An Alternative Approach to Managing the Massive Growth in
Unstructured Healthcare Data - in an Oracle Database
David Hanco...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Multiple Data Sources, 100’s of file
     types                            Image Manager -
                    Video Endos...
Classic Architecture for DICOM1 Objects
                 X-ray                                   MR Scanner




          ...
Classic Architecture for other Unstructured
Content
   Video
               Photographs                     Audio




    ...
Unstructured Content stores replicated
        across organisation
Video                                                  ...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Unstructured Content Data Management
     Challenges
• DICOM
   • Scalability
      • Scale to large information networks ...
Unstructured Content Data Management
      Challenges
• DICOM - continued
  • Data Integrity – Change of Patient Data and ...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Managing All Your Information in One
    Place
                                     Oracle SecureFiles
                   ...
Oracle Multimedia DICOM: Native DICOM
   Support
• Search based on any DICOM attribute
  • Extract all 2028 standard and v...
Oracle Multimedia DICOM for Managing
  Medical Images
• Vendor-neutral DICOM storage and DICOM data
  model
  • Supports n...
Oracle SecureFiles
                     Breaking the performance barrier…




      File Read Performance                 ...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Oracle Multimedia DICOM for Managing
 Medical Images
• Oracle Database 11g provides native and complete
  support for stor...
“…the easiest way to break system
 security is often to circumvent it
 rather than defeat it”
Oracle Database Vault
   Compliance and Insider Threats


• Controls on privileged
  users                                ...
Oracle Audit Vault Overview
 Trust-but-Verify


• Collect and Consolidate Audit Data
    –   Oracle 9i Release 2 and highe...
Key Platform Components for Maximum
          Availability Architecture
                                                  ...
Differentiators
• Equal or better performance with same hardware and larger datasets
  than todays architectures
• Lower C...
A perfect integrated & secured clinical
                                 environment
                                     ...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Oracle Multimedia DICOM is a Platform for
    Several Applications

• Image management for multi-disciplinary
  medical re...
Multi-disciplinary Medical Research: BioGrid
 Australia
• Simplifies research
    • Integrates health research data collat...
BioGrid Australia
         Oncology
                                                                                      ...
BioGrid Australia

• Chose Oracle Multimedia DICOM because:
   • Simplified IT requirements through native
     processing...
Clinical Research at Novartis
• Problem: Clinical trial images managed by third party
  Clinical Research Organizations (C...
Clinical Research Image Management:
              IBISimg
                                                                ...
Image-enabled EHR: I-Engineers Health
 Engine
• Customer case study with Health Engine:
    • Spitalnetz Bern hospital (Be...
AstraZeneca
Clinical Image Repository Helps AstraZeneca
Integrate, Manage and Protect Images to
Improve Data Integrity and...
Agenda
• How Healthcare manages unstructured
  content today
• Issues with today’s solutions
• Oracle infrastructure for m...
Conclusion
• Today’s DICOM and Unstructured Content
  solutions are inadequate for today’s 21st Century
  Healthcare
• Ora...
Slide 35
6.ŞĐFRE
  6. ŞĐFRE




