HIIG: A STANDARDS-BASED FRAMEWORK FOR MEDICAL IMAGE AND PATIENT DATA ARCHIVING AND INTEROPERABILITY

Transcription

1 HIIG: A STANDARDS-BASED FRAMEWORK FOR MEDICAL IMAGE AND PATIENT DATA ARCHIVING AND INTEROPERABILITY A White Paper

2 TABLE OF CONTENTS TABLE OF CONTENTS Objectives 3 Introduction 3 Adherence to Industry Standards is Critical in Complex Multi-site Environments 4 Introducing IBM s Healthcare Image and Information Grid 4 Clinical Application Tier 6 Integration and Interoperability Tier 6 Providing Reliable Access to Patient Data across the Enterprise: Master Patient Index Service Enabling access to distributed patient documents and reports: Cross Document Exchange Service Enabling Secure, Timely and Efficient Exchange of Clinical Images: DICOM Manager Service Storage Virtualization Tier 9 Network Optimization Tier 11 Healthcare Image and Information Grid Summary 12 Working with IBM and its Alliance Partners 12 2

3 OBJECTIVES The objectives of this white paper are to (1) provide an objective exposition of the major requirements generated by regionally distributed medical imaging environments, which will continue to grow in terms of study volumes, physical dispersion, and interdepartmental complexity; and (2) provide a succinct characterization of IBM s framework for medical archiving and interoperability, with emphasis on how this framework is specifically designed to provide the supporting infrastructure for advanced digital medicine archive requirements. IBM s architectural framework, the Healthcare Image and Information Grid (HIIG), provides the opportunity to reduce the long-term, on-going costs of managing healthcare information, while providing complete and timely access to prior studies. By providing access to patient data within, as well as across healthcare enterprises, HIIG can improve patient care and outcomes. Introduction Today s best practices in medicine rely heavily on the use of diagnostic images and reports, throughout the hospital and in nearly every part of the healthcare enterprise. For this reason it is indispensable that the provision for reliable, on-demand distribution of images and reports to physicians at all locations within the enterprise be made a central imperative in all image management systems. With robust enterprise-wide image distribution, radiologists can work remotely, healthcare practitioners can share radiology services, and healthcare enterprises can streamline and effectively manage the growing utilization of radiology services by the referring physician population. In the fast-paced healthcare environments of today, where maintaining high productivity is critical, these functionalities are not merely nice to have ; they are essential. Current enterprise-wide image management systems are distributed environments. The growth of geographically dispersed image management systems has been spurred in large part by the proliferation of imaging systems in disparate facilities of integrated delivery networks (IDN), including hospitals, outpatient surgery centers, and affiliated, free-standing imaging centers. Although a growing number of IDNs utilize a common PACS across all their constituent facilities, this is not the norm. The capability to distribute and retrieve images across the entire IDN often requires the interaction of multiple heterogeneous platforms. Multi-site implementations therefore require advanced integration capabilities and excellent IT skills. Fortunately, significant progress has been made in the technology needed to improve intercommunication and interoperability in multi-site image management networks. Progress includes web-based technology, compression algorithms to allow operating on a wide-area network (WAN), federated database architectures, intelligent database synchronization mechanisms, and other innovative advances. The Integrating the Healthcare Enterprise (IHE) cross-enterprise document-sharing integration profiles are an important step in support multi-vendor interoperability. A deep grasp of, and close adherence to, the IHE integration profiles, are vital for implementing effective enterprise-wide and cross-enterprise image distribution. Because IHE is fundamental to the Healthcare Image and Information Grid, it is important that key concepts and functionalities 3

