Colorado Vendor Neutral Archive (aka CTN Cloud VNA)

Colorado Vendor Neutral Archive

(aka CTN Cloud VNA)

Project Coordination Team:

• Toria Thompson, CTN Strategic Consultant (Project Coordinator)• Debby Farreau, CTN Program Director• Owen Hathaway, CTN Architecture Consultant• Michael Gray, VNA Consultant 1/23/2012 – Version 7.1 1

Project and Architecture Overview

2

• This feasibility study is the first part of a potentially multi-part project to establish a Colorado VNA.

• The feasibility study is being funded by Centura Health and is open to any health care organization that has a need to house and share images.

• The feasibility study goal is to make a Go/No Go decision, in general, about a Cloud VNA not to pick a specific vendor. The four vendors asked to respond to our RFI are Acuo, Teramedica, DeJarnette (Iron Mountain), InsightOne (Dell).

• If decision is to “Go”, next steps will be to work with specific vendor(s) to architect the final solution.

Colorado Vendor Neutral Archive(aka CTN Cloud VNA)

Project Goals:

1/23/2012 – Version 7.1


Participating Organizations:

3

•Aspen Valley Hospital•Banner Health•Boulder Community Hospital•Centura Health•Children’s Hospital Colorado•Colorado Springs Health Partners•CORHIO •Custer County Medical Center•Denver Health •Diversified Radiology of Colorado•Estes Park Medical Center •Longmont United Hospital

•Memorial Health System

•Metropath•Montrose Hospital•Oncure•Penrad •Poudre Valley Health System •Quality Health Networks (QHN)•Radiology Imaging Associates•University of Colorado Hospital •Valley Wide Health Systems •Yuma Hospital

…and growing

1/23/2012 – Version 7.1

4


Project Timeline: December 12, 2011 – February 10, 2012

•Request for Information emailed to vendors:Acuo, Teramedica, DeJarnette (Iron Mountain) and InsightOne (Dell)

•Questionnaire emailed to participating organizations.

• 1 ½ hour Cloud VNA Architecture Discussion with participating organizations.

January, 2012

•Vendor RFI’s due back to CTN.•Participant Questionnaires due back to CTN.

February, 2012

• Two hour business meeting with participating organizations to review vendor responses and pricing and make decision whether and how to proceed to next step.

Jan 6

Jan 24

Jan 25

Feb 6th

1/23/2012 – Version 7.1

Introduction to the Vendor Neutral

(enterprise) Archive

1/23/2012 – Version 7.1 5

Michael J. Gray, Gray [email protected]

Itemize the Enterprise Problems Problems with today’s PACS Archives A practical solution: Vendor-Neutral Enterprise Archive Proposed CTN Cloud VNA Architecture Key Features of the CTN Cloud VNA and UniViewer Considerations for Sharing Images via HIE Summary

Learning Objectives

1/23/2012 – Version 7.1 6

1. Multiple Silos (typical with multiple free-standing PACS)

Introduce redundant, often disparate platforms Expensive to purchase and manage

2. Incompatible Data There are Data Exchange issues between disparate PACS

caused by Variances in the Data Object Header, Inability to Query/Retrieve with foreign systems, Inability to accept study originating in another PACS

Requires complex Data Migrations between subsequent generations of departmental PACS

Itemize the Enterprise Problems

1/23/2012 – Version 7.1 7

3. Insufficient Information Lifecycle Management strategies Many PACS applications do not support an intelligent ILM

strategy and have no Purge application

4. Need for both Specialized and General Display Applications Each Department requires modality-specific tools for

Visualization, Image Processing & Measurements, Reporting Referring physicians require simple viewer that can

access/display images from all departments


1/23/2012 – Version 7.1 8

5. Need a solution for the image-producing departments that will not have their own local PACS.

Image Acquisition, ID Association, QA and QC Operations

6. Need a solution for the inevitable Data Migration The cost (in dollars and time) of repeated data migrations from

an Enterprise Archive is simply unsustainable!


