vue vna - clinical collaboration platfrom - v1.2 - 20140925 · integrated healthcare model 5...

Vue VNAVue VNAClinical Collaboration Platform

UK & I User Group – Manchester – October 1st

Ignace Wautier

Healthcare IT Business Development Manager, Northern EuropeUnrestricted Internal Use© 2014, Carestream Health

Healthcare in OECD Countries

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Unrestricted Internal Use© 2014, Carestream Health

OECD Data for Health Expenditure as a percentage of GDPSource: http://www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm

Healthcare in OECD Countries

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Not correlated with high quality of care

Healthcare system is not efficient enough•Too much avoidable healthcare escalations•Not appropriated exam prescriptions•Too much retake of exams•Lack of communication between healthcare professionals•Lack of communication between healthcare professionals•Chronic conditions account for appr. 75% of healthcare direct costs

Population is agingMore healthcare procedures - Less healthcare professional

Patient wants to be « engaged » in his treatment


Healthcare IT in Northern Europe

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More national systems are going to a “bundeled” payment.Fixed amount of reimbursement for one or more providers based on standardized procedures.

IT investment are seen as a primary driver of healthcare services IT investment are seen as a primary driver of healthcare services productivity/efficiency

•Increase Efficiency•Costs reduction•Efficient collaboration/sharing•Patient involvement/satisfaction


Integrated Healthcare Model

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McKinsey&Company estimates in a recently published report that the U.S. alone could generate upside of $1 report that the U.S. alone could generate upside of $1 trillion in savings if the entire system switched to integrated healthcare delivery.•Better Integration (Institutions, Specialist, Systems)•Better Accessibility to Patient Information•Better Collaboration•Better Efficiency•…


http://www.mckinsey.com/insights/health_systems_and_services/claiming_the_1_trillion_prize_in_us_health_care

Patient Clinical Information

p.6

EPR/EHR

Patient Demographics

ADT

Scheduling

Clinical Data

Diagnostic Images

Photos

VideosScheduling

Financials

Videos

Scanned Documents

WaveformsPatient and Physician Community

Unrestricted Internal UseCarestream Health, © 2014

Carestream Healthcare IT Mission

�Providing information technology solutions that

enable better healthcare delivery around the world

More than a Product Portfolio

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Building Healthcare IT Solutions that increase efficiencyBuilding Healthcare IT Solutions that increase efficiency

� Solutions to answer customer needs & to solve customer challenges

� Solutions to improve healthcare efficiency and quality

�Solutions to improve collaboration, integration and accessibility

�Solutions to place the Patient in the center of the care

We are the Clinical Data Workflow Experts


Introducing CarestreamClinical Collaboration Clinical Collaboration Platform


Optimized workflow for all Clinical Data

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Clinical Data Collaboration Platform

AcquisitionDepartment

Viewer

Enterprise Information

System

Web Import Tool, Grabber

Specific tool for each department Viewer

Accessibility, Sharing, Collaboration, …

AdministrationMeta-Data Update

Archive & Workflow Administration - Access

Business Analytics

Autonomous departmental workflow from

acquisition to diagnostic viewing. Intuitive

enterprise data sharing and distribution

Real-time dashboard for intelligent and

efficient management

Clinical Rich Reporting Capability Clinical Rich Reporting Capability

embedded in Web Viewer (*)embedded in Web Viewer (*)

RepositoryVue Archive

Carestream VNA for the Enterprise

Patient Centric Archive

Enterprise PortalWeb Portal to access data•Ingest images/documents – Enterprise information System•View/work/diagnostic•Share/Collaboration

Accessibility, Sharing, Collaboration, …

Patient centric foundation with build-in

interoperability, standards based storage.

Simple to deploy web-based patient data

aggregation , interface & Workflow

enterprise data sharing and distribution

Patient-centric management eliminates information silo’s and improves collaboration & EPR Integration

VALUE

embedded in Web Viewer (*)embedded in Web Viewer (*)

(*) available soonUnrestricted Internal UseCarestream Health, © 2014

VNA as a foundation

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What is a Vendor Neutral Archive?

Why do you need/want a VNA?


VNA Market definition

2009, Herman Oosterwijk, President, OTech Inc

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“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 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”.


Typical VNA Requirements

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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

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Workflow

Radiology

Viewer

Cardiology Other

EMR\RIS\CIS (non unified)

Workflow

Viewer

Workflow

Viewer

Ap

plic

atio

n S

erv

ers

Transfer protocol – Works like USB

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

Vendor Neutral Archive

Enterprise Viewer

DICOM//XDS

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),

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Workflow

Radiology

Viewer

Cardiology Other


Workflow

Viewer

Workflow

Viewer

Ap

plic

atio

n S

erv

ers

Transfer protocol 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?

Vendor Neutral Archive

Enterprise Viewer

DICOM//XDS

Standard Storage Format (DICOM Part 10 ???)