4 supported by IHE, as well as the underlying dynamics driving these developments, be clearly understood. Adherence to Industry Standards is Critical in Complex Multi-site Environments An intense interaction is taking place between DICOM, Health Level 7 (HL7), and their respective frameworks. This is demonstrated by a significant synergy between the RIS and PACS markets, consolidation in the industry, the development of integrated RIS-PACS solutions, and high rates of RIS/PACS integration in the market. DICOM has established itself as the preeminent interoperability standard for radiology imaging. Other medical imaging specialties such as cardiology, ophthalmology, and pathology are rapidly adopting DICOM, due in large part to the IHE consortium s embrace of DICOM and HL7 standards as the bases for handling images and patient data in enterprise workflows. The IHE is an industry-led initiative that brings together provider, information technology vendor, and medical professional society representatives to define frameworks for the consistent application of industry standards in medical information systems workflows. The IHE achieves its objectives by fostering integration through coordinated implementation of established standards such as Health Level Seven (HL7) and DICOM. The standards provide the tools and technologies; IHE specifies how to apply such standards to real world scenarios and integration problems. In recent years, the IHE has expanded its toolbox to include advanced XML and web technology standards such as Simple Object Access Protocol (SOAP), Message Transmission Optimization Mechanism (MTOM), and Web Services (WSDL). The IHE is currently expanding it s technical frameworks to include the functionality needed to support the IT Infrastructure services including patient identifier cross-reference and clinical document, including imaging data, exchange between and across large enterprises. Cross-enterprise Document Sharing (XDS) was introduced in 2005 as a technical framework within the IHE, in an effort to seek a mechanism to share diagnostic information between radiology and other departments. This occurs as the healthcare community contemplates the development of comprehensive electronic health records (EHRs) that are accessible throughout the enterprise, or even across multiple organizations. Introducing IBM s Healthcare Image and Information Grid The current enterprise imaging environment has created the demand for a scalable archive environment, a robust imaging application architecture, and the ability to access image studies based on a patient centric view of data. Imaging has moved beyond the domain of radiology and has become pervasive throughout healthcare enterprises. However, the pervasiveness of imaging does not mean that healthcare organizations have yet been able to fully integrate these new technologies with their existing systems to improve patient care. As a result, healthcare organizations must pursue a scalable, high performance and reliable medical imaging and interoperability architecture to meet these needs. As an example, in most healthcare enterprises today, in order to create a complete, imageenabled view of a patient, doctors and other clinicians often must manually compile this 4

5 view from information that resides in disparate systems, in different formats, and across many locations, and then attempt to manually amalgamate this information, which is often incomplete, to assist them in making the best diagnosis. Furthermore, clinicians must often rely on patients themselves to gather this information, and to maintain it for months, or longer, depending on the length of their treatment. This inefficient, makeshift system often results in either incomplete or erroneous information being leveraged for patient care. Even worse, it can delay by months or even years, identification of the correct diagnosis and treatment for a given patient. Through its intense experience and exposure working with healthcare enterprises to meet the challenges they face in creating integrated and highly interoperable image management systems, IBM understands these critical challenges. IBM s response to these challenges is Healthcare Image and Information Grid (HIIG). The goal of the HIIG framework is to enable healthcare and research organizations to provide complete and timely access to critical imaging/diagnostic information at the point of care, regardless of the source, age or location of the information. To address this need, IBM, in conjunction with its technology partners, has developed the HIIG as a services-oriented architectural framework built on four standards-based and interoperable services tiers. These tiers, shown in detail below, act as the technical foundation of the HIIG, and they provide healthcare organizations with an open, integrated solution, as well as providing a roadmap for the development of enterprise-wide image management archives. IBM Systems and Technology Group HIIG Logical Architecture and Key Components Clinical Application Tier Clinical Source Systems PACS/DICOM Workstation Integration and Interoperability Tier Storage Virtualization Tier Enterprise Master Patient Index Service Multi-protocol Gateways Multi-Site Control Multi-Site Online Storage XDS/ Registry & Repository Service DICOM Manager Service NFS, CIFS, API, XAM. Policy, Resources, Recovery very SAS, SATA, FC, iscsi. Network Optimization Tier Multi-Site Nearline Storage Tape, UDO, VTL, MAID 2008 IBM Corporation 5