1/23/2012 – Version 7.1 9

There are major problems with today’s PACS Data Object Format or the DICOM Header contents Inter-System Communications protocols (compression schemes) Archive Solutions

Very few PACS vendors think outside of their box Workable Solutions for today’s

enterprise image data management problems will require thinking outside of outside of their box


1/23/2012 – Version 7.1 10

1. Choice of storage media or storage solutions is often limited2. Potential for use of Private DICOM Header “tags”3. Ability to share only basic image data with another PACS4. Key work products may not be transferable to, or compatible

with, other PACS Radiology example - Presentation States, Key Image Notes

5. Limited ability to aggregate a patient’s data spread across other vendor’s PACS

Problems with today’s PACS archives

1/23/2012 – Version 7.1 11

6. Data is controlled by the PACS vendor, not the Healthcare Organization

7. Difficult or expensive to share an Enterprise-class Storage Solution tied to the Radiology PACS with all of the other departmental PACS application servers

8. Data management applications designed to match lifetime of the PACS, not the lifetime of the data…

there is no data purge mechanism!

9. Data Migration is inevitable When one vendor’s PACS is replaced by a different vendor’s PACS When the PACS vendor changes architectures or storage solutions When the vendor introduces a new generation of software

Problems specifically with today’s PACS archives

1/23/2012 – Version 7.1 12

1/23/2012 – Version 7.1 13

The Solution to the Problem?

Insisting that the vendors modify their PACS to be 100% DICOM-conformant is impractical The vast majority of PACS being sold today are technically “DICOM-

conformant” Unsupported DICOM functionality is missing, because the customer

doesn’t understand it, and is not demanding it Insisting that the vendors eliminate their use of private tags or

encrypted data is impractical Removing private tags in both modalities and PACS would take

years

The Solution?

1/23/2012 – Version 7.1 14

Placing faith in the evolution of XDS-I (Cross-enterprise Document Sharing for Imaging),recommended by IHE1, is not the solution either. Few (if any) current PACS support XDS-I Community efforts to implement cross-enterprise data sharing are

evolving very slowly Many PACS vendors remain years behind in implementing DICOM

Objects and SOP Classes, what is their motivation to support the more esoteric XDS-I?

XDS-I is intended to solve the more complicated problem of data exchange between Enterprises, not between disparate PACS within an Enterprise

The Solution?

1/23/2012 – Version 7.1 15

1 Integrating the Healthcare Enterprise

Placing faith in the evolution of XDS-I (Continued)

XDS-I imposes another layer of complexity on a PACS or Archive, typically adding a 30% technology surcharge

XDS-I assures aggregation of all studies belonging to the same patient regardless where each study was done and the different facility MRN’s

XDS-I does not assure functionality… o that the receiving PACS can fully utilize the data created by another

PACSo XDS-I does not perform DICOM tag mapping

The Solution?

1/23/2012 – Version 7.1 16

The Vendor-Neutral Enterprise Archive

The Solution!

• Acquisition & QC• Dept. Workflow• Specialty Viewers• Short-term Cache



• Enterprise Acquisition & QC• For Dept. w/o PACS• For Non-DICOM Objects

• Visible Light Dept. Workflow• Enterprise Image Directory

• Aggregated Patient Folder• Data Exchange Engine (Tag

Morphing)• Enterprise Viewer Set• Long-term Cache• Enterprise ILM• Disaster Recovery / Business

Continuity• Enterprise System Administration

Radiology PACS Cardiology PACS

Vendor-Neutral Archive

“X”-ology PACS

Visible Light• Data Conversion• Export to VNA

1/23/2012 – Version 7.1 17

This high-level graphic suggests the size and redundancy aspects of a VNA properly configured for a single Organization

The Solution!

Enterprise WAN

Facility A LAN Facility B LAN

PACS

PACS

C-PACS

Data Center A Data Center B

VNA

VNACacheR-PACS X-PACS

1/23/2012 – Version 7.1 18

The only workable solution to solving the problems listed in this presentation is to deploy a Vendor-Neutral Enterprise Archive Take the “A” out of PACS The Vendor-Neutral Archive would accept both DICOM and non-

DICOM image data and its related meta data Incorporate the tools to dynamically translate between disparate

PACS (Bi-directional Dynamic Tag Morphing) Bring sophisticated Information Lifecycle Management tools,

including Purge mechanism to enterprise image data management

The Solution!

