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Carestream VNA
An Oxymoron ?
Presented at UKRC 2013
Ignace Wautier
Healthcare IT Business Development Manager
11 June, 2013
Public
© Carestream Health, 2013
Agenda
Healthcare needs
Requirements for UK market.
What is a Vendor Neutral Archive?
How to chose the right VNA Supplier?
Public
© Carestream Health, 2013
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?
Public
© Carestream Health, 2013
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
Public
© Carestream Health, 2013
Single
Vendor Neutral
Archive
Public
© Carestream Health, 2013
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
Public
© Carestream Health, 2013
What is the
ideal VNA?
Who’s the right Partner
to provide your VNA?
Is there a standard
definition for VNA?
Is it answering
all the needs?
VNA Market definition
2009, Herman Oosterwijk, President, OTech Inc
p.7
Public
© Carestream Health, 2013
“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 definition
InMedica – Industry Report 2012
p.8
DICOM, HL7 and other Standards-
based communication
Support for multiple PACS
Non-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
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 Buzzword
p.9
VNA attempts to solve three main problems:
Public
© Carestream Health, 2013
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 Requirements
p.10
Public
© Carestream Health, 2013
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
EMRRISCIS (non unified)
Workflow
Viewer
Workflow
Viewer
Enterprise Viewer
DICOM//XDS
ApplicationServers
Standard Storage Format
Transfer protocol
EMRRISCIS (non unified)
Public
© Carestream Health, 2013
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
EMRRISCIS (non unified)
Workflow
Viewer
Workflow
Viewer
Enterprise Viewer
DICOM//XDS
ApplicationServers
Standard Storage Format (DICOM Part 10 ???)
Transfer protocol
EMRRISCIS (non unified)
Public
© Carestream Health, 2013
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
EMRRISCIS (non unified)
Workflow
Viewer
Workflow
Viewer
Enterprise Viewer
DICOM//XDS
ApplicationServers
Proprietary Storage Format
DICOM/XDS
EMRRISCIS (non unified)
Cache & DB Cache & DB Cache & DB
Cache & DB
Database / Interface
Public
© Carestream Health, 2013
p.14
VNA is also non-Dicom Support
Public
© Carestream Health, 2013
Vue Archive (VNA)
Tiered Storage
Lifecycle Management
XDS Repository
API
DICOM
HL7
XDSRegistry
Radiology:
DICOM /
HL7
Laboratory:
“Other”
data
Other Clinical:
“Other” data,
XDS
Cardiology:
DICOM / HL7 /
“Other “data
Additional IHE Profiles
XDS, XCA, BPPC, MPI, …
XDS Actors
p.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 Feed
Patient Identity Feed HL7v3Vendor
Neutral
Archive
XDS Consumer
Modality :
Workstation /
Clinical application
Public
© Carestream Health, 2013
p.17
BPPC – Basic Patient Privacy Consent
Under which condition?
Medical documents are labeled with a Confidentiality Code
Which functional role
may access which document?
What are
disclosure rules?
XDS Consumer
p.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 Consumer
p.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
Public
© Carestream Health, 2013
Can A PACS Vendor be a Vendor Neutral for Archive?
p.21
Public
© Carestream Health, 2013
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
Repository
Vue Archive - VNA
Consolidated clinical archive: interoperable, standards
based for longevity
Enterprise Management
Enterprise Management
Patient data aggregation
Data sharing
RIS PACS Cardio
Clinical Departmental Solutions
Advanced clinical toolsets: single workspace for
productivity from image review to report
Physician
Collaboration
Patient
Access
Universal Viewers
Access 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
Introduction
Of Cloud
Archive Services
2009
Single patient
worklist connects
multiple PACS
XDS on
Vue
Archive
VNA on
Vue Archive
Public
© Carestream Health, 2013
p.24
Rural
Clinic
Vue Archive
VNA
University
Hospital
DICOM
HL7
IHE XDS-i
Regional
Hospital
HL7
Public
© Carestream Health, 2013
One Software fit all needs
DICOM
DICOM
HL7
“Other” Data
XDS
Reading
Center
Teleradiology
CARESTREAM
Vue 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
Public
© Carestream Health, 2013
Universal Viewer
Vue Motion
A Vendor Neutral Portal for physicians
Zero foot-print
No installation
Pure Web
HTML 5
Zero Training
Intuitive User Interface
Enable
Remote collaboration
And what about the Patient?
p.26
Public
© Carestream Health, 2013
Pure Web HTML 5
Patient Portal
Easy to access
Easy to use
Ability to share
with referring
Patient defines
sharing rules
Patient keep control
of his medical data
My Vue
A Secured Vendor Neutral Portal for patient
p.27
Rural
Clinic
Vue Archive
VNA
University
Hospital
DICOM
HL7
IHE XDS-i
Regional
Hospital
HL7
Public
© Carestream Health, 2013
A complete solution
DICOM
DICOM
HL7
“Other” Data
XDS
Reading
Center
Teleradiology
CARESTREAM
Vue Archive
Physician’s
Office
Patient Portal
Clinical Portal
XDS
Smooth migration from your legacy archive
p.28
Public
© Carestream Health, 2013
Public
© Carestream Health, 2013
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

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Carestream VNA, an Oxymoron?

