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© 2009 Cisco Systems, Inc. All rights reserved. 1
Cisco’s‘Medical Data Exchange’
(MDES) Solution
Hal Gilreath & John VossGlobal Healthcare SolutionsMarch 2009
© 2009 Cisco Systems, Inc. All rights reserved. 2
Market Drivers & Current Environment
DriversCost reductions and avoidanceLost productivityPatient data exchange between or within healthcare organizationsData is needed locally but stored centrallyImportation of unstructured data into structured data
Current EnvironmentManual fax, copyBurn and transport CD ($10/CD)Multi-system log-inPoint to point proprietary interfacesProprietary health information exchanges (HIE)
© 2009 Cisco Systems, Inc. All rights reserved. 3
Solution Benefits
Cost reductionEliminate $10/CDCD burner maintenance costs
Improve productivity Interoperability between systems reduces efficient record accessReduce retests & rescans
Improve Quality of CareReduce delays in patient careAddress incomplete information for treatment decisionsReduce delays in patient care
© 2009 Cisco Systems, Inc. All rights reserved. 4
• Enables interoperability between disparate systems
• Enables the network as the platform for secure & standards based access & exchange
• Eliminates the need for manual transport of records & images
• Standards based (IHE) based PACS & EMR access
• Common patient identifier with network based IHE Cross Reference Manager & XDSi
Medical Data Exchange Enables Patient Centric Integration & Access of Records
© 2009 Cisco Systems, Inc. All rights reserved. 5
What is theMedical Data Exchange Solution?
+Cisco AXP
Network moduleCisco ISR
Router
Globally leadinng SW solution forIHE based medical data exchange
© 2009 Cisco Systems, Inc. All rights reserved. 6
Interoperability is based on a federated conceptAvoids copying all data centrally (Cross Reference Manager) Retains data where it was produced originally.Data is kept as well on a regional level for redundancy purposes(orange level)IHE‚ Cross Reference Manager enables communications between theregions (red) or countries (white)
Federated Data Distribution Enables Scaling
© 2009 Cisco Systems, Inc. All rights reserved. 7
Medical Data Exchange – Enabling TheMethod Patient Centric Access
Folie 7
System A
DICOMHL7 v 2
ISO 10781
EDI
SOAP
System B
HL7 v 2.5
HL7 v 3
IETF
XML
IHENetwork Broker Network Broker
© 2009 Cisco Systems, Inc. All rights reserved. 8
Example: Selectpatient with examsin different PACS
Exams located in PACS2Exams located in PACS1
Interoperability - IHE Based Medical Data Exchange
Without IHE, the PACS workstation from PACS 1 would normally only be able to access the imgesof a patient from PACS 1. The images from that patient produced in PACS 2 could not be seen easily from the GUI of PACS 1.
Enable patient centric view
Eliminate need for manual transport
Reduce exam & scan repeats
Lower operating expenses
Improve data confidentiality
© 2009 Cisco Systems, Inc. All rights reserved. 9
Internet
Cisco IntegratedServices Router +
ServicesEngine
GEGESFPSFPHWICHWIC HWICHWIC HWICHWIC HWICHWIC
NMENME NMENMENMENME NMENME
USBUSBUSBUSB GEGE
AXP Services Engine Overview
Router integrationBlade control protocol between Cisco IOS and service module
Hardware efficienciesEliminates separate appliance and preserves rack spaceOffloads processing/memory to application-specific platform
Lower total cost of ownershipSimplifies deployment/maintenance/management
Service Engines Enable Services Integration at the Branch While Preserving Router CPU/Memory for Critical Connectivity and Cisco IOS
Service Engine Hardware Offerings
AIM: integrated into base routers (1841, 28xx, 38xx)
NM: slot-based module (28xx, 38xx)
© 2009 Cisco Systems, Inc. All rights reserved. 10
MDES Architecture Blue Print: Sub Regional Level: Hospital Chains
GP1
GP2GP5
GP3
GP4
Document consumer
GP
Document source &Document Consumer
i.e. Imaging Centre
Hosp.
Document source &Document Consumer
10 K patients /Year/GP
10 K patients /Year
50 K patients /Year
WAAS blade (502)
AXP (502) Spirit blade
3825 Router
WAAS blade (WAE 522 or512 or 612 or
674?)
AXP (502) Spirit blade
3825 Router
WAAS blade (WAE 502 or612 0r 674)
AXP (502) Spirit blade
3825 Router
WAAS blade (WAE 522 or512 or 612 or
674?)
AXP (522) Spirit blade
3825 Router
Data Center.Document source
Document consumer to next level DC hirarchy
5 GPs per AXP solution
WAAS client
• Typical Cisco DC components• Catalyst 6500• ACE• MDS• NAPPA• FCoIP•Etc....•Etc.•etc
© 2009 Cisco Systems, Inc. All rights reserved. 11
MDES Architecture - DICOM Data Workflow
RadiologyRadiology
PACSSTS
1
5
1 DICOM data routed from STS to local AXP,DICOM KOS Objects generated and stored inLocal router
2 DICOM KOS Objects and DICOM data routedTo 2nd level AXP. DICOM KOS stored in second level AXP.
2
3
3 DICOM Data routed to SAN/NAS
DiagnosticWS
EPRWS
4
4 DICOM Kos objects to be viewed in EPR
5 PACS in hospital queries DICOM Datafrom LTA back to PACS STS or Diagnostic WS
5
SAN/NAS5
© 2009 Cisco Systems, Inc. All rights reserved. 12
MDES Architecture - HL7 Data Workflow
1
5
1 Updates to patient records are sent to AXP as HL7Messages
2 AXP processes HL7 messages and sendsDemographics to central AXP for indexing
2
3
3
Healthcare Provider 1
HIS Server
HISWS 4
4
5 AXP processes request and returns patient record from healthcareprovider premise via SSL.
5
SAN/NAS5
HISWS
HISWS
EPRWS
Physician at healthcare provider 2 reviews patient recordsand requests particular records for viewing
Index data stored in SAN/NAS
Healthcare Provider 2
© 2009 Cisco Systems, Inc. All rights reserved. 13
Architecture Guidelines
ScalabilitySeveral GP‘s may use one MDES Locator and up to 4 AXP could be put into 1 ISR Router. Host up to 100,000 Patients or 100 GPs.
