How to Break the VNA Entry Barrier Building a VNA in Multiple Stages

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1 How to Break the VNA Entry Barrier Building a VNA in Multiple Stages Michael J. Gray Gray Consulting HIMSS12 booth #2875 Cloud Computing Knowledge Center Booth #13642

2 Objectives Background PACS History Current Problems VNA Precursor Products VNA Entry- Level Strategies VNA Completion Strategies Economics Frequently Asked Questions Conclusions Introduction to GNAX and Its Technology

3 Background Vendor- Neutral Archive 1. An Enterprise- class data management system that consolidates primarily medical image data from multiple imaging departments into a Master Directory and associated consolidated Storage Solution, thus replacing the individual archives associated with departmental PACS systems with unfortunate proprietary characteristics that limit their interoperability. 2. A unified image data repository for the Electronic Medical Record system.

4 Background This high- level graphic suggests the size and redundancy aspects of a properly configured VNA R-PACS C-PACS X-PACS Facility A LAN Enterprise WAN Uni Viewer VNA Storage Server VNA Storage Server VNA Uni Viewer Primary VNA Subsystem Data Center A Secondary VNA Subsystem Data Center B

5 Background VNA Solves 7 of the Top 10 PACS Problems* 1. Integration Sharing images between specialties or loading patient information to other providers' EHRs are common problems 2. Downtime Business continuity systems are essential 3. Hanging Protocols Some success can be found in renaming or normalizing the image series descriptors 4. Interoperability Managing the hardware between different vendors 5. Support 6. Training * Top 10 PACS Problems Health Imaging & IT, July 19, 2011

6 Background VNA Solves 7 of the Top 10 PACS Problems 7. Out with the Old The migration of data to the new PACS is often the most challenging part of the process 8. Whose PACS? Decision- making for PACS- related purchases has, in some cases, shifted from radiologists to a more central process. The end choice may not be optimized for radiology 9. Ergonomics 10. Disaster recovery Like business continuity, disaster recovery can prevent a painful experience from becoming fatal.

7 Background The only workable solution to solving most PACS problems is to deploy a Vendor- Neutral Archive Take the A out of PACS Provide an enterprise class DR and BC solution The VNA would accept both DICOM and non- DICOM image data and its related meta data Incorporate the tools to dynamically translate between disparate PACS (Bi- directional Dynamic Tag Morphing) Bring sophisticated Information Lifecycle Management tools, including Purge mechanism to enterprise image data management

8 Background Cont. Eliminate future data migrations Expand choice of storage media Easier way for individual and/or dissimilar Departmental PACS to share a long- term Archive and effectively exchange data Shift Control of the study data from the Vendor to the Organization, making it easier to change PACS, and giving choice of PACS back to the department Simplify Enterprise Viewing under one UniViewer

9 Background How expensive is a VNA? Bigger than your biggest PACS, since it will be managing all of the organization s image data Twice again as big, because a DR/BC solution requires a mirrored dual- site configuration Big enough to probably require multiple years/budgets reminiscent of early years of radiology PACS deployments Learn

10 PACS History First Generation Radiology PACS required large investments, and there was doubt about being able to successfully replace film Early PACS deployment strategies focused on solving small problems with entry- level products at manageable cost Properly designed (DICOM conformant) Mini- PACS and teleradiology systems were PACS precursors Typical PACS deployments from late 80 s to mid 90 s were phased over several years/budgets)

11 Current Problems Small, more Manageable Problems that many Organizations face today PACS media replacement (requiring media migration) PACS replacement (requiring DICOM data migration) Electronic Image Data Sharing PACS to PACS (problematic CD/DVD exchange) Internet Access (secure image access by outside physicians) Image- enabling the EMR Bona- fide, geographically- dispersed, Disaster Recovery and back- up Business Continuity (access to priors when PACS is down)

12 Corresponding VNA Precursor Products Media Replacement Replace old media with open Storage Solution that has broader upgrade path and can be shared by multiple PACS Data Migration Engines Replace DR solution with VNA- fronted Open Storage converting Proprietary copy to Neutral copy Replace DR solution with VNA- fronted- Cloud Infrastructure DICOM Routers Facilitate PACS to PACS image sharing without CD/DVD Rules- based Auto- routing Automatic Tag Mapping

