Navy Medicine Clinical Imaging Archive

(NCIA)Symposium Brief

Michael Fortier4-6 June 2012

BRIEFING OUTLINE

1. History

2. Current Methodology

3. A New Approach to Imaging

4. Timeline

5. Benefits of a NCIA

6. Challenges

7. Future Possibilities

8. Conclusion

PURPOSE: Information briefing to provide and update and roadmap of the current lifecycle replacement of the Navy imaging archives.

Slide 2 of 18 - April 11, 2023– FOUO –

Alabama

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California

Colorado

Delaware

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Montana

Maine

Massachusetts

Maryland

Michigan

Minnesota

Missouri

Mississippi

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Wisconsin

Wyoming

Washington

West Virginia

Connecticut

District of Columbia

Hawaii

USNH Yokosuka,

Japan

USNH GuamUSNH

Okinawa, Japan USNH

Sigonella, Italy

USNH Naples, Italy

USNH Rota, Spain

USNH Guantomano

Bay, Cuba

CURRENT METHODOLOGY

PACS with individual archives

Slide 3 of 18 - April 11, 2023– FOUO –

CURRENT METHODOLOGY

Command Centric PACS Specialty Specific Systems – Radiology, Cardiology, Dental, etc… Silos of image data – each system has it’s own (usually proprietary) archive. Sharing relevant image data between specialty systems is manual and problematic. Some PACS allow images taken from within the command to seen throughout the command. Viewing images between commands requires manual sending and receiving of images, or patients with CD.

Migrate all the data to the new system (even with the same vender sometimes)

TBs of data, years to complete, every time, every region, at a huge costThis is just going to get worse

~8 million radiology studies currently being stored (100+ TBs)~1.2 million radiology new studies a year (10+ TBs)All the other imaging types are starting to be captured Slide 4 of 18 - April 11, 2023– FOUO –

A NEW APPROACH TO IMAGING Separate the archive from the PACS / Workflow Engine

Individual clinical workflow engines specific to specialty needsWorkflow management separate from medical image archive management

Move away from proprietary standards to open standardsVNA (vendor neutral archive)PNA (PACS neutral archive)IHE compliant archive (Integrating the Healthcare Enterprise)

XDS, XDS-I, PIX, DICOM part 10

Endoscopy

Radiology

Cardiology

Dental

Opthalmology

Dermatology

Current End StateOpthalmology

Dental

Radiology

Cardiology

Dermatology Endoscopy Clinicalapplications

Pre-decisional – FOUO – Pre-decisional Slide 5 of 18 - April 11, 2023

A NEW APPROACH TO IMAGING

FOR OFFICIAL USE ONLY6

Slide 6 of 18 - April 11, 2023

Alabama

Arizona

Arkansas

California

Colorado

Delaware

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Montana

Maine

Massachusetts

Maryland

Michigan

Minnesota

Missouri

Mississippi

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Wisconsin

Wyoming

Washington

West Virginia

Connecticut

District of Columbia

Hawaii

USNH Yokosuka,

Japan

USNH GuamUSNH

Okinawa, Japan USNH

Sigonella, Italy

USNH Naples, Italy

USNH Rota, Spain

USNH Guantomano

Bay, Cuba

A NEW APPROACH TO IMAGING

One Global ArchiveAll images in the archive are viewable at all sitesImages are federated across multiple facilities and sent to the primary Navy archive

Slide 7 of 18 - April 11, 2023– FOUO –

Alabama

Arizona

Arkansas

California

Colorado

Delaware

Florida

Georgia

Idaho

IllinoisIndiana

Iowa

Kansas

Kentucky

Louisiana

Montana

Maine

Massachusetts

Maryland

Michigan

Minnesota

Missouri

Mississippi

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Wisconsin

Wyoming

Washington

West Virginia

Connecticut

District of Columbia

Hawaii

USNH Yokosuka,

Japan

USNH GuamUSNH

Okinawa, Japan USNH

Sigonella, Italy

USNH Naples, Italy

USNH Rota, Spain

USNH Guantomano

Bay, Cuba

Slide 8 of 18 - April 11, 2023– FOUO –

One Global ArchiveAll images in the archive are viewable at all sitesImages are federated across multiple facilities and sent to the primary Navy archiveThe nodes will automatically propagate studies

