Challenge of a Best-of-Breed VNA is Skillful System Integration and Dedicated Back-end Support


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As medical imaging technology has proliferated throughout healthcare organizations, so has confusion and complexity. More and more departments have jumped on the medical imaging bandwagon, spawning multi-vendor systems for different applications that have made integration and support challenging and expensive. Failure to make sense of disparate, best-of-breed solutions has significant implications for IT professionals within healthcare organizations, forced to deal with incompatibilities and inefficiencies.

Join medical imaging data management expert Michael Gray for a discussion on how to plan, deploy and manage a Vendor-Neutral Archive (VNA) program to eliminate data silos and promote interoperability for medical imaging applications.

About the Speaker:

Michael Gray is the principal of Gray Consulting, a consulting practice established in 1991 to develop a number of consulting services designed to assist Healthcare Systems and Radiology Practice Groups.

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Challenge of a Best-of-Breed VNA is Skillful System Integration and Dedicated Back-end Support

  1. 1. Welcome to Today’s Web Seminar! November 17, 2011 2:00PM ETSponsored by: Hosted By:
  2. 2. Mike Perkowski is co-founder and partner of New Reality Media LLC. Mike hasnearly 30 years of experience following the computer industry as a reporter, editor,publisher and marketing executive. Before co-founding New Reality Media, he was co-founder and chief operating officer of Microcast Communications, a media companycovering the IT and municipal broadband marketplaces. Previously, he spent 10 yearsat Ziff Davis Media in a variety of executive roles, including VP and general manager ofZiff Davis’ Market Experts Group; vice-president of corporate marketing; publishingdirector of Smart Partner, and associate publisher for marketing at PC Magazine. Mikealso spent 13 years at CMP Media in various editorial and publishing leadership roles,including editor-in-chief and publisher of Computer Systems News. He has directed thedevelopment and implementation of numerous integrated marketing programs for hisclients at Ziff Davis, CMP and as an independent marketing consultant specializing innew-product launches, and has led such disciplines as market research, customerevent programs and sales training.Mike also was a member of the Board of Directors for the Computing TechnologyIndustry Association (CompTIA), the high-tech industry’s largest trade association. Hereceived a B.A. in Journalism from Rider University (Lawrenceville, New Jersey)..
  3. 3. Michael Gray is the principal of Gray Consulting, a consulting practice establishedin 1991 to develop a number of consulting services designed to assist HealthcareSystems and Radiology Practice Groups. Gray Consulting has provided consultingservices related to PACS and Enterprise Archiving to over 90 Organizations.Mr. Gray’s areas of expertise are Market Analysis, Technology Analysis, StrategicPlanning, Needs Assessment, Workflow Analysis and Re-design, Business CaseModeling, Vendor Analysis/Selection, and Technical Contract Negotiation. Mr. Gray’sunique perspective has proven invaluable to Radiology and Information Systemadministrators planning the introduction of new Image Management technologies intotheir imaging departments and hospitals. Mr. Gray routinely publishes articles on hisWeblog ( ) on subjects such as workflow design, business casemodeling, system deployment strategies, expansion or replacement of data StorageSolutions, development of Data Migration strategies from old to new PACS, and the latestmarket concepts including Vendor Neutral Archiving and EMR UniViewers.Mr. Gray has a BS in Biology and Chemistry from Washington University, St. Louis; hasbeen awarded three US patents; and has an extensive bibliography in medical imagedisplay and electronic information management systems.Mr. Gray and his family reside in Novato, California.
  4. 4. As WW Strategy and Business Development Executive for Dell’s UnifiedClinical Archive Solution, Dan M. Trott is responsible for guiding thedevelopment and implementation of Dell’s solution for enterprise archivingof clinical information in the Healthcare and Life Sciences market.Reporting to Dr. Jamie Coffin, Dan leads a team responsible for identifyingstrategies and technologies that will help Dell develop the clinical archivingmarket, integrating solutions into the Dell portfolio of healthcare archivingsolutions, and managing relationships with application developmentpartners who will add these solutions to their own portfolios.Prior to joining Dell in October of 2010, Dan spent seven and half years atIBM as part of the healthcare infrastructure team at IBM and more than 30years in companies addressing the needs of the medical imaging andhealthcare IT markets.Dan began his healthcare career as a Physicians’ Assistant in DiagnosticRadiology and holds a Bachelor’s Degree in Biology from the University ofTexas at Austin and an MBA from Rivier College in Nashua, NH.
