The VNA Era. Paving the Way for the High-Definition EHR. Clinical Content Interoperability White Paper

Transcription

1 Clinical Content Interoperability White Paper The VNA Era Paving the Way for the High-Definition EHR Shannon M. Werb Chief Strategy Officer Chief Operating Officer Larry Sitka Acuo Founder

2 Contents Introduction... 3 Healthcare IT and Clinical Content Management... 3 The Expensive and Vicious Lifecycle of Clinical Data... 4 Integration Architectures... 4 The VNA Checklist... 6 Acuo Technologies 2 The VNA Era: Paving the Way for the HD-EHR

3 Introduction The purpose of this whitepaper is to define the attributes, philosophical and technical, of a vendor neutral archive (VNA) through an understanding of: The challenges currently facing healthcare How a VNA can address these challenges; and The role a VNA platform can play in the future of healthcare IT, including a fully-image enabled electronic health record (the high-definition EHR ) Healthcare IT and Clinical Content Management Today s healthcare IT departments are struggling to manage the exploding growth and complexity of digital patient information across disparate facilities, applications and data silos. For much of this data, mostly medical imaging content, an attempt was made to create a canonical form (standard state) for acquisition, storage and exchange of clinical information. This standard, known as Digital Imaging and Communications in Medicine (DICOM), has been used within healthcare IT for the past 20 years as the basis for medical imaging content management requirements and innovation. During this time, the DICOM standard and the industry in general has been largely driven by PACS vendors. This has resulted in an enormous silo effect in how diagnostic data is produced and managed, with virtually no capability for sharing data outside the original acquiring system. This situation has created data ownership problems healthcare organizations need to solve to enable better data management, security, mobility and integration across the enterprise. Despite these challenges, DICOM strives to provide a good messaging framework for the acquisition and distribution of medical imaging content between multiple vendors. In addition to the management of DICOM content, healthcare institutions today are also challenged with management of other (non-dicom) digital content related to patient care. There are a number of mechanisms to manage non-dicom content, including conversion to DICOM (through either DICOM wrapping or enveloping technology) or through management of the content in native format. Moreover, there are other standards put forth by IHE (Integrating the Healthcare Enterprise) for management of non-dicom content, including XDS (cross- enterprise document sharing). Regardless of the technology chosen to manage both DICOM and non-dicom content, however, the primary purpose for any clinical archive, including a vendor neutral archive (VNA), is to support data at rest and provide access to the most accurate and relevant data at the point of care. As a source for all historical data, a VNA must provide real-time access to content. A key VNA function is to manage data for its entire lifecycle, well beyond acquisition and consumption of recent data typically managed by departmental systems (PACS). The VNA provides an enterprise with the ability to compress the capital and operational costs of managing clinical data. Acuo Technologies 3 The VNA Era: Paving the Way for the HD-EHR

4 The Expensive and Vicious Lifecycle of Clinical Data Clinical content generated today will easily outlive the system that generated it and the storage media where it is managed. Over the life of the content, the media and/or managing application may change several times. As the media or application needs change, a migration of the data is inevitable, typically introducing additional costs from the vendor that is managing the data. If the managing application becomes deprecated or upgraded, the data often needs to be migrated, re-indexed and often processed back through the application. A common investment pattern offered by data management vendors today includes: A license fee to place the order A license fee to acquire into the PACS A license fee to use speech recognition A license fee to archive the data A license fee to integrate to the EMR A license fee to integrate to another PACS A services fee to migrate when: Moving from PACS to PACS Upgrading an existing PACS software version Performing storage media change or consolidation The migration cycle and license fees never end Implementation of a VNA can remove costs that lie beyond archival of the data, including data migration, integration to other PACS and integration to an EMR for data sharing. A permanent stop to this vicious cycle can be achieved by implementing a VNA that puts data ownership back into the hands of the healthcare provider. Vendor neutral includes the ability to be PACS- neutral and infrastructure/storage neutral, along with friendly network services. This arrangement will finally enable the organization to remove its dependency on any single vendor, including the VNA vendor. If an organization should decide to move from the VNA vendor, it should happen at no cost to the organization through an embedded set of capabilities for data movement/migration. Integration Architectures Healthcare applications that manage images and other clinical content are often integrated using a silo approach where each application accessing content is directly integrated to the application (silo) that manages the content. With this scenario, it is easy to imagine the complexity and cost increases that can occur as more applications/silos are added and more requesting applications (EMR, portal, departmental systems, etc.) require data for a complete patient record. Acuo Technologies 4 The VNA Era: Paving the Way for the HD-EHR

5 In addition to application-level integration challenges, there is another set of challenges around how content is managed from a physical media perspective. To start, each application often has its own dedicated storage. Eventually, IT will require movement of this content to a more common/shared storage approach. As this occurs the enterprise ends up grappling with the storage platforms that are supported by each vendor without being integrated into a longer term IT strategy supported by the healthcare enterprise. Diagram 1 at right depicts a typical environment in which clinical applications are tied directly to physically-addressed storage along with proprietary integration that must occur between the electronic medical record (EMR) and clinical applications. Many challenges exist with this approach: EMR integration is complex and costly across many integration points Access to data from within the clinical systems (PACS) is restricted unless a horizontal integration exists between them Storage is locked-in as a departmental resource, not enterprise Diagram 1: Typical Integration Profile A VNA allows an enterprise to break the physical connection between the application and its content, providing for a virtualized approach to data management, with storage controlled by IT. Further, the VNA offers a set of services for storage, query and retrieval (to name a few) such that each application requires only a single integration point to a set of standardized services (DICOM, Web Services, RESTful) to enable access to a compete patient record. Diagram 2: VNA future state; virtualized storage management and data access Acuo Technologies 5 The VNA Era: Paving the Way for the HD-EHR