YAŞINDA
Mma For Turkey V1
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  1. 1. An Alternative Approach to Managing the Massive Growth in Unstructured Healthcare Data - in an Oracle Database David Hancock – Director, Healthcare and Life Sciences Industry Business Unit Slide 1
  2. 2. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  3. 3. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  4. 4. Multiple Data Sources, 100’s of file types Image Manager - Video Endoscopy C-Arm Images Monitor Report MD’s Staff RN, Tech EEG Monitoring MRI Image - PACS C-Arm Left side of OR Fluoroscopy Laser generator EMG Image view Monitoring Teleconferencing - boxes Patient in Operation Theatre telesurgery
  5. 5. Classic Architecture for DICOM1 Objects X-ray MR Scanner Files Server for storage DB used for Metadata Repository 1. DICOM = Digital Imaging and Communications in Medicine Slide 5
  6. 6. Classic Architecture for other Unstructured Content Video Photographs Audio Files Server for storage All stored on File System Slide 6
  7. 7. Unstructured Content stores replicated across organisation Video Video Video Photographs Photographs Photographs Audio Audio Audio Files Server for storage Files Server for storage Files Server for storage All stored on File System All stored on File System All stored on File System Cardiology Endocrinology Neurology Video Video Video Photographs Photographs Photographs Audio Audio Audio Files Server for storage Files Server for storage Files Server for storage All stored on File System All stored on File System All stored on File System Obstetrics Paediatrics Geriatrics
  8. 8. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  9. 9. Unstructured Content Data Management Challenges • DICOM • Scalability • Scale to large information networks – Health Information Exchange is coming to images too! • Handle massive increase in data volume – new modalities and diagnostics • File based solutions are inadequate v DBMS. Big issues including: • Security and privacy while sharing and accessing medical images • Business Continuity and Disaster Recovery • Losing images • Information Life Cycle Management is only as good as the weakest link by the vendor • Costs • Storage (hardware) – PACS are most expensive spinning discs in the world running on proprietary hardware • Development, deployment and maintenance (labor) • Significant issues with emerging (changing) DICOM standard and handling images with no DICOM standard defined
  10. 10. Unstructured Content Data Management Challenges • DICOM - continued • Data Integrity – Change of Patient Data and Image mismatch as they are stored separately • No interoperability - storage solutions are proprietary making it impossible to share data cross other PACS solutions and across care continuum • Cannot link images into Healthcare Records • Fast access to local, remote, and archived medical images • Other Unstructured Content • Critical clinical data managed in a very ad hoc way • Inadequate security • Poor back-up • No archiving or records management • Today’s solutions mean it is always separate to DICOM image archive • Images not linked to Healthcare Records
  11. 11. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  12. 12. Managing All Your Information in One Place Oracle SecureFiles High Performance, Secure LOBs • Uniform Management of XML DB Integrated Native XML Database content and metadata Oracle Text • Scalable Text Indexing and Classification • Secure Location & Spatial • Highly Available Location Enabled Databases Semantic Database • Integrated Ontologies, OWL, RDF • Robust Multimedia Audio, Image and Video • Available on all platforms New with 11g: DICOM Medical Imaging Relational Characters, Numbers, Dates
  13. 13. Oracle Multimedia DICOM: Native DICOM Support • Search based on any DICOM attribute • Extract all 2028 standard and vendor-specific extensions • Automate DICOM data quality verification • Include data from any source • Open data model • Ensure privacy • Mask specified DICOM attributes • Include DICOM content in reports and display in browsers • Convert DICOM to web-friendly formats • Create DICOM images from non-DICOM images • Reduce development and management costs • APIs for rapid development and deployment • Model driven architecture
  14. 14. Oracle Multimedia DICOM for Managing Medical Images • Vendor-neutral DICOM storage and DICOM data model • Supports networked systems for sharing images • Performance: As fast as underlying hardware device • Faster than file systems • Ex: Read 850 CT images/sec, Write 550 CT images/sec (published benchmark) • Reduces Risk • Protect images against loss with backup and recovery • Facilitate image-enabled EHRs • Complete and non-fragmented view of data to clinicians
  15. 15. Oracle SecureFiles Breaking the performance barrier… File Read Performance File Write Performance (MB/second) (MB/second) 100 60 80 50 40 60 30 40 20 20 10 0 0 0.01 0.10 1 10 100 0.01 0.10 1 10 100 SecureFiles File Size File Size (MB) Linux Files (MB) LOBs
