X-ray specs: how to upgrade and save money

For Community Medical Centres, a recent move to a filmless environment has had multiple business benefits. The traditional method — placing images such as X-rays, MRIs and ultrasounds on film — was expensive and time-consuming. Two years ago the non-profit hospital group began moving to a system that would let those images traverse the network, so technicians, doctors and other medical staff from just about anywhere could gain access to them.

Richard Cummins, Community Medical Centres’ manager of network services, had questions about how these large files would affect network performance. How would the organisation, which operates 30 hospitals, clinics, long-term care centres and other medical facilities in central California from its headquarters in Fresno, store and archive these very large images?

Implementing this project, called Picture Archival Computer System (PACS), was not Cummins’ direct responsibility, but it fell on the shoulders of the business applications unit of the 104-employee IT department. But the effect large imaging files would have on the organisation’s network and storage was indeed Cummins’ problem.

To prepare for the move to PACS, Cummins reviewed the project requirements and assessed the existing network, pinpointing areas where additional resources would be needed. He discovered all but one of the medical group’s locations could handle the 100Mbit/s network connection PACS would require; that location was upgraded from a 45Mbit/s to a 1Gbit/s connection, he says, giving the facility plenty of bandwidth to spare.

He purchased a second HP modular storage array with 14TB of Tier 2 storage, as well as two additional 4Gbit/s Brocade storage-area network (SAN) switches and an HP ESL 712 for tape backup. The organisation also installed diagnostic workstations for radiologists’ use, all with resources budgeted for PACS.

The architecture behind PACS was implemented last May, and the rollout to all of Community Medical Centres’ facilities was finished in November. Overall, PACS cost US$8 million (NZ$12.8 million) over five years; the infrastructure — servers and storage — made up $1million of that figure, Cummins says.

The ROI was instantaneous, he adds. “The same day a facility went live [with PACS], radiologists stopped using film and significantly reduced the time it took to read a study.” Although the organisation declined to specify how much money PACS has saved, officials refer to significant reductions in hard costs — including eliminating film and film processing expenses, as well as the cost of film jackets and storage — in addition to soft costs, such as the staff time spent looking for film and retaking over- or underexposed X-rays.

PACS was one of three strategic IT initiatives going on simultaneously at Community Medical Centres that had a significant impact on the organisation’s IT infrastructure. The second was the move to electronic medical records, completed just over a year ago, which makes it possible for physicians to sign off a patient’s chart digitally and remotely.

The third was a physicians’ portal, launched last October, that puts all the data doctors affiliated with the organisation need in one central location. These have cost-saving and competitive benefits similar to those PACS provides, but they also seriously affected the network, Cummins says.

“I manage the network infrastructure group, being responsible for the overall data infrastructure — all the switches, routers, data centre, network security, automated application deployment, new technology integration,” says Cummins, who has 11 employees in his department. “But we do all that stuff for one reason: so business and clinical applications can run on top of a robust but flexible on-demand data infrastructure.”

It took more planning than simply beefing up the network and storage systems to prepare for all these projects. It required strategic thinking to get the healthcare system’s infrastructure to a point where it can handle new applications effectively and in a cost-efficient manner.

For example, “A year before these projects went live, Rich’s team had to redesign how our storage architecture looked,” says George Vasquez, interim CIO and director of technology services, to whom Cummins reports. “Disk storage is very expensive ... Once a patient is no longer in the hospital [large image files] are put onto cheaper solutions. So, there’s constant movement from primary to archival storage to disaster recovery; we use a combination of disk and tape.”

What has let Cummins and his team prepare the organisation’s infrastructure for new projects is the network services group’s understanding that its principal responsibility is to make sure the strategic, revenue-generating aspects of IT keep running.

Understanding and planning for the impact strategic applications have on an IT infrastructure is crucial, but not all that common, says one consultant. “You’d be surprised how few organisations really do a good job linking their [project] portfolio management and investment planning with their enterprise architecture,” says Dennis Gaughan, research director with AMR Research.

This disconnect gets worse with the deployment of service-oriented architectures that let change happen much more quickly, he adds. By not aligning infrastructure with strategic applications “you’re introducing risk into the equation,” he says, because there’s a good chance the new application won’t run as expected over the existing architecture.

Cummins makes sure someone from his network services group is involved in each new IT project. “We can’t just say, ‘Here’s the server, go install your application’ each time there’s a business or clinical project. Someone from the infrastructure team has to be on that project,” Cummins says.

The IT department also has to be prepared to deal with projects that require tricky budgeting. For example, when the department is allocating its budget for the forthcoming year, it attempts to make sure there’s enough network bandwidth to accommodate new applications needed unexpectedly. “If, for example, we’ve got a brand-new application that the nursing unit needs in the middle of the year we’ve already got the network ready to accept that,” Vasquez says.

Community Medical Centres has a formula to strike this balance: the IT department spends 65% of its time maintaining the existing architecture, 30% on new projects and 5% on training. “We know we can’t do all of these projects and keep the systems running” without such a strong focus on maintenance, Vasquez says.

By doing his part to keep Community Medical Centres’ IT infrastructure on pace with strategic projects, Cummins is helping the organisation remain competitive. Forthcoming plans include rolling out electronic medical records to its clinics, bringing a new imaging centre online and upgrading its hospital information system applications. Cummins also plans to keep the infrastructure developing accordingly, with upgrades to Exchange and Windows XP SP2, by replacing edge switches and routers, and by adding even more capacity to the SAN.

“We’ve created an environment where, if physicians want to come here to practise we give them the best facilities — operating rooms, nursing staff, etcetera — and the best information systems as well,” Cummins says.