It’s a bit of a sticky wicket.  There are a handful of vendors out there that offer cloud-based storage and transfer.  The basis for their existence is to offer cloud storage for patients, so that they can share their imaging with all of their doctors.  These vendors offer this at a charge for retention.

To make this process work, they need the ability to get these images from hospitals and clinics.  So usually a hospital will sign up with one vendor and for a fee, enable other hospitals to receive their images.  So the hospital now spends money on sending images to the cloud instead of burning cds and mailing cds out.  That hospital then reaches out to the other hospitals that typically receive cds from the sending hospital and enlists them as a user.  The user will receive these image transfers at no cost but will be charged if they forward those images to another facility.  So you can see, this was built to replace cds but made the hospital build a client base.

As it turned out, not many hospitals actually enlisted their patients to sign up for this service.  It became a useful product to send images to frequently used facilities like MD Anderson and Mayo Clinic.  It became the norm to send conference images like Tumor board or Chest board via these shares.  Most hospitals would take these exams and load them directly into their PACS when received, cutting down on the time it took to import from a cd.

So here we are back to the list of vendors.  Not every hospital uses the same vendor or shares the same cloud space.  The products we use are what we use.  What ABC hospital or DEF clinic uses is their choice.  What iConnect or CHAShare provides is a way of sharing our images with other facilities with their own login and password to access our cloud for our images.  All of the vendors offer this, so in some form or fashion, we should be able to set whomever we want up to do the same thing as ABC hospital.

So I can safely say we are about to beat the dead ILM horse for the last time.  We’ve looked an this topic from a planning standpoint.  Making sure you have everyone on the same page and the major movers and shakers from your facility signing off on your testing and rules.

We’ve also looked at the cost of storage and whether its worth even purging or compressing your archive.  Are the radiologists or cardiologists going to be happy with a 50-80% compression of what they’re typically viewing now?  Makes sense to me to just keep adding storage. OR DOES IT?

If you’re an avid reader of healthcare litigation, you won’t be surprised if my attitude pendulum has started swinging in the other direction.  We’ve seen lawsuits that have hurt institutions that have decided to keep exams longer than the law requires.  So, even though you’re saving your exams to assist with your MDs in their interpretations, doing so could come back to haunt you.  Especially if there is some missed or overlooked pathology. Yep, keeping studies longer because you can opens you up to all sorts of sticky wickets.

My final point before we lay this horse into the ground is this, I don’t know!  I honestly don’t know what’s best for the patient because ultimately, that’s who we do any of this for.  So we’ve come full circle.  Some of us have great set ups and purge as often as the law allows, not holding anything longer than you needed.  Some of us keep everything because we can.  Some of us have added VNA and have thrown every bit of data into it for our fantastic universal viewers to regurgitate when needed.

My answer to what’s best? Still, I don’t know.

I’d love some feedback on this one.  Does it really matter what type of background and training you have to make a good IIM, PACS Admin, or RIS Admin?  I know this has been rehashed over the years but I’m ready to get off the fence.

Let me first begin in saying I have a BS in Electrical Engineering Technology.  What does that mean?  Well, it means I’ve sat through numerous classes in electrical theories, dozens of calculus classes, splattered with little drops of Programming, Humanities and English. Upon graduation, I worked in Medical Imaging my whole career.  18 years as a field engineer and 14+ in Imaging Informatics. So, does my degree say, “Watch out, I’m going to be great as an IIM” or does my experience speak to that?  Of course it’s the experience.

But, what if I had decided to go to radiology technology school?  I’d get the deep dive into anatomy, Roentgens, Mas.  If I did that for 18 years, then I’d know workflow, body parts, and reason for exams.  All of which are needed to be a superb PACS Admin.

What about completing everything you need know to be an effective IIM.  In most cases you need to know about voice-recognition.  Not too difficult if you get some vendor training.  You need to know about databases, utilities, and reporting to succeed as a RIS Manager.

