Microsoft Customer Solution:
Healthcare Industry
University of Pittsburgh Medical Center
Anticipates a 43% Reduction in Cost of
Handling Diagnostic Images
Published: June 2003
Solution Overview
The University of Pittsburgh Medical Center (UPMC) the leading health
care system in western Pennsylvania and one of the largest nonprofit
integrated health care systems in the United States, has dramatically
increased efficiencies and reduced the cost of managing diagnostic
images and patient information with a Stentor, Inc. iSite Enterprise
Picture Archive and Communications System (PACS), deployed on the
Windows platform. The solution allows clinicians to view instant
diagnostic quality images, such as CT scans and X-Rays enterprisewide, and provides long-term “always online” storage.
Stentor used Microsoft Visual Studio 6.0 to develop iSite Enterprise
First PACS. On the server side, Microsoft Clustering Service (MSCS)
deployed with Microsoft Windows 2000 Advanced Server provides
high availability, and Windows Load Balancing provides quick access.
The robust Windows platform helps Stentor guarantee hospitals
99.99% uptime for their data.
Customer Profile
The leading integrated health
care delivery system in western
Pennsylvania and one of the
largest not-for-profit integrated
health care systems in the United
States.
Business Situation
UPMC needed a distributed
digital storage and delivery
system to reduce costs of storing
and delivering diagnostic images.
Solution
Deployed the Stentor Inc. iSite
Enterprise, with a client created
using Microsoft® Visual Studio®
6.0, and a back end based on
Microsoft SQL Server™ 2000
running on Microsoft Windows®
2000 Advanced Server with
Microsoft Clustering Service.
Benefits

Situation

The University of Pittsburgh Medical Center (UPMC) consistently lands near the top of



