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"We had a green-field opportunity with cardiology. They don't have 100 TB worth of images," Passe said. "We've been waiting to kind of pull [radiology] into the fold but we needed some kind of track record . . . having IT manage the long-term stuff. We're still working through some of this stuff with radiology."
Even when everyone is on board, budget issues can thwart efforts. "This, to me, is something we want to do and we have to do, but when I think of everything else on the plate, I can see this being a much lower priority," said Brad Blake, director of infrastructure and engineering at Boston Medical Center (BMC). "This is all stuff that we all want to do, but I just can't fathom it being a priority or something that's going to get what little budget money is available in the coming year."
The difficulty of migrating data can also impede centralization efforts, according to Image Management Consultants' Cannavo, who predicts it will take years to see widespread progress on such projects. "Data migration is not cheap, not fast and you have to plan before you can use it," he said. "As it stands, virtually everyone out there has to migrate from one format to another."
Some resistance from PACS vendors
Users also say PACS vendors can stand in the way of merging archives. "If you look at PACS systems in general there's not a lot of standardization across a lot of these solutions. Each solution is vendor specific, and they package
NEBH's Botticelli said he's looking to use Iron Mountain Inc.'s Digital Records Center for Medical Images (DRCMI) to get around his data center space problem, but has run into resistance from his PACS vendors. "It's not like we're the first ones in the country to do this, but when we brought this solution to the table there was just a lot of resistance: 'How are you going to migrate the data?' and 'We need to sign off on it,'" he said. "It's taken us a long time -- a good six months -- to really utilize the technology that we feel would provide us a vendor-neutral solution for medical imaging."
Other users have encountered similar resistance, but not just because PACS vendors are trying to protect their own bottom lines. "PACS vendors are not open to remote hosted or centralized [storage] unless it's theirs. [But] it's really driven by the performance guarantees that health systems are requiring from the vendors," said Steven Roth, vice president and CIO at PinnacleHealth System, Harrisburg, Pa.
PinnacleHealth has much of its PACS data archived offsite by Philips, which also assumes the risk for uptime and performance, Roth said. "In our example, we had . . . an agreement with Philips where they are at risk for delivering [fast] response times with five-nines reliability, and they basically have said, 'We will not take the risk at that level of performance unless we can manage and control the environment,'" Roth said.
This was first published in August 2010