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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

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

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

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

UW Medical Center:Webcast Presenters

• William Shuman, MD, FACRProfessor and Vice Chairman of Radiology, and Director of Radiology

• Gene HoeflingAdministrative Director, Radiology

• Andy StricklandDirector of Imaging Informatics

Rush-Copley Medical Center: Webcast Presenters

• Dennis DeMasieVice President and CIO

• Tom MarkuszewskiDirector of Imaging

• Bob BrueckerPACS Administrator

Diagnostic Imaging Services: Webcast Presenters

• Anthony GettysCEO

• Kathy RabalaisDirector of Clinical Services and IT

• Andrew LeBlancIT Consultant

• Keith RobichauxPACS Administrator

Q & A Session

Please submit your questions by typing them in the “Ask A Question”

box in the right of your console.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DIS: Katrina and Beyond

• Once reopened, patients were happy to get images they needed

• Continuity of care for patients• Referring physicians were glad too

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

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’

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

Webcast Presenters

• William Shuman, MD, FACRProfessor and Vice Chairman of Radiology, and Director of Radiology

• Gene HoeflingAdministrative Director, Radiology

• Andy StricklandDirector of Imaging Informatics

• Dennis DeMasieVice President and CIO

• Tom MarkuszewskiDirector of Imaging

• Bob BrueckerPACS Administrator

• Anthony GettysCEO

• Kathy RabalaisDirector of Clinical Services and IT

• Andrew LeBlancIT Consultant

• Keith RobichauxPACS Administrator

• Andy VranesicGE Healthcare

• Vijay TanjoreGE Healthcare

Thank You

To view an archive of thisvideo webcast, please visit …

www.HealthImaging.com/Webcasts