This is where the roads split in my opinion.  I had broad knowledge of DICOM, servers, and system implementations as an FE.  I dabbled in networking of systems, switches, and facilitated computer deployments for a major imaging vendor.   I was fortunate to have learned radiology workflows throughout my FE years of constantly being in a radiology department.  So this is rather unique.  To me, it was the perfect storm for an engineer to excel as an IIM.

Unless a Rad Tech gets the opportunity to explore the IT realm, it will take years to understand completely all aspects of whats happening behind the curtain.  The little pieces of data that make up the huge quilt of healthcare imaging informatics.  Both avenues have their benefits.  Both have a better knowledge opposed to the other in some aspects.  To me, it’s the ability to make up for that shortcoming quick enough to not miss out on the overall Big Picture.

So, today I’m  on the engineer/IT bandwagon.  Apart from the department workflows, the majority of the skills needed for being an overall, up-to-speed IIM comes from the abilities of an average IT analyst.

With this said, I am not saying it can’t be the other way around.  I personally know many good rad tech IIMs.  I’m asking for your point of view.  Post ’em if you’ve got ’em!

After a couple of replies to an earlier topic on ILM, I thought I’d toss another round of ideas into the pool. Are we ready for forcing a vendor compliance on structuring how ILM works. I’m not sure it’s something we have that much control over but sounds like a good idea.  Here’s my response.

I absolutely think that VNA, although a cheaper alternative to the native storage of most of our legacy PACS systems, does not close the discussion on storage limits. It’s easy to say that 2 pentabytes of storage should take us into the next generation of archieving, it doesn’t discount the fact that what we really need is, as you mentioned, compliance. From what I’ve witnessed, and mentioned by Skip, Forever truly is a long time.

We as hospitals or as imaging system managers need to understand that by learning early on what it takes to purge exams, is the most important factor. You have got to have the fundamentals down. How does your vendor’s ILM work? What scripts are important? And the most important, at what compression rate will your radiologists be happy with after your final compression? You can set dates to begin scaling down your compression. At 7 years, for here in MS, we can purge general exams, not including infants and mammo. So, if we tell our rads that at the 7 year mark, we’re dropping you down to 80% compression rate, will they be happy? Then at 10 years, we make the big jump to 30%. We’ve just made a huge difference in our storage if we apply this across the board but have probably annoyed our radiologists. So, this is where an early conversation with radiologists, DI Managers, compliance officers, and hospital administrators pays off. Test early and often.

Although we’ve been through this process for years, we are still not purging. Why not you ask? Well, it could be as easy as a change in hospital management. A new Radiology Director. There are constantly changes that will nag us after a decade or more of use. The time has come for compliance. I believe it begins with understanding your systems, meeting with other like-minded customers, and have the tough talk with our mentors at SIIM, RSNA, or some other forum. This will not be as easy as coming up with, say DICOM compliance. That standard speaks for all vendors. This is more difficult, as each vendor has a different method.

I’d love to pick your brains and get your sides on this issue. Maybe we can start a grass-roots movement toward creating compliance or at least get the conversation started!

 

It’s time to forget all the days of burning image discs to send to out with your patients or to another hospital.  There’s a new game in town.  We’ve been playing this game for several years now but we’ve finally gained some new teams.  Hospitals, M.D.s and patients are now finding it easier and much quicker to access their images on the cloud.

There are at least a dozen HIPAA-compliant cloud storage systems available with just as many price levels to choose from.  These cloud storage systems can be tied directly into your PACS, VNA, or specific workstations.  With the proper planning and interfaces, you may never even have to touch the exam at all.

Basic set up includes an accelerator, vpn, and web access.  There must be a host system that sets up the cloud for its users (hospitals, M.D.s, patients, …) to access.  The host system also sets whether the receiving party can download the exam or just view the images from the cloud.  All of these vendors will work with you to properly set up your system and assist in getting your network of users to enlist.