A NEW APPROACH TO IMAGING

Alabama

Arizona

Arkansas

California

Colorado

Delaware

Florida

Georgia

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Montana

Maine

Massachusetts

Maryland

Michigan

Minnesota

Missouri

Mississippi

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Wisconsin

Wyoming

Washington

West Virginia

Connecticut

District of Columbia

Hawaii

USNH Yokosuka,

Japan

USNH GuamUSNH

Okinawa, Japan USNH

Sigonella, Italy

USNH Naples, Italy

USNH Rota, Spain

USNH Guantomano

Bay, Cuba

Slide 9 of 18 - April 11, 2023

One Global ArchiveAll images in the archive are viewable at all sitesImages are federated across multiple facilities and sent to the primary Navy archiveThe nodes will automatically propagate studiesDisaster recovery internal to the solution

A NEW APPROACH TO IMAGING

TIMELINE

Significant MilestonesMay 2012 - RFP releasedSep 2012 - AwardOct 2012 - Begin Global Archive project Nov 2013 - Begin specific site projects / migration ongoing

Timeline from one vender

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BENEFITS OF A NCIA

All completed images are viewableCompleted status is based on workflowAppears to be one archive

Allow multiple IHE-complaint COTS workflow systems to use the archiveRadiology PACSCardiology PACSOptometryiORDocument ManagementMedical PhotosDental ImagingReserve Health Readiness Record

End StateOpthalmology

Dental

Radiology

Cardiology

Dermatology Endoscopy Clinicalapplications

Slide 11 of 18 April 11, 2023– FOUO –

BENEFITS OF A NCIA

Built-in disaster recoveryThe system can self-replicate across multiple sites and/or the two Global ArchivesNo MigrationData stored in a standards-based system (DICOM part 10)Huge cost savings

~15% of the cost of a new system is migrationThe old system has to be maintained during migration

Years after it is not used by providers

Hardware agnostic

Interface Level

Storage Management Level

SANSAN SCSISCSI CAS/COSCAS/COS NASNAS SATASATA TAPETAPE OTHEROTHER

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CHALLENGES

Multiple CHCS hosts (Multiple Patient IDs)The new DEERS ID/MPI (Master Patient Index) will correct thisVNA solutions can do cross-domain patient identifications

BandwidthThe local sites will store 3-5 yearsof local images in FIFO CacheAfter 3 years, less than 1% ofimages are viewed again

Enterprise Workflow SupportDoes not support enterprise workflow

1st 2nd 3rd 4th 5th Age

The retrieval of images drops

significantly after the first year

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CHALLENGES

ManagementParadigm shift: Radiology images to medical images / artifactsSystem administrators are already in placeSeparating archives from workflow components enables easy transfer of responsibilities of archive management Potential for additional resources based upon policy decisions

PolicyVNA technology is matureNeed policy and guidance for MTFs

Compression policyRetention policyManagement policyIntegration policy

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FUTURE POSSIBILITIES

The VNA can also be used as an imaging repositoryAdd a zero download clinical viewerCan store multiple formats (jpg, pdf, mp4, wav)Provides XDS registry/repository Any number of XDS/IHE-compliant COTS workflow / ingestion systems can flow into it

Document scanning, video recording, photography, dental

HAIMS would only need one touch point for all images / artifacts within the Navy

Simplify deploymentSmaller footprint of HAIMS within MTFs

Less hardwareSmaller sustainment costs

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FUTURE POSSIBILITIESInteroperability with other Services

Army heavily involved in the contract requirements generation, pursuing the same strategySystem can integrate and query other archives

Other Services’ archives (Air Force, AGFA IDCs) with implementation of network connections Theater Image Repository (TIR)

Flexibility in infrastructureScalability provided through increasing node storage capacity or adding nodesReduction in number of nodes possible without migration requirements

Pre-decisional – FOUO – Pre-decisional Slide 16 of 18 - April 11, 2023

CONCLUSION

The initial driver for this effort is the projected savings on migration time and costs

Maturity of Vendor Neutral Archives results in unprecedented capability to share information across the enterprise

BUMED guidance and policy required to facilitate complete paradigm shift

Can be accomplished within 18 months using COTS products

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Questions

Questions

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