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Carestream VNAAn Oxymoron ?Presented at UKRC 2013
Ignace WautierHealthcare IT Business Development Manager11 June, 2013
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Agenda
Healthcare needsRequirements for UK market.What is a Vendor Neutral Archive? How to chose the right VNA Supplier?
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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?
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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
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Single Vendor Neutral
Archive
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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
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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
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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 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:
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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
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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
•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
EMR\RIS\CIS (non unified)
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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
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 (DICOM Part 10 ???)
Transfer protocol
EMR\RIS\CIS (non unified)
Challenges lead to the Practical VNA being deployed today. Introduces additional layers to the Ideal VNA design
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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
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
Proprietary Storage Format
DICOM/XDS
EMR\RIS\CIS (non unified)
Cache & DB Cache & DB Cache & DB
Cache & DB
Database / Interface
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p.14
VNA is also non-Dicom Support
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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
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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
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Can A PACS Vendor be a Vendor Neutral for Archive?
p.21
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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”
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
Public© Carestream Health, 2013
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
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p.24
RuralClinic
Vue Archive VNA
UniversityHospital
DICOM
HL7
IHE XDS-i
Regional Hospital
HL7
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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
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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
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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
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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
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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