whitepaper Smart Client Technology: Enabling a wide & flexible PACS presence with fewer IT resources

whitepaper Smart Client Technology: Enabling a wide & flexible PACS presence with fewer IT resources Success stories with the Merge Healthcare Fusion Matrix PACS Solution

Executive Summary The development of picture archiving and communications systems (PACS) has ushered in a new era in which centralization of storage and distribution within extended imaging environments is the norm. With recognition of the necessity of PACS for maximal productivity, the demand for access to PACS images has grown exponentially within healthcare enterprises. Meeting the demand, the prices for PACS hardware - from processing units to storage systems to monitors - have never been better. A ubiquitous PACS presence, within major facilities and at multiple outreach sites, has never seemed more possible. But what enterprise has the necessary information technology (IT) staff to deploy and maintain a wide PACS presence? Luminary hospitals and diagnostic clinics with a wealth of resources have ample staff for PACS implementation and management. A large hospital with 1000 beds might have up to 20 dedicated full-time IT employees in the radiology department alone. In comparison, a 200-bed community hospital is likely to have a total of 10 to 15 IT staff throughout the enterprise, with only one or two dedicated to radiology. Smaller hospitals and imaging centers might have only two to four IT staff members overall. These smaller facilities face enormous competition for radiologists as well as patients at the same time that procedure volumes are exploding and file sizes increasing. The shortage of radiologists and radiology technicians is acute. Radiologists in imaging groups are now commonly expected to rotate through different facilities. To maintain a competitive identity, an imaging enterprise, no matter what its size, must offer accurate and fast subspecialty reading and consultation. Under such circumstances, to handle increased volume and maintain excellent service with limited staff, efficiency must be maximized. To achieve this level of efficiency and service, hospitals and imaging groups need to implement an enterprise-wide, cost-effective PACS solution enter the Fusion Matrix PACS solution from Merge Healthcare. Built on a powerful new platform enabled by Microsoft.NET s smart client technology, Fusion Matrix PACS expands the far edges of enterprise service networking.

Smart client technology: An introduction The term smart client was coined to highlight the key differences between these new applications and those of yesteryear. A client is a local computer, like a diagnostic or viewing workstation or an ordinary personal computer, that is set up to interact with a network server. As recently as the mid 1990s, most client applications ran on local computers with little regard to the environment of other computers and network services in which they operated. The applications were feature rich and took full advantage of local processing power and memory, creating a rich user interface: this was the rich client model. But there was a major price in terms of deployment and maintenance. As the complexity of the client application grew, so did the difficulty associated with reliably deploying the application to the client machine. As client applications were increasingly connected with network services, tight coupling became more and more difficult to maintain and deployment and maintenance increased. With expanding use of the internet came a new alternative - the thin client model. A thin client application running on a local computer is totally dependent on a centralized network server for its functionality. On the plus side, thin client applications simplified the deployment and management problems that had developed in association with rich client applications. The unfortunate trade-off was that with thin client applications little individuation was possible at local workstations or computers, and consequently the usability was reduced and responsiveness diminished. Now, however, with next-generation smart client technology, users can expect rich, fast, and responsive applications to perform their work in a flexible, efficient manner, while being robustly connected to a network server. With smart client technology, that impediment of rich client applications - the price and aggravation of deployment and management - is avoided. Smart client technology takes advantage of the rich client model, providing the user with an excellent experience, while at the same time reaping the thin client benefits of centralized SMART CLIENTS Tough to Deploy Heavy Footprint Rich User Experience Responsive Device Adaptability Offline and Online Support Broad Reach Easy Change Management Easy to Deploy Poor User Experience Network Dependency deployment and updates. In short, smart client technology provides the best of both worlds with a bonus in terms of intelligence to manage data and connectivity. THICK CLIENTS THIN CLIENTS How do you know you have smart clients? Smart clients employ smart client applications built on the Microsoft.NET framework and have common traits: They use full local client resources, from hardware to software. They take full advantage of local processing power, local memory, and local devices connected to the client, such as dictation devices or barcode readers. They also takes full advantage of local software, such as the installed business application (like Fusion Matrix PACS) and Microsoft Office applications. They are connected to a network server. Smart clients always form part of a larger distributed solution, like a PACS. The installed business application has access to specific deployment and updating services. They can function independently of the network server as feature-rich clients. Because they are running smart client applications, local client machines can run business applications even when users are not connected to the network. When connectivity cannot be guaranteed at all times, being able to work while disconnected can be essential. In the case of the Merge Healthcare Fusion Matrix PACS, for example, when connection to the centralized PACS server is not available, radiologists can read images from the archive or even directly from modalities. When clients are connected to the network server, smart client applications improve performance and usability by data caching and managing the connection in an intelligent way. The installation and updating of applications are intelligent. The Microsoft.NET framework allows applications to be deployed or updated either on demand or automatically. The Microsoft.NET framework also provides a powerful security mechanism that guarantees the integrity of applications.