Transfer protocol



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I don’t give a …

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 &

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Workflow

Radiology

Viewer

Cardiology Other


Workflow

Viewer

Workflow

Viewer

Ap

plic

atio

n S

erv

ers

Cache & DB Cache & DB Cache & DB

•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 conceptVendor Neutral Archive

Enterprise Viewer

DICOM//XDS

Proprietary Storage Format

DICOM/XDS


Cache & DB

Database / Interface


Vendor Neutral Archiving Solutions

Vue Archive

• Integrates data from disparate clinical vendors via: DICOM, HL7, PIX, MPI, IHE XDS Framework, XDS-I, WADO and other Non-DICOM objects

• Intelligent Clinical Information Lifecycle Management using meta data for cost effective management and migration

• Archives data in a neutral format – Easy migration to new vendor

• Standard XDS Registry/Repository

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• Standard XDS Registry/Repository

• Smart layers to ensure efficiency

Provide centralized, scalable, redundant, clinical information management control and archiving solution

On-Site or Cloud


Can A PACS Vendor be a Vendor Neutral for Archive?

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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”


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RuralClinic

Regional Hospital

One Software fit all needs

DICOM

Reading Center

CARESTREAMVue Archive

Vue Archive VNA

UniversityHospital

DICOM

HL7

IHE XDS-i

HL7

Public© Carestream Health, 2013

DICOM

HL7

“Other” Data

XDS

Teleradiology

XDS

Over 100 year experience in Clinical Image Mgmt.

p.21

First Clinical 10 Cloud

Smart Innovations

Patient Imaging Introduction

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

2004

First Non radiological department connected to Neutral Archive

2003

First Clinical Neutral Archive installed

2010

10 CloudInfrastructures managing 80M studies

Clinical Collaboration Platform2011

Flexible enterprise access

Imaging portal

20122008

IntroductionOf CloudArchive Services

2009

Single patient worklist connects multiple PACS XDS

complianceVue Archive

VNA onVue Archive

2014FDA clearance Vue MotionDiagnostic on mobile devices

Carestream Clinical Collaboration Platform

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Web Enterprise Clinical Data Capture

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www.algotecregion.org/portal


Mobile Capture (Concept)

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• Simple mobile web application to capture images or record short videos with the integrated camera of the mobile device and immediately upload to the VNA archive

• Possibility to upload via WiFi or even in 3G/4G for full mobility • Possibility also to select files from the internal camera roll• Allows capture of clinical images anywhere at any time, gathering information that

would be lost:• Accident scene, Ambulance• Home care • Legal proofing


Video Grabbing

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medXchange Evolution HD

� SDI / DVI / S-Video / Composite� 750 Gbyte internal drive� Medical device class 1� ISO 13485� Pedal / Hand switch integration availableavailable� Small size (10x20x17)� Full HD 1080p� H264 Video encoding, MP4 format� Multi language

medXchange is integrated with Carestream Vue PACS (worklist, bookmarks)


Departmental Diagnostic Applications

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Any Dep. Diagnostic Application Launched from Vue Motion


Carestrean Vue Enterprise Report

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Simple and powerful multimedia rich Report

Where ever you can see images – you can report

Native embedded Reporting capabilities

• Structured, Typing, Voice Recognition

• No third-party integration

• Minimize error and discrepancy

Carestream Vue Reporting enables you to:

Clinical-context rich report fosters collaborationVALUE

Clinicians appreciate the comprehensive diagnostic report with quantitative measurements, comparison and key images

Carestream Vue Reporting enables you to:

• Reduce on-going operational costs as a native module

• Automatically include relevant data from the modalities generated DICOM Structured data into the report

• Embed clinically rich insight such as key images or quantitative analysis into the report

• Incorporate image with the textual report to aid diagnosis and treatment decisions

• Hyperlink and automatic data sharing – Multimedia Report


Multi-Media Reports (As Seen in Vue Motion)

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Increase the Clinical Value of Report for Clinicians with Hyperlink, Quantitative Analysis and NavigationIncrease the Clinical Value of Report for Clinicians with Hyperlink, Quantitative Analysis and Navigation

VALUE


Vue Motion - Universal HTML-5 Viewer

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Enterprise Vue Report production in Vue Motion

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Provides Efficient Native Reporting Solution to any department VALUE


Patient involvment – My Vue

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MyVue: Patient Web Portal

• Patient access to images & reports

• Patients share mages & reports

• Clinicians may share Patient images & reports

• SMS enrollment

• Patient Scheduling

• Benefits: Save on burning CDs, less dosage exposure, increase communication efficiency, improved collaboration


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Global Clinical Collaboration Platform

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Site C

Site D

DICOM


Site B

DICOM

HL7

Site A

HL7

DICOM

Solving Customer’s Challenges

Clinical Content Management

• DICOM and Non-DICOM data to be stored and viewed

• Address consolidation of archives and EMR enabled viewer

• Examples such as VNA for Radiology, Cardiology, Endoscopy, Dermatology

• Maintain departmental autonomy while federating multiple workflow

Telemedicine (“Store and Forward”)

• Acquire remotely and distribution of image data

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• Acquire remotely and distribution of image data

• Focus on shortage of specialty care, quality of care for remote patients

• Examples such as Tele-dermatology, tele-radiology, specialty consultancy

• Enable additional service lines and economical access

Information Sharing and Exchange

• Clinical images to be shared outside health system

• Focus on interoperability, standards based integration,

• Example such as HIE, Regional Exchanges

• Minimize duplication of exams and costs, enable collaboration within the patient population


Clinical Collaboration in Europe

AT A GLANCE

� National Pgms NHS Scotland

� Regional Pgms & Regional Collaboration: HSÖ, Cheschire & MerseysideMerseyside

� Vue Cloud & Enterprise distribution: Spire

� Clinical Data Collaboration: Reggio Emilia

� Tele-medicine MSC Cruises


Thank you