Taking the “A” out of PACS

Standards Based VNA Concepts

Taking the “A” out of PACS

Agenda

Current State Market Research

• The “next” PACS• Vendors considered for VNA• Reasons for Considering a VNA

Vendor Neutral Archiving• Requirements for a VNA• Providers of VNA• Architecture of a VNA• Next Generation VNA• Strategy for deploying a VNA

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2012 Acuo Technologies® Proprietary and Confidential

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Current State

What are the drivers for Healthcare IT Growth of Data

• Size of Studies Increasing CT – Cath – Path

• Number of Studies Increasing Access to Data

• Number of Users Requesting Data Big data sets moving across the wire

• Complex Business Models Association and integrations of healthcare providers EMR enablement – images critical

Requirements Are Constantly Changing Government Mandates Compliance with Current and

Future Rulings Dynamic Vendor Environment Standards Become More Important

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What is Current Situation in Imaging?

Applications Own The Data• PACS control Data Format and often the

Storage Hardware, OS, and Networks • PACS Proprietary Format Makes It Difficult

To: o Replace a PACSo Add New Applications To Existing Storage

Systemo Share Data Between Applicationso Add New HW or IT Strategies, i.e. Business

Continuityo Integrate with HIS, EMR and other IS systems

• Data Migration Is Required When:o Selecting A New Vendoro Upgrading - Either Replacing Storage or PACS

SW Upgrade• Adds Cost, Reduces Flexibility and

Increases Complexity

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Market Research

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Gray ConsultingP.O. Box 972Novato, CA 94948-0972Phone: 415-892-0943Cell: 415-328-2842Fax: 415-897-0384Email: [email protected]

http://www.graycons.com/about/

mailto:[email protected]

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Vendor Neutral Archiving

What a VNA MUST Do BREAK the Proprietary Link to YOUR data Eliminate Custom Engineering

• Integrate via Configuration• Must be GUI driven by the customer

Require full Standards-based Interoperability

Manage Storage as an Enterprise Resource

Enable PACS as Applications, Not Storage Systems

Provide Efficient Access and Administration

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Results: Higher Quality of Service - BC – Dedicated Viewer Streamlined Operations/Improved Productivity Effectively Lower TCO In All Areas


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Choice – The ability to choose the right solutions to benefit end-users and the patient.Control – The ability to make decisions when and how it is appropriate for ITFlexibility – The ability to quickly address business, technical, political and regulatory challenges

Vendor Neutral Archiving A True Vendor Neutral Archive solution is

a single set of software tools to centralize all medical imaging systems into one perpetual repository.

Simpler management Seamless migrations Independent of PACS deployment Scales to meet all your capacity needsBefore After

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Any-ologyRadiology – CT, MRI, PET, Diagnostic Radiology, Fluoroscopy,

Ultrasound, Nuclear Medicine, Breast Imaging, Interventional

Radiology, DEXA

Dermatology - Visible Light Imaging

Cardiology – Cardiac Cath, Echocardiology,

Nuclear

GI Lab

Ophthalmology Pathology Wound Care

Otorhinolaryngology

Neurosurgery Oncology

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What is expected now

How are non-DICOM objects handled?

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A B CFile

System Interfac

e• Normally existing integration through CIFS/NFS

Enterprise Storage Platform

DICOMWrappin

g• Standardized Information Model for store / retrieve / display

• Can facilitate ILM• Uniform Image Viewer

Portability• Established use in

healthcare• Additional DICOM SOP’s

being added all the time

• Does not easily support non-image content types

• Normally lower cost integration

• Proprietary file format• Proprietary Information

Model • Doesn’t solve data

mobility issues• Many systems store

content in database directly

Native Content

Management

• Web Services Integration

• Costs associated with integration

• Adapter development• Portability

(compatibility with other systems)

• Accessibility challenges

• Increases migration liability

DXDS

• Standards based – IHE driven

• Standardized Information Model for store / retrieve / display

• Can facilitate ILM• Requires

deployment across entire enterprise

• Expected to emerge in HIE projects

Application Neutral Middleware Direct Application Read/Write Custom APIXDS

• CONSIDER: If this route is chosen use an XDS information model


Additional Expectations of a VNA Enables a Clinical viewer for the EMR

that allows viewing of all images• Provide one integration point for images• Move to a rendering viewer strategy with no

image cache End of Migrations

• It is a replacement market in PACS Robust support of next generation

storage• Business continuity• Cloud Hosting

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Who provides VNA Pure Play VNA Vendors

• Software only – smaller - innovative• No Diagnostic Viewer

Infrastructure Providers• Often already providing enterprise storage

solution• Often use Pure Play VNA Vendors for software

Solution Providers• Combine software, hardware, network and

service• Offer “one-throat-to-choke”

PACS Providers• Send us everything, we can manage it.• Many deployments, few if any without their

PACS• Will require future migration

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Enterprise Archive Strategy Choice

MAIN FACILITYDISASTER RECOVERY SITE

DICOM DICOMHL7

Radiology PACS

Cardiology PACS

EMR

Storage Management Software

TAPE

Enterprise Image Archive (VNA)

OTHERSATA

CIFS, NFS, API

SAN CASSCSI

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RIS / HIS / EMPI

DICOM / WADO

Custom Interfaces

Proprietary File AccessCIFS, NFS, API

HTTP/REST

Future Imaging

???????

Cloud based

iSCSI

Image Enabled

Multiple Patient ID’s• PIX (Patient Identifier Cross Referencing)

Universal Viewer• Provide one integration point for images• Separate the PACS viewer from EMR

viewer• Ensure that the clinical viewer is robust

XDS Registry and Repository• XDS provides standards support for

management of non-DICOM without locking customers into vendor proprietary technology

• VNA’s should provide simplified Web Services for ease of non-DICOM compliancy the create XDS context automatically within the VNA

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Next Generation VNA’s

Build a Plan to Gain Control• Sever the Proprietary Link Between

Applications (PACS, CPACS) and Storage

Require Applications to Interoperate in a High Performance, Standards-based Format

Identify PACS as a Valuable Departmental Workflow Application, NOT Storage Systems

• Decide on an Infrastructure Solution Storage/Network Business Continuance Strategy

• Bring DICOM Skills into IT• Come to Terms With the Inevitable

Migration

Commit to Make it Your Last Migration!

Develop the Strategy


The Solution!There are a number of strategic approaches to

building a Vendor-Neutral Enterprise Archive

Take the “A” out of PACS• Migrate to VNA platform BEFORE PACS

replacement• Put out RFP for the non-archiving portion of

PACS• Connect new PACS directly to VNA• Shut Down Legacy PACS quickly after new

PACS is up

PACS A Lifetime

VNA Lifetime

PACS B Lifetime

Data Migration phase

1 2 3 4 5

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Questions?

Thank you

Gillian Ryan – Director of Sales(773) 368 – 6899

[email protected]

Taking the “A” out of PACS

Documents

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