6 Clinical Application Tier The first tier in IBM s HIIG is the Clinical Application Tier. This tier is comprised of the existing clinical source systems (e.g. PACS, RIS, HIS, clinical systems) and diagnostic viewers and workstations that are either already resident or will be deployed within the healthcare enterprise. These applications will be the requesters and receivers of the information, and they typically reside at the point of patient care. These applications, especially in larger organizations, have often been procured from many manufacturers and have been deployed over time, often using different formats and implementation methodologies. Some are integrated and communicate with each other while others do not. Within the HIIG, a key design principle that is strictly adhered to is that changes to the Clinical Application Tier should be kept to a minimum. The goal of interoperability should be achieved with as little change as possible to the applications that clinicians, researchers and physicians use on a daily basis. This can be achieved, of course, only if those applications in place today support open standards like IHE, DICOM and HL7, which allow the interchange of information from one application and location to another. The open or, conversely proprietary nature of any application will determine how well it will perform within the open, standards-based framework of IBM s HIIG. Integration and Interoperability Tier The second tier in IBM s HIIG Framework is the Integration and Interoperability Tier. The Integration and Interoperability Tier provides the Services that allow applications that reside within the Clinical Application Tier to safely and effectively share information across a disparate and heterogeneous healthcare enterprise. There are three Services that make up the Integration and Interoperability Tier, all of which work together to provide a requesting clinical application with an integrated view of the patient: 1. Master Patient Index Service: Used to uniquely identify a patient across multiple systems, formats and locations and create a master patient identifier with which to catalog, store and query patient data. 2. Cross Document Sharing (XDS, XDS-I) Service: Used to construct a patient registry and repository of both documents from source systems across the enterprise. 3. DICOM Manager Service: Used to manage the storage and interchange of clinical images from source systems across the enterprise. The combination of these Services provides key functions, such as DICOM Store & Query/Retrieve interfaces, IHE XDS/XDS-I storage and query, classification of patient data according to its content, application of differential management rules and routing of different data to different locations and to storage infrastructure components appropriate to data content. Data transformation services are also provided to match the requirements of the various clinical systems which utilize the archive, such as using the Electronic Master Patient Index (EMPI) to transform image data to a retrieving facility s local patient identifier scheme on retrieval from the archive. Each of these three Services is described below in greater detail. 6

7 Providing Reliable Access to Patient Data Across the Enterprise: Master Patient Index Service Because imaging studies require services from multiple organizations for every patient encounter, there is an increasing need to provide patient-centric image access, independent of where the images are stored. This increases the relevance of enterprise master patient index (EMPI) services for health information systems. Healthcare organizations rely on multiple systems handling various different data processing needs, from laboratory to billing, or from ADT [DEFINE: HL7 Admission Discharge and Transfer (ADT) messages are used to communicate to episode details (typically inpatient episode details but may also be used for emergency details) to external applications] to Image Manager. In today s world, each system will likely have its own patient database and its own proprietary identification schemes. When data must be transferred or correlated across domains, the ID numbers across those domains may be different. Additionally, the same ID may exist in multiple domains but identify different people, preventing access or raising the possibility of mismatched data. Errors in patient identification and variations in medical record numbers can undermine the system, leading to fragmented, inaccurate information or overlay of patient information. Such situations may cause failure to bill a patient or payer properly or mistreatment of a patient which could result in a loss of life. An EMPI is a database that contains a unique identifier for every patient in the enterprise. This would include the medical center, outpatient clinics, practice offices and rehabilitation facilities. All registration systems look to the EMPI to obtain patient information based upon several identifiers. An EMPI acts as a record locator service to facilitate access to a single source of truth for patient care data, provider information, medical records and billing information. This record locator service (RLS) eliminates redundant and inaccurate information, yielding gains in internal efficiency, as well as improving clinical and financial outcomes. Through standards-based implementation of the EMPI, this tier creates a patientcentric architecture to provide seamless access to patient data residing on multiple systems and physical locations. The EMPI service is fully IHE compliant, built upon well-defined industry standards and protocols, such as Patient Identifier Cross-Referencing (PIX), Patient Demographics Query (PDQ), and Cross-Enterprise Document Sharing (XDS). PIX allows all enterprise participants to register the identifiers they use for patients in their domain. Participants retain control over their own domain s patient index. PIX supports domain systems queries for other systems identifiers for their patients. The advantages offered by PIX are great. PIX allows system architects to maintain all systems identifiers for a patient in a single location. It allows for the use of any encapsulated algorithm to find matching patients across disparate identifier domains. It also allows for a lower cost of synchronizing data across systems, since there is no need to force identifier and format changes onto existing systems. Critically, PIX leverages standards and transactions already used within IHE. 7

