipment from a variety of vendors. Cooperation among vendors will make the system rollout and maintenance much smoother.

Adoption is an important key to the success of any PACS implementation. It is important to train the staff and make sure they understand how the new system will benefit them, improving the workflow and quality of work they do. But the patients must also understand the benefits of a PACS solution. It’s important to educate the patients, showing all the ways in which a PACS system will improve their treatment, from reducing potential medical errors to allowing patients to take X-ray images home on CD.

DOCTOR ACCESS

Workstations located throughout a healthcare facility allow doctors to quickly access X-Rays, medical records and other essential patient data, while specialized monitors provide high-resolution views of medical images. In a wireless network, physicians can even pull up files on a Tablet PC.

OUTPUT

Hard copies and portability are still essential. Networked printers are still an integral component in health facilities, allowing administrators, for example, to print out prescriptions for patients. Some facilities will also provide patients with copies of their medical images on CD-R.

REMOTE ACCESS Secure Web-based access to images enables patients to access their information from home. It also provides an easy way for consulting doctors located off site to access images and collaborate in real time.

STAFF ACCESS

Because all data (from medical records to insurance information) is stored centrally, administrators can quickly retrieve patient data from any computer located throughout the organization.

CAPTURE

In a PACS environment, medical images (such as X-rays, Ultrasounds and MRIs) are still captured using dedicated medical machinery like those that doctors have used for years. But the images are captured digitally, stored on the network and immediately available.

STORE

With more data being stored, and larger files as medical images and videos, such becoming increasingly common, it’s important to plan a well-rounded storage solution that includes SAN, NAS and backup hardware.

NETWORK

A PACS system integrates with the core network infrastructure, creating a unified system of data that can be accessed throughout the organization. Meanwhile, access rights and audit trails protect the privacy of patients.

DICOM

The DICOM standard is used to ensure that every piece of medical equipment, software and commercial hardware in an organization’s infrastructure is fully compatible.

Anatomy of a PACS Infrastructure

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“ Storage needs in the

healthcare enterprise will

increase rapidly in the next

few years...Image files will

make up as much as 95%

of the increase in storage

requirements.”

From “Integrated Implementation

Revamps Information Storage,”

by Edward M. Smith, Sc.D.,

PACSweb (January 20, 2005)

Balancing Your Storage Needs

Planning a storage solution is a tricky matter. PACS systems require a large amount of storage space. Whereas healthcare organizations now often handle terabytes worth of information, the size of digital images and video are quickly forcing facilities to think in terms of petabytes (thousands of terabytes).

A well-rounded solution requires a variety of storage types, each addressing different storage needs. The problem is that there is a sliding scale when it comes to storage options; some are fast and expensive while others are inexpensive but slower. So it’s important to weigh your organization’s needs, finding the balance between fast storage that will provide the necessary throughput and inexpensive storage that can handle the large amounts of data the organization must archive.

When planning a complete solution, you need to analyze the data your organization deals with. Consider things such as:

• How much data consisting of large files must be immediately accessible

• How much space will be required for large databases and general storage purposes

• How much storage you’ll need for hosting server-based applications

• How much archival data will the organization accumulate over time

Storage Area Network (SAN): A SAN solution is a high-speed network of storage devices. SAN storage is some of the fastest network storage available, due to the use of vast amounts of memory and Fibre Channel technology that transfers data at the speed of light. This is an excellent choice for data that needs to be accessed instantly. Unfortunately, this is also one of the most expensive storage solutions per gigabyte. Nevertheless, a PACS solution will require an ample amount of SAN storage to handle the large mission-critical files that doctors will want to access quickly.

Network Attached Storage (NAS): A NAS is a self-contained server and storage device that connects to a network and stores files. It is easy to maintain and can be easily upgraded by simply adding more hard drives. It isn’t the fastest solution, but is an efficient way to store a lot of files that can be accessed over the network.

Archival Storage: Hospitals and other healthcare providers have always dealt with large amounts of patient information. However, new digital solutions are generating exponentially more data that must be dealt with. Meanwhile, new HIPAA regulations are requiring such organizations to maintain even more patient information for longer periods of time. Archival storage, such as optical and tape drives, is not only the most cost-effective way to backup vast amounts of data, but it allows for seldom accessed data to be accessed easily and securely.

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Product Spotlight

A Unified PACS Solution

Implementing a PACS solution can be a daunting task, but with the right planning it will pay off quickly. When designing your PACS network, it is important to understand your hardware needs and ensure that all the components, from RIS equipment to storage, will integrate.

With account managers and technical specialists who know the healthcare market and its needs, CDW can aid in the design and implementation of a technology solution that best serves all your organization’s needs.

HP LaserJet 4345xs mfpPrinter, copier, fax, scanner, digital sender with stapler/stacker

Print is not dead, and paper will always have a place — even in a paperless environment. In fact, the law requires that the prescriptions for certain drugs be printed out and signed by the prescribing physician.

Healthcare providers will continue to depend on their printers, scanners and fax machines. However, having all of those machines in one work area can hinder productivity. An economical and space-efficient solution is to invest in multi-function printers that will serve all your imaging needs. You’ll want something that will integrate seamlessly with your network, meet all the standards to integrate with a PACS network and be able to support the demands of your organization.

The HP LaserJet 4345xs mfp lets you print, copy, scan and fax documents all from one single machine. It provides multiple paper trays, and can support stapling, stacking and double-sided printing to ease your daily tasks and increase productivity.

