Smarter Planet: Healthcare Interoperability Solutions

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1 IBM Healthcare and Life Sciences Dynamic Infrastructure Smarter Planet: Healthcare Interoperability Solutions Marcin Kaczmarski December 2009

2 OUR VISION IBM Healthcare and Life Sciences: Let s Build a Smarter Planet SMART PLANET INSTRUMENTED INTERCONNECTED INTELLIGENT OPERATIONAL EXCELLENCE PATIENT-CENTERED COLLABORATION VALUE-FOCUSED HEALTHCARE Our vision is to bring a new level of SMART to how the world works how every person, organization, and system interacts. Each interaction represents a chance to do something better, more efficiently, more productively. As the systems of the planet become smarter, there is hope for meaningful new progress. 1

3 Four Themes Enable Smart Healthcare Data is exploding and it s in silos I need insight New business and process demands I need to modernize My infrastructure is inflexible and costly I need to respond quickly Our resources are limited I need efficiency How can providers take advantage of the wealth of information available in patient records to make more intelligent care decisions? How can providers collaborate more easily, supported by flexible and dynamic processes modeled for the way they make decisions? How do providers create an infrastructure that drives down cost, is intelligent and secure, and is just as dynamic as today s business climate? How can provider s align their goals and behaviors with their evolving responsibilities, so that patient-centered healthcare becomes a reality? Healthcare Analytics Collaborative Care Dynamic Infrastructure Streamline & Transform 2

4 The Fundamental Problem Patient medical information is regionalized, fragmented and neither standardized nor integrated across healthcare organizations It is estimated that there are more than 785 million health care tests conducted each year in the United States. The lack of interoperable systems to effectively communicate the results among the various providers who need to review them is consuming 1 billion hours of administrative processing time just to get the data in the right place, according to one estimate Million Healthcare Tests/Year - Scott McCabe, EMRs vs. Information Convergence, April

5 Clinical systems and IT operational roadblocks Challenges to overcome... - Applications own the data, with unique formats and patient identifiers - No single patient registry to accurately link patients and validate identity - Complexity of aggregating the information needed to support effective collaboration between and among organizations and medical specialists - Lack of patient access to an integrated view of my health information... Toward Patient-Centric Collaboration - Care coordination across healthcare organizations - Integrated health information is available at each episode of patient care - Cost-effective and flexible infrastructure - simplified, optimized and secure - Flexible, scalable and manageable components - Non-disruptive high availability network integration and performance 4

6 The goal of IBM s Healthcare Image and Information Grid: Deliver a single, timely view of patient medical images and associated reports regardless of location or system source Image Archive other Ologies DICOM Services RIS XDS Image Archive Technical Support Services ehr XDS PACS DICOM Services Network Network PACS RIS ehr other Ologies Technical Support Services Current Situation Seamless Integration facilitated by 5

7 Enterprise Interoperability & Archiving Clinical Application Layer 1. Diagnostic and Clinical Viewing Grid PACS Enterprise Medical Neutral Records Archive Management Solution 2. Voice Recognition/Dictation Integration 3. Departmental Workflow 4. RIS Reconciliation DICOM DICOM Integration & Interoperability Layer DICOM Image Manager Enterprise Image and Information Archive Network Optimization CIFS, NFS, API Layer CIFS, NFS, API CIFS, NFS, API Radiology PACS Cardiology PACS RIS / HIS / EMPI Storage Management Layer SAN SCSI SATA HL7 Storage Management Software 1. Patient Identification 2. Application Independence 3. Global search Federation 4. Content based ILM 1. High Availability 3. Load Balancing 4. Transport Optimization 5. Quality of Service QoS IBM s Healthcare Image and Information Grid 1. Data Integrity 2. Replication & ILM 3. Failover and Synchronization 4. Virtualization 5. Data Migration SATA TAPE OTHER MAIN FACILITY DISASTER RECOVERY SITE 6

8 Healthcare Image and Information Grid (HIIG) With IBM s HIIG framework, a Healthcare enterprise can add interoperability components over time as part of a staged, deliberate transformation. Enterprise Storage Archive Management - For clients looking for enterprise virtualized storage infrastructure - An open, highly scalable, fixed-content archive solution - Designed for multi-site healthcare institutions - Easy to manage, affordable and highly resilient Enterprise Image Management - For clients looking for enterprise image archive used by multiple applications - Manages image/dicom data - Built on GMAS foundation Enterprise Records Management - For clients looking for cross-enterprise document sharing and patient indexing - Provides a single, timely view of patient medical images and associated reports - Works across multiple locations and system sources - Built on PACS-Neutral Archive foundation 7

9 Enterprise Storage Archive Management 8

10 Healthcare Storage Pain Points Massive and growing data volumes - Storage growing at 54% a year : 60% of world s storage will be medical images Data Outlives Hardware and Media - Chest X-ray for middle-aged male: 5 years - Pediatric CT: 14 Years - Pediatric Echocardiogram: 18 Years - Mammography: patient lifetime PB shipped Critical nature of application reliability - Patient care cannot wait for images Protect Patient Data and Records - Recover from hardware failures - Access limited to those with a need to know 9