  16. 16. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  17. 17. Oracle Multimedia DICOM for Managing Medical Images • Oracle Database 11g provides native and complete support for storing and managing medical images and other unstructured content • Scalable to petabyte and exabyte medical image archives • Guaranteed security and privacy • Uniform security policies across all types of data and all tiers of data • Lower costs • Unified management of images and patient data • Eliminates maintenance of specialized code for image stores • Flexible choice in hardware • Information Lifecycle Management • Archive images based on clinical tags, have online access to archive
  18. 18. “…the easiest way to break system security is often to circumvent it rather than defeat it”
  19. 19. Oracle Database Vault Compliance and Insider Threats • Controls on privileged users Realms – Restrict DBA access to application data Reports – Provide Separation of Duty Multi-Factor – Security for database and Authorization information consolidation • Enforce data access security policies Command Separation – Control who, when, where and how is data accessed Rules of Duty – Make decision based on IP address, time, auth…
  20. 20. Oracle Audit Vault Overview Trust-but-Verify • Collect and Consolidate Audit Data – Oracle 9i Release 2 and higher • Simplify Compliance Reporting Monitor Policies – Built-in reports – Custom reports Security Reports • Detect and Prevent Insider Threats – Alert suspicious activity • Scale and Security – Robust Oracle Database technology – Database Vault, Advanced Security (Future) Oracle 9iR2 Other Sources, – Partitioning 10gR2 Databases 10gR1 • Lower IT Costs with Audit Policies – Centrally manage/provision audit settings
  21. 21. Key Platform Components for Maximum Availability Architecture MAMA DICOM MAA (RAC, Data Vault, Grid, HA, EM, Partitioning, DataGuard) Facilitate access to image data Dicom Comprehensive DICOM Support: Full DICOM Part 10 format support Standard Support Metadata extraction of all 2028 attributes and vendor-specific attributes, validation for quality, anonymization for privacy Benefit Support for all content: DICOM image, video, audio, non DICOM images using same Database capability Mining and knowledge discovery: To suggest “other” or “hidden” perspectives Open access to interface with any existing systems Allow clinicians to very quickly and accurately come to a correct, more Dicom informed diagnosis Search Features Enhanced search: Fast and comprehensive search based on all DICOM metadata and device vendor-specific metadata, can link in medical ontologies Faster delivery of medical imaging leading to speedier availability of results Dicom Speed: As fast as or faster than file systems to give “immediate” access to results Storage Benefits Lower Costs: Automatic storage management, compression, partitioning, information lifecycle management for lower cost per byte Distribute image data in a secure and interoperable way MAA Business Continuity and Disaster Recovery: Scalable, fault tolerant solutions with grid architecture and other large database technologies to deliver Maximum Availability and Manageability Architecture & Security: Secure storage for privacy and auditing requirements and strict regulation support MAMA
  22. 22. Differentiators • Equal or better performance with same hardware and larger datasets than todays architectures • Lower Costs: • DICOM capability is available in Standard Edition for iSVs • Allows commodity hardware to be used • All benefits of Oracle Information Life Cycle Management which lowers total cost per byte stored • Guaranteed data integrity at no cost – image and metadata stored in one place • Scalability and MAMA • Model driven definition of DICOM objects supports evolving DICOM standard and use of private (vendor-specific) tags • Security - Images and metadata are subject to the same access and control capabilities in the database including the auditing of access • Simplifies and facilitates consolidation and sharing of DICOM Content • iSVs who use 11g DICOM and Secure Files can jointly go to market with Oracle.
  23. 23. A perfect integrated & secured clinical environment All Other Content -For ISVs : decrease workload development in integrating file systems and dbms, concentrate development staff on interpretation functionalities, offer a better Radiology MRI Scanner image/data integrity -For customers, decrease storage costs by Data acquisition by modalities accessing to low cost hardware solutions Results viewing & distribution as image volume increase, benefit of OracleDB security and safety options, unify multimedia information storage CT Scanner Orthopedics Collect, organize and distribute clinical imaging data and UltraSound other content in- and in- Nuclear outside the hospital Operating Medicine Multimedia: Room DICOM X-ray Web Distribution Emergency Department Film Digitizer Ward Referring Physician Internet/Intranet Internet/Intranet Patient Slide 23