13 Corresponding VNA Precursor Products UniViewer Zero- Client, Server- side Rendering Display Application Image- enable EMR with single viewer that can aggregate patient image data across multiple PACS Secure Internet image access for both inside and outside physicians UniViewer + bona- fide geographically dispersed DR Solution is Business Continuity Solution

14 VNA Entry- Level Strategies Level 0 Data Sharing and Interoperability Deploy local DICOM Router to facilitate both local and remote PACS - PACS data exchange Features Rules- based Auto- routing based on metadata VNA- like dynamic, automated Tag Morphing Rationale Efficient data transfers Guaranteed compatibility

15 VNA Entry- Level Strategies Level 1a Data Storage Deploy Open Storage Solution on site and migrate Primary copy of data to Open Storage, as PACS media is retired Retain most recent 3yrs on site, transfer balance to Cloud Infrastructure Features Performance matched to PACS requirements Rationale Improve price/performance ratio Protection against obsolescence Transferring older data to Cloud reduces support costs

16 VNA Entry- Level Strategies Level 1b Data Storage Create / Transfer Secondary (DR) copy of data entirely to the Cloud This step does not require investment in VNA technology therefore does not modify data Features Geographically- dispersed, HIPAA- conformant DR solution Rationale Secures data integrity Reduces capital costs and operational expenses

17 VNA Entry- Level Strategies Level 2 Vendor Neutral Data Management Deploy Migration Engine (subset of VNA) on- site Pro- active DICOM migration to the VNA- fronted Cloud Infrastructure Retire PACS- driven DR Solution when migration is completed Features Tag mapping to create Neutral DR Solution Pay only for data migration and managed storage costs HIPAA- conformant, geographically- dispersed DR Data Center Rationale Transfers control of data from PACS vendor to organization Eliminates future DICOM data migrations Reduces capital costs and operational expenses for DR Returns choice of next PACS to imaging departments

18 VNA Entry- Level Strategies Level 3 Neutral Data Management/Distribution Activate UniViewer in the Cloud Infrastructure after first 6 months of new and most recent data is migrated to Cloud (Level 2) Image- enable the EMR with UniViewer and Cloud- based Secondary copy of data Features Zero- client, Server- side Rendering Viewing application 3 second delivery of first screen image content Operations performed on loss- less Secondary copy of image data Rationale Reduces capital cost and operational expenses associated with BC, Image- enabling EMR, Internet Image Sharing

19 VNA Completion Strategies What is required to get from Level 3 to full VNA Deploy Primary instance of VNA and UniViewer in Organization s primary data center Perform media- media migration of organization s Secondary copy of data to Primary Storage Solution in Cloud vendor s data center Ship Primary Storage Solution to Organization s primary data center Establish local PACS, EMR and HL7 interfaces Upgrade DR/BC- level VNA license to full- functionality VNA license Reduce local PACS storage to months

20 R- PACS C- PACS X- PACS Gateway Organization LAN Organization WAN Cloud Data Center LAN Organization Data Center LAN Uni- Viewer VNA Storage Server Storage Server VNA Uni- Viewer Storage Network Storage Network Cloud Data Center Organization Data Center

21 Economics One example of cost comparison for Level 1a Replacing 3+ year- old, on- site, self- managed, long- term Storage Solution with a new high- end, mirrored Storage Solution Versus Keeping most recent 24 months on- site and migrating all data from the old, long- term storage solution to a Cloud- based Storage Solution.