Merge Healthcare is transforming the medical imaging world Merge Healthcare, a Merge Healthcare company, is focused on accelerating productivity for radiology departments and specialty practices, imaging centers and hospitals. By combining sophisticated RIS, PACS, advanced visualization and clinical imaging applications, Merge Healthcare delivers integrated end-to-end software solutions and professional services that are transforming the way our customers interact with referring physicians, manage their workflow, position their businesses in their markets and deliver imaging and information services to their customers. We ensure our customers success in today s competitive healthcare environment by streamlining business and clinical workflow with digital image and information solutions and services. Smart client technology and the Fusion Matrix PACS solution The Merge Healthcare Fusion Matrix PACS solution with smart client technology is now being used by hospitals, imaging centers, and specialty clinics throughout the United States. These enterprises are united by a single common need: Because they have to operate at the cutting edge of productivity, they require the highest degree of functionality and networking capacity from a PACS. The future of PACS is no longer being forged at academic centers. Rather, that future is now emerging in highly competitive imaging marketplaces, where groups of radiologists must organize and manage their core business of reading images - across widely dispersed facilities integrating different brands of imaging equipment - in a fast, cost-effective, and smart manner. With Fusion Matrix PACS and its smart client technology, PACS delivers the clinical and productivity results these businesses require. A large and immediate advantage of smart client technology with the Fusion Matrix PACS solution is that it lessens the demand for IT services and IT personnel. Fusion Matrix PACS facilitates deployment of a feature-rich application from a centralized network server to widespread workstations or computers. More important, Fusion Matrix PACS also makes application maintenance easy. Every time a user logs in to the Fusion Matrix PACS application resident on a workstation, it simultaneously checks the network for automatic upgrades. With Fusion Matrix PACS, downtime is minimized for diagnostic and viewing workstations. There is no need for dedication of an IT staff member to move from workstation to workstation and from site to site to perform upgrades and maintenance. Because the Fusion Matrix PACS application residing on a local client is so rich and uses the full power of the local client hardware - hardware that is becoming ever more powerful at ever more affordable prices - the time required to load images is reduced. The Fusion Matrix PACS server manages the quality of the connection for faster study loading and faster Clinical Facilities Main Hospital Site FUSION MATRIX PACS Home Offices Clinic Department PACS server and archive Radiology Department Imaging Facilities Affiliate Facilities

