Carestream VNA, an Oxymoron?
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The document discusses vendor neutral archives (VNAs) and their role in healthcare. It begins by defining an oxymoron and what makes a VNA potentially oxymoronic. It then discusses healthcare trends driving needs for consolidated, cross-site data sharing and reviews definitions of a VNA. The document outlines typical requirements and challenges for an ideal VNA. It also discusses practical VNA implementations and how standards like DICOM, HL7, and IHE profiles can enable data sharing. Finally, it argues that a PACS vendor can provide a truly vendor neutral solution through Carestream's Vue Archive platform.
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.
- 10. Typical Requirements p.10 Public © Carestream Health, 2013
- 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
- 30. Thank you
Editor's Notes
- #13: 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
- #14: 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