Performance Automatically load Balances with data normally accessed in thelocal units and not remotely or centrally.
Cost-effectiveAvoids complex & expensive high availability solutions forcentralized repositories.
RoadmapIncrease capacity per single MDES unit with solid state disks
© 2009 Cisco Systems, Inc. All rights reserved. 14
Prior Environment• 64 sub-systems in one hospital• Organizational environment constantly
changing• Unscalable• Difficult to integrate GP’s into the hospital
environment• 1500 proprietary data interfaces • Multiple patient Indexes
MDES Reference in Wels Healthcare (Austria)
Folie 14
“Tiani Spirit software, based on Cisco and Intel technology has enabled us to substantially raise the level of information where it is needed and when it is needed, to help our doctors in their effort to provide the best care possible for our patients.”
Dr. Walter Aichinger, Chief Physician of the Klinikum Wels-Grieskirchen
© 2009 Cisco Systems, Inc. All rights reserved. 16
Spirit MDES Reference MeDIswiss - Hospital St. Gallen /Switzerland and connected GPs
Reports and referals RadiologyReferrals
Radiology Report
Referal to cardilogyspecialist
Cardiology Report
Hospital admission
Pre-operative exams and results
Surgery report
Patient Summary afterhospital discharge
Labor reportsDischarge summary
Exam ResultsImages (X-Ray, MR/DICOM)Static ECGLong Term ECGErgometry
© 2009 Cisco Systems, Inc. All rights reserved. 17
MDES Value Proposition
Improve productivity - a clinician can access records from different institutions in a simple and straightforward manner
Lower cost - avoid redundant clinical tests or procedures w/ access to this data
Improve patient care - diagnosis and treatment plans w/ a more holistic view of a patient's record
Avoid Costs - eliminate the need for production of CD's to transport images
The net benefit is better and more cost-effective care.
© 2009 Cisco Systems, Inc. All rights reserved. 18
Application eXtension Platform
AIM-102256MB, 1GB, Intel Celeron
Light-Weight Applications
NME-302/502/522512MB-2GB, 80/160GB,
Intel Celeron Pentium M General-Purpose Applications
SDK and Development
Portal
AXP Partner
Program
AXP DeveloperServices
AXP Advanced Services
Complete Ecosystem
Linux-based integration environment with downloadable SDKMulti-app support: segment and guarantee CPU, memory, disk Extensible Cisco CLI with Cisco IOS APIs Cisco ISR 1841, 2800, 3800 series support
www.cisco.com/go/axp
© 2009 Cisco Systems, Inc. All rights reserved. 19
Architecture and Components
Cisco AXPPacket
MonitoringCisco IOS Information
Event Trigger
Cisco IOS Config.
Serial Device
IOS
Interface
Logging/Debugging
Facilities
AXP-based Application Appears as a Router Extension
Virtualized OS
JAVA
OSGI
3rd Party Applications
Cisco Linux OS
Extensible IOS-like CLI
Virtualized OS
Perl/Python
C/C++ App
Custom Network Services
Java Application
© 2009 Cisco Systems, Inc. All rights reserved. 20
Security Services:Linux:
SW Trust ChainHardened Linux OS
Rogue SW Protection
Cisco IOS:ACLs
Stateful FWIPS
Network Security:Self-Defending NW
Management Services:AXP Services Model
Cisco AXP:ApplicationeXtensionPlatform
Software:Virtualized hosting environmentCisco Linux OSMonitor/Configuration API’s
Hardware:Standalone CPU, HD, MemoryNM, AIM service-modulesISR 3800, 2800, 1800 support
Application-LevelAXP-LevelISR-Level
Inst
all /
U
pgra
de
Adm
in /
Con
figur
atio
n
Mon
itorin
g
Rep
ortin
g A
naly
sis
Inte
grat
ion
Wor
kflo
w
Not
ifica
tion
Integrated Services
© 2009 Cisco Systems, Inc. All rights reserved. 21
Use Case: Spirit Local Adapter (SLA)
The Spirit Local Adapter is used to connect a non IHE environment to an IHE compliant environment for
Patient Identity Source AdapterPatient Management (PIX, PDQ)Document Management (XDS)Image Management (XDS-I / DICOM)
HospitalInformation
System
PatientIdentitySourceAdapter
DocumentSourceAdapter
ImagingDocument
SourceAdapter
PIXManager
DocumentRepository
PDQSupplier
Patient Identity Feed
Provide and RegisterDocument Set
PatientDemographics
QueryForward
Patient Demographics Query
Acquisition Modality /Image Archive
(DICOM)
Patient Demographics Query
HL7 v2.x Message (e.g. ADT)
HL7 v2.x MDM T^xx Message
Store Images (C-STORE)
SpiritEHR SLA
Hospital IHE compliantElectronic Health
Record