Getting started is fairly simple once you’ve got the OK from your compliance and HIPAA guru.  We use a VM set up as our accelerator but any pc will do.  Your pc must have either the vendors Dicom host software or a generic installed.  Routing takes place on ours to auto-route our images directly to our PACS.  We manually touch each patient to merge them into our hospitals MRN.  If you are lucky enough to have a Dicom and RIS interface, then these can do the work for you.

Speaking of awesomeness, some of these cloud systems are FDA approved for diagnostic interpretation.  Not only that, they can be set up with your hospitals voice recognition software.  Purchase this model and you’ll be certain to put a smile on your Rads or Cards faces.  Do a little research and don’t delay.  The future is here!

As I mentioned in our earlier topic of upgrading, there are simple software upgrades and much more advanced upgrades, such as hardware.  I’ve seen supposedly easy software updates take a system down to it’s knees.  Nothing worse that telling your users to go grab a cup of coffee, you’ll be done in 15 minutes and “Say What!”, your 15 minutes ended up causing a complete system rebuild.

So, were you prepared the best you could be?  Did you do your due diligence in testing the software upgrade on your ‘supposedly’ exact copy test system?  If you did, then chalk it up to testy gremlins.  If you didn’t, then shame, shame, shame.  When you’re dealing with clinical systems, they’re all important.  Do yourself and your hospital a favor and keep your ‘Live’ and ‘Test’ systems up to date.  Yes it’s time consuming but that’s what you’re getting paid to do.  As most hospitals are spinning up VMs, the easier it is to have test systems, if not backup systems, sitting ready to go at a moments notice.  The days of waiting for a forklift replacement is a thing of the past.

Now, speaking of forklifts, your upgrade may be taking out that old boat anchor and replacing it with the newest, sleekest model around.  Here’s where you can go from Zero to Hero or the other way around.  It’s all about preparedness and project management.  You should have scheduled meetings which spell out everything the vendor expects from you and your facility.  During these meetings, assignments are doled out and names assigned to each piece of the puzzle.  Listen up, this is important.  Your name will be assigned to lots of lines on the spreadsheet being drawn up for this project.  These means that you will be responsible for those assignments.  Knock these out as soon as humanly possible.  If it involves you staying on someone else to get it done, stay on them.  Not only will your project manager be happy, you are showing that you own it.

Get your Test and Live systems up and running as soon as you can.  Ensure that you are current with the software for both and are updating each system together, as you build.  This will eliminate the potential of one system having the wrong data on them.  It’s better to be prepared for the worst that running for the door when trouble strikes.  If your Live system bites the dust during ramp up and your Test is up to date, you are the Hero!  If not, and you haven’t decommissioned your old system, well you can always go back to it.  Won’t your Drs be so excited?  You are now the Zero.

Proper planning and execution will give you your best chance at getting a timely, uneventful upgrade.  Just remember, stuff happens!  Be prepared, have a plan, and let your experience be your guide!

So it’s time to upgrade your system. Are you fork lifting it (total removal and installing new system) or are you updating your legacy system? It’s important to know the answer to these two choices. If you already know which path you’re taking, then you know there is a great difference in time involved for the upgrade.

In imaging, your choices are huge. From an overnight software upgrade to a months long replacement. These changes involve decisions being made from medical staff to imaging departments to CIOs.  Downtime is not to be taken lightly, even to the long in tooth Imaging professional. Sometimes we’re blessed with having test servers and VMs to assist in making the changes seamless. After confirmed testing of the new system or software, we can have that upgrade “go live”.

If we’re talking about system replacements or adding new workflow changing upgrades, there better be a Radiologist or Cardiologist involved. Don’t even think about moving forward with any changes without consulting and getting approval from the end users. Hopefully, they’ve already sat through numerous  demos and asked all the questions that are imperative to them. It would be smart to get a sign off list. Make sure you also understand what you are getting and understand the SOW (scope of work) and timeline.

