Cloud eHealth in Medical Imaging & Radiology
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The document discusses how cloud-based infrastructure can support various healthcare workflows. It provides two case studies: 1) Maasstad Hospital in the Netherlands used the cloud to archive radiology images and consolidate clinical data to avoid managing storage itself. 2) Imadis, a French teleradiology company, used the cloud to enable a dedicated reading workflow and ensure performance, security, and 24/7 support for emergency readings. The cloud infrastructure allows customization of workflows while outsourcing complexity to cloud providers and avoiding large capital investments. This flexible model is positioned to support diverse healthcare needs going forward.
Cloud eHealth in Medical Imaging & Radiology
- 1. Presented at World of Health IT 2010 Barcelona, Spain March 15, 2010 How a Radiology Cloud Infrastructure Supports a Variety of Customer Workflows Real world case studies from emergency teleradiology to hospital cross reading and long term archiving
- 2. Presentation Overview Overview of cloud based services in hospitals End user needs and third party support eHealth implementation example Case studies: Maasstad Hospital, Rotterdam, The Netherlands Imadis Teleradiologie, France Conclusion Presenter: Pierre Yves Nectoux
- 3. A Fundamental Move In Hospitals Volume of data Clinical Expertise dispersion Level of IT Expertise required In a context of Increasing demand for quality and security of care Costs pressure Regulatory and legal pressure Resources sharing IT complexity Expertise sharing Collaboration Patient mobility How to face these challenges ?
- 4. Real Life: Multiple Requirements, Multiple Needs Neutral Secured Open to multiple workflow Expertise sharing Clinicians looking at patient records from other health institutions Resource sharing Hospitals looking at consolidating and sharing their IT infrastructure Collaboration Hospitals wanting to organize reading between different sites, to deal with patient mobility Multiple solutions ?
- 5. A New Approach: Cloud-based Services… Cloud Archiving Collaboration Reading Site A Site B Site ... N Sharing
- 6. What Is Cloud-based Service? The Users define Their requirements Their workflow Their use cases Their expectations The Supplier brings The Technology The infrastructure The expertise The guaranteed SLA A Business model + An architecture Pay as you go Flexible & Distributed The User benefits No capital investment Personalized workflow Peace of mind versus data management Capability to access to more and more services
- 7. The eHealth Cloud: A cloud For Healthcare The eHealth cloud Workflow elements General purpose cloud Google, Amazon, … The eHealth cloud Security Confidentiality Signature Access tracking Long term mgt
- 8. The eHealth Cloud: Implementation Example Hospital Site Data Center Online communities Combination of on site and off site infrastructure Vendor neutral Infrastructure Virtual datacenter concept
- 9. A local system: The Service Access Point Service boundary Interoperability module of infrastructure (HL7, DICOM, XDS, PIX…) Belongs to the cloud Brings local features when needed (e.g. storage, etc…)
- 10. Behind the Cloud: The “data centers” Data management Service logic implementation Data Security implementation Event & Access tracking
- 11. Access Management Authentication Smooth and secure data access (Streaming) State of the Art internet security
- 12. The eHealth Cloud: The Ultimate Peace Of Mind No System Change Vendor Neutral Infrastructure Customer responsibility Cloud supplier responsibility Service boundary
- 13. A Service Oriented Architecture Service Access Point #1 Tele radiology Service Access Point #2 Service Access Point #3 Service Access Point #4 Tele radiology Tele radiology Archive Information Exchange PIX Data Management Bus Service Interface Local site Service Logic Workflows Service Infrastructure Data management One infrastructure, supporting multiple needs Data & Metadata
- 14. One Architecture, Two Examples Maasstad Hospital Imadis Service Access Point #1 Tele radiology Service Access Point #2 Service Access Point #3 Service Access Point #4 Tele radiology Tele radiology Archive Information Exchange PIX Data Management Bus Data & Metadata Service Interface Local site Service Logic Workflows Service Infrastructure Data management
- 15. Application To Use Cases Use Case 1: Long Term Archiving
- 16. User Profile Leading Dutch healthcare institution currently active on 2 sites Moving to a new facility in 2011 and rethinking global health IT strategy 180,000 radiology studies per year (10 TB) GE Centricity PACS used for 5+ yrs GE Centricity / Centera Archive Filling Up Quickly Maasstad Hospital, Rotterdam, The Netherlands
- 17. Requirements Keep current PACS Get rid of long term data management (Archive) New data Legacy data Want to get a Clinical Data Repository service, DICOM & Non DICOM Radiology: GE Centricity (DICOM) Cardiology & echo-cardio: Philips Xcelera (DICOM and non-DICOM) Digitized paper records: KOVIS (TIFF) Other file systems Maasstad Hospital, Rotterdam, The Netherlands
