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Medical imaging to boost IT hardware sales
Large hospitals are investing in Digital Imaging and Communication
in Medicine. This is expected to lead to increased spending on IT hardware,
says AKHTAR PASHA
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Earlier, physicians
and surgeons had to make the rounds of
the imaging department before they could
undertake a consultation with their patients. Now, says PRAKASH
KAMAT, consultation can happen from anywhere—the
diagnostic room, in-patient floors or even the clinical room |
AFTER recovering from a road accident where I broke my wrist bone, I noticed
a swelling around the spot where the bone had cracked. Recently, on developing
chest pains, I decided to visit the same hospital where I had been treated the
first time around. To my surprise, the hospital hadn’t kept a record of
my diagnosis. Nor were they able to trace my X-ray report. Left with no choice,
I had to take fresh X-rays at additional cost to see the orthopaedist. But had
I visited a speciality hospital such as Sri Satya Sai Baba or Max, I wouldn’t
have had to go through this because these hospitals use Digital Imaging and
Communication in Medicine (DICOM).
Untapped market
Imaging in healthcare is largely an untapped market. Shailesh Agarwal, country
manager, Storage, IBM India, says, “Today it [the medical imaging market]
is an under-served market.” The ability to store and share medical images
can be done in a more efficient and effective manner by applying storage networking
technology. Adds Avijit Basu, marketing manager, Network Storage Solution, HP
India, “We look at the medical imaging market from the ILM standpoint.”
The market is growing, and by year-end it will emerge as a strong vertical for
IT hardware sales. Large super-speciality hospitals such as Sri Satya Sai Baba,
Jayadeva Institute of Cardiology, Apollo Hospital, CMC (Vellore), Tata Memorial
and dozens of others are spending an average of Rs 90 lakh-Rs 2 crore (mostly
on servers and storage) for rolling out DICOM. Industry observers say that end-2004
will find 20 new large cardiac hospitals. Another 20 hospitals will be looking
for technology upgrades. PACS (Picture Archiving and Communication System) deployments
by these healthcare providers will result in spending on servers and storage.
Eight to 10 hospitals are expected to invest in full-blown medical imaging systems
that cost around Rs 1.5 crore-3 crore. About 10 small hospitals will implement
single systems with imaging solutions that will cost Rs 15 lakh-20 lakh. Adding
all this we come up with a market spend of Rs 200 crore-300 crore annually on
IT hardware by hospitals investing in DICOM.
Catalysts
Enhanced patient and clinical care
The ready availability of images from MRI (magnetic resonance imaging), CT (computerised
tomography) scans and cath lab reports when a patient is rushed to the hospital
for emergency treatment is critical. It eliminates the need to develop and process
films; images captured from cath labs are send to the central data centre where
the DICOM system manages the images.
A source of revenue
Medical imaging solutions can bring in much-needed revenue for hospitals. They
do away with the need for a dark-room for processing, developing and storing
films (X-rays), and also for review station projectors, thus saving crores of
rupees over a period of three to four years. The typical payback time is two
years.
Legal requirements
Insurance firms like to cross-check with hospitals regarding the medical claims
made by policy holders. DICOM helps hospitals provide this data.
Linking hospitals
Hospital chains (Apollo, Max, Sri Satya Sai Baba) need to keep track of their
patients irrespective of where they are treated.
Hardware
Handling the storage needs
of a hospital can give an IT manager a migraine. IBM, HP and Sun offer the hardware.
IBM has formed a partnership with SoftLinks International, a mini-PACS solution
provider, to offer a solution called HCP DICOM Net. HP has alliances with Agfa,
Philips, Siemens and Tele- medica. Says Anil Valluri, director, Systems Engineering,
Sun, “We don’t see medical images as a business opportunity and hence
we are not focusing on this market. But from the technology point of view, we
have solutions for them.”
Hospitals should look at designing a storage architecture where patient data
can be stored for a seven-year period. A SAN architecture can be used if money
is not a constraint since it is a more robust and scalable solution. HP offers
its entry-level MS1000 redundant disc array. IBM is positioning FAST 600 SAN
boxes that can scale up to 10 TB. Sun has its 3000, 6000 and 9000 series storage
boxes that can scale from 5 TB to 145 TB. On the server side, IBM has a certified,
Intel-based, medical workstation (T221) that offers 9.2 megapixels and can open
two images on the same screen. Sun has the Performance Suite and Utilisation
Suite that can be combined with the Sun Fire V280, V240, and V440 servers to
provide a Storage Archival Manager-Quick File System (SAM-QFS).
