King Edward VII’s Hospital

King Edward Vll’s Hospital is a prestigious private hospital in London with a long history of providing care to the British royal family. It is the only hospital in the UK where consultants must be invited to practice. Known for its use of state-of-the-art technologies and a highly credentialed medical staff, the Hospital enjoys a reputation as the “foremost private hospital” in London.

The Challenge
King Edward VII’s Hospital had an aging PACS that was performing poorly. The hospital was also challenged to provide uniform access to imaging in all service areas. When an upgrade was proposed by another vendor at high cost with no new functionality, leadership at the Hospital decided to consider other options.

Why Vital?
Having had a positive business relationship with Vital and Toshiba Medical in the past, King Edward VII’s Hospital launched a tender process to look at alternatives to the current vendor. After careful review, IT, medical and administrative staff all selected Vital.

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Implementation
King Edward VII’s Hospital outlined requirements that included a timeline for project completion within three months. The hospital set up a dedicated team of clinical and IT resources to direct the implementation of the Vitrea® Enterprise Imaging solution into their clinical informatics structure. Vital dedicated a team of software engineers and professional services staff to provide environmental set up, configuration and workflow integration.

“The project went really well. The Vital team are brilliant to work with! It is a pleasure to be involved with a highly motivated, forward-thinking group with a can-do attitude.”

-Corey Frazer, Imaging Services Manager, King Edward VII’s Hospital

Project tasks completed by Vital:

  • Project planning
  • New IT infrastructure built
  • New radiology system (RIS) installed
  • Migration from legacy PACS
  • New vendor neutral archive (VNA), enterprise viewer, diagnostic viewer
  • Integration with hospital systems
  • Staff training and go-live

Components:

  • Vitrea Vision
  • Vitrea Connection

References:

  • Corey Frazer, Imaging Services Manager
Fairview Health Services logo.

Fairview Health Services

The Challenge
Fairview’s imaging leaders faced several barriers to accessing actionable information to support their business decisions. Although the reporting module built into their EMR provided some preconfigured strategic reports, the process of getting ad-hoc information to support an immediate decision was long, requiring the submission of service requests to IT and the involvement of specially trained analysts to construct new reports. Often by the time the requested information was provided, the timeframe for making a critical decision had already passed. Compounding the problem, the EMR is not the only source of operations-related information. The RIS (radiology information systems), PACS (picture archiving and communications systems) and imaging modalities themselves also contain valuable data which contribute to the overall picture.

The Solution
Fairview worked with Vital to implement Practice Management to empower the imaging leaders with self-service access to data. As part of this implementation, one year’s worth of historical data was imported into Practice Management to provide users with immediate insights into performance trends. Fairview’s implementation includes four applications: KPI Dashboard, On Demand Reporting, Scanner Utilization and Clinical Report Search.

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The Solution Continued..
Using the On Demand Reporting application, Fairview’s users can track operational trends such as identifying the top ordering providers by site, as well as how many of each procedure they are ordering. Such insights help the organization guide its referring physician outreach program and market its services to the local physician community. The application also allows easy access to modality productivity numbers, allowing identification of appropriate staffing levels at each location by shift.

The KPI Dashboard application allows Fairview’s users to create Key Performance Indicator (KPI) dashboards to monitor key metrics upon the opening of the new outpatient facility. Using this tool, they can identify modality resource usage trends and create a quality dashboard for radiology to present to Fairview Quality, Peer Review and Medical Executive Committees.

With the Scanner Utilization application, Fairview’s imaging leaders have a visual tool for tactically managing modality throughput at both the organizational as well as the individual department level; this tool identifies underutilized modality resources.

Research at Fairview’s UMMC facility is aided by the Clinical Report Search application, which gives physician researchers the ability to easily aggregate similar cases by searching the report repository using keyword search terms.

The Success
Efficiency Gains
Implementation of Practice Management led to immediate efficiency gains by removing barriers to accessing data.

Cost Control
While planning for the opening of the new Clinics and Surgery Center, Fairview used Practice Management to analyze resource usage trends which supported plans to optimize the use of consolidated modality resources from many specialty clinics. Practice Management supported Fairview’s volume and procedure planning and also helped analyze required staffing during the new facility’s extended operating hours.

As part of the move, Fairview also created Key Performance Indicator (KPI) tools allowing them to measure and manage the transition, supporting proactive decisions moving forward.