- 18. Workflow - Archive DICOM Encrypted data Copies
- 19. Workflow - Retrieve DICOM Encrypted requests Priors? Encrypted data Only if data not already in the DAP
- 20. Workflow - Prefetching HL7 Encrypted requests Priors? Encrypted data Only if data are not already in the DAP Rules DICOM
- 21. Workflow – File System NFS/CIFS
- 22. Workflow – Scanned Records XDS
- 23. Workflow – Migration Automatic Take over Migration strategy
- 24. Maasstad Hospital Benefits Outsource complexity of data management Allow to concentrate on application & workflow Access to data management expertise “The last migration” Keep full control All clinical data consolidated into a single repository Data from different sources No more “silos” No capital investment Service model with pay as you go No re-investment when obsolescence occurs
- 25. Application To Examples Case Study 2: Emergency Teleradiology
- 26. User Profile 5 radiologists created Imadis, a Teleradiology company Their Objective: Solve the night and week end duties nightmare for public hospitals Their vision: Radiology is a medical act Requests must be validated Examination protocol is defined by radiologist Radiologist can refuse an examination (argued) Nominative reading with electronic signature Their choice : a dedicated reading center Imadis, France Lack of radiologists Duties spread on less radiologists Radiologists leaving hospitals
- 27. Requirements Requirements Dedicated workflow, exactly tuned to their needs Want to concentrate on their business – Reading – not on IT Constraints Compliance with regulation, best practices and institution recommendation Security Confidentiality Activity tracking Redundancy Strong support when they are working i.e. at night and Week End No initial capital investment (small company)
- 28. Their Workflow A workflow tuned to their requirements, with dedicated and redundant tools 2 Formalization 3 Protocol 4 Images 4 Images 5 Report 1 Telephone Emergency department Radiographer Reading Center IMADIS Data Center Carestream
- 29. Reading Center Reading Station: CARESTREAM PACS Virtual Reading
- 31. Real Time Follow Up Of The Request
- 32. Reports
- 33. Workflow: Image Transfer DICOM Encrypted data DICOM Encrypted data 1- Studies sent from local PACS 2- Transfer to data center 3- Studies forwarded to reading center Hospital Reading Center Datacenter
- 34. Workflow: Redundancy And Alternate Route Hospital Reading Center Datacenter Alternate route always available to ensure redundancy
- 35. Imadis Benefits A workflow dedicated to Imadis requirements Replicate operations usually executed when present at hospital site Ensure Performance and Security Transfer of IT responsibility on a knowledgeable partner Access to state of the art IT expertise Comply with French legal requirements 24x7 Support No capital investment Service model with pay as you go Operating Costs aligned with Incoming Revenues
- 36. Conclusion
- 37. One Infrastructure, Several Needs Moving to cloud-based eHealth services is the future Health IT is increasing complexity. And it is just a beginning ! Healthcare providers core activity is not to build and maintain adequate IT expertise Anyway, shared infrastructures between several independent entities are necessary Different requirements, different needs, one cloud! Cloud based service infrastructure must be open enough to handle the different requirements Customization of workflows is key The Future is Now ! Few leading eHealth cloud infrastructure already exist ! A large range of services is already available, from archiving to PACS and collaboration services
Editor's Notes
- #29: Connexion de l’urgentiste : Portail Web = favoris Login et mot de passe Sommaire = options disponibles Création du bon d’examen : Formulaire minimum Prescripteur et son mot de passe Patient Type d’examen Niveau d’urgence Formulaire secondaire Confirmation de la demande dans la liste Arrivée du bon Liste de travail Provenance Type d’examen Priorité Formulaire de téléradiologie Consultation de la demande Saisie du protocole Impression de la fiche suiveuse Examen accepté Connexion du manipulateur Portail Web = favoris Login et mot de passe Sommaire = options disponibles Production des images Modalité DICOM du site DICOM Storage vers le DAP Transfert vers le centre Carestream Routage vers le centre IMADIS Arrivée des images Liste de travail Affichage de l’heure d’arrivée des images Rédaction du compte-rendu Intégration contextuelle Zone de frappe Accès aux modèles Saisie d’une conclusion/ d’un résumé Validation pour publication Suivi par l’urgentiste Liste de travail Suivi de l’état de l’examen Consultation du compte-rendu préliminaire Signature du compte-rendu Zone de rédaction du compte-rendu Contrôle de la conclusion/du résumé Icône de signature Liste de travail Affichage de signature du compte-rendu