Using Health System-Wide Data Storage to Improve Access to Cardiovascular Images ata Tertiary Heart Center

About St. Mary’s Duluth Clinic Health System (SMDC) SMDC is a major regional referral center based in Duluth, Minnesota. With three hospitals and 20 clinics, SMDC serves a patient population of several hundred thousand in Minnesota, Wisconsin and upper Michigan. For the past four years, the SMDC Regional Heart Center has been named one of America’s Top 100 Heart Hospitals® by Solucient the only hospital in Minnesota to earn this distinction. More than 600 cardiac surgeries, 5,600 catheterizations and coronary interventions and 11,000 adult, pediatric and stress echocardiograms are performed annually at the Heart Center, making it one of the largest programs in the state. Deciding Against Islands of Data To manage the images generated from our four cardiac catheterization labs, we had purchased a cath lab PACS in 1999. Unfortunately, the system was not appropriately scaled to our case volume requirements and we were able to keep only three weeks worth of studies online (online meaning immediate network access from diagnostic review stations). A tape-based institution archive stored studies beyond three weeks of age, but it sometimes took up to an hour to retrieve and view prior studies, causing unacceptable delays. As we evaluated options to remedy our cath lab bottleneck, the echocardiography department staff was also considering digital echo network solutions. This presented an opportunity to make a big change that would integrate and streamline access to cardiac patient data in the Heart Center. We evaluated the echo mini-PACS that were available, but determined that it didn’t make sense to create islands of modality-specific data in the Heart Center. We wanted integrated patient data that could be accessed by physicians with a single system and a single user interface from multiple locations throughout the health system. We determined that Vericis® for Cardiology from Camtronics Medical Systems (Hartland, WI) offered the opportunity to meet these objectives. Storage Area Networks: Scalability, Fault Tolerance and Centralized Management What is a Storage Area Network? The Vericis system at SMDC connects to our hospital-wide Storage Area Network (SAN). SANs are highly scalable, centralized storage systems that provide high-speed storage, archiving, backup and disaster recovery mechanisms for an entire organization. Traditional direct-attached server storage is where a back-up device such as an optical or tape jukebox is connected to a single file server. In contrast, a SAN uses high-speed fiber connections, routers and switches to send and retrieve data to and from a mixture of hard disk arrays and tape libraries. SANs offer cost and reliability advantages compared to the many individual departmental direct-attached server systems found in many institutions. Furthermore, with the increased emphasis on disaster recovery and business continuity required under HIPAA, many health systems are considering centralizing these services by implementing SAN architectures. This was our rationale for implementing a 19 Terabyte (TB) IBM SAN to store and manage the health systems’ data. With an operation the size of ours, the data storage requirements are enormous and growing all the time, said Jeff Nast, our systems analyst. Implementing a SAN gives us the scalability, fault tolerance and centralized management that we need to address these requirements now and in the future. Consequently, connecting to the SAN was a requirement for any system or application on the hospital network including the Vericis system for the Heart Center. Seven terabytes of the SAN are dedicated to storing the Heart Center’s cardiac cath and echocardiography studies. The Vericis system handles all study transfers from the modalities, the study database and review session functions. In addition to all current studies, images from our prior cath lab mini-PACS have been migrated and the database merged with Vericis. Now, nearly three years of multi-modality studies are stored on the SAN and are instantly available at Vericis workstations distributed throughout the Heart Center. Five-Minute Room Turnover Time Means Immediate Image Access Needed Our cardiac cath labs’ operational efficiency creates demanding data accessibility requirements. An eleven-bed holding area and three interventional cardiologists who exclusively perform diagnostic and interventional catheterizations enable us to turn over rooms in five minutes. Our physicians therefore need immediate access to images from prior cases. With our Vericis - SAN configuration, physicians have instantaneous access to prior studies performed up to three years ago. Disaster Recovery A robust capacity for data protection and disaster recovery is another reason we use a SAN. SMDC’s particular disaster recovery implementation is comprehensive, fault tolerant and fully automated. At the end of the day we have four copies of new cardiovascular images generated at the Heart Center. One resides on a disk array and another on an archive server across the street. The images are backed up to a tape jukebox. Then each tape is backed up and stored offsite. The entire process is automatic, centralized and off the main hospital network, which helps improve network and application performance, explains Jeff Nast. Growing SDMC Outreach To Remote Clinics We’ve used the Vericis system and the SAN for nearly two years. We have recently developed a plan to use Vericis to help us expand outreach to remote clinics. Currently, we have a bi-directional telecardiology link with our sister hospital in Superior Wisconsin that allows us to access and receive studies. We also send out two mobile echo carts with the Vericis echo acquisition unit each day to outlying clinics, to capture studies for reading at the Heart Center. Some of the higher volume sites will be brought online in the very near future.

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