“The other day we avoided a $50,000 mobile CT contract when a scanner went down and would be out for six weeks. On-the-fly, we were able to look at the volumes and procedure mix being performed on the down scanner and assess that we could leverage availability on in-house equipment to pick up the slack.”
     -Matt Henry, VP System Imaging Services, Fairview Health Services

The same data (which detailed types of exam by day, resource, etc.) supported an idea to rearrange schedules and use existing equipment to service patients whenever one of Fairview’s CT scanners required an unscheduled repair.

Referral Management
Practice Management is now a key tool for helping Fairview manage exam referrals by guiding provider outreach activities to drive order capture and reduce referral leakage.

“Practice Management lets us search by individual provider, by physician group, by sub-specialty, by modality across our health system. This is something we haven’t been able to do in an actionable way before. We can now understand: who’s ordering the most MRIs of the head without contrast? Is there a noticeable difference in the number of orders with and without contrast? What about joint injections? Ultrasound? We can go across the board to look at all our referral patterns. We can aggregate by any provider to any referral location, allowing us to identify proactively where volumes might be leaking out. We can initiate a conversation to discover our key next steps in capturing critical referral business and optimizing patient care.”
     -Matt Henry, VP System Imaging Services, Fairview Health Services

Johns Hopkins Medicine Case Study

Johns Hopkins Medicine

The Challenge
Johns Hopkins Medicine (JHM) was interested in providing a consistent view of patient information across the enterprise and, to this end, is in the process of rolling out a new EMR from Epic, which is live and in use at several JHM facilities. JHM also has been working to provide enterprise access to patient imaging history and to clinicians directly from the EMR system.

JHM had a vision of providing all clinicians with enterprise-wide access to medical images – accessing imaging studies directly through the EMR, discovering and including prior studies regardless of location and allowing side-by-side comparison of these images. Ideally, this would be provided from a single web-based system where clinicians would learn once and then access images through the EMR via their existing laptops, desktops and mobile devices.

Why Vital?
JHM selected and implemented Vital’s enterprise viewer in phase one of the enterprise viewer initiative. Clinicians can view patient images, radiology reports and related documents from within the EMR via secure link. They launch Vital’s enterprise viewer by simply clicking on a link in the EMR and within seconds they are viewing the images and have access to patient prior imaging studies stored within the VNA.

Phase two extended this capability by implementing Vital’s image streaming technology to provide direct access to studies stored in the PACS at Johns Hopkins Suburban Hospital and Sibley Memorial Hospital facilities without requiring data migration, routing or caching.

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The Solution
JHM selected and implemented Vitrea® Enterprise Viewer in phase one of the enterprise viewer initiative. Clinicians can view patient images, radiology reports and related documents from within the EMR via secure link that integrates with JHM’s single sign-on mechanism eliminating an extra login prompt. They launch Vitrea Enterprise Viewer by simply clicking on a link in the EMR and within seconds they are viewing the images and have access to patient prior imaging studies stored within the VNA. Since its introduction at JHM, clinicians have come to rely on the ability to quickly access patients’ medical imaging, and consequently, Vitrea Enterprise Viewer adoption has increased steadily on a month-by-month basis. Phase two extended this capability by implementing Vitrea Data Stream technology to provide direct access to studies stored in the PACS at Johns Hopkins Suburban Hospital and Sibley Memorial Hospital facilities without requiring data migration, routing, or caching.

The Success
Quick access to all studies, regardless of their location within the JHM enterprise, was met with enthusiasm as it resolved a long-standing issue of study access across the enterprise. The combination of Vitrea Enterprise Viewer with Vitrea Data Stream proved to be a solution that addressed the enterprise imaging challenges at JHM. Vitrea Enterprise Viewer provides secure web-based, zero-footprint access to patient imaging, and Vitrea Data Stream extends this access across multiple systems and archives without costly data migration. Ultimately, this solution enables a holistic view of patients’ medical imaging records, thus enhancing clinical decision support and communication.

Critical success factors in the JHM implementation of Vitrea
Enterprise Viewer and Vitrea Data Stream include:

  • Rapid access to imaging studies within the patients’
    records in the EMR, with an intuitive suite of tools that
    provides clinicians with a full patient imaging history.
  • Access to a broad set of imaging studies, regardless of
    how many PACS or VNA systems they are stored in, or
    where they are located.
  • Easy to deploy, easy to maintain solution supporting IT
    security and reliability needs.
Summit Medical Group Customer Profile

Summit Medical Group

The Challenge
When Summit Medical Group decided imaging was a key component in improving healthcare and outcomes, they had to confront a daunting puzzle. Their wide base of practitioners, vast specialties, multiple facilities, dynamic needs and supporting infrastructure were all pieces that had to fit into their vision as they moved forward.

