Schwabisch Hall is a 492-bed academic teaching hospital affiliated with the University of Heidelberg and located in the northeastern part of Baden-Württemberg, Germany.
Schwabisch Hall serves a community of about 300,000 residents, and treats approximately 20,000 in-patients and 30,000 outpatients annually through 22 hospital departments and clinics. They also partner with Hospital Crailsheim, which lies 32 kilometers (20 miles) to the east.
In 2013, Schwäbisch Hall’s Institute for Diagnostic and Interventional Radiology, a full-service radiology department, began evaluating PACS systems to replace the legacy system that was approaching the end of its 5-year service contract.
“Five years isn’t very long for information technology,” said Joachim Zaers Birkholz, a consultant who advised the hospital. “But the system they had was unreliable and unable to meet the hospital’s increasing demands.”
Prof. Martin Libicher, M.D., chief physician for Diagnostic and Interventional Radiology, told us that it was not only their requirements that had changed, but also the IT strategy of the University of Heidelberg. The new thinking was that the PACS should now serve as central image repository for all imaging modalities.
“We need a state-of- the- art system”, explained Prof. Libicher, “that can handle the workflow in Schwäbisch Hall and also connect the neighboring hospital in Crailsheim. More than anything, we need the PACS to be able to work efficiently in the face of growing challenges.”
In addition to radiological images, they wanted to archive images from the C-arm, endoscopes, and ultrasound equipment, as well as ECG curves and cardiac image data from two linked Cath Labs. The institute has been adding more services, and the number of images per patient continues to rise.
“These challenges can no longer be overcome without a reliable and fast PACS”, the Chief of Radiology told us.
Also, because the configuration includes two independent hospitals, security measures were important, and they needed to implement a sophisticated authorization concept. Various authorization mechanisms were used to meet the requirements for cross-site image access; image data is stored locally at Crailsheim on a caching server and also in Schwäbisch Hall for central, long-term archiving and image distribution to both sites. User access and authorization are determined by the system administrator.
“Previously we had to copy data and double archive….the construct is really not easy; some large hospitals work on much simpler authorization concepts. But we were able to implement all our ideas with INFINITT, within our time constraints and budget,” stated Zaers.
Positive Feedback from Users
Users and administrators of the INFINITT PACS have been pleased with the new system. The transition to the INFINITT PACS in the 492-bed facility took barely four months, including migration of nearly ten terabytes of data. The radiologist team has learned the system quickly as the PACS has a very intuitive user interface. Clinical users are also satisfied with the simplicity of the application.
“The roll out was pleasantly straightforward and efficient”, reported Zaers. In particular, he praised the intensive support by INFINITT after the installation, which has contributed to the smooth introduction and high acceptance of the INFINITT PACS.
“INFINITT proved to be very flexible with their solution, adapting the system to our needs in many ways,” reported Robert Gerich, head of information technology. “INFINITT employees looked after us with great care, as well as all individual requirements – implementing additions, enhancements and changes.”
Gerich also discussed the issue of scaling. “We are planning to expand image distribution and extend imaging services. With INFINITT, we have a multi-level concept with separate levels for database, application services and image distribution that uses our virtualized resources for servers and storage.”
Shorter Turnaround Time
As a service provider, Prof. Libicher feels an obligation to turn around results within the same day. At 50,000 X-ray examinations per year, Prof. Libicher says radiologists in Schwäbisch Hall can generate the report 80% of the time within 2 hours. But the remaining 20 per cent of cases — requiring complex diagnostics and intervention – need 80 per cent of the time. For patients in the stroke unit, diagnosis must be made immediately because every second counts.
Prof. Dr. Libicher said 3D/Advanced Visualization is also a factor, as it contributes significantly to the quality of the radiological diagnosis.
“Previously the reconstructions were done at the modality and the radiologist had to move to a different workstation. With the new PACS installation, any doctor can view the CT and MR data with 3D capabilities at his PACS workstation, and provide the images with the report,” explains Prof. Dr. Martin Libicher.
The radiologists also report satisfaction with the hanging protocols. The presentation of the images on the monitor is defined individually for each examination type. That accelerates the reading process, because arranging the studies used to require the radiologist’s time. Prof. Libicher says the hanging protocols help them prepare more effectively for routine reading as well ad-hoc consultation.
Joachim Zaers expects the life of the INFINITT PACS at Schwäbisch Hall to be greater than 5 years, even though the maintenance contract only runs that long.
“We feel the INFINITT PACS is designed well for non-obsolescence. We are confident that it will continue to grow with our increasing demands,” Zaers said.