Dell servers for RIS and PACS in four outpatient clinics near Rome.
In an outpatient clinic with diagnostic imaging, if the server stops, the imaging devices, reporting and report delivery stop with it. For four clinics in Lazio we look after the servers running Bollino's RIS and PACS, and everything around them.
A healthcare group in Lazio runs four outpatient clinics with diagnostic imaging. Their management software, RIS and PACS come from Bollino, a software house specialised in healthcare. In the clinics we install Dell PowerEdge servers with Hyper-V, with one virtual machine for the RIS and one for the PACS; Bollino installs and updates its applications, and we look after servers, network, workstations, imaging devices, backups and day-to-day support.
Context
The group runs four outpatient clinics with diagnostic imaging: two handle about a hundred patient check-ins a day, the other two between twenty and thirty. The clinics' management software, RIS and PACS come from Bollino, a software house specialised in healthcare applications. We are the group's external IT lead.
The problem
RIS and PACS are the operational core of a clinic with diagnostic imaging: the RIS runs doctors' and technicians' worklists and reporting, the PACS stores and distributes images. Devices must receive worklists and send studies, doctors must be able to report from outside the clinic, and everything has to sit on machines that can be updated, with valid licences and backups that actually restore.
What we did
- 01
One server, two virtual machines
In the clinics we install Dell PowerEdge servers with Windows Server 2022 Standard and Hyper-V. Two virtual machines run on top: one for Bollino's RIS, one for BollinoPACS. The host's Standard licence covers both VMs, as long as the host only acts as a hypervisor.
- 02
From physical server to virtual machine
Where the RIS still ran on a physical server, we converted it into a virtual machine and moved it to the new host. We also moved VMs that had started as evaluation editions to the Standard edition, under the server's licence.
- 03
Devices and worklists
The RIS sends worklists to the imaging devices through the DICOM Worklist service and checked-in patient details through DICOM and HL7; images go to the PACS. When a device is connected or moved we handle its network, and we coordinate with Bollino's technician when the problem touches the application.
- 04
Remote reporting
BollinoPACS's web viewer lets doctors open images from outside the facility, with the permissions provided for: doctors report remotely. The RIS handles remote digital signing of reports, and where needed we set up access to a workstation for cloud-based signing.
- 05
Support for the clinics
We give the four clinics real-time support on connectivity, workstations, Microsoft 365, RIS and PACS and device connections, with a NAS and backups for each facility. With Bollino we follow regulatory updates, such as the two-factor authentication required for electronic prescriptions, and we are rolling out 2FA across the clinics.
How it went
The servers have been in service since 2023. The clinics have a single point of contact for IT, from the front-desk PC to the PACS, and Bollino a technical counterpart for everything beneath its applications.
Tools
FAQ
Why run RIS and PACS on virtual machines rather than two servers?
One server with two VMs costs less and is easier to manage: backups, snapshots and moving to new hardware become operations on the VMs. With Windows Server Standard the host licence covers two virtual machines.
Who looks after the software, you or Bollino?
Bollino installs, updates and supports its applications. We look after hardware, operating system, virtualisation, network, workstations and backups, and act as the bridge when a problem touches both.
How often should a clinic replace its server?
Usually after five years, as long as the operating system and firmware can still be updated and the warranty still covers the server. On a clinical system it is better not to cut it close.