Carestream VNA, an Oxymoron?

Carestream VNAAn Oxymoron ?Presented at UKRC 2013

Ignace WautierHealthcare IT Business Development Manager11 June, 2013

Public© Carestream Health, 2013

Agenda

Healthcare needsRequirements for UK market.What is a Vendor Neutral Archive? How to chose the right VNA Supplier?


What is Vendor Neutral Archiving? What is an Oxymoron?

An Oxymoron is defined as:

“A figure of speech that combines contradictory terms. The plural is Oxymora.”

Oxymora usually reveal a paradox, especially when applied to Vendor Neutral Archiving.

If it’s Vendor Neutral, who do you buy it from? Nobody? Anybody? Everybody? What makes it Vendor Neutral?

What is Vendor Neutral Archive?


http://en.wikipedia.org/wiki/Figure_of_speech

Healthcare Trends

Department Silos archives replaced by unique archive

Cross site secured data sharing

Benefits to the overall enterprise rather than one specific department.

Consolidate Patient Centric Data Repository


Single Vendor Neutral

Archive


Consolidate data in a cost effective way, without the need to replace the existing infrastructure in one single step

Easily integrate with legacy systems, expanding production and replace existing systems when needed

Archive and share data that are not necessary DICOM compliant.

Keep control/ownership of data produced when replacing clinical applications. Cost control. Be vendor independent

Constant increase in performance & speed of data transfer

Healthcare organisations needs in UK

VNA appear to be a solution


What is theideal VNA?

Who’s the right Partnerto provide your VNA?

Is there a standarddefinition for VNA?

Is it answeringall the needs?

VNA Market definition

2009, Herman Oosterwijk, President, OTech Inc

p.7


“A Vendor Neutral Archive (VNA) is a medical device that provides scalable image and information and life cycle management so that images and related information can be queried, stored, and retrieved in a manner that is defined by open standards at multiple department, enterprise, and regional level while maintaining patient privacy and security.

Characteristic for a VNA is that it provides a patient-centric approach that transcends upgrades and changes of the different viewing, acquisition, and workflow management components as they should be interchangeable without having to migrate, convert, or change the data formats or interface of the VNA”.

VNA Market definitionInMedica – Industry Report 2012

p.8

DICOM, HL7 and other Standards-based communicationDICOM, HL7 and other Standards-based communication

Support for multiple PACS

Non-DICOM data sharingNon-DICOM data sharing Clinical lifecycle management

Security, long-term archive and disaster recovery

Optionally: XDS registry and repository, storage virtualization, web-based access & zero-client viewer

Optionally: XDS registry and repository, storage virtualization, web-based access & zero-client viewerPublic

© Carestream Health, 2013

A vendor-neutral architecture (VNA) for medical data is a platform that provides long-term, disaster recovery, lifecycle management and the ability to easily share medical by communicating with different PACS. It serves as a central repository for medical images and other patient data based on an open architecture for multiple department, or multiple hospitals. It should also accept data irrespective of the originating PACS or other viewing, acquisition and workflow management system, making these originating sources changeable without having to change the data formats or interface of the archive. Outside the sharing of information based on secure access and authorization, it offers resilience against network interruptions, long-term archive, and disaster recovery services.

VNA – More Than a Buzzwordp.9

VNA attempts to solve three main problems:


Consolidate data archiving from different PACS within an

organisation, region, country, … Cost reduction, foundation for

data sharing, …

Provide repository for other departments beyond radiology.

This is true for single or multi-site environments.

PACS replacement has proven to be costly & lengthy.

Important information stored in PACS such as image

annotations, Key Images, and changes to studies are

sometimes lost.

Typical Requirementsp.10


The Ideal VNA: Design•Specialised EMR modules drive the viewer of each “ology” taking care of departmental workflow

•Image/data transfer protocol is standard & efficient

•All departmental application servers are independent & replaceable without affecting the rest of the organisation

•Data is accurate with all modifications

•VNA is replaceable (no data migration)– Works like USB

•Any enterprise viewer can access ANY data in the VNA, a patient-centric view.

p.11

Vendor Neutral Archive

Workflow

Radiology

Viewer

Cardiology Other

EMR\RIS\CIS (non unified)

Workflow

Viewer

Workflow

Viewer

Enterprise Viewer

DICOM//XDS

Appl

icati

on S

erve

rs

Standard Storage Format

Transfer protocol



The Ideal VNA: Challenges

This Ideal VNA may introduces challenges

•Lack of "hyper speed" transfer protocols. Current standard communication protocols are slow and limited (DICOM)

•Vendors optimise their solutions to provide enhanced functionality and features through proprietary mechanisms.

•Customers expect more benefit out of the centralised archive (e.g. enterprise viewer, patient portals, etc), May require non standard components.

•Customer are not willing to compromise on performance.

•Master Patient Index management! Who is responsible? EMR driven MPI or VNA vendor?

p.12


Workflow

Radiology

Viewer

Cardiology Other


Workflow

Viewer

Workflow

Viewer

Enterprise Viewer

DICOM//XDS

Appl

icati

on S

erve

rs

Standard Storage Format (DICOM Part 10 ???)

Transfer protocol


Challenges lead to the Practical VNA being deployed today. Introduces additional layers to the Ideal VNA design


The Practical VNA:

•Each department has its own workflow and display needs. Departmental systems include an additional Cache + DB layer to address performance issues.

•There is continuous traffic between departmental systems and the VNA

– to ensure data integrity. Requires overhead monitoring.