Once work has been started, make sure you or an assigned member of your weekly progress team is keeping notes and assignments. Who’s responsible for what and where are we with progress. PMs should be holding meetings and they will hold you responsible for delays that aren’t brought up in the weekly meeting, so stay up to date and do what you’re assigned to do.

In our next discussion, we’ll go over system go lives.

I asked a question to a group of IIPs a month or so ago, “What title do you use?”.  There are quite a few, but nothing written in stone.  They all seem to revolve around Imaging, such as Specialist, Administrator, Analyst …  They all fit but one in particular has spiked some ire in the tech UN-savvy world.  That title being Imaging Informatics Manager or IIM.

To the average nontechnical person, the word Manager, means something completely different.  In our world, it makes very good sense.  We manage an assorted number of systems including PACS, RIS, Voice Recognition, CPACS, CVIS, VNA, just to name a few.  We integrate, test, and push upstream and down.  These Managers of people often say WHO do you manage?  Really?  Who?  These people tend to understand the term system manager.  Is it really a leap to understand IIM?

Well, it really is.  I’ve seen it first hand.  I’ve seen Radiology Managers throw all kinds of employees under the guidance of the IIM.  In one case, front desk staff, since they use a cd burner for sending images outside the hospital or to the cloud.  In another, transportation staff, since they use a computer to tell their coordinator where they currently are in the hospital.  I jest not.  These are true examples.

Now, I’m not saying that we don’t manage people.  Most of us have plenty of staff, or wished we did, to assist in supporting all the systems that fall under the imaging title.  True systems such as MUSE, Powerscribe, or iSite.  These systems are our ‘meat and potatoes’ so to speak.  No one person can handle all of those systems, unless you’re working a clinic, 9 to 5, M-F and no Holidays. Right?

We IIM are a different breed.  We have an innate desire for pressure.  We can never fail, nor can we, without a written letter from the engineer that dreamed up and created one of our systems, tell an irate end-user that it’s operator error.  So, knowing all this, be careful of your current manager and prospective new managers, when searching for a title that is really just a label on our name tags.

I’m not really surprised that this topic has come back around so quickly but it just shows that listening is very important for IIPs and IT professionals.  It’s only been a month and here we are discussing it again.  Why?  What went wrong so quick?

Well…

Usually it’s a communication breakdown.  Are you frustrated or is your customer frustrated?  Your customer? Really?

“Oh they never listen to anything I tell them.”

“They always complain.”

“They’re never happy.”

Unless you graduated from some customer skills class with a 4.0, you’ve probably said these same words.  It’s inevitable. When you get frustrated and are convinced you’re listening correctly, it’s time to step back and think about what went wrong.

Let’s say I’ve worked with my current customers for nearly 15 years.  I’ve grown know them and their quirks pretty well.  So now I know that it’s probably not me when they start complaining about something.  It’s what they do.  Wrong.  All I’ve done in 15 years time is develop a perspective and an assumption.  What happens when you assume…?

Realistically look at the situation.  Sit down, watch, listen, and learn.  That’s right, LEARN.

“Ah, there’s nothing to learn here.”

“They’re not listening to me!”

Uh, yes they are and they see the attitude you’re giving them.  It’s obvious who the listener is in this situation and bets are, it’s not you.

Pick up your pride and confidently head back for another round of discussions.  Let your customer talk.  Don’t say a word. You’ve already shown your customer that you’re not a good listener, so be prepared to summarize.  Repeat their concerns and let them know you hear them.  Seriously consider taking notes.  They don’t want to waste your or their time spouting off about the same thing again.  Show them you are listening.  It’s your credibility that is at stake.  It’s easily fixed but you don’t have the opportunity to squander multiple times.  Even if it turns out to be a mutual issue, take the high road.  Regain their faith in mankind and resolve the issue quickly and thoroughly.

Now that you’ve redeemed yourself and learned a lesson, continue to listen, watch, and learn.  It only takes a little effort and goes a long way towards smoothing out the road to the future.