1/23/2012 – Version 7.1 19

Arguments for a Vendor-Neutral Enterprise Archive Eliminate future data migrations Expand choice of storage media Easier way for individual and/or dissimilar Departmental PACS to

share a long-term “Archive” and effectively exchange data Control of the study data by the Organization, not the vendor,

makes it easier to change PACS Support of sophisticated Information Lifecycle Management

strategies (especially Purging)

The Solution!

1/23/2012 – Version 7.1 20

1/23/2012 – Version 7.1 21

CTN Cloud VNAProject Overview

Owen Hathaway, CTN Architecture [email protected]

221/23/2012 – Version 7.1

House a secondary (archived) copy of medical images from healthcare organizations across Colorado.

Enable sharing of these images among providers in partnership with CORHIO and QHN.

Enable access and sharing of these images through a hosted Universal Viewer.

Provide disaster recovery and business continuity based on these copies.

Be totally vendor-managed and provided under a master Fee-per-Study pricing model. CTN will receive sustainability revenue for each study stored in the CTN Cloud VNA.

The CTN Cloud VNA will….

Project Objectives:

How the Architecture

Evolved for theCTN Cloud VNA

1/23/2012 – Version 7.1 23


1/23/2012 – Version 7.1 24

Minimal Solution:Cloud-based DR

Facility A LAN

R-PACS C-PACS X-PACS

Current State -Individual Heterogeneous PACS Environments, each with on-site Primary and Secondary (DR) copy of the image data

Facility C LAN

R-PACS C-PACS

CTN WAN

Facility B LAN

R-PACS C-PACS

DICOM communication of image data in individual PACS formats

1/23/2012 – Version 7.1 25

Facility A LAN


CTN WAN

1 - Remote (Cloud-based) Disaster Recovery Solution, where Gateway servers pass individual PACS Data (in original data formats) to individual storage solutions in the Cloud

Facility C LAN

R-PACS C-PACS

Gateway

Facility B LAN

R-PACS C-PACS

GatewayGateway

Cloud Data Center

Storage Server

Data Center LAN

Storage Network

1/23/2012 – Version 7.1 26

Facility A LAN


CTN WAN

2 - Remote (Cloud-based) PACS-Neutral Disaster Recovery Solution, where Gateway Servers pass individual PACS Data (in original data formats) to Vendor-Neutral Archive in the Cloud, where the VNA application normalizes the data before forwarding it to the Storage Server

Facility C LAN

R-PACS C-PACS

Gateway

Facility B LAN

R-PACS C-PACS

GatewayGateway

Cloud Data Center

VNA

Storage Server

Cloud Data Center LAN

Storage Network

1/23/2012 – Version 7.1 27

Individual PACS DR solutions are relocated to the Cloud Gateway Server in each facility receives and forwards

individual PACS data Vendor Neutral Archive application

Normalizes data (fixes header idiosyncrasies) Manages PACS data from individual facilities in individual logical

partitions of the storage solution (compartmentalizing data at the more granular department level is optional)

Remote PACS-Neutral DR Solution

1/23/2012 – Version 7.1 28

This PACS-Neutral DR Solution: Supports fully interoperable exchange of the Second Copy of the data

(Image Sharing) between any PACS both in the facility and across all facilities

Supports Aggregation of the Second Copy of the patient data across all PACS and all facilities

Supports ILM functionality for the Secondary Copy Eliminates future data migrations

This PACS-Neutral DR Solution does NOT: Image-enable the EMR Provide a Business Continuity solution

Remote PACS-Neutral DR Solution

1/23/2012 – Version 7.1 29

Electronic Medical Record (EMR) systems are typically not self-contained systems EMR does not store image data EMR does not include a multi-modality image viewing application

The Portal’s Patient/Study UID can be used to create a URL pointer to the study data stored in the specific Departmental PACS BUT a Multiple PACS scenario forces the user to learn and use

