Dr David Piraino 4 7 11

Host Team: Stephen Donaldson, Boban Josipovic, Eric Levicky


Visit from Dr. David Piraino, Albert Edwards, Roy Kittelberger, and John Paganini

Dr. David Piraino


Biographical Sketch

David Piraino, MD, is Head of the Section of Computers in Radiology of the Department of Diagnostic Radiology and is on Staff in the Department of Orthopedic Surgery at Cleveland Clinic, where he was appointed in 1985.

Dr. Piraino received his BS from Allegheny College in Meadville, Pa. He earned his medical degree from Case Western Reserve University School of Medicine in Cleveland, Ohio. Dr. Piraino performed his radiology residency at Cleveland Clinic in Cleveland and completed a bone and joint fellowship at Vanderbilt University in Nashville, Tenn.

His specialty interests include magnetic resonance imaging, musculoskeletal radiology, three-dimensional image processing and imaging informatics.

Research In

  • Fuzzy logic image registration
  • Neural network image diagnosis
  • Digital x-ray detectors
  • Radiology work-flow analysis
  • Speech recognition

Professional Highlights

Past Chairman, IHE Strategic Development Committee
Past Chairman, Radiology Information System Consortium

Albert Edwards



Director, IT Clinical Integration & Interfaces at the Cleveland Clinic

Systems Analyst at FirstEnergy Corp. (Hospital & Health Care industry) 1979 – 1985 (6 years)


Capital University

Groups and Associations

HL7 Interface Professionals
Smarter Healthcare

Roy Kittelberger



Manager, Enterprise Core Systems and Support at the Cleveland Clinic
January 2010 – Present (1 year 4 months)

Manager, Core Systems and Operations Support at the Cleveland Clinic
April 2009 – January 2010 (10 months)

Manager, Operation Support at the Cleveland Clinic
April 2008 – April 2009 (1 year 1 month)

Manager, IT Infrastructure at the Cleveland Clinic
August 2007 – April 2008 (9 months)


Fairleigh Dickinson University
MS, Computer Science
1988 – 1992

Teaneck High School
1980 – 1984

Groups and Associations:

Disaster Recovery Journal (DRJ)

John Paganini



IT Clinical Interfaces Consultant at Cleveland Clinic
Senior Director of Product Management at Guardian Technologies Intl. Inc.

Owner/President at Paguar Informatics (Sole Proprietorship)
Founder, CIO, Director of Business Development at RIS Logic, Inc
General Manager - IBSI Singapore Ltd at IBSI Singapore Inc
Manager of Computer Services at Praxair


University of Phoenix


Creative and driven Radiology Information Systems (RIS/PACS/CAD) expert; including systems design, development, implementation and support. Extensive sales and marketing experience including exhibit management, budgets, marketing plans, sales force training and hiring. Establishment of various healthcare related industry strategic alliances, OEM and distributor relationships. International experience in running a small healthcare focused IT company in Singapore.


*Dr. Piraino started off*

Vendor Neutral Archive

Purpose: to standardize ways to access images and view images.
Functionality: works on all existing platforms
Concept: de-coupling, so that many different systems can be involved
Goal: increase flexibility

Picture Archive Communication System (PACS) archive

Departments involved: ultrasound, radiology, cardiology, etc.
Method of communication: each department has its own communication with the EMR and all other pieces.
Problem: this is very complex and difficult to understand, not to mention the implications of setting up a new system using PACS.

A Switch to Vendor Neutral Archive (VNA) - 2 petabytes of storage

Departments involved: ultrasound, radiology, cardiology, etc.
Method of communication: one communication between systems (not one for each, but one for all)
Benefits: common archive, will be able to access anything from any point that reaches this system
Future: data will be stored in a cloud

Single Access Method



  • Common IT management of storage
    • Currently everything communicates separately (different systems, storage etc)
  • Standard storage will handle complete list of DICOM objects
  • Radiology department alone produces 100 terabytes of data/images a year

*Albert Edwards followed*

Smart Storage vs. Dumb Storage

META data has to be included to make storage of anything smart
This META data keeps everything organized and searchable

What kind of people does this kind of project take?

Problem: Dealing with this amount of data is like herding cats (hard to do)
Procedure: Admit patient, order radiology transfer, person is still treated no matter where they are
Problem with treating anywhere: Medical record must not hold up the process (technology isn't meant to hinder, it's supposed to help)
Mentality: Patients first, the patient will be taken care of no matter what (no insurance, no problem)

*Roy Kittelberger was next*

Groups of Technology

Desktop and server
Radiology Information System
Imaging Archive System


Problem: A person must be able to change directions on a dime, because doctors change their minds often.
Cause: Radiology Society of North America (RSNA) meets right after Thanksgiving
What usually happens: Doctors see something they like at this meeting and they want it right away (4 weeks later)

Potential employees must be able to…

Write reports using SQL
Make new or modify interfaces
Know limitations of the product

*John Paganini finished up*

**KEY CONCEPT: ** It is imperative to work closely with the users throughout all phases of development.

See the powerpoint below

John Paganini also emailed us the following information from Northwestern University

Dear John,

There is an enormous need for a skilled workforce in medical informatics. The Master of Science in Medical Informatics program offered at Northwestern University provides you with the knowledge and skills needed to be a leader in this exciting field.

Earlier this year congressional lawmakers introduced legislation that would "create a public-private partnership to promote portable, consumer-controlled EHRs." Several other lawmakers also have proposed legislation that aims to expand the use of health IT.

To aid with the adoption of electronic health records, a $150 million Medicare pilot program has been launched this year to help practices switch from paper records to digital record keeping.

In the meantime, the American Medical Informatics Association is focused on training 10,000 health care professionals in medical informatics by 2010.

This is an exciting time to be exploring how you can join others in responding to a national challenge for improved health care systems. For more information about the growing field of medical informatics, please visit these sites:

American Medical Informatics Association, HIMSS -- Healthcare Information and Management Systems Society White House Technology and Health Care Agenda

Please let me know what additional information you are seeking, as well as when might be good for us to get in touch for a short conversation. I will be happy to help you evaluate whether this program is a good match with what you are looking for.


Rhea Dysangco
Office of Graduate Admissions
Northwestern University School of Continuing Studies
Wieboldt Hall, Sixth Floor
339 East Chicago Avenue
Chicago, Illinois 60611-3008
P: 312 503 2579 | Toll Free 877 664 3347


Does Microsoft or Google disclose Information?

Answer: We don't really know for sure, but they claim they do not.

What would that HIPPA violation be if they did disclose that information?

Answer: Risks of having your record public is worth the reward of the quick results and such. The user is responsible for their records once they get them. In order to even enroll in these services there is a disclaimer that you can opt out of.

What are the costs involved with third party vendors?

Budget: $50 million / 20 person years
A lot of planning goes into these projects to justify spending this kind of money.