Why Vital?
After they found the PACS viewer did not fit their needs, Summit Medical Group looked into several universal viewer products to solve the problem of expanding imaging outside of radiology, with Vital’s enterprise viewer clearly rising to the top of their list after multiple rounds of review.

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Why Vital? Continued..

With Summit Medical Group’s keen understanding of its providers and their most compelling needs, Vitrea View enterprise viewer was the only solution. The ability to provide the right depth of tools, user-centric experience and design, while enabling Summit Medical Group to view almost any image type, from anywhere, on demand, is what sets the Vitrea View solution apart.

Purchasing the product was just the first step – having the fastest car in the world is not any good unless you can drive it. Backing
the Vitrea View solution is Vital Images’ world class maintenance and support organization.

Long, poorly managed implementations can degrade the value of your investment from the start. User adoption of a solution is how true ROI is generated. Many vendors struggle with implementation and charge the customers for inadequate training and messaging. For Summit Medical Group, this was not an issue with the Vitrea View product.

“Our problem was that our providers were getting frustrated with our clunky PACS viewer. Our current solution for providing images to providers in our enterprise was to push our entire PACS viewer through an image link in our EMR. We were forced to push the entire PACS application through our EMR. This meant the providers were getting all the tools and functionality that is required by the radiologists, but unnecessary for the referring physicians, the bulk of our providers. This slowed our response time and increasingly frustrated our providers as time wore on. We wanted to find a fast, easy to use viewer that provided a small, simple toolset and would allow access to current and previous images, for all of our providers.”
     -Richard Gawlowski, PACS Administrator, Summit Medical Group

References

  • Richard Gawlowski, PACS Administrator
  • Kathie Vendemia, Associate Director of Imaging

Implementation
In the end, the selection and implementation of an enterprise imaging solution impacts the confidence and efficiency of your providers. You want to choose a solution that provides easy access from day one. These concerns, risks and goals led to the development of Vitrea View software. For Summit Medical Group, Vitrea View enterprise viewer proved to be the right product, implementation and investment. It helped solve the challenge of providing the right information to referring physicians and helped increase efficiency and response times.

“When we saw Vitrea View, our first impression was that it looked simple to use. We saw a large main viewing window with image thumbnails across the left side of the screen. There were a few relevant tools. There was a ruler, window contrast/density, zoom, pan and rotate, and a pointer. There was also a clearly defined history button, which launched a compact window that listed the prior exams in chronological order.”

“One of our major concerns was that we have over 500 referring providers and training them on the viewer would be a task. Seeing that Vitrea View was designed with ease-of-use as a consideration made our choice easier. We knew that we would be able to provide a fast image viewer to all of our providers spread out across our enterprise. We have over 60 locations and were able to provide training materials and videos through email and our intranet.”

“The response has been overwhelmingly positive. We have made some follow-up visits to providers asking for feedback and there have been no complaints about being confused on how to use the viewer. We are excited about the value we are getting from this solution, today and tomorrow.”
     -Richard Gawlowski, PACS Administrator, Summit Medical Group

“This was our best experience with a product implementation, EVER! From planning, to delivery, to post project review, Vital was on point and helped us every step of the way. It was completed on time, on budget and everyone on our implementation team had nothing but praise for the way the solution was implemented. In fact, I just recently listed them as my favorite vendor in the peer60 survey.”
     -Kathie Vendemia, Associate Director of Imaging, Summit Medical Group

Banner Health Customer Profile

Banner Health

The Challenge
Banner wanted to implement an enterprise solution that would provide access to all of the advanced visualization tools currently available on their Vitrea® Advanced Visualization workstation deployments and from multiple PACS workstations. Their requirements called for access at sites in a variety of geographic locations, without any compromises in functionality or speed.

Why Vital?
Vital provided a multi-modality, vendor-neutral platform that supports a PACS-integrated enterprise deployment for PACS (Fuji), as well as CT and MR (Toshiba, GE, Philips and Siemens). The deployment provides a single user interface and standardization across facilities, which improves user adoption and lowers support costs.

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References

  • Jon Pavlicek, Clinical Technology Planning and Assessment,
    Banner Health
  • Perry Kirwan, Technology Management, Banner Health
  • David Wright, Biomedical Engineering Project Consultant,
    Banner Health
  • Tom Sadler, Digital Imaging / PACS Manager, Banner Good
    Samaritan Medical Center
  • Tim O’Dell BS, RT(R), Senior Manager, Medical Imaging,
    Banner Boswell Medical Center and Banner Lakes
    Imaging Center

Implementation
Prior to implementing the enterprise solution, Banner Health had 17 standalone VitreaWorkstationsTM and multiple PACS access points dispersed across their IDN. Now, with the centralization of disparate databases and the ability to use Vital’s rich toolsets from anywhere in the enterprise, physician workflows are available through existing PACS and upgrades and support are streamlined.

