IU Health: Achieving Data Ubiquity with a Little Help from the Cloud

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 - Jonas Rydberg
Jonas Rydberg, MD

In recent years, constituents across many industries have strongly embraced a cloud-based infrastructure to achieve data ubiquity. Healthcare is not one of these segments, but there are exceptions to the rule, among them the 19-hospital Indiana University Health (IU Health) system. 

Headquartered in Indianapolis, IU Health has transitioned from CD-based to Internet image transfer, using its proprietary IU Health Radiology Cloud as a conduit for transferring imaging exam data generated at 54 area hospitals (53 in Indiana and one in Illinois) to its Synapse® Radiology PACS from FUJIFILM Medical Systems U.S.A. Two Synapse components facilitate access to that data. 

Dr. Jonas Rydberg is professor of clinical radiology at Indiana University School of Medicine and chief of radiology at IU Health Methodist Hospital.  He explains that IU Health is the main referring hospital group in Indianapolis (and all of Indiana) providing Level 1 Trauma, Level 1 Stroke, Level 1 Vascular and several other acute services. 

“To provide the level of patient care necessary in that role, we needed an alternative to CDs—which can malfunction, become lost, and are only HIPAA-compliant when they don’t get lost," Rydberg explains. "We saw the cloud and, eventually, Synapse’s features as a secure alternative; fortunately, many hospitals that refer to us got on board.”

Under the current configuration, IU Health maintains two parallel databases on its Synapse Radiology PACS. One such repository, known as the “IU Health database,” houses data from 10 different IU Health hospitals, including Methodist Hospital, University Hospital, and Riley Hospital for Children in downtown Indianapolis; two other hospitals have their own databases. 

 - IUH Cloud MapImage transfer network serviced by IU Health system.

The second database, referred to as the “Outside Exams” database, is used to store imaging exam data from hospitals outside the IU Health network, as well as exams conducted at other non-IUH facilities (e.g., freestanding imaging centers or physician offices) and downloaded from CDs. 

Outside hospitals upload images from their own PACS to the IU Health Radiology Cloud, which is supported by the SeeMyRadiology.com cloud-computing portal. Images are then automatically downloaded to the IU Synapse Radiology PACS. Via a single click, authorized clinicians can access images stored in either database from any PC within IU Health, as well as in mobile mode using a Synapse Mobility app on an iPad, iPhone or similar device.

The two databases are linked, with two components of Synapse—PowerJacket and CommonView—facilitating access to the contents of both. PowerJacket enables access to clinical information in Synapse for a particular study, including priors, study information, reports, notes, documents, and series. 

CommonView displays all studies for patients with multiple identifiers within the same database and can find exact matches using MRNs or MPIs. It can also be configured to display near-matches using configurable demographic criteria; for IUH, this includes patient first and last name, gender, and date of birth. It automatically searches across multiple Synapse data sources for relevant comparisons.  

“The intelligence of CommonView, and PowerJacket remove the barriers to making comparisons between exam data that are loaded from disparate PACS,” Rydberg says. 

Faster Treatment, Lower Costs 

Rydberg notes that harnessing the IUH Radiology Cloud with support from CommonView and PowerJacket yields significant benefits to the hospital system, patients, and physicians alike. For example, he says, eliminating the use of CDs for image-sharing and affording clinicians anytime, anywhere access to current and prior studies minimizes the need for re-scans; IU Health’s re-scan rate for acutely transferred patients now stands at 1 percent to 2 percent, down from 10 percent to 15 percent.

 - UHI Cloud

“Cutting down on re-scans saves patients money and conserves our resources,” Rydberg observes. “It costs nothing for referring hospitals to send exams through the cloud, but every time a CD is sent FedEx® overnight, it costs about $38.  Single web applications are not particularly easy for referring physicians and other clinicians to use; many have problems or delays logging in, and finding studies when you have different MRN and MPI numbers can be difficult. That’s not true now. Additionally, avoiding re-scans means lower radiation doses for patients, which is, of course, better for them and is especially important in pediatric imaging.”