  24. 24. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  25. 25. Oracle Multimedia DICOM is a Platform for Several Applications • Image management for multi-disciplinary medical research • Clinical research image management at Pharmaceutical Companies • Image-enabled EMRs • Content management for all types of content • Multi-Media Medical image archives • Storage for PACS systems
  26. 26. Multi-disciplinary Medical Research: BioGrid Australia • Simplifies research • Integrates health research data collated by clinicians in different institutions • Links data from multiple institutions in disparate silos • 12 years of MRI images was scattered on 1000 tapes, taking weeks to months for retrieval • Multi-terabyte Archive • Consolidates 32 databases from 14 institutions across 4 Australian states • Intranet based solution with 7 million images • Image retrieval in seconds • Continues to grow
  27. 27. BioGrid Australia Oncology Authorised researchers query n=1,265 the federated research Tissue Bank repository & download data to n=1,764 their workstations for computer uArray n=80 test aided diagnosis. PeterMac Extract Transform & Load Nightly updates De-identified data Oncology n=965 RMH– LRR (Inc WH Data) Tissue Bank n=1,663 Oracle Biomarkers PMC-LRR n=0 Database Austin 11g Austin- LRR Oncology n=3,600 Tissue Bank Researchers’ n=454 feedback is Familial Ca GenBank input back to n=3,758 the system Surveillance Institute specific data UniProt LocusLink n=3,541 loaded into institute Growing Epilepsy specific Local Research PubMed research data n=1,823 Diabetes Repository n=21,048 Public Data Sources Biomarkers n=50 Melbourne Courtesy: Naomi Rafael, BioGrid Australia
  28. 28. BioGrid Australia • Chose Oracle Multimedia DICOM because: • Simplified IT requirements through native processing of DICOM images • Accelerated development and deployment • Preserved patient privacy by anonymizing DICOM images without losing the link between the image and patient record • Reduced storage requirements • Superior functionality at lower cost • Re-use implementation for future projects • Skilled programmers readily accessible
  29. 29. Clinical Research at Novartis • Problem: Clinical trial images managed by third party Clinical Research Organizations (CROs) • Poor Quality Management • Difficult Cost Control • Direct access to images limited and expensive for pharmas • IBIS solution on Oracle 11g Multimedia DICOM enabled: • Efficient, lower-cost solution • Improved data quality • Security to restrict access to authorized users • Compliance • Data validation • Quick deployment of standard Oracle Database-based solution
  30. 30. Clinical Research Image Management: IBISimg IBISimg User Systems Adm. Reports Image/data Viewer Presentation User User Authentication User Target Synchronized metadata Systems Security with images Archive Oracle Data Export CDMS Backup Multimedia Site DICOM Migration Data Study Data Integration Module Archive DICOM Image Data DICOM Image Files CRO Data Acquisition Interface Study Management Systems Rules Engine Site Courtesy: IBISWorks
  31. 31. Image-enabled EHR: I-Engineers Health Engine • Customer case study with Health Engine: • Spitalnetz Bern hospital (Bern Health Network, Switzerland) • Universal archive for all content (images and patient data), will be used by 2000+ users • Content management solution in hospital administration office • Built a DICOM node using Oracle Multimedia DICOM platform • Receive images from DICOM-enabled applications • Extract image metadata to include in patient health record • Convert DICOM images to JPEG for viewing using web clients
  32. 32. AstraZeneca Clinical Image Repository Helps AstraZeneca Integrate, Manage and Protect Images to Improve Data Integrity and Advance Regulatory Compliance “Our desire was to build a scalable system for managing images that is as robust as our system for managing clinical data. Oracle helped us plan for the future by creating a centralized repository to serve our needs today and moving forward. It also allowed us to create a singular back end for data storage, giving us the flexibility to support multiple workflows in AstraZeneca's various practice areas." Dr. Goutham Edula, Business Lead for Clinical Imaging Informatics, AstraZeneca
  33. 33. Agenda • How Healthcare manages unstructured content today • Issues with today’s solutions • Oracle infrastructure for multi-media medical archive • Benefits of Oracle Infrastructure • References • Conclusion
  34. 34. Conclusion • Today’s DICOM and Unstructured Content solutions are inadequate for today’s 21st Century Healthcare • Oracle is unique in being able to store DICOM images and other Unstructured Content within a single repository and read/write faster than file systems • Oracle is the leading database for Maximum Availability, Manageability Architecture (MAMA) and Security • This technology is proven in key partners and customers
  35. 35. Slide 35
  36. 36. 6.ŞĐFRE 6. ŞĐFRE YAŞINDA

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