  5. 5. Challenge of a Best-Of-Breed VNAis Skillful System Integration andDedicated Back-end SupportMichael J. Gray Dan TrottPrincipal, Gray Consulting WW Strategy and Business Development Dell Healthcare
  6. 6. Michael J. Gray Principal of Gray Consulting6
  7. 7. Challenge of a Best-Of-Breed VNAis Skillful System Integration andDedicated Back-end Support
  8. 8. Objectives • Challenges in a Heterogeneous PACS Environment • Solutions for Data Management, Archive and Distribution VNA • Architecture and Deployment – Issues and Options Challenges & Choices • Considerations for Selecting a Solutions Partner • Ideal Solution Ideal • Requirements to Assure Success Solution • Dell Healthcare’s Approach to the Enterprise Image Archive Dell’s • Conclusion Approach8
  9. 9. Problems• The Silo Effect • Lack of Information Lifecycle Management• Limited Choices • Inadequate Disaster Recovery• Proprietary Data Formats9
  10. 10. Problems• Lack of Business Continuity • Multiple Vendors• Costly Data Migrations • Non-DICOM Data• Data Sharing and Collaboration10
  11. 11. Solutions• Not all VNA Solutions are Created Equal• Fundamental Requirements of the Neutral Archive Application – Bi-Directional Tag Morphing – Full DICOM conformance – Methodology for non-DICOM – Organize/Manage by Organization Node – Intelligent metadata driven ILM – Ability to create/associate Unique patient/study ID – Pre-fetching and Auto-Routing with Relevant prior Algorithm – Mirrored, dual-sited configuration – Virtualization – Data Integrity and Propagation of HL7 updates – Data Compression options (negotiating any DICOM-conformant Syntax) – Create/Maintain XDS-I Manifest – Transaction Logging and Reporting – Security – Comprehensive Pro-active 7/24/365 remote monitoring of all components11
  12. 12. Solutions • Mirrored configuration supports realistic Disaster Recovery • Inclusion of the Viewer Application on both sides provides true Business Continuity Primary Data Center A Secondary Data Center B EMR Datacenter LAN Datacenter LAN WAN Univiewer VNA App Univiewer VNA App Local Storage Local Storage12
  13. 13. SolutionsMany options available for the Storage Solution• NAS or SAN solutions managed by the VNA application• Intelligent Data Management solutions – Featuring Object Storage Platforms and Storage Virtualization – Interface options: NFS, CIFS, simple HTTP, or custom API – Storage Solution itself uses metadata › To optimize data storage and data flow across tiers › To apply preservation, retention and deletion policies › Uses thin provisioning capabilities which eliminate the need to pre-allocate capacity and eliminate the practice of buying capacity before it is required• The right Storage Solution could store medical images AND emails, Sharepoint files, videos, pictures, digital documents, etc.• 5yr TCO for an Intelligent Storage solution better than that of a SAN13
  14. 14. SolutionsFundamental Requirements of the UniViewer Application – Absolute Zero client – Server-side Rendering – Cache-less – Virtualization – Supports Multiple OS and Browsers – URL-based Portal Interface – EMR Authentication – Auditable Transaction Logging – Methodology for displaying non-DICOM – Medium to Advanced Features/Functions – Optional Web Services interface (to the VNA and/or Storage Solution)14
  15. 15. Architecture and Deployment…Issues and OptionsThe Organization needs to focus inward in order to establish theirposition on these Key Considerations…• IT Resources – Staffing level and skill set• Second Data Center – Does it already exist? – Is co-location with a business-class provider an option?• Storage Utilization – Can the organization achieve a just-in-time procurement model?15
  16. 16. Architecture and Deployment…Issues and OptionsThe Organization needs to focus inward in order to establish theirposition on these Key Considerations…• Disaster Recovery Strategy – Proper Infrastructure and Professional Services must be established to assure timely recovery of lost data• Proximity Requirements for Business Continuity – True BC requires the Secondary Display Application and the Secondary VNA Application in close proximity• Funding – Is the Organization prepared to commit the Capital vs Operational Funds? – Does the fee-per-study in a Software as a Service model make sense?16
  17. 17. Architecture and Deployment…Issues and OptionsConsider the Variations on System Architecture• Mirrored Configuration – Dual-sited – Geographic Separation• Local Facility Cache Servers (multi-facility organizations)• Virtualization – VNA application – UniViewer• Direct Image Acquisition for imaging departments without PACS – DICOM – non-DICOM17