multiple viewers, AND Separate PACS require separate viewing sessions

Solution! - Image-enabling the EMR

1/23/2012 – Version 7.1 30

The Solution! -The Enterprise UniViewer

• Single Access • Single Session• Ability to “aggregate” data

from multiple sources

Electronic Medical RecordPhysician Portal

URL call

UniViewer

Radiology PACS Cardiology PACS


“X”-ology PACSVisible Light• Consolidated Enterprise-

wide Patient Record• Enterprise Image Directory• Enterprise Image Data

DICOM

1/23/2012 – Version 7.1 31

The Solution! -The Enterprise UniViewer

1/23/2012 – Version 7.1 32

Electronic Medical RecordPhysician Portal

URL call

UniViewer


DICOM

• Second Copy of Data

CTN CloudVNA

Proposed Solution:CTN Cloud VNA

1/23/2012 – Version 7.1 33

Facility A LAN


CTN WAN

3 - Remote (Cloud-based) PACS-Neutral DR/BC Solution, where Gateway servers pass individual PACS Data (in original data formats) to Vendor-Neutral Archive in the Cloud, and UniViewer application image-enables the EMR with normalized data and serves as an organization’s BC solution

Facility C LAN

R-PACS C-PACS

Gateway

Facility B LAN

R-PACS C-PACS

GatewayGateway

Cloud Data Center

VNA

Storage Server


Storage Network

Uni-Viewer

1/23/2012 – Version 7.1 34

This PACS-Neutral DR/BC Solution: Image-enables each organization’s EMR with the organization’s

Second Copy of its data being managed in the Cloud-based VNA Supports internet image access by authorized outside physicians to

the Second Copy of the organization’s data Provides the organization with a Business Continuity solutiono New studies can be interpreted on modality workstations and Cloud-

based UniViewer can provide access to Second copy for comparisono Modalities can forward new data to the Cloud when local PACS is

unavailableo New image data can be downloaded from Cloud to the PACS when PACS

are back on-line

Remote PACS-Neutral DR/BC Solution

1/23/2012 – Version 7.1 35

This PACS-Neutral DR/BC Solution does NOT: Support local exchange of the Primary Copy of the data between

PACS (exchange data must be retrieved from Cloud) Support non-PACS departments with

o Image acquisitiono QA/QCo Study Reconciliation

Provide ILM functionality for the Primary Copy of the data

VNA Functionality and Benefits can be brought into each Organization with a local VNA deployment

Remote PACS-Neutral DR/BC Solution

1/23/2012 – Version 7.1 36

1/23/2012 – Version 7.1 37

Optional Add-on Solution:Local VNA

Deployment

Facility A LAN


CTN WAN

Facility C Upgrade to the Hybrid VNA

Facility C LAN

R-PACS C-PACS

Facility B LAN

R-PACS C-PACS

Cloud Data Center

Storage Server

Facility C Data Center

Gateway Gateway

VNA

Storage Server


Storage Network

Uni-Viewer

Facility C Data Center LAN

VNA

Uni-Viewe

r

Storage Network

Facility C WAN

1/23/2012 – Version 7.1 38

Facility’s Gateway Server is eliminated Primary Vendor Neutral Archive subsystem is deployed in

Facility’s data center Normalizes Primary Copy of data for all Facility’s PACS Manages the Primary Copy of all data across the Enterprise

Facility PACS storage can be reduced to 18-24 month cache Local instance of the UniViewer image–enables Facility’s

EMR

Upgrade to local VNA Functionality

1/23/2012 – Version 7.1 39

The Hybrid Solution: Supports fully interoperable data exchange of the Primary Copy of

the data between all PACS in a Facility Supports Aggregation of the Primary Copy of the patient data across

all PACS in the Facility Supports non-PACS departments in the Facility with

o Image acquisitiono QA/QCo Study Reconciliation

Supports ILM functionality for the Primary Copy of the data


1/23/2012 – Version 7.1 40

The Hybrid Solution: Eliminates future data migrations for Facility/Organization Improves performance of EMR and Internet access to Facility’s

images by drawing on the Primary Copy of Facility data Lowers cost of Facility PACS storage by cutting back PACS cache to

18 to 24 months Secondary subsystem in Cloud provides Facility with both DR and

BC solutions


1/23/2012 – Version 7.1 41

1/23/2012 – Version 7.1 42

Key Features of VNAAddressed in

RFI to Vendors

1. Bi-Directional, Dynamic Tag Morphing to facilitate data exchange (on-the-fly conversions of data formats in support of data exchange between disparate PACS)

2. Fundamentally a manager of DICOM Objects…but must support methodologies for accepting/managing non-DICOM Objects (DICOM-wrapping, DICOM encapsulation, Web Services)