CDW 699868

HP StorageWorks Modular Smart Array 1500 csSAN starter kit

Providing enough throughput for PACS environments that rely on static image files, the HP StorageWorks Modular Smart Array 1500 starter kit is a Fibre Channel SAN attached 2U controller shelf that connects to SCSI and/or SATA disk enclosures. This combination provides you with a low cost, high-capacity storage solution, perfect for networks looking for less expensive storage solutions using HP SCSI and/or SATA enclosures to store data.

CDW 730659

HP Workstation xw8200Dual-processing workstation

With more powerful systems and better integration, medical applications are no longer limited to expensive, specialized workstations. Legacy systems and old Intel® Pentium® II desktops don’t offer the power required for a modern PACS environment. The workstations

radiologists and doctors use still require vast amounts of power so they can quickly open large image and video files, as well as run the necessary applications.

Available in a variety of configurations, the HP xw8200 Workstation supports dual Intel Xeon® processors, up to 16GB of DDR2 memory, and a wide range of graphics cards. It includes a 74GB 10,000-RPM hard drive and has a front-side bus speed of 800MHz, giving it the ability to handle the intense demands of accessing and working with large amounts of data.

CDW 727740

Planar Dome C3i-220" Single Head Display - Grayscale

When reviewing X-rays, radiologists require large, crystal-clear displays that offer the best representation of images. Planar Systems designed the Dome C3i-2 monitor with this in mind. The C3i-2 provides dual 20.8" high-resolution flat-panel displays that are approved for

radiography. With support for 3,061 unique shades of gray, resolutions of up to 1,536 x 2,048 and a 600:1 contrast ratio, these monitors deliver crisp grayscale images that can be displayed in portrait and landscape modes. The Dome includes a PCI graphics card with 128MB of memory.

CDW 664466

HP Proliant BL20p and BL40pHP BladeSystem servers

HP Proliant BL20pThe HP BladeSystem offers a powerful network foundation that is easy to install, manage and scale as your organization’s needs grow. Built upon HP’s space-efficient blade enclosures, you can quickly add more server blades, switches and storage devices

as necessary. Each enclosure includes a centralized power system, hot-plug switches, convenient interconnections (for connecting to additional enclosures and storage devices) and a centralized management tool that allows you to manage all your modular network components from a single console, making it easy to build and manage a well-integrated network infrastructure.

Servers are the backbone of the network. It’s essential that the servers are reliable and can efficiently handle the amount of traffic being produced by users logging onto the network and accessing large amounts of data.

The core of your network are the server blades. HP’s ProLiant BL20p blades are highly capable, dual-processor servers that include up to 8GB of PC3200 memory and four gigabit network interface cards. The BL20p is designed to support clusters and integrate seamlessly with SAN and NAS devices.

CDW 696213

HP Proliant BL40pThe HP ProLiant BL40p blade servers feature four processors and support up to 12GB of PC2100 memory, offering all the power needed for intensive enterprise applications. This is an ideal solution for implementing an application server, hosting large

networked databases or creating a failover cluster.

CDW 595544

For more information,

contact your CDW account

manager today.

Glossary

Blade serverA complete server in a thin module that slides into a rack, blades share the backplane, reducing the number of cables required. Known for their diminutive size, blades can reduce the amount of floor space required in a data center by more than 20 percent. They are often used in a cluster of other blades and dedicated to a particular task.

DICOM (Digital Imaging and Communications in Medicine)A standard that is used to ensure medical imaging devices and other networked hardware and software in healthcare organizations communicate data properly.

Fibre Channel technologyA data transfer architecture that uses optical fiber to connect devices, providing full-duplex, high-speed data transfer rates.

HIPAA (Health Insurance Portability and Accountability Act)A set of federal laws written to protect the rights of individuals in regards to health insurance and patient privacy. The laws define, among other things, how patient data is to be stored, distributed and kept secure.

Magnetic resonance imaging (MRI)An imaging technique used to produce high quality images of the inside of the human body. Based on nuclear magnetic resonance, the technique is capable of capturing microscopic chemical and physical information about molecules.

ModalitiesA term used to refer to various types of medical imaging equipment. X-Ray machines and MRI scanners would be two different modalities.

Network Attached Storage (NAS)A self-contained server and storage device that connects directly to a network, offering large amounts of space for storing data that can be accessed by servers and systems across the network.

PetabytesA unit of measurement, in reference to storage space, equal to one thousand terabytes.

Picture Archiving and Communications System (PACS)A network system designed for digitally handling medical images. In a PACS environment, images, such as X-rays and ultrasounds, are stored, accessed, distributed and viewed digitally.

Radiology Information System (RIS)A medical imaging system used by radiology departments to process and store data.

Serial ATA (SATA)A serial interface used for connecting devices — such as hard disks — in a system.

Small Computer System Interface (SCSI)A parallel interface used for connecting peripherals and devices — such as scanners and hard disks.

Storage Area Network (SAN)A high-speed network of storage devices. Utilizing Fibre Channel technology, which transfers data at the speed of light, this is one of the fastest network storage solutions available.

TelemedicineThe use of information technology — including Web-based collaboration and videoconferencing — to improve medical treatment by allowing for long-distance diagnosis and consultation.

The Right Technology. Right Away.™

CDW.com • 888.419.7437

published in association with ZIFF DAVIS