11 d i gi t a l d i gi t a l d i gi t a l d i gi t a l d i gi t a l d i gi t a l d i gi t a l d i gi t a l d i gi t a l d i gi t a l IBM Healthcare and Life Sciences: Let s Build a Smarter Planet IBM s Grid Medical Archive Solution (GMAS) A storage solution that intelligently manages the interaction between an application and its storage resources via client business rules Before GMAS After GMAS App 1 App 2 App 3 App 4 App 10 App 1 App 2 App 3 App 4 App 10 GMAS Storage Platform Location 1 Location 2 Loc 3 Location 1 Location 2 Loc 3 Siloed infrastructure: Difficulty sharing resources across applications Requires application downtime for maintenance Manual administration, upgrades & conversions Inherently vulnerable to storage failures Virtualized infrastructure: Collapses silos into a single shareable storage pool across applications Enables maintenance, support & data conversion without application downtime Automates upgrades, conversions & administration No single point of failure 10

12 Select GMAS Customers University of Michigan University of Kentucky University of Mass Health Alliance Vanderbilt University New York University Iowa Health System Spectrum Health Rapid City Regional Hospital Hoag Memorial Bryan LGH Wentworth-Douglass Hospital FN Motol (Czech Republic) Ardent Health Vanguard Hospital Government of Northern Ireland (Ireland) Tucson Medical Center Baptist St. Anthony s ASL Napoli (Italy) St. Peters Allegiance Hospital 11 Lakeland Regional Medical Center HealthPartners Orlando Regional Health System Richardson Regional Lee Memorial Presbyterian New Mexico New York Health and Hospitals Corporation Children s Hospital of Philadelphia Yale University City of Hope Medical Center Munson Medical Center Condell Health System Yavapai Regional Health System Adventist Health System Centura Health Sanford Health Columbus Community Health Northside Hospital Health Management Associates Meriter Hospital

13 Enterprise Image Management 12

14 PACS (Imaging Applications) Pain Points PACS owns the Data - Proprietary Formats & Headers Tags - Metadata stored in proprietary database and not in image itself - Presentation States and Notes not compatible among systems Difficult to collaborate between Cardiology, Radiology, etc. - PACS data managed in silos - Viewing applications are PACS-specific Data Migration required for - PACS replacements - Infrastructure changes (Media) - PACS upgrades 13

15 Network Optimization Layer IBM Healthcare and Life Sciences: Let s Build a Smarter Planet PACS Neutral Archive Logical Architecture Clinical Applications CT Scanner Clinical Source Modalities PACS/DICOM Workstation Integration and Interoperability Layer DICOM Image Manager Storage Virtualization Layer Gateway Nodes Admin Node Archive Nodes Control Nodes Storage Nodes IBM GMAS Storage Grid 14

16 Why a PACS Neutral Archive? Eliminate the need for expensive data migration - On-the-fly data format conversion between disparate PACS Improve patient care through better cross-departmental collaboration - Timely access to all images across an enterprise regardless of PACS, storage or location - Ability to interrogate and present complete patient information across all systems - No change to PACS look and feel Realize cost efficiencies by centralizing archive management - Storage consolidation - Intelligent Information Lifecycle Management Enable standards-based growth to full enterprise records management - Standards-based interface support (HL-7) - Creation of XDS-I manifest and optional XDS-I registry and repository - Straightforward future integration of XDS and EMPI 15

17 Enterprise Patient Records Management 16

18 Healthcare EHR Pain Points Clinical applications own the data - Proprietary formats and user interfaces Applications do not talk to each other - Proprietary communication interfaces Providers cannot access data from all locations Providers identify the same patient differently Patient data managed as files, not as information - Not all images and reports should be managed identically Patient data exchange must be secure and monitored - Access must be limited to people and applications with a need to know 17

19 Network Optimization Layer IBM Healthcare and Life Sciences: Let s Build a Smarter Planet HIIG Framework for EHR Management Clinical Applications Clinical Source Systems PACS/DICOM Workstation Integration and Interoperability Layer PIX/PDQ EMPI XDS/ Registry & Repository DICOM Image Manager Storage Virtualization Layer Gateway Nodes Admin Node Archive Nodes Control Nodes Storage Nodes IBM GMAS Storage Grid 18

20 HIIG Patient Record Flow Patient Document Query and Registration Submission Retrieve Healthcare Image and Information Grid Patient Identity Source Patient Identity Feed Record Registry Query Document PACS / RIS / HIS PACS / RIS / HIS Register Document Set Record Viewer Record Source Record Repository Retrieve Document Provide and Register Document Set 19

21 Completing the Puzzle Adding cross-enterprise document sharing and master patient indexing to the interoperability solution image-enables the patient record and provides the ability to share the record across the healthcare enterprise. Health Information Exchange - IHE cross-enterprise document sharing (XDS and XDS-I) - Centralized search for patient data across different applications and clinical locations using dissimilar patient identifier schemes DICOM Enterprise Archive - Application independent image data archive used by multiple independent imaging applications - Manages image/dicom data Storage Management with Information Lifecycle Management - Managed flow of Healthcare data and metadata from creation and initial storage to the time it becomes obsolete and is deleted - Differential backups are done on files as they change 20

22 21

23 In Summary IBM Healthcare and Life Sciences: Let s Build a Smarter Planet Clinical and IT Benefits: Based on open standards Layered architecture for incremental adoption Supports sharing of all documents (images, reports, etc) No changes to clinical application look and feel Ensures consistent and fast access to images over the network Vendor neutral middleware (DICOM, HL7, IHE/XDS) Reduces effort and cost to integrate new and existing systems Brokers communication between single and multiple PACS with single queries and federated search across sites Proactively protects data for life ensuring no data loss Automates storage administration Virtualizes storage and eliminates downtime.. all delivered, implemented, and supported by 22

24 23

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