Address the multidepartmental digital imaging conundrum with enterprise level data management
W H I T E P A P E R Hitachi Clinical Repository Address the Multidepartmental Digital Imaging Conundrum with Enterprise-level Data Management By Hitachi Data Systems December 2011
2 Table of Contents Executive Summary 3 Department or Enterprise? No Need to Choose 4 The VNA Capabilities of Hitachi Clinical Repository 5 Support for Open Standards 5 Assured Patient Privacy and Security 5 Intelligent Data Lifecycle Management 5 Maintain Data Interoperability without DICOM Wrappers 5 Auditing and Chargeback Capabilities 6 The Enterprise Capabilities of Hitachi Clinical Repository 6 Summary 7
3 Executive Summary Radiology departments using picture archiving and communication systems (PACS) have been at the center of hospital digital imaging efforts over the past 2 decades. More recently, departmental imaging has spread to other areas of the hospital, such as cardiology, womens care and, in the last several years, digital pathology. Physicians and clinical staff moving between these departments not only need access to the resulting trove of images (regardless of where the imaging data resides). More importantly, they need and expect the images to be associated to, and made available with, all of a patients other medical data. But in reality, for many healthcare institutions this type of data access is either not possible or made more difficult by IT investments that fail to consider the needs of the enterprise.
4 Department or Enterprise? No Need to Choose Hospitals increasingly are looking for ways to optimize and consolidate resources, often by eliminat- ing multidepartmental data silos. The space taken up by siloed data sources, as well as their ongo- ing support requirements, is costly and does nothing to help the healthcare facility improve data use and access. Simultaneously, as PACS technology matures, hospitals must plan for the replacement of legacy departmental solutions. The result is often a departmental-only strategy that does nothing to further enterprise data initiatives, such as electronic medical record (EMR) and electronic health record (EHR) goals. As a consequence, hospitals are faced with difficult tactical and strategic deci- sions. Tactically, they must consider how to efficiently and cost-effectively migrate existing imaging data while ensuring that the data remains intact. Strategically, full data visibility across the hospital enter- prise is the end goal and must be supported and protected by IT investments. Healthcare providers must consider the needs of the whole enterprise, encompassing both image- and nonimage-related data, when making infrastructure decisions. One popular solution has been to consolidate multidepartment PACS silos into a vendor-neutral archive (VNA). VNAs provide the opportunity to consolidate an enterprises imaging demands into a single repository, using DICOM1 standards to ensure that data can be easily retrieved. VNAs provide the ability to share multiple PACS vendor images by removing proprietary formatting. In addition, VNAs allow for economies of scale, as the organization can consolidate storage into a single sys- tem. Finally, backup and disaster recovery become much easier with a VNA. Consolidating data silos, even if they only encompass medical images, could appear to be a good short-term strategy. However, hospital organizations must ask themselves whether a VNA invest- ment is going to support their long-term enterprise data strategies, including longitudinal patient views, EHR adoption and meaningful-use initiatives. Although a step in the right direction, typical VNAs dont go far enough to meet enterprise data- access requirements. For instance, VNAs typically restrict data access only to digital images, which generally represent no more than 20% of a patients record. An EHR strategy must include the other 80% of patient content in order to achieve full view of a patients longitudinal record. In the long run, VNAs create an entirely new, and larger, silo of data that eventually will need to be integrated into the enterprise in order to attain EHR goals. Consolidating data from all departments is critical to developing a longitudinal view of patient medical records. 1 DICOM (digital imaging and communications in medicine) is a standard for handling, storing, printing and transmitting information in medical imaging.