“The move to an enterprise model was part of our original vision when we first partnered with Vital Images approximately eight years ago. The move from thick client to thin client has given us the tools that the physicians and technologists need at any location within Banner. We no longer have to worry about hardware upgrades on our workstations when new versions of software are released. Everyone is using the same version of the software and everyone now has access to all the advanced applications, rather than having licenses unevenly dispersed around the individual facilities.”
     -Tim O’Dell, Senior Manager, Medical Imaging

Allina Health logo.

Allina Health

The Challenge
In 2011, Allina Health announced that all of its hospitals met the First Stage of Meaningful Use. To continue with their efforts, Allina needed to implement an appropriate technology to be able to attest to Stage Two Meaningful Use for image results, which included providing fast and convenient access to all of the images stored in their various PACS systems.

Why Vital?
Vital’s enterprise viewer integrates seamlessly with Epic, Allina’s electronic medical record system (EMR). It helps to deliver medical images within Allina’s current workflow of reading radiologic reports and meets or exceeds their requirements for ease of use, single sign-on, average time to launch first image and scalability.

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Why Vital? Continued..

Vitrea® View, Vital’s universal viewer, integrates seamlessly with Epic, Allina’s electronic medical record system (EMR). Vitrea View helps to deliver medical images within Allina’s current workflow of reading radiologic reports and meets or exceeds their requirements for:

  • Ease of use: Vitrea View provides a solution that is fast, intuitive, and easy to learn
  • Single sign-on: Vitrea View is accessible via single sign-on for more than 20,000 Epic workstations
  • Average time to launch first image — less than 5 seconds for all modality types, with the exception of Mammogram or studies with more than 5 series, which should launch first image in less than 10 seconds: Vitrea View is providing average times in the 3-5 second range.
  • Scalability: please see the table below

References

  • Dr. Anthony Berliner, Internal Medicine, Hospitalist. Epic Medical Director
  • Dr. Steven P. Hanovich, Cardiac Care, ICU, Hospitalist
  • Chad Johnson, Manager, Medical Technology Systems

Implementation

  • Allina’s Epic EMR includes more than 20,000 EMR workstations.
  • Storage of images is handled by Acuo, a vendor neutral archive (VNA), with a cache set with a high-water mark of 20%-to-capacity limit.
  • Two Vitrea View servers with Network Attached Storage (NAS) and a load balancer were installed in a virtual environment.
  • The servers were placed on a gigabit switch and active directory integration was implemented. No proxy servers were used.

“Vitrea View provides access to images that is much more convenient than our previous process, which involved logging into a separate viewer and waiting for it to bring up the images. Since access is quicker and because Vitrea View makes it easy to look at images while we are in the EMR, we are absolutely looking at more images and getting greater value from them.”
     -EMR Medical Director, Allina

HackensackUMC logo.

HackensackUMC

The Challenge
HackensackUMC wanted to meet physician demand for better access to radiologic images. They wanted to bring the images to the care teams, when and where they need them, helping to garner more value from investments already made in image acquisition and improving the patient care process.

Why Vital?
To stay ahead of its competitors, HackensackUMC wanted to provide image access across their medical enterprise. Vital’s enterprise viewer provides fast access to DICOM images from any archive on browsers and mobile devices.

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References

  • Shafiq Rab, M.D., Vice President and Chief Information Officer
  • Jeremy A. Marut, Director of Enterprise Architecture

Implementation
HackensackUMC set up a dedicated team of clinical and IT resources to direct the implementation of VitreaView into their clinical informatics structure. Vital dedicated a team of software engineers and professional services staff to provide environmental set up, configuration and workflow integration.

Components

  • 5 virtual Vitrea View servers
  • 1 VIMS with 6Tb storage
  • 5 DICOM archives
  • 1 load balancer
  • SAN network storage

After testing and a pilot phase, go-live was implemented for the entire facility. Education was provided via email announcements, internal messaging and short face-toface sessions. Remote sessions were also offered. After implementation, Vitrea View support was incorporated into HackensackUMC’s standard support processes.

“Our partnership with Vital helped us respond to the needs of our physician community. We already had positive experiences with the image quality and ease of use provided by our Vitrea Workstations, and we knew we could partner with Vital to successfully architect a solution to image-enable our EMR.”
     -Jeremy A. Marut, Director of Enterprise Architecture