performance over a local area network and a distributed wide area network. While radiologists read images on the cache on local Fusion Matrix PACS smart clients, the Fusion Matrix PACS application is connected to the PACS server to provide the dynamic benefits of the PACS worklist and HIS/RIS information. Most radiologists today do not practice from single offices but are constantly on the move, and they need access to images wherever they are. In the past, PACS applications simply sat on local workstations. Radiologists did not log in to the network, and the customization of PACS applications was specific to individual workstations. With the Fusion Matrix PACS solution, individual preferences - hanging protocols, tool bars, shortcut menus - follow radiologists wherever they go. Every radiologist has a Fusion Matrix PACS user name and password; these can be synchronized with an organization s Windows Active Directory domain accounts to eliminate the confusion of multiple sets of user names and passwords. As soon as a radiologist logs in to a workstation, his or her individual preferences are downloaded - as are any updates the local workstation requires. The Fusion Matrix PACS also presents the radiologist s last worklist for review, which can be refreshed by a click of the mouse. An additional benefit of log-in is that the audit trail of study activity is automated, improving an organization s compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Radiologists can see the complete history of an image or set of images - who is looking at them now or has viewed or read them. Adapting to how radiologists work, the Fusion Matrix PACS solution makes it easy to set the preferences that can travel with radiologists from computer to computer, site to site. For example, after a radiologist has set up on Fusion Matrix PACS how he or she would like to view a spine computed tomography case, the Learn wizard feature of Fusion Matrix PACS is activated, and the viewing protocol is saved for automatic reproduction wherever the radiologist logs in. The Fusion Matrix PACS provides the capabilities of instant messaging, whereby radiologists can easily and unobtrusively communicate with connected colleagues. Voice over IP allows radiologists to engage in voice conversations over the network right from workstations. PACS how you practice Employing smart client technology, the Merge Healthcare Fusion Matrix PACS solution creates a seamless PACS environment, with customized interface preferences that follow busy radiologists wherever they go, wherever they log in. The smart client benefits of the Merge Healthcare Fusion Matrix PACS solution: Faster deployment time Easier maintenance Faster image download time Individualized preferences from any workstation or computer logged into Fusion Matrix PACS Summary Smart client technology based on the.net framework is an exciting new development from Microsoft. Built into the Fusion Matrix PACS solution, smart client technology lessens the demands for IT resources to deploy and manage an enterprise PACS and the reach of PACS can be expanded. Smart client technology allows ever more mobile radiologists to access the preferences and settings they need, wherever they go, to interpret images with the highest degree of efficiency. With the full processing resources of the local smart client workstation, image load times are significantly improved. In short, smart client technology now makes possible a PACS that truly reflects the reality of a radiologist s day and the reality of the competitive imaging business. Smart client technology is what helps make the Fusion Matrix PACS solution from Merge Healthcare a PACS how you practice.

Smart client technology: Cases in point Washington Radiology Associates, Washington, DC Washington Radiology Associates (WRA) is a six-site imaging business with 23 full-time radiologists. WRA has two central offices on K street in downtown Washington, DC, close to the Columbia Hospital for Women Medical Center, while outlying facilities are located in the suburbs of Chevy Chase, Bethesda, Sterling, and Fairfax, circling the I-495 ring. Ramin Abrahim, MD, was instrumental in helping WRA move fully into the digital world, and it was the smart client technology of Fusion Matrix PACS that made this leap possible. With 23 radiologists, six busy sites, enormous procedure volume, and intense competition for business, one might imagine that deploying and maintaining a full-scale PACs would entail an investment in many IT staff members - at least one per facility site with an overall PACS administrator. But that assumption would be wrong with the Fusion Matrix PACS, says Dr. Abrahim: A significant advantage of the Fusion Matrix PACS solution and its smart client technology is that it does not require large IT resources. We have one PACS administrator and one IT manager - and that is all we need. The PACS at WRA runs with minimal babysitting. Each radiologist logs in in the morning, and as each logs in, the local Fusion Matrix PACS application looks for upgrades and keeps itself up to date. This automatic maintenance not only helps to make the cost of IT resources manageable; it eliminates downtime for workstations and other computers for upgrading and maintenance. In fact, when we deployed the entire Fusion Matrix PACS solution across our six sites, we added only one internal IT person. Two immediate benefits of the Fusion Matrix PACS solution at WRA were load balancing and increased subspecialty readings. The Fusion Matrix PACS solution coordinates the radiologists of WRA as they have never been united before, and the quality of their service is enhanced. Now when musculoskeletal cases are imaged at one facility, they are being read by a musculoskeletal subspecialist at another. With the Fusion Matrix PACS solution, says Dr. Abrahim, it is easy to see which radiologists are available, and since I know who has what subspecialty, I can instantly choose the right person for a consultation, and within seconds we are talking or messaging about the case, and it s done. One of the demands associated with having six different sites is that WRA radiologists be fluid in moving from office to office. For Dr. Abrahim, a major advantage of smart client technology is that no matter where he logs in to the Fusion Matrix PACS solution, his own customized PACS settings are provided to him. None of us at WRA has a fixed office, and I often travel between three different locations. Fluidity is simply a fact of life for us. But with the Fusion Matrix PACS solution, whenever I log in, it is as though I am logging in from my own home office. Everything on the Fusion Matrix PACS solution is the same for us, everywhere. Not only do I receive my own customized protocols. Equally important is that I get my shortcuts, my tool bar customized with different tools - in fact, everything on the Fusion Matrix PACS solution as I have adapted it month after month. No time is wasted adjusting the workstation I happen to be sitting at.

