In August 2019, Dr. Marc Kohli and Dr. John Mongan from the Department of Radiology and Biomedical Imaging were challenged with replacing Radiology’s 10-year old Picture Archiving and Communication System (PACS) which would no longer be supported by the vendor.  PACS is the primary system used by technologists to capture images such as x-rays, CT scans, and MRIs and by radiologists to diagnose conditions.  

Did You Know? Two UCSF MRIs of a human brain take up 5 GB of data, which is the same storage needed to download Return of the Jedi in high definition. 

Getting Ready 

The Radiology Departments at UCSF, UCLA, UC Irvine, UC San Diego and UC Davis have a history of collaborating, contracting, and sharing knowledge. They also faced similar challenges with their technology.   Collectively, they created one Request for Proposal in their search for a partner who could work with each campus.  

After several rounds of interviews, discussions, and research, they unanimously selected Visage Imaging and UC will invest $31 million with this technology partner over seven years.  Although they were not the least expensive vendor considered, Visage had the strongest focus on creating a good user experience for the technologists and radiologists. 

The Cohesive Team  

Typical Radiology projects involve about 10 Faculty and Staff from a handful of functional areas.  However, for this project, more than 80 people from numerous disciplines and five campuses were involved, including 15 people from Visage.  Due to project complexity and the team size, they invested time creating a very large RACI chart to clarify roles and responsibilities for each team member.   

Joe Bengfort, UCSF Chief Information Officer and Mo Bagadi, Chief Technology Officer both from UCSF IT made this project a priority and devoted time and resources to make it happen in partnership with Radiology IT. Working together they had the right UCSF knowledge and experience and by involving Visage, they had the tools to pull it off.  

“I’m incredibly proud of what we produced and of the teams, people and collaboration.  There was a great relationship between central IT and department IT. Making everything work required new skills, including multi-disciplinary relationship building and clear communications about responsibilities.” 

Dr. Marc Kohli, Professor of Radiology and Biomedical Imaging, Medical Director of Imaging Informatics for UCSF Health 

Challenges and the Value of Expertise 

Encryption is important to protecting PHI and PII, especially when transmitting images and the new technology presented new challenges. The knowledge of the Networking and Security teams helped them find the right solution without negatively impacting performance.  

“One major hurdle for us was using encryption when transferring images such as MRIs and CT scans to the cloud. There are ways of doing this, but they’re not widely used.  Coming up with solutions here was definitely a challenge." 

Jeff Block, Director of Infrastructure, Department of Radiology & Biomedical Imaging 

To address a concern about extra time being needed when transferring images, the team conducted a proof of concept.  The IT Data Storage and Cloud Architecture teams introduced faster, less expensive technology and the result was a success.  The team now stores many of the images in three locations: one onsite and two in the cloud for redundancy and security.  This protects data and keeps it safer from cybercriminals.  

The Unexpected 

A major surprise was the degree of change for everyone, especially those at UCSF.  They are accustomed to changes in design and requirements along the way, but this was different.  Changes were faster, more frequent, and larger.  For example, where UCSF faculty and staff may be accustomed to a 1-month duration for a set of activities, Visage used a just-in-time approach and expected a 1-week duration.  

“The sheer scope was far larger than we expected. We knew it would be hard, but not REAL hard.” 

Dr. Marc Kohli 

Tips for Partnering on IT Projects 

Technology projects are often complicated and involve people with highly specialized technical knowledge or mission-specific expertise.  When these groups collaborate, Dr. Kohli has some tips to be successful:  

• Make sure that people are clear on the requirements and the objectives, because this generates more discussion as people seek to understand.   
• Take advantage of the opportunity to learn something new from Central IT experts who have the most current knowledge (e.g. cloud environments). Complexity in an IT person’s world is constantly expanding and they must stay current.  
• Consider using a proof of concept to see how the system would perform. We did, and it eased our concerns when it worked out well.    
• Look for the commodity IT work in your organization and automate it or shift it to Central IT where the deep knowledge exists.  This is more efficient and enables mission areas to focus on what we do best. 

“Fall in love with the problem, not with the solution.” 

Dr. Marc Kohli, attributed to Dr. Aaron Neinstein, Vice President of Digital Health for UCSF Health 

The Results 

Through 2028, five UC campuses will be using Visage as the single vendor for PACS.  UCSF went live in late November (for technologists) / early December (for Radiologists).  UC Irvine went live in January 2022; UC San Diego is scheduled for March, then UCLA and UC Davis will go live this summer. There is also an option for affiliates to adopt the technology.    

Technologists are enthusiastic about the new PACS because it allows them to capture and upload images in much less time.  Radiologists now have a modern, sophisticated toolset that enables them to sign more reports per day.  Given the volume of reports, even small time savings add up quickly.  Patients and physicians receive test results sooner, allowing them to determine the best course of treatment in less time.  

The success of this UCSF IT and Radiology collaboration is another excellent example of how technology enables the UCSF mission: advancing health worldwide.