East Coast Academic Medical System

Executive Summary

An East Coast Academic Medical System, a prominent multi-hospital system serving 29 counties in central Pennsylvania, experienced significant latency issues within their medical imaging systems. These performance problems—particularly affecting DICOM image load times—were impacting diagnostic workflows, physician satisfaction, and ultimately patient care.

To address this, the system engaged Disruptive Innovations / Asbury HealthTech Partners (DI / Asbury) to conduct a comprehensive root cause analysis across their radiology and cardiology imaging environments. Over an 8-week engagement, DI / Asbury employed rigorous diagnostic methodologies, implemented performance monitoring tools, and collaborated with multiple stakeholders and vendors.

The Challenge

The system's radiologists and cardiologists reported persistent delays in loading medical images across various platforms, including McKesson Radiology PACS (RPACS), Cardiology PACS (CPACS), Philips IntelliPACS, and remote VPN access points. These delays had wide-reaching effects:

  • Delayed diagnoses and care: Critical imaging data was not always accessible in a timely manner
  • Workarounds and risk: Providers used multiple platforms and manual processes to mitigate slow load times, introducing error risk
  • Frustrated clinicians: Remote radiologists, particularly those in California and Hawaii, struggled with image latency, affecting job satisfaction and retention
  • Undermined reputation: The system's standing as a leader in care delivery was challenged by IT limitations

Compounding the problem was the absence of performance monitoring infrastructure, leaving the system without visibility to root causes and reliant on anecdotal user reports.

Our Solution

DI / Asbury deployed a cross-functional team of healthcare executives, IT experts, and infrastructure analysts using a Scrum-based methodology. The 8-week engagement was structured in three progressive stages:

  • Discovery & Baseline: Engaged over 15 physicians, compiled infrastructure inventories, and implemented diagnostic tools (e.g., LogicMonitor, ThousandEyes, PerfMon, Wireshark)
  • Root Cause Analysis: Conducted deep analysis of four main systems—RPACS, CPACS, Philips iPACS, and VPN access—identifying multiple architectural, configuration, and hardware deficiencies
  • Remediation Planning & Recommendations: Delivered actionable recommendations for network design, system architecture, VPN performance, and organizational accountability


Key findings and interventions included:

  • Memory and resource upgrades on CPACS and RPACS servers
  • Reconfiguration of stale DNS records and inefficient Mach7 VNA query/retrieve threads
  • Vendor collaboration with Dell, McKesson, Philips, Cisco, and Citrix
  • Proposed performance accountability structure for the system's IT leadership
  • Proactive implementation of monitoring frameworks and diagnostic playbooks

Results & Impact

Measurable Operational and Strategic Improvements

While Phase 1 was diagnostic in nature, the engagement produced tangible improvements and a foundation for long-term transformation:


Clinical Impact

  • Reduced wait times for image loading in some environments
  • Improved diagnostic reliability by eliminating VNA queuing issues
  • Reduced physician cognitive load by addressing slow workflows


Infrastructure Readiness

  • Enhanced memory, storage, and system configurations for key PACS environments
  • Identification of high-risk remote access bottlenecks (VPN latency and Philips architecture)
  • Vendor tickets initiated and escalated for open issues


Strategic Alignment

  • Initiated performance governance model under the system's CTO
  • Recommendations for PACS consolidation, SLA renegotiation, and standardized image pre-fetch protocols
  • Elevated executive visibility of imaging IT risks across the system

Testimonials

"The DI / Asbury team brought a level of precision, speed, and cross-functional collaboration that exceeded expectations. Their methodical root cause analysis gave us visibility we've never had before, and their recommendations have already begun to change the way we think about imaging performance. They worked shoulder-to-shoulder with our clinicians, IT teams, and vendor partners, always with patient care at the center of every conversation. This was a model engagement."


— CIO, East Coast Academic Medical System