– Supporting the prefetch mechanisms required for performance to access the complete patient record

•Some VNA’s are implemented with local database & proprietary file formats to maintain adequate performance against the departmental systems

•VNA’s vendors provide exit strategies to support the Vendor Neutral concept

p.13


Workflow

Radiology

Viewer

Cardiology Other


Workflow

Viewer

Workflow

Viewer

Enterprise Viewer

DICOM//XDS

Appl

icati

on S

erve

rs

Proprietary Storage Format

DICOM/XDS


Cache & DB Cache & DB Cache & DB

Cache & DB

Database / Interface


p.14

VNA is also non-Dicom Support


Vue Archive (VNA)

Tiered Storage

Lifecycle Management

XDS Repository

API

DICOM

HL7

XDS Registry

Radiology: DICOM / HL7

Laboratory:“Other” data

Other Clinical:“Other” data, XDS

Cardiology:DICOM / HL7 / “Other “data

Additional IHE ProfilesXDS, XCA, BPPC, MPI, …

XDS Actorsp.15

Document Registry

Document Consumer

Document Repository

Document Source

Provide & Register Document Set

Query Registry

Register Document Set

Retrieve Document

Patient Identity Source

Patient Identity FeedPatient Identity Feed HL7v3Vendor

NeutralArchive

XDS Consumer

Modality : Workstation / Clinical

application


p.17

BPPC – Basic Patient Privacy Consent

Under which condition?

Medical documents are labeled with a Confidentiality Code

Which functional rolemay access which document?

What are disclosure rules?

XDS Consumerp.18

Zero foot print client

List of Medical data stored

Launch a web viewer/browser to display data

Support BPPC profile to guaranty patient privacy

BPPC & XDS Consumerp.19

Confidentiality code defines document access

In of emergency user can “brake the glass”.

Action will be traced in the Audit Log repository following the ATNA profile

VNA is the foundation for data sharing

p.20


Can A PACS Vendor be a Vendor Neutral for Archive?

p.21


One of the biggest misconceived notion is that a PACS vendor cannot provide a VNA

If it’s Vendor Neutral, who do you buy it from?Nobody? Anybody? Everybody?

While some legacy solutions would fall under that category, Carestream strives to provide an enterprise clinical data repository

that fits the description above and addresses the needs of the healthcare

Entire portfolio has been articulate around Central VNA solution called “Vue Archive”

At Carestream we believe …

p.22

RepositoryVue Archive - VNAConsolidated clinical archive: interoperable, standards based for longevity

Enterprise ManagementEnterprise ManagementPatient data aggregationData sharing

RIS PACS CardioClinical Departmental SolutionsAdvanced clinical toolsets: single workspace for productivity from image review to report

Physician Collaboration

Patient Access

Universal ViewersAccess to Patient Medical records regardless of clinical system: secure, device neutral, mobile


A complete portfolio articulated around Vue Archive

p.23

2004

First Non radiological department connected to Neutral Archive

2003

First Neutral Clinical Archive installed

2010

10 Cloud Infrastructures managing 80M studies

“Trendsetter” someone who starts a new style or helps to make it popular

Smart Innovations

2011

Flexible enterprise access

Patient Imaging portal

20122008

IntroductionOf CloudArchive Services

2009

Single patient worklist connects multiple PACS

XDS on Vue Archive

VNA onVue Archive


p.24

RuralClinic

Vue Archive VNA

UniversityHospital

DICOM

HL7

IHE XDS-i

Regional Hospital

HL7


One Software fit all needs

DICOM

DICOM

HL7

“Other” Data

XDS

Reading Center

Teleradiology

CARESTREAMVue Archive

XDS

Secured “Patient Centric” archiving solution.

Endless number of data sources

Unlimited storage volume

Vendor Neutrality: Data format, platform, PACS vendor

Ingensts data from disparate clinical vendors via:DICOM, HL7, IHE XDS, XDS-I, Other

All data types managed through one centralized system

p.25

A “PACS” Vendor can also provide you additional layers


Universal Viewer

Vue MotionA Vendor Neutral Portal for physicians

Zero foot-printNo installation

Pure WebHTML 5

Zero Training Intuitive User Interface

Enable Remote collaboration

And what about the Patient?p.26


Pure Web HTML 5

Patient Portal

Easy to accessEasy to use

Ability to share with referring

Patient definessharing rules

Patient keep controlof his medical data

My VueA Secured Vendor Neutral Portal for patient

p.27

RuralClinic

Vue Archive VNA

UniversityHospital

DICOM

HL7

IHE XDS-i

Regional Hospital

HL7


A complete solution

DICOM

DICOM

HL7

“Other” Data

XDS

Reading Center

Teleradiology

CARESTREAMVue Archive

Physician’s Office

Patient Portal

Clinical Portal

XDS

Smooth migration from your legacy archivep.28

Public© Carestream Health, 2013Public© Carestream Health, 2013

Legacy Archive

Meta-data Take-over

Intelligent Data Migration

Query

Data Retrieve

Vue Archive VNA

Retrieve Command

Data Retrieve

p.29

Fully Owned Capital Investment

Carestream Vue Cloud Services

Purchasing Options

p.30

Imagine an Enterprise Health IT Strategy with a Complete Patient Medical Records Platform that can…

Manage patients not pixels. Easily provide global patient medical records, shifting the reporting workflow paradigm.

Collaborate and share. Enable on-demand access to critical clinical insight regardless of system or geography.

Infinitely scalable. Seamlessly manage and archive all imaging source and document formats beyond traditional radiology or cardiology departments, throughout the entire medical data lifecycle.Public

© Carestream Health, 2013

Thank you

Health & Medicine

Carestream VNA, an Oxymoron?