The Challenges of Healthcare Enterprise Image Data Management Image Management Session D1 John S....

The Challenges of Healthcare Enterprise Image Data Management

Image ManagementSession D1

John S. Koller

APIII 2007Advancing Practice, Instruction, and Innovation through Informatics

Restricted Use – Not for Duplication

©2007 Koller Associates, Inc.

Introduction & DisclosuresJohn S. Koller - President of KAI Consulting

• 25+ years experience in secure, highly available IT solutions.

• Employment & Consulting relationships– Philips Medical Systems– EMC Corporation– Multiple Major Healthcare Imaging & Informatics Vendors – Multiple Major IT Technology Vendors

• Other Relationships– Contributing Editor

• ITN & AuntMinnie.com• SCAR – Archiving Primers & Security Primer

– Board of Directors• HealthSphere Corporation

– Advisory Board Member• Bycast & ITN

2©2007 Koller Associates, Inc.

Traditional Healthcare Infrastructure

Pharmacy, Laboratory and Ancillary Data

Financials

Disaster Recovery plan(mainframe only)

DK tape

E-Medical Records

Backup by FDR Upstream

Employee DataImagingCenter

HSM to Tape

ADSM to

3490s OmniBack

FinancialRecords

PACSCICS

Ambulatory DataHospital Data

HR

STKSilos

Batch

OLTP

Exchange

Backup by tar—8mm

Billing e-commerce

Server/OS

Network

Application

Storage

Test

Backup

Disaster Recovery

DatabasePatient Care

Billing

Cheyenne to 4mm

Lotus Notes

Physician Practice Data

Cyclic Process Reactive Proactive

Operations


The Digital Healthcare Enterprise (DHE)• Business Centric

– Billing

– Accounts Payable

– HR, Payroll

– Supply-Chain Management

• Patient Centric– Hospital Information System

(HIS)

– Electronic Medical Record (EMR, EPR, EHR)

– Computerized Physician/Provider Order Entry (CPOE)

– Networked Intelligent Devices

– Asset Tracking & Management

• Departmental Systems– Radiology

• RIS (data)• PACS (images)

– Cardiology• CVIS (data & waveforms)• PACS (images)

– Radiation Oncology• Treatment planning systems

(images)

– Pathology

– Pharmacy

– Laboratory

– Etc.

The Typical Healthcare Enterprise has an average of 100 to 175 Applications.


Clinical Systems Support Pressures

• New Accountability for IT– Regulatory & Compliance– Security (CIA)

• Confidentiality• Integrity• Availability

• Usability of the Data

• Explosive Growth in Connected Devices

• Lifecycle Data Management Costs


The Side-Effects of Digital Data in the Healthcare Enterprise


Importance of Standards

• HL7 (Health Level 7)– Simple protocol to exchange

information• Current version of HL7 is Version

2.x• Version 3.x compliant with XML –

Extensible Markup Language

• CCOW (Clinical Context Working Group)– Simplify and improve workflow

and functionality between applications

• DICOM (Digital Image and Communication in Medicine)– A true standard dealing with

objects – images > series > study>patient

– Deals with images, waveforms and structured reports

• IHE (Integrating the Healthcare Enterprise)– Focuses on the interoperability

within & between departments in the enterprise.


Challenges of Image Management

• Very Large Datasets– Storage– Communications

• Very Large Annual Volumes– Data Protection Requirements

• Variable Retention Periods– Lifecycle Management

• Variable Locations– Communication Delays


Path&

Other

• Radiology– Tens of TBs

• Cardiology– 2-3X of Radiology

• Pathology– Tens / Hundreds of

TBs to PBs• Usually no way to age

studies out of storage

Growth in Departmental Imaging


Evolving Imaging Architectures

• Film & Processors

• Proprietary Interfaces

• Dedicated Print Networks

• Closed Mini-PACS

• Enterprise PACSPACSxIS


Pathology Imaging ModelsImage Acquisition & Workflow Management

Slide Scanning

Image Server

Whole Slide

Imaging Scanner

(WSI)

WSI Analog to Digital Acquisition1. System Calibration2. Robotic slide positioner3. Special light & filters (Fluorescence)4. Camera for Digital Image acquisition

Physical Slide

Storage Archive

Digital Image

Digital Image

Diagnostic Workstation

Analog-Digital Conversion in

Scanner (Camera)

Digital Image Storage &

Management

Digital-AnalogConversion inDisplay (LCD)

Laboratory Information System (LIS)Automated Preparation

System

Image Acquisition & Display Chain

Finished Slide

Images & Reports


Lessons & Landmines from Radiology• Modality <-> PACS - Standards “Grey” Areas

– Limited inter-vendor compatibility in early years

• ROI– Can we really eliminate film?

• Installation of xIS prior to or with PACS– The installation of Image Management prior to Workflow

Management introduces potential for errors and lost studies.

• The 2nd PACS Challenge – Was it truly stored in a standard format? – How is all the data migrated when changing vendors?


Technology Obsolesce & Data Migration

• Technology Obsolesce– 12” & 14” Optical Disk– 9 - Track Tape

• Data Migration– Usually Application Vendor Dependant– Long Migration Times (Can be Years)

How long do you have to keep data?


