Taking the “A” out of PACS
Standards Based VNA Concepts
Agenda
 Current State
 Market Research
• The “next” PACS
• Vendors considered for VNA
• Reasons for Considering a VNA
 Vendor Neutral Archiving
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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
Current State
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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
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Requirements Are Constantly Changing
Government Mandates Compliance with Current and Future Rulings
Dynamic Vendor Environment
Standards Become More Important
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2012 Acuo Technologies® Proprietary and Confidential
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
o
o
o
o
Replace a PACS
Add New Applications To Existing Storage System
Share Data Between Applications
Add New HW or IT Strategies, i.e. Business Continuity
Integrate with HIS, EMR and other IS systems
• Data Migration Is Required When:
Selecting A New Vendor
o Upgrading - Either Replacing Storage or PACS SW
Upgrade
o
• Adds Cost, Reduces Flexibility and Increases Complexity
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2012 Acuo Technologies® Proprietary and Confidential
Market Research
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Gray Consulting
P.O. Box 972
Novato, CA 94948-0972
Phone: 415-892-0943
Cell: 415-328-2842
Fax: 415-897-0384
Email: graycons@well.com
http://www.graycons.com/about/
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Vendor Neutral Archiving
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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
Results:
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Higher Quality of Service - BC – Dedicated Viewer
Streamlined Operations/Improved Productivity
Effectively Lower TCO In All Areas
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2012 Acuo Technologies® Proprietary and Confidential
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.
Before
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Simpler management
Seamless migrations
Independent of PACS deployment
Scales to meet all your capacity needs
After
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What is expected now
Any-ology
Radiology – CT, MRI, PET,
Dermatology - Visible
Cardiology – Cardiac
GI Lab
Ophthalmology
Pathology
Wound Care
Otorhinolaryngology
Neurosurgery
Oncology
Diagnostic Radiology,
Fluoroscopy, Ultrasound, Nuclear
Medicine, Breast Imaging,
Interventional Radiology, DEXA
Light Imaging
Cath, Echocardiology,
Nuclear
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2012 Acuo Technologies® Proprietary and Confidential
How are non-DICOM objects handled?
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•
A
B
C
D
XDS
DICOM
Wrapping
File
System
Interface
Native
Content
Management
Normally existing
integration through
CIFS/NFS
•
Standards based –
IHE driven
Standardized
Information Model
for store / retrieve /
display
•
Standardized
Information Model for
store / retrieve /
display
•
Direct Application
Read/Write
Application Neutral Middleware
Enterprise
•
•
•
Can facilitate ILM
Requires deployment
across entire
enterprise
Expected to emerge in
HIE projects
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Storage
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
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•
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Web Services
Integration
Custom
XDSAPI
Platform
Normally lower cost
integration
Proprietary file format
Proprietary Information
Model
Doesn’t solve data
mobility issues
Many systems store
content in database
directly
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Costs associated with
integration
Adapter development
Portability (compatibility
with other systems)
Accessibility challenges
Increases migration
liability
CONSIDER: If this
route is chosen use an
XDS information model
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2012 Acuo Technologies® Proprietary and Confidential
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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2012 Acuo Technologies® Proprietary and Confidential
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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2012 Acuo Technologies® Proprietary and Confidential
Enterprise Archive Strategy
Image
Enabled
DICOM
Choice
RIS / HIS /
EMPI
DICOM
HL7
DICOM /
WADO
???????
Enterprise Image Archive (VNA)
EMR
Interfaces
CIFS, NFS, API
Custom
Radiology
PACS
Cardiology
Storage
PACS
Management Software
HTTP/
REST
Proprietary File
CIFS,
NFS, API
Access
SAN
Future
Imaging
SCSI
MAIN FACILITY
CAS
iSCSI
Cloud
based
SATA
TAPE
OTHER
DISASTER RECOVERY SITE
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Next Generation VNA’s
 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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2012 Acuo Technologies® Proprietary and Confidential
Develop the Strategy
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
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
Storage/Network
Business Continuance Strategy
• Bring DICOM Skills into IT
• Come to Terms With the Inevitable Migration
Commit to Make it Your Last Migration!
2012 Acuo Technologies® Proprietary and Confidential
The Solution!
There are a number of strategic approaches to building a
Vendor-Neutral Enterprise Archive
Take the “A” out of PACS
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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
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2
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PACS B Lifetime
PACS A Lifetime
Data Migration phase
VNA Lifetime
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2012 Acuo Technologies® Proprietary and Confidential
Questions?
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Thank you
Gillian Ryan – Director of Sales
(773) 368 – 6899
gryan@acuotech.com