  18. 18. Architecture and Deployment…Issues and OptionsDecisions that determine the Deployment Options• Economics – Own the system (Capitalize or Lease)? – Fee-per-Study or SaaS solution? – Are there sufficient funds to support single phase or multi-phase?• System Management – Self-Management vs Contract Management depends on IT Resources• Storage utilization – Ability to create and execute an on-demand storage procurement schedule• On-Premise vs Off-Premise – Is organization willing and able to support the second data center? – Can the vendor be trusted to manage the data in their Cloud?18
  19. 19. Considerations for Selecting a SolutionsPartner IT Economics Resources• Many options to weigh Technology Logistics Ideal Solution Partner• Building the right VNA should be a process of choosing the right option from a wide range of choices in each of those categories• So why do so many organizations find themselves choosing from a very limited number of options?19
  20. 20. Considerations for Selecting a SolutionsPartner • Expertise in • Expertise in professional Infrastructure services management Consultants Hardware /Integrators Vendors VNA PACS Vendors Vendors • Expertise in Data • Expertise in Clinical Management applications and solutions workflowAny one stakeholder typically lacks depth and breadth to be experts in all areasand have control of every one of the many options required to constitute the rightVNA20
  21. 21. Considerations for Selecting a SolutionsPartner• Most commercial VNA packages are best-of-breed solutions, but the vendor has chosen each of the specific components in advance – The configuration options that they are offering suite THEIR requirements – The sales process focuses on making the argument that their pre- configured system ideally suits the organization’s needs• WHY is this?21
  22. 22. Considerations for Selecting a SolutionsPartner• Why each of the Stakeholders is focused on their own specifics… – Limited Core Competence – Limited Integration Experience – Limited Resources (limited staffing with limited experience) – Limited Technology (limited software and hardware choices) – Limited Business Partners (limited by conflicts of interest) – Complexity working with other vendors › Technology partners › Local PACS, HIS, RIS, EMR vendors › Modality vendors › Other galaxies of vendors in the HIE22
  23. 23. Stakeholders in an Ideal Solution Professional Hardware Services Infrastructure - Ideal VNA Configuration comprised of choices in all four major categories - Choices derived from thorough and unbiased analytical process / consulting - Components of solution integrated, installed and supported by a team with experience with that specific configuration Imaging / Clinical Software Workflows (PACS)23
  24. 24. Ideal Solution• Software Choices – Vendor Neutral Archive (inclusive of all related multi-vendor applications) – Non-DICOM Source Interfacing (DICOM wrapping/encapsulation) – UniViewer – System Monitoring (umbrella monitoring of all applications/components)• Hardware Infrastructure Choices – Hardware Infrastructure (Servers, Load Balancers, Network Components) – Storage Solution for both Primary and Secondary subsystems – Organization should seek to ”future proof” its hardware investments• Professional Services Choices…who will provide the following services software or hardware vendor, reseller, value-added reseller? – Integration Services – Project Management – System Monitoring Support – Hybrid VNA24
  25. 25. Requirements to Assure Success• Recognize that “One Solution Does not fit All”…If ever there was an argument for a Best-Of-Breed solution, this is it• Unfortunately, truly customized, unique solutions comprised of many choices in software, hardware, and service components are extremely difficult to build and then support• Vendor would have to – Possess a good understanding of many potential components – Have expertise in all three major categories; software, hardware and services – Demonstrate strong services capability (consulting, design, implementation) – Ability to offer choice/flexibility in software, hardware, deployment models – Ability to meet future needs25
  26. 26. Requirements to Assure SuccessVendor would have to meet all of the following: – Consulting…a substantive process not merely a consultative sales program – System Design…matching the component options to the organization’s needs and resources – Financial Modeling…compare projected total cost of ownership (TCO) of existing heterogeneous PACS environment with TCO for proposed custom VNA – Flexible Financing…provide range of financing options from fully capitalized to fully operationalized26
