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


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Dan Trott, WW Strategy and Business Development Executive, Dell Healthcare and Life Sciences presents System Integration solutions for Vendor Neutral Archiving that will assist with collaborative care via three use cases at HIMSS 2012, Interoperability Showcase, Wednesday, February 22, 2012.

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  • Here are the Objectives of today’s presentationI’ll start by summarizing the challenges presented by a Heterogeneous PACS environmentThen describe what many believe to be the appropriate Solutions for data Management, Archive and Distribution …a Vendor Neutral Archive with associated UniViewer.We’ll look at Architecture and Deployment optionsI’ll offer some considerations for Selecting a Solutions PartnerI’ll discuss what I believe would constitute the Ideal VNA SolutionWe’ll look at what it takes to Assure SuccessMr. Dan Trott from Dell Healthcare will present Dell’s Approach to Enterprise ArchiveWe’ll wrap up with a Conclusion and a short Q&A session
  • Much has been written about VNA, but I think it would be good to summarize the problems we believe it is supposed to addressThe most obvious problem is the Silo Effect… the proliferation of individual, different storage solutions for each PACS. This data management strategy increases complexity, it raises costs, and it presents support challenges to IT.Most PACS vendors support a limited number of technology and vendor choices for those storage solutionsAll PACS applications manipulate the DICOM header associated with the image data produced by the imaging modality, in effect they create proprietary image data that is not completely compatible with another PACSMost PACS lack the ability to move data around in the storage solution based on the metadata that defines the image and study. Of course,PACS do not support a data purge mechanismMost currently installed PACS are configured with an inadequate Disaster Recovery Solution. It might be HIPAA conformant, but data integrity is at risk and data recovery rates would probably not be acceptable.
  • Word document
  • See the Word Document
  • Based on informal polling of a majority of VNA vendors 95 plus percent of all currently installed VNA solutions are mirrored configurations.As you can see in this high-level graphic, there is an instance of every major component of the system in each of the two data centers. That includes VNA application, UniViewer application, and Storage Solution.I want to specifically point out that there should be a second instance of the UniViewer application in the second data center. This duplication of the UniViewer is a litmus test for true Business Continuity.If the only instance of the PACS application, and the entire primary VNA subsystem are both out of service, that second instance of the UniViewer is the key to accessing and viewing the back-up copy of the data.
  • Let’s take a look at Architecture and Deployment IssuesHere are some key issues and options that the organization must considerDoes IT have the staffing level and skill set to assist in the initial deployment of the system and then the ongoing 7/24 administration and operational support of the VNA? If self management is not a realistic option, the organization should consider contracting with the vendor for some percentage of system managementDoes the organization already have that second data center? Is co-location with a business-class provider a viable option?The organization needs to find a way to procure storage in a just-in-time model to avoidall of the costs associated with storage that is under power but sitting idle.
  • The organization must consider the infrastructure and associated professional services that will be required to achieve a reasonable recovery time for replacing any of the primary data that is lost or damaged. Can the organization perform its own disaster recovery, or will it have to depend on the vendor? Then there is the issue of true Business Continuity. That will require configuring the VNA with a second instance of the UniViewer and a second instance of the VNA in close proximity in the second data center. Achieving acceptable performance over the WAN is highly dependent on the choice of UniViewer and the choice of interface methodology between UniViewer and VNA. That is why I recommend Zero Client, virtualized rendering server and a web services interfaceLastly there is the issue of Funding. The major decision is between investing Capital funds, funding the system through an Operational Lease, or entering into a multi-year Fee-per-Study contract.Timing is also an issue. Can the organization afford to implement the entire system in one year, or will it be necessary todeploy the system over multiple budget cycles?
  • The organization must consider these architectural issuesI really don’t consider a mirrored configuration an option. I consider it a requirement. A mirrored configuration split between two geographically separate data centers is the correct and responsible approach to Disaster Recovery and Business Continuity.If the organization’s imaging operations are spread across multiple facilities, consideration must be given to whether it makes sense to place a mini version of the VNA in each facility as another measure of redundancy.Ideally both the VNA and the UniViewer applications support virtualization. This simplifies failover scenarios, as well as system expansion.The VNA architecture must also provide some methodology for acquiring both DICOM and non-DICOM image data directly from Imaging Modalities in departments that do not have their own PACS. The VNA must function as the PACS for these departments.
  • So there are four major decisions that determine the VNA Deployment Options First there are the Economic Decisions. Does the Organization want to own the system, or does the Fee for Study option make more sense? Are there sufficient funds to deploy the system in a single phase? Second there is the issue of System Management. Is IT capable of self management, or should some percentage of the system be managed by the vendor?Third there is the issue of Storage Utilization. Can the organization create and manage an on-demand storage procurement schedule, or would it be more cost effective to have the vendor deliver storage under the Fee for Study model?Last, there is the BIG decision, On-Premise versus Off-premise. Is the organization willing and able to support the second data center? How does the organization feel about the vendor managing a significant percentage of the data in an off-premise, remote data center? What conditions will be required to establish that TRUST?