industry rankings as one of the leading healthcare facilities in the nation. Its strong reputation
draws patients from throughout the United States and from more than 30 countries across the
world. UPMC's consortium of 20 healthcare facilities includes tertiary, specialty and
community hospitals, physician practices, and imaging and surgery facilities.
Radiographic studies and other modes of diagnostic imaging such as CT, MRI, and PET
scans, play an important role in medicine. The UPMC consortium of hospitals employs more
than 5,000 physicians, and performs more than one million radiographic studies each year.
Managing such a large volume of studies, and distributing images between its member
hospitals became too expensive using traditional film libraries and delivery services. UPMC
deployed a digital picture archiving communication system (PACS), but found its domain too
limiting. “With our existing PACS solution, we were able to provide reliable digital images
within the radiology department, but couldn’t share these images between facilities,” says Dr.
Paul Chang, Director of UPMC’s Radiology Informatics Lab. “This meant time, money and
Anticipates a 75% reduction in
the cost of handling diagnostic
images.
Common PACS framework
between 20 facilities
A better patient experience
Ease of use
99.99%uptime
Software
Microsoft Windows 2000
Advanced Server with Internet
Information Services 5.0 and
with Microsoft Clustering
Service
Microsoft SQL Server 2000
Microsoft Visual Studio 6.0
Hardware
IBM servers
Partner
Stentor, Inc.
resources were being devoted to ensure the correct film got to the right place in time for a
diagnosis or consultation. We needed a solution that would scale to our entire health system.”
The challenge was how to distribute large imaging files – the average image size is about 20
“Cost savings associated
with film elimination are
megabytes -- across a network without subjecting clinicians to delays in viewing and working
significant. We’ve reduced
with the content.
imaging costs from an
average of $20 per case to
Solution
Dr. Chang believed the answer could be found in delivering data from an image on an asneeded basis. His informatics team began developing a solution based on wavelets,
mathematical representations of images, which enable the “on demand” delivery of lossless,
$6 per case. We handle
about one million imaging
cases per year, so the
full-fidelity image data over the healthcare institution’s existing network. This technology,
savings could be up to $14
called Dynamic Transfer Syntax (DTS) worked so well that UPMC worked with Stentor to
million annually.”
shape the technology into a product. The result was Stentor’s iSite Enterprise PACS, which
includes iSite Enterprise for Web distribution, iSite Radiology for diagnostic reading, and
iVault for always-online long-term storage. iSite Enterprise PACS was developed with
Microsoft® Visual Studio® 6.0. Microsoft SQL Server™ 2000 serves as the data store on a
Microsoft Windows® 2000 Advanced Server MSCS cluster. Windows Load Balancing is used
for scalability on the Windows Internet Information Server (IIS) Web servers on the
presentation tier. UPMC hospitals connecting via a T1 line can download images from more
than 90 miles away in less than two seconds. And the system supports thousands of
concurrent users.
“Ninety percent of the users that associate with images are at an enterprise level,” said
Chang. “Successfully deploying images to the emergency room, the sports clinic,
orthopedics, cardiology, the ENT clinic, physicians’ homes and everywhere else across the
enterprise is the most critical requirement of a truly successful PACS. We were able to
achieve this by offering iSite Enterprise to our referring physician population, proving its value
and then transitioning into radiology and always online long-term storage. Our referring
physicians really championed this project and the relationship between our referring
population and our radiologists has never been stronger.”
Benefits
Potential to Reduce the Cost of Managing Images by 75%
The UPMC consortium of 20 hospitals generates about one million diagnostic images per
year. By law, the images must be stored for seven years. The old films continue to be stored
in a library, but the digital store of images, now about 75 gigabytes and growing daily, are
stored electronically. The cost of developing traditional films, storing them in libraries, and
paying couriers to deliver them from one place to another became prohibitive. Dan
Drawbaugh, CIO of UPMC says UPMC Presbyterian is seeing a 75% reduction in the cost of
handling diagnostic images since “going filmless” and transitioning to a completely digital
solution for storing and delivering images. He anticipates a 43% decrease across the health
care network.
“Cost savings associated with film elimination are significant,” says Drawbaugh. “We’ve
reduced imaging costs from an average of $20 per case to $6 per case. We handle about
one million imaging cases per year, so the savings could be up to $14 million annually. With
Dan Drawbaugh
Chief Information Officer
University of Pittsburgh Medical
Center
iSite’s “always online” architecture, we have also eliminated the immeasurable yet major
“The Microsoft platform is a
costs of not having the access to the required images and information at the point of patient
perfect match: it allows us to
care which occurs regularly when using traditional hierarchical storage systems that utilize
pre-fetching and autorouting.”
achieve our goals of
delivering the most
“We have 20 hospitals in our network with different architectures, iSite provides a common
framework between all of our facilities which drastically improves efficiencies, he added.”
innovative technology, the
most reliable and effective
Providing a Better Patient Experience
solution, and the greatest
The patient is at the center of all decisions at UPMC, where the iSite solution has reduced by
ease of use.”
50% the time patients need to wait for a radiology image to be read -- because the images
don’t have to be processed first as film and can be delivered instantly at an enterprise level.
Multiple copies of patients studies are stored online which means that clinicians have access
to instant patient data whether it’s one hour old or seven years old.
The solution also improves the experience for patients transferring between hospitals. “We’ve
eliminated what could be hours of waiting in some cases since care providers don’t need to
wait for physical film to be delivered or located before seeing patients,” said Dr. Chang. “And
for cases where consultation with a specialist is desired, the consultation can be done
immediately from anywhere within our system. The patient doesn’t have to wait for the
specialist to come on-site or for films to be delivered to them.”
The ability to electronically transfer diagnostic images can also save time when dealing with
serious trauma cases transferred from smaller hospitals. Dr. Gary Gruen, orthopaedic
surgeon and Vice Chairman of the Department of Orthopaedic Surgery at UPMC describes a
scenario in which a trauma patient is stabilized at one of the smaller UPMC hospitals and
then helicoptered to UPMC Presbyterian Hospital, a Level-1 trauma center.
“I could go online to view a CT scan taken at the first hospital while the patient was still en
route,” Dr. Gruen says. “When the trauma patient arrives, I would be able to go down to the
emergency department, evaluate the patient, and make immediate treatment decisions with
the trauma team. Without iSite Enterprise, I would have to do things the old fashioned way-repeat the CT and X-Rays, which would delay treatment, possibly compromising the patient
outcome.”
Ease of Use
Chang says ease of use has been part of the success of the iSite Enterprise rollout, which
has included strong word-of-mouth promotion with radiologists eager to have the solution
deployed at their hospital after hearing about it from UPMC colleagues already using the
system.
“Most importantly, the digital images can produce an even better diagnostic tool than film,”
says Dr. Chang. “iSite gives clinicians the tools for making adjustments to the images when
looking for specific details. With film, you are bound to whatever acquisition techniques were
used by the radiology technician.” Dr. Chang said radiologists required just minimal training
on how to use the system and were enthusiastic adopters.
Jonathon Reis, Chief Software Architect at Stentor, said the company chose to build on
Microsoft technology because Visual Studio provides a great development environment, and
Oran Muduroglu
President and CEO
Stentor
the operating system, with its support of clustering, and its seamless integration with SQL
Server and other Microsoft servers and services makes a great deployment platform.
“We have a client-server architecture and use an ActiveX® delivery method to verify that the
user always has the most recent version of the client,” says Reis. “This lets us deliver
optimum performance because it’s compiled code -- not Java that needs to be compiled on
the fly. We’re able to deliver very high performance code with the ease of plug-and-play
architecture.”
Upwards of 99.99% Uptime
Stentor serves as an application service provider (ASP), hosting data on SQL Server running
on an MSCS cluster to provide hospitals with the 24x7 reliability they require. Stentor’s
Windows 2000 Advanced Server back end is so stable that it contractually guarantees
hospitals 99.99% uptime. “The Microsoft platform is a perfect match: it allows us to achieve
our goals of delivering the most innovative technology, the most reliable and effective
solution, and the greatest ease of use,” says Stentor President and CEO Oran Muduroglu.
The Microsoft .NET Framework offers healthcare organizations the most flexible, costeffective enterprise platform that empowers providers, payers, employers, suppliers, and
consumers to collaborate across the healthcare continuum, turning the accelerating pace of
change into competitive advantage.
For more information about Microsoft solutions for the healthcare industry, go to:
http://www.microsoft.com/healthcare/
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For more information about University of Pittsburgh Medical Center, see http://www.upmc.com. For more
information about Stentor products and services, see http://www.stentor.com.
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