Migration to IMPAX 6 helps busy Maryland hospital meet zero downtime goal

USA, Baltimore, Maryland Hospital 

University of Maryland Medical Center, Baltimore, Maryland, US

Higher degree of fault tolerance, increased opportunities for collaboration and new view of business metrics among benefits of major IMPAX upgrade.

One of the first teaching hospitals in the United States, the University of Maryland Medical Center (UMMC) is a major, innovative teaching hospital in downtown Baltimore providing a full range of healthcare to more than 300,000 patients annually. Its facilities include the R Adams Cowley Shock Trauma Center (named after founder R Adams Cowley, who came up with the concept of the 'golden hour' in trauma treatment), which treats more than 7,500 critically-injured patients each year.

For Chris Meenan, Director of Clinical Information Services, Department of Radiology, this aspect of UMMC's patient care commitment was central in deciding to migrate to IMPAX 6. "Our tolerance for any downtime is zero. Because we have a trauma center and care for other critically ill patients around the clock, our system is in use 24 hours a day, and we really can't afford for it to ever go down," he says. "So we really needed an architecture that could support that type of availability."

Composed of the University Hospital, the University of Maryland Marlene and Stewart Greenebaum Cancer Center, the University of Maryland Hospital for Children, as well as the Trauma Center, UMMC has 5,800 employees, 1,082 attending physicians and a combined totalof 669 licensed beds. Providing a comprehensive range of diagnostic imaging and treatment services, the department of Diagnostic Radiology conducts approximately 500,000 exams per year.

Upgrade to IMPAX 6 helps UMMC meet three key goals

For this forward-focused hospital, the migration to IMPAX 6, the latest version of Agfa HealthCare's PACS (Picture Archiving and Communication System) has enabled enterprise-wide improvements in three important areas. "The main reasons behind the migration were to achieve a higher level of fault tolerance, improve collaboration between our radiologists and clinicians, and get better business metrics out of our PACS," says Chris Meenan. UMMC started in 1998 with IMPAX 3.5, upgraded to IMPAX 4.5 in 2004, and moved to IMPAX 5.2 in 2005 as a transition step in the migration to IMPAX 6. For Chris Meenan and the core members of the migration team, it's been an intense but rewarding process. "Our radiologists have always been pleased with the functionality provided by IMPAX. But as an IT person, I know that other industries have moved to highly available systems, service oriented architectures, web services and singlesign-on technology. We wanted to take advantage of those technologies to better understand and serve our clinical customers and build better tools for our radiologists. We worked closely with Agfa HealthCare to implement these technologies with the new architecture in IMPAX 6."

New Blade-based architecture enables higher level of fault tolerance

The previous PACS architecture was UNIX-based, while UMMC's new architecture is based on Blade servers from HP (with Sun UNIX equipment used now only for the core database servers). The new architecture features load balancing, which routes traffic to the different servers based on rules implemented by the UMMC team. For storage, UMMC uses a NAS (Network Attached Storage) system linked to a SAN (Storage Area Network) back-end. This element of the architecture has been incorporated into the Blade server enclosure, allowing the system to run much faster than a standard NAS.

A higher level of fault tolerance was one of the key aims of the migration process. "The architecture we had before was not completely fault tolerant," says Chris Meenan. "It had many single points of failure in it - not that they were failing, but they had the potential to fail. Essentially what we wanted to do was design an architecture with multiple servers doing the same job, so that if one server fails, the other servers can pick up the load and just continue to run," he says. "That's our goal - to keep our users unaware of any hardware failures that might occur. And with IMPAX 6, we're able to achieve this."

Enabling increased collaboration between radiologists and clinicians

Improved communication between UMMC's radiologists and clinicians was another primary goal. "It was a struggle from a collaboration perspective between the two groups who were using different tools," says Chris Meenan. Now, with IMPAX 6, both radiologists and specialists, including neurosurgeons and orthopaedic surgeons, have access to all of its web-based advanced tools, and share precisely the same perspective when conferring on cases.

Better view on business metrics

A more in-depth perspective on the business side of radiology was another advantage. "We wanted to get more information out of our system," says Chris Meenan. "Not just image arrival time and those types of things, but real business intelligence.
We wanted information on who is using the PACS, who's looking at what, how many people are looking at images, what sort of volumes per day. The PACS has all that information, and we are working on ways to extract it using SMMS (Solution Monitoring and Management Services) and other tools. We're able to improve the delivery of our clinical services because we have the details of what we need to work on."

Joint team steers smooth migration process

Thanks to the extensive planning process and the strength of the combined UMMC/Agfa HealthCare team, the migration itselfwent very smoothly. "It ultimately went very well," says Chris Meenan. The use of a traveling temporary server during the migration ensured minimal downtime for UMMC. "This allowed us to have almost a zero downtime upgrade. In fact, users didn't experience any disruption when we were actually upgrading the core system," he says. While the bulk of the migration process is now complete, migrating data on older storage archives is still underway, and is expected to be completed by July, 2007. "We've had PACS for some time, so we have a ton of data in older storage archives," says Chris Meenan. "As part of this process, we have transitioned our long-term image archiving to a very low-cost spinning disk system. That's allowed us to store a lot more data in a cost effective manner than we would have been able to otherwise."

Glowing reviews from IMPAX users

Another benefit of IMPAX 6 is that, interfaced with the hospital's LDAP (Lightweight Directory Address Protocol), it allows the PACS to take authentication information from the main hospital directory system. "Your e-mail password, your desktop password, your password for all the other systems is your PACS password as well. We get glowing reviews from our users on that," says Chris Meenan. Ultimately, providing users with easy-to-use, yet sophisticated tools so they can be most effective is Chris Meenan's goal.
"All the complexity of the systems management, and the upgrades, and all that stuff in the background - I want to protect my users from all that," he says. "I want to communicate that we're doing great things to improve the system, but for the most part, if their experience with the technology is seamless with no disruptions then I'm doing my job."