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

5. Typical Rural Radiology Environment The patients perspective: May have to wait for a radiologist consult while image is couriered to the radiologist. 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. 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. Patient may be transferred as an end result.

6. Typical Rural Radiology Environment From the radiologists perspective: Delay in reading films in emergency situations. Delay in reading films in emergency situations. Difficulty in meeting customer expectations. 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. Stuck in the middle between the patient and the radiologist. Images not always where they are needed, when they are needed resulting in inefficiencies. Images not always where they are needed, when they are needed resulting in inefficiencies. Costs associated with film, storage, courier services, etc. 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. NSA Centralized Archive System Image Cache / DICOM Broker / Web Access Modalities Diagnostic Workstations HCIS / RIS Internet T-1 or better VPN Clinical Workstations VPN Network Configuration Medical Facility Radiologist Office Radiologist Home

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. 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. 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: Integrating our healthcare information system with the PACS for five of our facilities. This interface will: Pass ADT information to the PACS. Pass ADT information to the PACS. Pass radiology order information to and from 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. Allow the users to call up an image from within our enterprise medical record system. Pass transcription to the PACS. 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. 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. 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. Continue enabling access to HCIS / PACS environment by remote radiologists & physicians.

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

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

15. NSA Centralized Archive System Modalities Diagnostic Workstations HCIS / RIS Clinical Workstations Current PACS Configuration Medical Facility Less Resilient Lower Cost Highly Resilient Higher Cost DICOM Broker Image Cache Server Web Access Server

16. NSA Centralized Archive System Modalities Diagnostic Workstations HCIS / RIS Clinical Workstations Even Lower Cost Configuration Medical Facility Less Resilient Lower Cost Highly Resilient Higher Cost DICOM Broker Image Cache Server Web Access Server

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