22 Economics Profile Descrip-on Annual Procedures Ave. Study Size (MB) 2.5:1 Historical Study Volume A 1 Hospital 200, ,000 Total TB (New + Historical) in Year 1 (Raw) RAID (Mirrored) Years 2-5 (Raw) Years 2-5 (RAID) Total TB Needed (RAID) Cost of Storage Hardware Purchase Cost of Hardware Maintenance (yr 2-5) Cost of Power & Cooling (5 yrs) Cost of Data Center FaciliRes (5 yrs) Cost of Storage AdministraRon (5 yrs) Five year Total Cost Ownership* $750,000 $600,000 $91,800 $90,000 $112,500 $1,644,300 *Excludes cost of media migration

23 Economics Three examples of the cost of a DICOM Migration conducted in Year 1, 3, 5 and 7 are compared to the cost of a Pro- active DICOM migration conducted in Year 1 Migration is conducted by a Service Provider at the average cost of $0.21/study Data is migrated to a VNA- fronted Storage Solution managed on- site by the organization

24 Economics Profile DescripRon Ave. Study Historica Annual Size l Study Procedures (MB) Volume Year 1 MigraRon cost Year 3 Year 5 MigraRon MigraRo cost n cost Year 7 MigraRon cost A 1 Hospital 200, ,000 $214,200 $298,200 $382,200 $466,200 Cost of VNA license* to manage both new and historical data (5 years) Cost of VNA Server/Storage Hardware Purchase Cost of Hardware Maintenance (yr 2-5) Cost of Power & Cooling (5 yrs) Cost of Data Center FaciliRes (5 yrs) Cost of Storage Admin (5 yrs.) Five year Total Cost Ownership $650,000 $145,000 $116,480 $91,800 $90,000 $112,500 $1,420,580 * Price for simply managing data at Rest (no access)

25 Economics Profile DescripRon Annual Procedures Ave. Study Size (MB) Historical Study Volume Year 1 MigraRon cost Year 3 MigraRon cost Year 5 MigraRon cost Year 7 MigraRon cost B 1 Hospital 160, ,805 $241,039 $308,239 $375,439 $442,639 Five year Total Cost Ownership $1,264,200 C 2 Hospitals 560, ,362,500 $613,725 $848,925 $1,084,125 $1,319,325 Five year Total Cost Ownership $2,997,925

26 Economics In all three examples The cost of a Pro- active Data Migration to a self- managed VNA- fronted Storage Solution is more than the projected costs of migrating all of the image data at a future date when the PACS are replaced. So what is the economic argument? Migration from one proprietary format to another is a waste VNA Data is ready for use by the next PACS, there are no future DICOM migrations Existing VNA infrastructure will off- set Archive infrastructure of the next PACS Pro- active migration to a Cloud- based VNA Infrastructure offers same advantages at significantly lower operational cost

27 Economics Radiology Clinical Viewer Cardiology Clinical Viewer "X"- Ology Clinical Viewer Uni Viewer Hardware and Soaware 100 Concurrent Users $135,000 $110,000 $125,000 $111,638 ImplementaRon and Training $10,000 $10,000 $10,000 $7,000 Viewer $81,000 $66,000 $100,000 $89, EMR Interface $20,000 $20,000 $20,000 $20,000 Interface $12,000 $12,000 $16,000 $16,000 Admin costs (assumes.2 $80K) $48,000 $48,000 $80,000 $80,000 Totals: $141,000 $126,000 $351,000 $323,948 Totals: $618,000 $323,948 % Savings 47.58% Single UniViewer vs Multiple PACS Viewers

28 Economics Radiology Clinical Viewer Cardiology Clinical Viewer "X"- Ology Clinical Viewer Uni Viewer Hardware and Soaware 100 Concurrent Users $135,000 $110,000 $125,000 $111,638 ImplementaRon and Training $10,000 $10,000 $10,000 $7,000 Viewer $108,000 $88,000 $100,000 $89, EMR Interface $20,000 $20,000 $20,000 $20,000 Interface $16,000 $16,000 $16,000 $16,000 Admin costs (assumes.2 $80K) $80,000 $80,000 $80,000 $80,000 Totals: $369,000 $324,000 $351,000 $323,948 Totals: $1,044,000 $323,948 % Savings 68.97% Single UniViewer vs Multiple PACS Viewers

29 Economics On- site vs Off- site? Capitalized, self- managed, on- premise, mirrored, dual- sited VNA vs Hybrid VNA, where Secondary VNA subsystem is hosted in Cloud Infrastructure and managed by the vendor Issues? IT Resources? Geographically disparate Second Data Center? Storage Procurement Funding? Cost Models repeatedly suggest that 5 year TCO of Hybrid VNA 30% lower than Capitalized on- site