  • To answer that question, let’s take a look at the four stakeholders that are involvedThe PACS Vendors are the developers of the Clinical Applications used to collect or create data that is interpreted resulting in a text-based report object. The VNA Vendors are the developers of the clinical Data Management Software. In partnership with a chosen UniViewer vendor, they provide the tools for distribution of the image and report data throughout the enterprise. The Consultants / Integrators are the providers of a series of Professional Services that facilitate product and vendor selection and then provide project management. The Hardware Vendors are the providers of the servers and storage…the Infrastructure of the system.Any single one of these stakeholders will typically lack the depth and breadth to be experts in all areas, to understand and have control of every one of the many options required to constitute the right VNA solution for the organization. Any single one of these stakeholders can only present a limited number of options to the organization
  • Ideally an organization would be able to configure their VNA system with choices in each of the four major categories depicted in this slide: Software, Hardware Infrastructure, ProfessionalServices, and Imaging/Clinical Workflows supported by the departmental PACS.Choices in each category would be determined through an analytical process.Step one is a formal Needs Assessment. Step two is an introspective assessment of the organization’s strengths and weakness, its resources, etc. This process would be conducted with or without external help.The resultant component choices would then be integrated, installed, and supported by a team with experience with that specific configuration
  • Here is a little more detail… the vendor would have to meet all of the following requirements#1 Provide consulting services, not merely a sales process thinly disguised as consulting services#2 A System Design process that matches the component options to the organization’s needs and resources#3 A Financial Modeling Service that accurately compares the Total Cost of Ownership of the proposed system to the existing Heterogeneous PACS environment#4 Flexible Financing ranging from a totally capitalized proposal to a fully operationalized proposal
  • Dell’s Unified Clinical Archive is a End-To-End solution for all your Medical Imaging and Clinical Data storage needs. It provides a consolidated and application neutral storage platform that can be scaled across multiple clinical departments. The solution is flexible and can be uniquely customized as an On-Premise storage platform or fully managed enterprise archive service or any combination of the two. It provides a standards based solution for sharing and collaboration across your enterprise network. Dell Clinical Data Management: This is the software layer that consolidates medical images and other unstructured content from multiple sources and creates a standards based, vendor neutral data repository. Dell On-Premise Clinical Archive : Provides a reliable and validate hardware platform that is specifically designed for:Policy-driven retention & replication/distributionScalabilityManageabilitySecurityDiscoverabilityDell Clinical Collaboration Portal: Facilitates Web Access and distribution of clinical data across the medical enterprise. Image enablement of EMRsSharing of medical imaging data through an Health Information ExchangeDell Cloud Clinical Archive: A fully managed Enterprise Archive Service that vastly simplifies your IT Infrastructure and frees up IT bandwidth. It provides increased availability, continuity and disaster recovery, while at the same time reducing total cost of ownership.
  • My advice?If a single vendor solution, or one of those limited option solutions doesn’t quite fit the organization’s requirements,Don’t give up looking for a real Best-Of-Breed solution, one that meets all of the requirements that I have discussed in this presentation.
  • Thank you for your time, and now I believe we have some time left for some questions
  • Challenge of a Best-Of-Breed VNA is Skillful System Integration and Dedicated Back-end Support

    1. 1. Challenge of a Best-Of-Breed VNAis Skillful System Integration andDedicated Back-end SupportDan TrottWW Strategy and Business Development ExecutiveDell Healthcare & Life Sciences –Unified Clinical Archive Solution
    2. 2. 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 Approach2
    3. 3. Problems• The Silo Effect • Multiple Vendor Management• Limited Choices • Non-DICOM Data• Proprietary Data Formats • Lack of Information Lifecycle• Lack of Business Continuity Management• Costly Data Migrations • Inadequate Disaster Recovery• Data Sharing and Collaboration3
    4. 4. 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 components4
    5. 5. 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)5
    6. 6. 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 Storage6
    7. 7. 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?7
    8. 8. 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?8
    9. 9. 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-DICOM9
    10. 10. 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?10
    11. 11. 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 rightVNA11
    12. 12. 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)12
    13. 13. 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 operationalized13
    14. 14. Dell Unified Clinical Archive - Visit #3607Helping 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 Distribution14 Confidential 2/21/2012 Healthcare and Life Sciences
    15. 15. 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 Solution15
    16. 16. Questions & Answers16