Bronson Healthcare Group When Bronson Healthcare Group opened the doors of its award-winning 348-bed Bronson Methodist Hospital in Kalamazoo, Michigan, in 2000, it was as a completely filmless facility. It was Merge Healthcare that created that original seamless PACS environment. Filmlessness also extended to Bronson Vicksburg Hospital, a 45-bed sister facility located 18 miles away and equipped with outpatient imaging services; images from that site are interpreted on workstations at Bronson Methodist Hospital. Both hospitals are served by the 23-member radiology group Bronson Advanced Radiological Services. According to Scott Dent, IT director of Bronson Healthcare Group, the integration of smart client technology with the Merge Healthcare Fusion Matrix PACS makes every workstation more productive. If a problem arises with hardware at any particular workstation, a radiologist can move to another one anywhere within the hospital and have his or her workstation preferences immediately available. With individual workstations now more productive, says Mr. Dent, radiologists can be more productive: Because workstation preferences travel with them, radiologists now conveniently use the workstations that are at hand wherever they are while undertaking different procedures throughout the hospital, rather than having to return to specific workstations configured just for them. For example, if a radiologist works in our angio or fluoro rooms, he or she now logs in to the workstations right there where the procedures are taking place. Not only is there the opportunity for better medicine because of proximity to the procedures; there is also a more productive use of the radiologist s time. And radiologists love the greater flexibility. The Merge Healthcare Fusion Matrix PACS also improves the quality of compliance with HIPAA at Bronson Healthcare Group. Because the Fusion Matrix PACS application requires a log-in and a password, says Mr. Dent, the HIPAA audit trail is now more completely automated, ensuring better accountability. Paper and film flow can even be controlled from the centralized Fusion Matrix PACS server, limiting where images are sent or printed. The management of user names and passwords for the Fusion Matrix PACS is simplified, too: User names and passwords for the Fusion Matrix PACS application are coordinated with user names and passwords assigned to all radiologists as part of our organization s Windows Active Directory domain user accounts. What a great convenience! Now each radiologist needs to remember only one user name and password in order to launch the desktop and then the Fusion Matrix PACS application. Smart Client Technology: enabling a wide and flexible PACS presence with fewer IT resources Success stories with the Merge Healthcare Fusion Matrix PACS Solution

Next Generation Radiology, Great Neck, New York Next Generation Radiology operates on the northern shore of Long Island, New York, and in 5 years has grown to an imaging business with ten radiologists practicing at four different sites: two sites in Great Neck, one in Garden City, and another in Port Jefferson. Local competition for imaging business is fierce. For Dan Castaldo, director of information services at Next Generation Radiology, imaging is an information-dissemination business predicated on high volume and quality of service. To become competitive in this business, Next Generation Radiology has attempted to leverage PACS for the greatest possible efficiency. Now the Fusion Matrix PACS solution with its smart client technology has made a cutting- edge PACS operation even more effective. Consider workstation deployment time, says Mr. Castaldo: Formerly, it would take at least 2 hours to deploy a workstation once it is set up and plugged in, and very often much longer. The set-up also consumed IT resources. With smart client technology, deployment time of the Fusion Matrix PACS application is 15 minutes. We click a URL on the local client workstation for deployment from the PACS server, and the workstation is literally built for us. Another improvement made possible with smart client technology is a reduction in image load time. In the past, recalls Mr. Castaldo, images took 2 to 3 minutes to load to a workstation over Next Generation s wide area network. Now the loading time is 20 seconds. Mr. Castaldo comments: With smart client technology, workstations use local resources to cache images, employing the two gigabytes of RAM available on each workstation client. The result is a sense of simultaneity: In the less than half a minute it takes a radiologist to open his or her dictation box, the images are there, ready to be interpreted. From scan to reading to dispatching of the interpretation to the referring physicians, our case typical management time has been reduced to 20 to 22 minutes. 6737 W. Washington Street Milwaukee, WI 53214 ph: 414.977.4000 www.merge.com