Enterprise Storage Consolidation

Staff Data and Records

Patient AccountsBilling

Radiology and CardiologyAll Ancillary Dept. Data

E-Medical Records

StandardizedStandardizedTesting & Change Testing & Change

ControlControl.

Consolidated Consolidated Backup/RestoreBackup/Restore

Centralized Centralized ManagementManagement

Prod

Test

FinancialData

Common Common Disaster Disaster RecoveryRecovery

Cyclic Process Reactive Proactive

DataMart

High AvailabilityHigh AvailabilityHigh PerformanceHigh Performance


Backup Vs. Archiving

Backup• When to Use?

– Variable Content Data– Transactional w/ Small to

Medium Records– Commercial Database

• Examples– HIS / RIS / LIS Databases– Image Pointer Database

• Backup Management– Create Regular Backups– Manage & Rotate Multiple

Generations– Database Snapshots &

Replication

Archiving• When to Use?

– Fixed Object Based Content

– Long-term Retention Requirements

– Large Volume of Objects• Examples

– PACS Image Database– Other Large / Fixed

Content Objects• Archive Management

– Create Data Protection & Retention Policies

– Automate Everything Possible


Image Data ManagementHow can your image data be managed?• Let your Image Application (PACS) vendor decide.

– Dependent on vendor for all storage & future migration.

• Use an all disk solution with multiple copies managed by vendor.– No real intelligence– Not responsive to conditions affecting individual data objects– Still potentially dependent on applications vendor for future migration.

• Use an HSM to archive your images.– Better control, but minimal metadata for policy-based automation.– No Linkages Back to Application System for Aging of Studies– Still potentially dependent on vendor for future migration.

• Use an Information Lifecycle Management (ILM) strategy.

ILM – What is it?16©2007 Koller Associates, Inc.

Definition of ILM

Information Lifecycle Management is comprised of

policies, processes, practices and tools used to

align the business value of information with the

most appropriate and cost effective IT

Infrastructure from the time information is

conceived through its final disposition…

Source: SNIA Data Management Forum


ILM – What is it?• What ILM is not!

– Hardware, – Software, – A product!

• Depends on the Vendor – DLM? ILM? xLM?

• All Solutions Should be Standards-based (if possible)

• ILM = DLM + Awareness of Business Value of the Data

• The Entire Life of a Information Object is Pre-destined at Time of Creation, But …


DLM vs. ILM• Data Lifecycle Management

– Focus is to make efficient & cost effective use of storage resources

– Based on basic characteristics of the data and data access

– Basic Metadata • Date/Time, Last Access, Owner

• Object Size, System Watermark

• Information Lifecycle Management– Requires information about business

processes (application aware)

– Holistic view of managing information

– Robust Metadata• DICOM, Derived from HL-7, Other

– Uses functions of data lifecycle management

Excerpted from Storage Industry Primer by Dennis MartinRMWTUG – Fall ‘05

ILM

Application & Business Process

DLM

Processing

StorageTier 1

StorageTier 2

StorageTier 3


Image Data Management

• Workflow Aware

• Routing

• Pre-fetching

• Other departmental specific features

• Basic Metadata

• Date/Time

• Access

• Size

• Watermark

• Location

• Manages any storage type

• Application Aware

• Robust Metadata

•PACS / RIS / xIS

• HL-7

• DICOM

• XDS

• Web Services

Departmental Workflow Policies

Clinical Archive Policies

(PACS Virtualization)

Storage Archive Policies

(Storage Virtualization)

DLM

Clinical ILM

Clinical Archive Storage HW & SWPACS & xIS

Business Value


DLM Policy Engine

Rad PACS

Fast Disk Slow Disk Long-Term DR

DLM vs. ILM – An Imaging Example

DLM (Typical HSM)

30 Days 1 yr. 7 yrs.


Clinical ILM Policy Engine

DLM Policy Engine

xIS (s)

Rad PACS


Intelligent Enterprise Image Archive


ILM – Negative

7 yrs.

ControlData

ILM – Positive

6 mo. 2 yr. +++ yrs.

22


DLM Policy Engine

xIS (s)

Rad PACS




Cardiac PACS

ILM – Cardiology

ControlData

23


DLM Policy Engine

xIS (s)

Rad PACS




Cardiac PACS

ILM – Pathology

7 days 30 days Key Images – 7 yrs

WSI SACS

ControlData

24

Benefits of an Automated Clinical ILM

• Provides an integrated BC & DR platform

• Maximizes storage infrastructure utilization

• Provides opportunity to address location based performance requirements

• Addresses current and future technologies

• Can provide application independent data migration


Summary

• Images are Very Different to Manage• Departmental Silos are Not Cost Effective to

Acquire or Manage• New Accountability for Clinical IT Solutions

Requires Enterprise Data Management• Effective Enterprise Image Management

Requires Intelligence in the Infrastructure• No Single Imaging or Informatics Vendor

Provides an Effective Single Source of Scalable True Clinical ILM


Questions?Contact Information

John S. Koller

Email: [email protected]

Office: 303.681.2854

APIII 2007 Support Page (Private Event Page)

www.kaiconsulting.com/conferences/apiii2007/index.htmPassword: given at conference

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