3. Sophisticated Information Lifecycle Management, including policy-based Study Deletion, driven by patient/study meta data

4. Pseudo Master Patient Index (MPI) MRN matching capabilities and optional full-featured MPI

5. Automated / scheduled Pre-fetching and Auto-routing using user-defined Relevant Prior Algorithm Compensation for smaller PACS Cache

Key Features of the CTN Cloud VNA

1/23/2012 – Version 7.1 43

6. Logical Segregation of Data by Organizational Node (departments, facilities, outside groups)

7. Creation of XDS-I Manifest and Optional XDS-I Registry and Repository

8. Flexible, Auditable Transaction Logging

9. Disaster Recovery / Business Continuity configurations with automated Failover and post-recovery Reconciliation

Not part of requested Vendor Solution Image Acquisition, study Reconciliation, manual QC tools (workflow for

departments without PACS)

Key Features of the CTN Cloud VNA

1/23/2012 – Version 7.1 44

1. Zero Client, Server-Side Rendering Rendering Server operates on loss-less version of the image HTML object download

2. Cache-less (dynamically retrieves image data from local image repositories such as PACS, VNA)

3. Supports multiple OS, multiple Browsers4. URL-based Interface to EMR (Physician Portal)5. Accepts user Authentication from EMR6. Auditable Transaction Logging7. Optional web services interface to VNA/Storage Solution8. Basic to Advanced display features/functions9. Compatible with both DICOM and non-DICOM image objects

Key Features of the CTN Cloud VNA UniViewer

1/23/2012 – Version 7.1 45

1/23/2012 – Version 7.1 46

Sharing Images through

CORHIO and QHN

Owen Hathaway, CTN Architecture [email protected]

Considerations for HIE Image Sharing

1/23/2012 – Version 7.2 47

Enabling technology is XDS-I Requires XDS-I enabling of very PACS repository and Viewer Assures aggregation of all studies belonging to the same patient Does not assure PACS compatibility

Significant infrastructure “in the middle”…XDS-I Registry & Repository and associated eMPI

HIE data repositories do not act as DR or BC solutions for the participating organizations Rolling 30 day repositories of image data

Represent Incremental Costs

Shared VNA DR/BC is a more pragmatic and less expensive alternative Facilitates PACS-PACS Image sharing with guaranteed data

compatibility Any DICOM-conformant PACS/Viewer can participate Cost of appropriate DR solution shared across many organizations Integrated UniViewer image-enables local EMR, provides BC,

enables both inside and outside Internet Image Sharing Shared VNA DR/BC can also interface to any HIE

Requires only one XDS-I and eMPI upgrade Guarantees data compatibility in the XDS-I environment

1/23/2012 – Version 7.2 48


1/23/2012 – Version 7.2 49


1/23/2012 – Version 7.1 50

Summary


Conventional PACS Archives are limiting PACS effectively create proprietary image data

Complicating data exchange within the organization and between organizations participating in a Health Information Exchange

Necessitating costly data migrations when PACS are replaced Giving the vendor control over next PACS decision

Vendor-Neutral Archive is a better, cost-effective way to manage data for the Clinical/Legal Lifecycle

Summary

1/23/2012 – Version 7.1 51

Wide range of real-world problems are resolved by DICOM Header Tag Morphing Consolidating all image data in an Enterprise Directory Providing Physicians with unified multi-modality UniViewer

Strategic First Step is the pro-active Migration of all of the organization’s PACS Data to the proposed CTN, Cloud-based, VNA-enabled DR/BC Solution Shared Infrastructure Data Segmentation by Organizational Node

Summary

1/23/2012 – Version 7.1 52

Proposed CTN Cloud-based Solution facilitates numerous applications using each organization’s Secondary copy of its image data… Geographically Separate Disaster Recovery Solution Local PACS-to-PACS Image Data Sharing Optional participation in HIE data exchange Image-enabling each organization’s EMR Secure Internet Image Sharing with outside Physicians Viable Business Continuity Elimination of costly future Data Migrations

Summary

1/23/2012 – Version 7.1 53

QUESTIONS?

THANK YOU

1/23/2012 – Version 7.1 54

Documents

Colorado Vendor Neutral Archive (aka CTN Cloud VNA)