Microsoft Customer Solution:
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.
UPMC needed a distributed digital storage and delivery system to reduce costs of storing and delivering diagnostic images.
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.
Anticipates a 75% reduction in the cost of handling diagnostic images.
Common PACS framework between 20 facilities
A better patient experience
Ease of use
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
University of Pittsburgh Medical Center Anticipates a 43% Reduction in Cost of Handling Diagnostic Images
Published: June 2003
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 enterprise-wide, 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.
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 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 megabytes -- across a network without subjecting clinicians to delays in viewing and working with the content.
“Cost savings associated with film elimination are significant. 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.”
Chief Information Officer
University of Pittsburgh Medical Center
r. Chang believed the answer could be found in delivering data from an image on an as-needed basis. His informatics team began developing a solution based on wavelets, mathematical representations of images, which enable the “on demand” delivery of lossless, full-fidelity image data over the healthcare institution’s existing network. This technology, called Dynamic Transfer Syntax (DTS) worked so well that UPMC worked with Stentor to 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.”
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 iSite’s “always online” architecture, we have also eliminated the immeasurable yet major costs of not having the access to the required images and information at the point of patient care which occurs regularly when using traditional hierarchical storage systems that utilize pre-fetching and autorouting.”
“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.”
Providing a Better Patient Experience
The patient is at the center of all decisions at UPMC, where the iSite solution has reduced by 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 d
“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.”
President and CEO
epartment, 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 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, cost-effective 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:
For More Information
For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234 in the United States or (905) 568-9641 in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to:
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.
© 2003 Microsoft Corporation. All rights reserved.
This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.
Microsoft, ActiveX, Visual Studio, Windows, and the Windows logo are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.