Moreover, quick, efficient data access and transfer, as facilitated by the system, permits treatment decisions to be formulated sooner than ever before. In many situations, these decisions can be made while a patient is in transit from the referring hospital, Rydberg explains. 

“We can prepare accordingly and not risk complications or loss of life in the ER from delays on arrival because how-to-proceed hasn’t been determined,” he says. “We can better determine when it is not necessary to transfer a patient—something ER physicians in small hospitals may not be able to do. Clinicians treating outpatients referred to us by other hospitals can review images in advance of appointments. All of this has a bearing on the caliber of care—plus, it is a great timesaver all around.”

 - IUH Cloud MapIU Health acute-transfer protocol using the Radiology Cloud.

Rydberg shares two real-life examples that illustrate how the transition to the cloud and wider access to patient data has enhanced care while simultaneously benefitting clinicians. 

In one instance, which involved an acute patient transfer, a 60-year-old female (who had fallen from an SUV two days previously) experienced a syncope episode along with nausea and vomiting. The patient was taken to a local hospital, where a CT scan completed at 5:47 a.m. revealed that she had sustained severe injuries to her liver and spleen. Shortly thereafter, at 7:30 a.m., she was dispatched by ambulance to Methodist Hospital. Meanwhile, at 7:05 a.m., images from the procedure were uploaded to the IU Health Radiology Cloud; at 8:00 a.m., the images were reviewed by a trauma surgeon at Methodist Hospital, and the case was upgraded to Trauma 1 status. 

Methodist Hospital’s interventional radiology team was contacted about the case at 8:27 a.m.; nine minutes later, the interventional radiology suite was already being prepared for surgery. The patient arrived at the hospital at 8:43 a.m. and by 9:05 a.m., was undergoing treatment for active bleeding in the interventional radiology suite.

“Had there been a wait to view the patient’s images or a need for a re-scan, or had everything not been ready for the patient when the ambulance brought her here, it is very possible that the outcome of this case would not have been as good as it was,” Rydberg asserts.

The second case involved a patient who had undergone a C1-C2 fusion procedure. Seven days after the surgery was performed, the patient went to a local hospital with neck pain, and a CT exam was administered. Physicians at the hospital were uncertain how to interpret the images, so they were transferred to the IU Health Radiology Cloud for review by the surgeon who had handled the procedure. 

The surgeon accessed the patient’s priors via PowerJacket and CommonView and compared them to images sent through the cloud, then conducted a telephone consultation with the physician at the hospital to which the patient had been admitted. The latter was advised that nothing was amiss with the C1-C2 and that there was no need to transfer the patient to Methodist Hospital.

“Here, the patient wasn’t forced to endure an unnecessary transfer or another CT scan, and that made a world of difference from a patient experience standpoint,” Rydberg says. “The clinicians saved a lot of time and trouble, too.”

The system also has proven valuable to transplant surgeons in evaluating potential donor candidates. 

Next Steps

The benefits reaped by IU Health through a combination of a cloud platform and next-generation PACS features to achieve data ubiquity have been so significant, they have inspired additional, related initiatives. The first will involve leveraging the cloud as a conduit between connected hospitals’ cardiology PACS and IU Health’s Synapse Cardiovascular PACS. Regional healthcare facilities will upload images from their PACS to the cloud server, followed by download to the IU Heath cardiology PACS. 

The system has been pilot-tested at two hospitals that are connected already to the IU Health Radiology Cloud. Rydberg, his colleagues and hospital management will discuss a timetable for moving forward with wider implementation at a meeting this month.

IU Health also is in the midst of creating an HL-7 interface between its Cerner EMR system and the cloud server. Once the interface has been established, clinicians at remote hospitals will have the option to tap into the cloud repository. From there, they will be able to download reports generated by IU Health radiologists, along with the images on which interpretations are based. The report download will be available for exams performed within the last 60 days.

Yet another positive outcome of the initiative is that other hospitals have become interested in converting themselves from cloud spokes to hubs, thereby helping to create a larger web of interconnected hospitals.

Rydberg says it is likely that IU Health will explore other ways to harness the power of the cloud and its PACS. He concludes, “CDs, single Web applications, and [the like] are a thing of the past. This is the wave of the future.”