The near-line storage requirement can be addressed effectively with a LTO/DLT
library that can be used where patient data is older than 90 days. Data up to
seven years can be archived and kept on tape libraries with a typical combination
of two-eight slots and multiple cartridge slots. HP has some offerings for archival
data similar to what it offers for e-mail archiving. Magneto-optical jukeboxes
offer WORM (write once, read many) features. Spending on storage and servers
can range from Rs 15 lakh-20 lakh.
Happy ending
Today I’m registered at Sri Satya Sai hospital. When I visit it, all my
recent records and medical images are pulled out before I go for a consultation.
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| Sri Jayadeva Institute of Cardiology (SJIC)
is a 530-bed super-speciality hospital for cardiac care with six operating
theatres and six cath labs. (A cath lab consists of equipment to diagnose
and treat various cardiovascular diseases by making use of X-rays through
image intensifier and digital recording systems). It is one of the largest
such institutions in the Asia-Pacific region.
Before and after
SJIC gets about 40 cardiology
cases per day on an average. These used to require development and processing
of 35 mm large films that had to be stored physically. The process of
developing and processing films was tedious and time-consuming—it
typically required 24-48 hours to develop them. Additional resources in
the form of staff were required for carrying out film-development. The
net result? Patients had to wait 24-48 hours, and pay more for in-patient
treatment. The doctor had no choice but to wait for the report before
making a diagnosis.
Says Prakash Kamat, chairman
and chief executive officer, SoftLinks International, a provider of a
mini-PACS solution for hospitals, “Earlier, physicians and surgeons
had to make the rounds of the imaging department before they could undertake
a consultation with their patients. Now consultation can happen from anywhere—the
diagnostic room, in-patient floors or even the clinical room.” The
turnaround time has been slashed from 48 hours to 10 minutes. Images are
instantly available for review by referring doctors and radiologists.
This is especially important in urgent care centres and ICU settings where
life-threatening patient management decisions need to be made on a priority
basis. Today, images captured from six cath labs are directly pooled into
the centralised repository where the DICOM system is installed. These
images are distributed across concerned departments and made available
in the diagnostic or treatment rooms for review.
The set-up
SJIC implemented SoftLinks’
HCP DICOM Net solution that runs on a Compaq ML 530 server (dual Xeon
processor, 1 GB RAM and 320 MB SCSI hard drive). Another Compaq ML 530
server is used for fail-over. Records that need to be reviewed after one
or two months are kept online on a RAID 5 storage box with a capacity
of 200 GB. SJIC has segregated old data on to an HP SureStore 2-20 DLT
Robotic library with a capacity of 1.6 TB. Medical images are distributed
across departments, and diagnostic and clinical rooms have eight workstations
(HP AP200), all of which are Pentium 4 dual-processor machines with 19-inch
monitors and high-performance graphics cards. The total investment, including
the cost of servers, storage, network connectivity and DICOM was roughly
Rs 1.2 crore.
Payback
SJIC used to spend Rs 1,500
per examination (cath lab report). After implementing DICOM, the hospital
is saving Rs 1,000 per examination. Assuming that 5,000 cases are registered
every year, SJIC can save Rs 50 lakh annually, so the payback period will
be about two years. There is an additional saving of Rs 6 lakh on Tagarno,
a projector used for viewing 35 mm films. Thus there is a clear return
on investment for hospitals, and they are not hesitant about investing
in an IT set-up.
The second payback is that
SJIC has done away with its darkroom and it is utilising the extra space
for providing better patient care. Last but not the least, cath lab reports
are ready for review in 10 minutes, which translates directly to better
patient care since doctors can start treatment right away and confer about
a patient with colleagues—all doctors can now look at the same images,
even if each doctor is in a different location.
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| DICOM |
The Digital Imaging and Communication in Medicine
(DICOM) standard was created by the National Electrical Manufacturers Association
to aid the distribution and viewing of medical images such as CT scans,
MRIs and ultrasound. Part 10 of the standard describes a file format for
the distribution of images. |
| PACS |
It helps hospitals store, retrieve, distribute
and display medical images in a digital format. The basic infrastructure
underlying a PACS implementation relies on a combination of tape, optical
discs and magnetic discs for archiving medical images, and servers to route
images to appropriate locations where they can be viewed. The increased
digitisation of medical images through MRI, CT, ultrasound and digital x-ray
is the catalyst for the development of PACS. |
akhtar@expresscomputeronline.com
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