Agenda
Current State Market Research
• The “next” PACS• Vendors considered for VNA• Reasons for Considering a VNA
Vendor Neutral Archiving• Requirements for a VNA• Providers of VNA• Architecture of a VNA• Next Generation VNA• Strategy for deploying a VNA
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What are the drivers for Healthcare IT
Growth of Data• Size of Studies Increasing
CT – Cath – Path • Number of Studies Increasing
Access to Data• Number of Users Requesting Data
Big data sets moving across the wire• Complex Business Models
Association and integrations of healthcare providers EMR enablement – images critical
Requirements Are Constantly Changing Government Mandates Compliance with Current and
Future Rulings Dynamic Vendor Environment Standards Become More Important
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What is Current Situation in Imaging?
Applications Own The Data• PACS control Data Format and often the
Storage Hardware, OS, and Networks
• PACS Proprietary Format Makes It Difficult To:
o Replace a PACSo Add New Applications To Existing Storage
Systemo Share Data Between Applicationso Add New HW or IT Strategies, i.e. Business
Continuityo Integrate with HIS, EMR and other IS systems
• Data Migration Is Required When:o Selecting A New Vendoro Upgrading - Either Replacing Storage or PACS
SW Upgrade
• Adds Cost, Reduces Flexibility and Increases Complexity
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Gray ConsultingP.O. Box 972Novato, CA 94948-0972Phone: 415-892-0943Cell: 415-328-2842Fax: 415-897-0384Email: [email protected]
http://www.graycons.com/about/
What a VNA MUST Do
BREAK the Proprietary Link to YOUR data
Eliminate Custom Engineering
• Integrate via Configuration
• Must be GUI driven by the customer
Require full Standards-based Interoperability
Manage Storage as an Enterprise Resource
Enable PACS as Applications, Not Storage Systems
Provide Efficient Access and Administration
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Results: Higher Quality of Service - BC – Dedicated Viewer Streamlined Operations/Improved Productivity Effectively Lower TCO In All Areas
2012 Acuo Technologies® Proprietary and Confidential
Vendor Neutral Archiving
A True Vendor Neutral Archive solution is a single set of software tools to centralize all medical imaging systems into one perpetual repository.
Simpler management Seamless migrations Independent of PACS deployment Scales to meet all your capacity needs
Before After
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Any-ology
Radiology – CT, MRI, PET, Diagnostic Radiology, Fluoroscopy,
Ultrasound, Nuclear Medicine, Breast Imaging, Interventional
Radiology, DEXA
Dermatology - Visible Light Imaging
Cardiology – Cardiac Cath, Echocardiology,
Nuclear
GI Lab
Ophthalmology Pathology Wound Care
Otorhinolaryngology
Neurosurgery Oncology
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What is expected now
How are non-DICOM objects handled?
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A B C
File System Interfac
e• Normally existing integration through CIFS/NFS
Enterprise Storage Platform
DICOMWrappin
g• Standardized Information Model for store / retrieve / display
• Can facilitate ILM• Uniform Image Viewer
Portability• Established use in
healthcare• Additional DICOM SOP’s
being added all the time
• Does not easily support non-image content types
• Normally lower cost integration
• Proprietary file format• Proprietary Information
Model • Doesn’t solve data
mobility issues• Many systems store
content in database directly
Native Content
Management
• Web Services Integration
• Costs associated with integration
• Adapter development• Portability
(compatibility with other systems)
• Accessibility challenges
• Increases migration liability
D
XDS
• Standards based – IHE driven
• Standardized Information Model for store / retrieve / display
• Can facilitate ILM• Requires
deployment across entire enterprise
• Expected to emerge in HIE projects
Application Neutral Middleware Direct Application Read/Write
Custom APIXDS
• CONSIDER: If this route is chosen use an XDS information model
2012 Acuo Technologies® Proprietary and Confidential
Additional Expectations of a VNA Enables a Clinical viewer for the EMR
that allows viewing of all images• Provide one integration point for images• Move to a rendering viewer strategy with no
image cache End of Migrations
• It is a replacement market in PACS Robust support of next generation
storage• Business continuity• Cloud Hosting
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Who provides VNA Pure Play VNA Vendors
• Software only – smaller - innovative• No Diagnostic Viewer
Infrastructure Providers• Often already providing enterprise storage
solution• Often use Pure Play VNA Vendors for software
Solution Providers• Combine software, hardware, network and
service• Offer “one-throat-to-choke”
PACS Providers• Send us everything, we can manage it.• Many deployments, few if any without their
PACS• Will require future migration
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Enterprise Archive Strategy Choice
MAIN FACILITYDISASTER RECOVERY SITE
DICOM DICOMHL7
Radiology PACS
Cardiology PACS
EMR
Storage Management Software
TAPE
Enterprise Image Archive (VNA)
OTHERSATA
CIFS, NFS, API
SAN CASSCSI
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RIS / HIS / EMPI
DICOM / WADO
Custom Interfaces
Proprietary File AccessCIFS, NFS, API
HTTP/REST
Future Imaging
???????
Cloud based
iSCSI
Image Enabled
Multiple Patient ID’s• PIX (Patient Identifier Cross Referencing)
Universal Viewer• Provide one integration point for images• Separate the PACS viewer from EMR
viewer• Ensure that the clinical viewer is robust
XDS Registry and Repository• XDS provides standards support for
management of non-DICOM without locking customers into vendor proprietary technology
• VNA’s should provide simplified Web Services for ease of non-DICOM compliancy the create XDS context automatically within the VNA
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Next Generation VNA’s
Build a Plan to Gain Control• Sever the Proprietary Link Between
Applications (PACS, CPACS) and Storage
Require Applications to Interoperate in a High Performance, Standards-based Format
Identify PACS as a Valuable Departmental Workflow Application, NOT Storage Systems
• Decide on an Infrastructure Solution Storage/Network Business Continuance Strategy
• Bring DICOM Skills into IT
• Come to Terms With the Inevitable Migration
Commit to Make it Your Last Migration!
Develop the Strategy
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The Solution!There are a number of strategic approaches to
building a Vendor-Neutral Enterprise Archive
Take the “A” out of PACS• Migrate to VNA platform BEFORE PACS
replacement• Put out RFP for the non-archiving portion of
PACS• Connect new PACS directly to VNA• Shut Down Legacy PACS quickly after new
PACS is up
PACS A Lifetime
VNA Lifetime
PACS B Lifetime
Data Migration phase
1 2 3 4 5
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2012 Acuo Technologies® Proprietary and Confidential