6 The VNA Checklist A vendor neutral archive is often defined by a checklist of features and functions that it must perform in order to provide neutrality to a hospital. Some of these capabilities include tag mapping/morphing, clinically-based information lifecycle management and universal viewer support. Each of these functions clearly provides value to the end user, especially when abel to be implemented by the end user without conflict from the VNA vendors experience integrated other clinical or IT solution. The success of a VNA, however, hinges on a single core philosophy, without which execution on such a checklist would not be possible. First and foremost, a VNA should be provided by an organization dedicated to full interoperability with every other healthcare IT vendor (i.e. real vendor neutrality ). In many cases, this will result in making legacy PACS and other departmental systems work better with the VNA than without it. This attribute excludes traditional PACS vendors from offering a valid VNA solution. Answers to the following questions support this position: Will a PACS vendor certify interoperability with another PACS (in front or behind in the data flow)? Will a PACS vendor offer you the choice of adding or selecting another company s PACS application, now or in the future, at no cost for integration? Will a PACS vendor offer the flexibility to address any storage now or in the future at no cost for integration? Will a PACS vendor design for interoperability within a RHIO or HIE? Once the vendor neutrality requirement is met, look for the following: Experience implementing VNAs across every major PACS vendor, reducing financial risk to your organization A built-in migration engine that is licensed to you, enabling you to migrate into and out of the VNA with no service cost Dynamic tag morphing, allowing a high level of interoperability across integrated systems Information lifecycle management, enabling you to drive clinical policies derived from the metadata for replication, numbers of copies and retention/purge policies, lowering the total overall cost for data management including integrating these policies and meta-data to the storage platform of choice PACS aggregation/federation, allowing access to content across any PACS before, during or after migration, preventing costly forklift upgrades Implementations in front of the PACS, behind the PACS or both, enabling workflow specific to each PACS (some PACS are better-enabled on the back end of the VNA which can enable routing, tag mapping and compression to improve PACS functionality) Hybrid offerings that enable a high level of workflow enhancement within the facility while also natively integrated cloud storage and cloud VNA offerings from the VNA vendor or third parties IHE compliance with testing and certification by IHE Acuo Technologies 6 The VNA Era: Paving the Way for the HD-EHR

7 Configuration not customization, as a standard set of configurations will help you understand true TCO over the life of the system (typically service engagements are unbudgeted and should not prevent usage or modification of the VNA configuration) Hardware agnostic and optimized, as certified integrations to major hardware/storage providers, including next generation CAS/COS solutions, offer more flexibility in long-term data management A core solution tenet is that the VNA should be built with a philosophy of true vendor independence, both clinically (the PACS) and technically (the infrastructure/storage). This capability will yield enhanced organizational freedom and flexibility, including the ability to choose and interoperate across any PACS/clinical application and with any IT infrastructure and storage. The rest of the features on the list above, while important, will have no impact if this core tenet is not met. As the imaging industry continues to evolve, leaders at Acuo Technologies rely on foresight, vision and experience to help our customers develop comprehensive clinical content management strategies that will deliver the scalability, flexibility and accessibility required for healthcare success. Our enterpriseclass interoperability and workflow solution, the Universal Clinical Platform (UCP), offers true vendorneutral middleware that delivers data liquidity that helps accelerate patient information to clinical decision makers. UCP provides a comprehensive clinical content management platform that ensures the lowest long term TCO, provides reliable highly-available systems, and delivers scalability that is sensible and affordable. With Acuo as your VNA partner, you will: Gain flexibility in your choice of clinical imaging applications, avoiding vendor lock-in and providing liberation of your data from PACS and other departmental systems Deploy a technology solution that allows you to implement best of breed storage, viewing, network and server components, when and how you choose Build a foundation for an integrated information infrastructure based on the IHE technical framework Allow for incremental scalability and agility to grow and change as your business evolves, maximizing organizational freedom and enhancing clinical operations Acuo Technologies 7 The VNA Era: Paving the Way for the HD-EHR

8 About Acuo Acuo Technologies, now part of Lexmark s Perceptive Software (NYSE: LXK), was founded in 2000 with the objective of developing the first enterprise-wide collaborative Universal Clinical Platform (UCP) solution for medical image content, both DICOM and Non-DICOM. Today, Acuo supports implementations of UCP around the world, including locations in Africa, Australia, Europe, North America and South America. For more information on providing superior clinical content management and data migration while simplifying operations and reducing costs, visit ACUO TECHNOLOGIES, POWERED BY ACUO, ACUO, and Universal Clinical Platform are trademarks of Acuo Technologies, LLC. Acuo Technologies, LLC All rights reserved. DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information. Acuo Technologies 8 The VNA Era: Paving the Way for the HD-EHR