8 IHE PDQ enables on-demand, patient-centric access to image data across diverse systems and devices. It allows quick retrieval of a patient list including common patient names, identifiers, contacts, and visit information. It also enables selection of the correct patient when full identification data may not be available, while limiting access to only a subset of demographic and visit information. Enabling Access to Distributed Patient Documents and Reports: Cross Document Exchange Service The IBM Healthcare Image and Information Grid leverages IHE infrastructure profiles to integrate healthcare information within and across care delivery organizations. IBM has developed an IHE compliant set of assets that include an industry leading XDS Registry, and XDS and Audit Repositories. These assets enable centralized search functions across distributed environments from any patient care location. This is achieved by using the XDS and XDS for imaging (XDS-I) protocols to store a brief description of clinical data and related images in a centralized database called the registry. In turn the registry then accesses patient documents and images from either the XDS repository or from source systems that feed the repository and return the integrated information to the requesting application or user. The XDS assets keep track of what documents belong to which patient integration by a standards based integration with HIIG s EMPI Service. IHE XDS enables sharing of images, reports, and other clinical data across multiple clinical departments/disciplines in multi-vendor environments. The solution automates complex routing and retrieval protocols to and from heterogeneous storage devices. Images, diagnostics reports, and evidence documents derived from the processing of images represent important components of a patient s medical record. However, they are managed and archived on a variety of imaging information systems such as RIS and PACS over the course of diagnosis and treatment. XDS-I extends XDS by sharing, locating and accessing DICOM instances from an imager manager, e.g. for radiologists or oncologists. Moreover, XDS-I may be useful for sharing cardiology and other imaging documents. Enabling Secure, Timely and Efficient Exchange of Clinical Images: DICOM Manager Service The DICOM Manager is the Service that provides the image management and workflow functions within the HIIG. The DICOM manager not only provides the traditional DICOM services but is also tightly integrated with the other components of the HIIG framework. It uses the industry standard PIX/PDQ interface to associate DICOM studies with the master patient ID for patients. It also acts as an XDS Source, storing Manifests within the XDS Registry and Repository and serves ups images and imaging related information to requesting applications and users. The DICOM Manager Service is an advanced image management software solution that facilitates an open DICOM infrastructure for any PACS or imaging environment. The 8

9 DICOM Manager brokers communication between single and multiple PACS vendors, modalities, and other systems allowing federated searches across imaging systems. Built on a collaborative and extensible grid computing and SOA model, the DICOM Manager Service features a flexible architecture that can aggregate and federate DICOM objects and query results, as well as virtualize and replicate storage assets via tight integration with the Storage Virtualization Tier. The DICOM Manager Service incorporates a content-aware router that dynamically caches, queues with priority, compresses and encrypts data through an automatic yet tightly controlled batch interface to trigger efficient packet movement to in-network storage. It is highly scalable, able to achieve truly massive storage requirements, in a centralized or fully decentralized (but centrally managed) storage environment that is not based upon any central instance. Through this robust set of functionalities and characteristics, the HIIG s DICOM manager provides timely access to all imaging throughout the enterprise, regardless of application, storage or location, over the long term. Storage Virtualization Tier The third functional tier of IBM s HIIG is the Storage Virtualization Tier. The storage Virtualization Tier is responsible for the long-term management, security and protection of the HIIG s integrated clinical information. Within the HIIG, the storage virtualization tier leverages IBM s proven Grid Medical Archive Solution (GMAS), which integrates state-ofthe-art grid computing technology to enable the efficient and highly reliable management of medical images and other patient data. GMAS ensures that the information requested by the Integration and Interoperability tier is provided in a timely, uncorrupted and complete manner. Grid computing technology, traditionally associated with the harnessing of unused computational cycles on heterogeneous servers, enables IBM to deploy storage grids, effectively creating pools of storage by linking previously unconnected imaging storage silos. The unique IBM GMAS architecture enables the logical separation of imaging and other clinical application from the storage infrastructure. Thus, IBM GMAS enables the healthcare enterprise to extract additional utility from its existing storage investments, or alternatively, maximize its utility from any future storage upgrades. In addition, by deploying grid computing technologies, the IBM GMAS solution allows the entire enterprise storage infrastructure to be centrally managed like a single storage network, so that storage capacity can be automatically allocated wherever needed as it becomes available. More specifically, GMAS exhibits best in class functionality in four areas: 1. Provides an enterprise storage platform for all of the HIIG s documents, reports and images across all applications, enterprise sites and storage tiers (e.g. disk, tape, maid, vtl) 2. Ensures uptime and availability of the HIIG applications via real time failover and automated re-synchronization and self healing functions. 3. Protects data for life via digital fingerprint and proactive data verification technology. 9

