1. Collaborative Picture Archiving & Communication System (PACS) Project SISU Medical Systems July 17, 2006

2. “I have traveled the length and breadth of this country and talked with the best people, and I can assure you that data processing is a fad that won't last out the year.” The editor in charge of business books for Prentice Hall, 1957

3. Acronyms & Definitions PACS – Picture Archiving Communication System. Defined as a system that enables the capturing, storage and retrieval of digital images. SAN – Storage Area Network. Defined as a high-speed sub-network of shared storage devices. HCIS – Health Care Information System. RIS – Radiology Information System

4. Overview of SISU • Non-profit information technology consortium for hospitals & clinics. • Currently 14 members throughout Minnesota. • Shared technology and I.T. staff. • SISU is NOT a vendor!

5. Typical Rural Radiology Environment The patient’s perspective: • May have to wait for a radiologist consult while image is couriered to the radiologist. • In general, is at the mercy of delays related to the physical media being shuttled between multiple locations. • Patient may be transferred as an end result.

6. Typical Rural Radiology Environment From the radiologist’s perspective: • Delay in reading films in emergency situations. • Difficulty in meeting customer expectations.

7. Typical Rural Radiology Environment From the hospital / clinic perspective: • Stuck in the middle between the patient and the radiologist. • Images not always where they are needed, when they are needed resulting in inefficiencies. • Costs associated with film, storage, courier services, etc.

8. Every healthcare organization could build its own PACS solution, but… • they would miss the opportunity to share the risks and costs associated with maintaining common elements of a PACS environment. • they would need to build their own methodology for connecting the radiologist to their site. • the radiologist would likely have multiple means of accessing multiple locations and need to learn multiple PACS environments. • the radiologists would likely miss the opportunity to share resources such as on-call duty with other radiologists.

9. “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” Sir Winston Churchill

10. Medical Facility S A N Centralized Archive System Network Configuration Modalities Diagnostic Workstations Clinical Workstations Image Cache / DICOM Broker / Web Access HCIS / RIS Radiologist Office T-1 or better VPN Radiologist Home Internet VPN VPN

11. Shared PACS Network - Current Status • Seven hospitals have already purchased jointly from our selected vendor: Grand Rapids, Crosby, Aitkin, Ely, Bigfork, Deer River, Detroit Lakes. • Five hospitals are in the process of installing computed radiography in preparation for PACS. This project was assisted by a joint state grant. These hospitals include Grand Marais, Cook, Cloquet, Moose Lake, and Mora. • Integrating our healthcare information system with the PACS for five of our facilities. This interface will: • Pass ADT information to the PACS. • Pass radiology order information to and from the PACS. • Allow the users to call up an image from within our enterprise medical record system. • Pass transcription to the PACS.

12. Shared PACS Network – The Future • Four additional hospitals are evaluating and preparing to purchase PACS technology - Cook, Cloquet, Mora, Hastings, Hutchinson and Moose Lake. • Likely begin the integration between our healthcare information system and the PACS for the remainder of the hospitals. • Continue enabling access to HCIS / PACS environment by remote radiologists & physicians.

13. Advantages of Working Collaboratively • Negotiated pricing with our PACS vendor. • Shared hardware costs. • Reduced maintenance costs. • Reduced interface costs through standardization. • Data resides in at least two locations at all times allowing member sites to go film-less. • Reduced pricing on computed radiography (CR). • Ability to contract jointly for radiology services.

14. Examples of Shared Expenses • Centralized Long-term Archive: • Hardware • Licensing • Maintenance • Potential savings in “like” modality interfaces. • Savings in “like” HCIS vendor interfaces. • Shared information technology staffing for archive and network maintenance. • Shared internet / VPN access expenses. • Reduced on-going training expenses through shared vendor training sessions and sharing of expertise with other members.

15. Medical Facility S A N Centralized Archive System Current PACS Configuration Modalities Diagnostic Workstations Clinical Workstations HCIS / RIS Image Cache Server DICOM Broker Web Access Server Less ResilientLower Cost Highly ResilientHigher Cost

16. Medical Facility S A N Centralized Archive System Even Lower Cost Configuration Modalities Diagnostic Workstations Clinical Workstations HCIS / RIS Image Cache Server DICOM Broker Web Access Server Less ResilientLower Cost Highly ResilientHigher Cost

17. Thank You! Sisu Medical Systems / Solutions 5 W 1st St, Suite 200 Duluth, MN 55802 (218) 529-7900 (218) 529-7920 / Fax www.SisuNet.org