  27. 27. Requirements to Assure SuccessVendor would have to meet all of the following: – System Integration…demonstrate extensive past experience in complex system integration in healthcare – System Monitoring and Support…identify staff that will build the system and subsequently play an integral role in monitoring/ supporting the system – Meet Future Requirements…Through real-world examples, demonstrate ability to expand system to meet future requirements › Image enabling other clinical applications › Accommodating non-image data › Electronic image sharing through participation in a Health Information Exchange27
  28. 28. Requirements to Assure SuccessAny vendor claiming to offer best-of-breed VNA that cannot meetthese exacting criteria, would most likely fail to meet required servicelevel agreement…assuming that they could deliver the system in thefirst place.28
  29. 29. Dell’s Approach to Enterprise ArchiveThe Unique 5th Stakeholder: A vendor that can effectively build and support aVNA that is customized to meet the needs of the healthcare organizationProfessional Services: HardwareIn-House expertise with Perot Infrastructure:Systems Dell’s broad portfolio of enterprise solutions Dell’s Unified Clinical ArchiveSoftware: Imaging / ClinicalPartnerships with leading VNA Workflows (PACS):ISVs and InSite One Integrations with leading PACS29
  30. 30. Dan Trott WW Strategy and Business Development Executive for Dell’s Unified Clinical Archive Solution30 Healthcare and Life Sciences
  31. 31. Dell Unified Clinical ArchiveHelping Healthcare providers efficiently store, manage and share medical image data Women’s Medical Radiology Oncology Cardiology Pathology health Record Unified Clinical Archive Unified Clinical Archive Dell Clinical Data Management Data Consolidation and Information Life cycle Management Dell On-Premise Clinical Archive Dell Cloud Clinical Archive Object based storage platform Managed Enterprise Archive Dell Clinical Collaboration Portal Cross Enterprise Data Access and Distribution31 Confidential 11/16/2011 Healthcare and Life Sciences
  32. 32. UCA – Portfolio At a Glance Unified Clinical Archive Portfolio Dell Services: Consulting, Implementation, Integration, Global Support Dell On-Premise Dell Clinical Data Dell Clinical Dell Cloud Clinical Clinical Archive Management: Collaboration Portal: Service Hardware deployed on-site Software layer to consolidate Tools to enable data sharing Integrated solution for and collaboration Cloud based managed to store and manage medical images from multiple PACS enterprise archive images modalities • Long Term Archive: • Dell Cloud Clinical DX6000 Series • Multiple Universal • All Major VNA providers Archive Viewers • Compellent*, EQL* • DICOM, HL7, • Dell Cloud Clinical • InDex Passport* • Capital Expense model • Non-DICOM Recovery • Image Enablement of • Automated replication • CIFS/NFS, HTTP • Utility / Managed EMRs • Data protection • XDS/XDSi Service Model • HIE, XDS Registry • Seamless scaling • DR / BC • Web Distribution • DICOM, HL7, XDSi • IHE Compliant Secure – FDA Certified – Supports Compliance* To be included in future
  33. 33. Dell’s – Integration and Support Services • #1 in Worldwide Healthcare IT Services – Pre-sales Consultative Services – Dell/Perot Enterprise Solutions Group (ESG) • Skilled solution architects: – Automated tools, analysis, and industry best practices – Modular, flexible approach – Regulatory compliance – Tested and Validated integrations with partners – Single point of contact for Implementation and support33 Healthcare and Life Sciences
  34. 34. Dell’s Unified Clinical Archive Flexible and integrated end-to-end solution for medical image management, distribution and archiving34 Healthcare and Life Sciences
  35. 35. Conclusion• Concept of the VNA is straightforward, but Configuration of the VNA can be Complicated• There are fully integrated single vendor solutions worth consideration, but if there ever was a situation that argues for a Best- Of-Breed solution, this is it• Pre-configured solutions with limited options may suite the vendor’s requirements, but they may not suite the Organization’s Needs• Unfortunately, the end-to-end solution based on choices from multiple technologies from individual vendors will require – Experienced system integration – Ability to work with a galaxy of other vendors that all have some stake in the organization – Very sophisticated back-end support35
  36. 36. Conclusion• If a single-vendor solution, or one of the limited option solutions doesn’t quite fit the Organization’s Requirements… Don’t give up looking for a real Best-Breed Solution36
  37. 37. Questions & Answers37