10 4. Automates storage administration functions such as replication, backup, hardware related migration and storage expansion. IBM s GMAS product is precisely the type of paradigm-breaking technology that is required in order to enable healthcare enterprises to deliver high levels of integration, performance and accuracy despite the explosion in data throughput and the ever-increasing complexity of healthcare environments. However, unlike the hardware-centric solutions traditionally favored by IT vendors selling into the healthcare market, IBM GMAS is centered on cuttingedge software technology that revolutionizes the way hardware assets are managed, thereby providing more options to healthcare organizations as they expand their imaging archives and facilities. Moreover, by providing a rational framework that provides high levels of automation as data transitions from high value to lower value storage media, IBM GMAS helps healthcare facilities reduce the cost and complexity of managing images across the complete data management life cycle. Thus, IBM GMAS provides the functionality traditionally provided by hierarchical storage management schemes, while introducing enhanced safeguards against data loss and offering a greater degree of freedom from concerns about hardware obsolescence. A direct benefit of these technologies is that future infrastructure upgrades or migrations from older to newer imaging systems can be managed more efficiently via automated conversion and autonomic functions. Thus, establishing a storage infrastructure like GMAS today will continue to deliver benefits as the imaging archive continues to grow and evolves in the future. A key feature differentiating IBM s HIIG Framework, based on GMAS, from other solutions on the market is its innovative approach to business continuity. IBM understands the mission-critical nature of medical images and related patient data and the importance of ensuring that imaging systems do not fail. IBM GMAS leverages IBM s portfolio of storage and business resiliency solutions, enabling users to implement reliable backup and restore procedures, ensure the continuity of crucial storage operations by reducing downtime to scheduled maintenance events, and assure the on-demand availability of images and data to users throughout the enterprise. Unlike competitors implementing traditional disaster recovery solutions that rely on data centers to house backup images and data, IBM GMAS deploys grid technology in order to create a resilient solution that proactively anticipates business continuity contingencies rather than providing a reactive plan for disaster recovery. Traditional disaster recovery schemes have a single point of failure, since they rely on a unique pathway to the data center. The IBM GMAS architecture, on the other hand, allows the system to be both network-aware and content-aware. For example, if an image file is corrupted, IBM GMAS automatically allows the user to obtain an uncorrupted image from the closest location on the storage grid. If a network pathway is unavailable, IBM GMAS can automatically find another path to the requested data. All of this is done transparently to the application itself. 10

11 Scalability is also a critical requirement for any image and interoperability management archive being implemented today. As an ever-expanding flow of imaging data and reports flood into archiving systems, a point is reached when the existing storage infrastructure can no longer cope, and an expensive, often complex migration is required. This issue is gaining critical importance as on-demand access to prior diagnostic images becomes a firmly established requirement, while at the same time the complexity of imaging datasets and average file sizes are steadily increasing. According to estimates by the American College of Radiology (ACR), imaging procedure volumes grew at annual rates of 8 to 10 percent during the last decade. If this trend continues, the number of diagnostic medical imaging procedures performed in the United States can be expected to grow from approximately 600 million in 2006 to well over 1 billion annual procedures in IBM GMAS, with its software/non-hardware based architecture, can scale seamlessly to petabytes of data while ensuring consistent performance and timely access to critical patient information. Network Optimization Tier The fourth and final tier within the HIIG is the Network Optimization Tier. This tier is critical, as the addition of images, with their exponentially larger file sizes and complex characteristics will place a great strain on any existing non-optimized network, if not appropriately planned for. The HIIG Network Optimization Tier operates across Local and Wide Area Network (LAN/WAN) environments to provide multi-vendor image security, optimized and transparent multi-site image transport, access and performance. Leveraging partnerships with industry-leading network technology providers, it provides application availability, security, load balancing, TCP transport optimization and Quality of Service ("QoS"). The Network Optimization Tier provides a high-performance, secure and reliable foundation from which to deliver images at the point of care. It utilizes proven architectures to address the demands of both exponential image volume growth and an increasingly time-pressured clinical staff. Built to deliver imaging as a service from the network environment, the network optimization tier enables clinicians to access and utilize images based on the acuity and urgency of care. The Network Optimization Tier supports the entire HIIG document and imaging environment, providing a secure, cost-effective, high-performance and highly available image environment. World-class routing and switching at the network tier enable high performance image routing and transport. Within the Network Optimization Tier, load balancing technology reduces DICOM latency and transaction timeouts to help improve application performance and availability, leveraging industry-leading technology to provide compression and caching capabilities that speed image transport between sites. This helps to improve application performance and overall scalability. The load balancing functionality, provided by IBM s network technology partner, is available in a module form factor for larger multi-site and data center switch deployments, and in an appliance model for singlesite deployments. IBM s technology partners have optimized and validated this load balancing functionality to work together with DICOM communication solutions. By coupling this functionality with DICOM enterprise communication services, image application performance and availability is significantly enhanced. 11