5 The VNA Capabilities of Hitachi Clinical Repository For hospitals with a VNA strategy, Hitachi Clinical Repository (HCR) acts as a VNA (see Figure 1). It supports import and storage of DICOM studies as well as query and retrieval of studies, regardless of the original PACS vendor. HCR, a registered medical device, provides a single online repository that enables protection, search and retrieval across all image and nonimage healthcare data and provides scalable images, information and lifecycle management in an imaging environment. HCR enables images and related information to be queried, stored and retrieved in a manner defined by open standards while maintaining patient privacy and security. HCR provides a patient-centric ap- proach that transcends upgrades and changes to viewing, acquisition and workflow-management components. Such components are interchangeable, without the need to migrate, convert or change the data formats or interfaces. Support for Open Standards HCR fully supports DICOM and Health Level Seven (HL7), the most common accepted medical protocols. Support for these standards means other systems in your enterprise can query against HCR to retrieve data. In addition, metadata is captured in XML, the ideal format for easy retrieval by the various applications that may be used to access and view the data, such as electronic health records or physician portal applications. Assured Patient Privacy and Security Security is a critical requirement of any healthcare IT infrastructure. HCR provides multiple layers of features designed to safeguard and secure the data entrusted to it. It is a highly scalable, secure, self-healing, cloud-enabled object repository platform that is capable of supporting multiple simul- taneous applications. HCR takes a layered approach to security, ensuring the safety of data while restricting unauthorized access. Stored data is encrypted at rest to prevent tampering, and HCR provides automated policy enforcement, failover and integrity checks to ensure data remains secure and robust. Intelligent Data Lifecycle Management Managing the flow of data and information, from creation and initial storage to obsolescence, is the goal of a data lifecycle management strategy. It is also a requirement of good regulatory standards. HCR intelligent data lifecycle management automates and optimizes data storage, taking into ac- count clinical usage patterns. HCR manages the tiering of data between different disk performance levels with robust retention and deletion capabilities. Maintain Data Interoperability without DICOM Wrappers When converting unstructured data (which is typically non-DICOM) to structured data, a VNA typi- cally relies on DICOM wrapping, which creates DICOM headers that contain the metadata element to include with the data object. HCR captures data in its native format, indexes the metadata as- sociated with the study, and returns a URL to tell the consuming applications where the medical in- formation is stored. Maintaining the original format of the data allows it to be recalled by the original
6 application and modified without conversion and maintaining data interoperability. Auditing and Chargeback Capabilities Through HCR tenant administration, IT administrators can allocate storage to namespaces. This en- sures that each departments data production can be individually monitored and allows for individual department usage reports and association of relevant costs. Figure 1. Hitachi Clinical Repository functions as a vendor-neutral archive. The Enterprise Capabilities of Hitachi Clinical Repository By leveraging the HCR infrastructure beyond the imaging department and across multiple departments, enterprises and regional facilities can realize their enterprise data management
7 strategy. A scalable solution that can be leveraged beyond the medical imaging component, HCR provides a single online repository that enables protection, search and retrieval across all healthcare data. By aggregating any data type, both image and nonimage, and indexing the associated metadata, HCR removes the proprietary nature of the data. This enables a consolidated view when used with ap- plications such as electronic records or physician portals and facilitates enterprise-wide consistency. Business rules, privacy and security requirements, quality and audit assessments, governance and workflow processes can all be applied against the data for further improvements to patient care. Managing metadata centrally allows the enterprise to create a master data management approach. Developing a metadata repository improves the interoperability of information and virtualizes data within and between systems. This enhances clinical efficiencies, reduces healthcare delivery costs and improves patient-care decisions. Hospitals that today seek only to integrate their imaging data silos will benefit from the efficiency of HCR while simultaneously laying a scalable foundation for future integration of data types. Summary As data grows at an explosive rate, so does the need to use it more productively. Electronic health records hold the promise of improving the safety, quality and efficiency of healthcare delivery. But many organizations are struggling with implementation and clinical adoption, primarily due to costly and complex department-based IT infrastructures. EHR implementation depends on successful enterprise-wide consolidation and interoperability. Hitachi Clinical Repository provides a departmental- to enterprise-wide infrastructure that is vendor neutral. HCR supports policy-based integration from multiple distributed or centralized repositories, such as radiology, cardiology, pathology and other imaging systems. HCR also allows any type of fixed content data, including electronic patient record (EPR) summary records, laboratory results, pharmacy records and even video files, to be stored and intelligently mined within one system. With HCR, hospitals can meet their departmental goals, while laying the foundation for successful EHR implementation, by combining clinical and nonclinical data into one data management system. This drives meaningful use through access to an improved metadata-plus-data registry.