  • 1. Carestream VNA An Oxymoron ? Presented at UKRC 2013 Ignace Wautier Healthcare IT Business Development Manager 11 June, 2013 Public © Carestream Health, 2013
  • 2. Agenda Healthcare needs Requirements for UK market. What is a Vendor Neutral Archive? How to chose the right VNA Supplier? Public © Carestream Health, 2013
  • 3. 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? Public © Carestream Health, 2013
  • 4. 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 Public © Carestream Health, 2013 Single Vendor Neutral Archive
  • 5. Public © Carestream Health, 2013 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
  • 6. VNA appear to be a solution Public © Carestream Health, 2013 What is the ideal VNA? Who’s the right Partner to provide your VNA? Is there a standard definition for VNA? Is it answering all the needs?
  • 7. VNA Market definition 2009, Herman Oosterwijk, President, OTech Inc p.7 Public © Carestream Health, 2013 “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”.
  • 8. VNA Market definition InMedica – Industry Report 2012 p.8 DICOM, HL7 and other Standards- based communication Support for multiple PACS Non-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 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.
  • 9. VNA – More Than a Buzzword p.9 VNA attempts to solve three main problems: Public © Carestream Health, 2013 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.
  • 11. 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 EMRRISCIS (non unified) Workflow Viewer Workflow Viewer Enterprise Viewer DICOM//XDS ApplicationServers Standard Storage Format Transfer protocol EMRRISCIS (non unified) Public © Carestream Health, 2013
  • 12. 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 EMRRISCIS (non unified) Workflow Viewer Workflow Viewer Enterprise Viewer DICOM//XDS ApplicationServers Standard Storage Format (DICOM Part 10 ???) Transfer protocol EMRRISCIS (non unified) Public © Carestream Health, 2013
  • 13. 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 EMRRISCIS (non unified) Workflow Viewer Workflow Viewer Enterprise Viewer DICOM//XDS ApplicationServers Proprietary Storage Format DICOM/XDS EMRRISCIS (non unified) Cache & DB Cache & DB Cache & DB Cache & DB Database / Interface Public © Carestream Health, 2013
  • 14. p.14 VNA is also non-Dicom Support Public © Carestream Health, 2013 Vue Archive (VNA) Tiered Storage Lifecycle Management XDS Repository API DICOM HL7 XDSRegistry Radiology: DICOM / HL7 Laboratory: “Other” data Other Clinical: “Other” data, XDS Cardiology: DICOM / HL7 / “Other “data Additional IHE Profiles XDS, XCA, BPPC, MPI, …
  • 15. XDS Actors p.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 Feed Patient Identity Feed HL7v3Vendor Neutral Archive XDS Consumer Modality : Workstation / Clinical application Public © Carestream Health, 2013
  • 16. p.17 BPPC – Basic Patient Privacy Consent Under which condition? Medical documents are labeled with a Confidentiality Code Which functional role may access which document? What are disclosure rules?
  • 17. XDS Consumer p.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
  • 18. BPPC & XDS Consumer p.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
  • 19. VNA is the foundation for data sharing p.20 Public © Carestream Health, 2013
  • 20. Can A PACS Vendor be a Vendor Neutral for Archive? p.21 Public © Carestream Health, 2013 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”
  • 21. At Carestream we believe … p.22 Repository Vue Archive - VNA Consolidated clinical archive: interoperable, standards based for longevity Enterprise Management Enterprise Management Patient data aggregation Data sharing RIS PACS Cardio Clinical Departmental Solutions Advanced clinical toolsets: single workspace for productivity from image review to report Physician Collaboration Patient Access Universal Viewers Access to Patient Medical records regardless of clinical system: secure, device neutral, mobile Public © Carestream Health, 2013 A complete portfolio articulated around Vue Archive
  • 22. 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 Introduction Of Cloud Archive Services 2009 Single patient worklist connects multiple PACS XDS on Vue Archive VNA on Vue Archive Public © Carestream Health, 2013
  • 23. p.24 Rural Clinic Vue Archive VNA University Hospital DICOM HL7 IHE XDS-i Regional Hospital HL7 Public © Carestream Health, 2013 One Software fit all needs DICOM DICOM HL7 “Other” Data XDS Reading Center Teleradiology CARESTREAM Vue 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
  • 24. p.25 A “PACS” Vendor can also provide you additional layers Public © Carestream Health, 2013 Universal Viewer Vue Motion A Vendor Neutral Portal for physicians Zero foot-print No installation Pure Web HTML 5 Zero Training Intuitive User Interface Enable Remote collaboration
  • 25. And what about the Patient? p.26 Public © Carestream Health, 2013 Pure Web HTML 5 Patient Portal Easy to access Easy to use Ability to share with referring Patient defines sharing rules Patient keep control of his medical data My Vue A Secured Vendor Neutral Portal for patient
  • 26. p.27 Rural Clinic Vue Archive VNA University Hospital DICOM HL7 IHE XDS-i Regional Hospital HL7 Public © Carestream Health, 2013 A complete solution DICOM DICOM HL7 “Other” Data XDS Reading Center Teleradiology CARESTREAM Vue Archive Physician’s Office Patient Portal Clinical Portal XDS
  • 27. Smooth migration from your legacy archive p.28 Public © Carestream Health, 2013 Public © Carestream Health, 2013 Legacy Archive Meta-data Take-over Intelligent Data Migration Query Data Retrieve Vue Archive VNA Retrieve Command Data Retrieve
  • 28. p.29 Fully Owned Capital Investment Carestream Vue Cloud Services Purchasing Options
  • 29. 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

Editor's Notes

  1. EMR management:As moredepartments seek access to PACS, the proper identification of patients and exams becomes anissue. Often, each department will have its own patient and exam requisition system, AccessionNumbers may or may not be used for identification, and patient and exam IDs may be assigned by
  2. EMR management:As moredepartments seek access to PACS, the proper identification of patients and exams becomes anissue. Often, each department will have its own patient and exam requisition system, AccessionNumbers may or may not be used for identification, and patient and exam IDs may be assigned by