12 Data compression and caching capabilities enable seamless access over the WAN to centrally hosted applications such as PACS servers, and storage systems. These products allow healthcare organizations to consolidate their distributed servers and storage into centrally managed data centers, while offering LAN-like access to their remote users. With this IBM partner technology, IT organizations can consolidate PACS deep archive servers and storage into centrally managed data centers. Within the Storage Virtualization Tier, network optimization capabilities, integrated with the IBM GMAS storage tier, provide physical and logical virtualization to lower storage total cost of ownership. A fully integrated group switch system (GSS) ensures business continuity. This is especially important as many sites now replicate images between multiple data centers. The Network Optimization Tier also integrates powerful, centralized and customizable fault management and remote monitoring system that filters out network noise using eventtriggered automations, allowing operators to focus on critical network and service-affecting alarms. Fault management and remote monitoring are critical tools for managing and monitoring the network infrastructure from a single point. Healthcare Image and Information Grid Summary This paper has reviewed the key challenges in today s growing medical imaging environments and how the Healthcare Image and Information Grid addresses those challenges. This joint solution, developed by IBM and its industry-leading technology partners, provides the key capabilities required to deliver imaging studies to the point of care in an efficient, secure, reliable and cost-effective manner. In turn, healthcare providers have the ability to improve patient care, lower operational costs and broaden access to imaging services. Working with IBM and its Alliance Partners IBM teams with top-tier alliance partners to design and deliver the IBM Healthcare Image and Information Grid. IBM combines deep expertise as a technology provider and broad experience as a system integrator to develop the underlying solution design, lead any unique customization of functions, manage on-time implementation and ensure the project meets both business and technical objectives. IBM also functions as the service/maintenance provider. Alliance partners bring exceptional skills and share IBM's commitment to the development of innovative, fully-integrated, end-to-end solutions in the healthcare industry. Frost & Sullivan believes that, based on the architecture and industry leading technologies integrated by IBM into its four-tier HIIG framework, the set of solutions embedded in this framework can substantially enhance the efficiency and performance of heterogeneous, multi-vendor image management environments distributed across multiple clinical sites. The benefits of working with IBM extend beyond the considerable enhancements it can ensure with regard to the availability and integrity of data for enterprise users. IBM also provides for improved business resiliency by anticipating network and data contingencies rather than 12

13 planning for reactive measures, such as those employed in traditional disaster recovery schemes. Moreover, through its consistent support of industry standards, IBM s four-tier framework enables more efficient data migration and management of image data over its entire lifecycle. IBM serves as the prime contractor and integrator for solution implementation and ongoing support, bringing its decades of experience and successful track record to bear on projects requiring development and integration of all aspects of information technology projects. A key differentiating aspect is its underlying technology base. One example is the GMAS storage foundation tier of this solution. Customers can also draw on IBM s network of business partners that specializes in various complementary solutions. Implicit is its deep healthcare expertise, technology and experience for taking on data management challenges in environments of any size or complexity. 13

14 Silicon Valley 331 E. Evelyn Ave. Suite 100 Mountain View, CA Tel Fax Beijing CONTACT US San Antonio 7550 West Interstate 10, Suite 400, San Antonio, Texas Tel Fax London 4, Grosvenor Gardens, London SWIW ODH,UK Tel 44(0) Fax 44(0) Bengaluru Bogotá Buenos Aires 877.GoFrost Cape Town Chennai Delhi Dubai Frankfurt Kolkata Kuala Lumpur London Melbourne Mexico City Milan Mumbai New York Oxford Paris San Antonio São Paulo Seoul Shanghai Silicon Valley Singapore Sydney Tel Aviv Tokyo Toronto Warsaw ABOUT FROST & SULLIVAN, the Growth Partnership Company, partners with clients to accelerate their growth. The company's TEAM Research, Growth Consulting, and Growth Team Membership empower clients to create a growth-focused culture that generates, evaluates, and implements effective growth strategies. employs over 45 years of experience in partnering with Global 1000 companies, emerging businesses, and the investment community from more than 30 offices on six continents. For more information about s Growth Partnership Services, visit