30 Frequently Asked Questions Will Cloud- based Vendor Neutral DR/BC solution (Level 3) effect my choice of next PACS?

31 R- PACS C- PACS X- PACS Gateway Organization LAN Organization WAN Cloud Data Center LAN Uni- Viewer VNA Storage Server Level 3 Cloud- based, Vendor Neutral, DR/BC Solution Storage Network Cloud Data Center

32 Frequently Asked Questions Will Cloud- based Vendor Neutral DR/BC solution (Level 3) effect my choice of next PACS? ü Significantly ü Current vendor has much less leverage ü Next PACS ü Has to meet interoperability requirements ü Does not require long- term Archive or enterprise Viewer, thus lowering cost ü Will focus entirely on department operations ü Choice shifts to back to imaging department (clinical criteria)

33 Frequently Asked Questions How does this eliminate conventional Data Migration to my next PACS? ü Only most recent 18 to 24 months of image data needs to be migrated from the VNA to the short- term Storage Solution of the next PACS ü VNA modifies data headers to meet PACS requirements ü Department- specific VNA Directory is copied to next PACS Directory, making it aware of all historical studies ü These are simpler, faster, less expensive migrations

34 Frequently Asked Questions Does Deploying a Level 3 solution lock me into that vendor s VNA technology? ü No ü Data can be moved to another VNA solution w/o costly migration (contractual guarantee) ü You can choose any other legitimate VNA solution for an on- site deployment ü You can choose a different UniViewer for on- site deployment

35 Frequently Asked Questions At what Level could I participate in an HIE? Level 2 - Cloud- based Vendor Neutral Data Management

36 R- PACS C- PACS X- PACS Gateway Organization LAN Organization WAN Cloud Data Center LAN Uni- Viewer VNA Storage Server Level 2 Cloud- based, Vendor Neutral, Data Management Storage Network Cloud Data Center

37 Frequently Asked Questions At what Level could I participate in an HIE? ü Level 2 with XDS- I and companion empi upgrade options activated in Cloud Infrastructure ü No requirement to add XDS- I functionality to each local PACS and deploy a local empi ü Non- DICOM and non- Image Data can also be uploaded to and managed by VNA / Cloud Infrastructure

38 Frequently Asked Questions What level of performance is supported by the UniViewer in the Cloud? ü Assumptions ü Rendering Server and VNA are on the same LAN ü Interface between the two is web services or the rendering server has a day image cache ü Typical zero- client, server- side rendering UniViewer can deliver first images / display screen in 3 seconds over modest Internet connection (commercial broadband) ü User directed (server- side rendered), basic display operations like W/L, Zoom, etc. are delivered in typically < 1 sec.

39 Conclusions Conclusions Vendor Neutral Archive can solve 7 of top 10 PACS problems VNA is large, complex, capital- intensive project that will probably require multiple years and budgets to deploy Similar to early Radiology PACS deployments, there are small VNA precursor products that solve small problems that plague many organizations

40 Conclusions Conclusions Precursor products/strategies include PACS Media Replacement Pro- active Data Migration to the Cloud DICOM Routers to simplify data exchange UniViewer to image- enable the EMR A step plan that utilizes VNA precursor products can build- out a full VNA over time, using a pay- as- you- go strategy

41 VNA Introducing GNAX

42 HIT Ecosystem Colocation Archive, Backup & DR Application Delivery Offload base, non- core IT functions: Tier IV, SSAE 16 Type II data center Complete infrastructure reliability, Geo redundant, VNA Offload 2 nd tier apps, APM, private cloud SaaS HIE, PACS, E- prescribe, EHR

43 GNAX DOES TM Distributed Object Elastic Storage GNAX DOES TM Dallas GNAX DOES TM Atlanta

44 GNAX DOESTM VNA Acuo Technologies Globally deployed since 2001 Over 660 installs of Acuo solution for archiving, routing and migrations Interoperability with every major PACS Frost & Sullivan Product Leader Acuo VNA GNAX DOESTM Learn

45 GNAX DOES TM VNA Stream studies to any workstation or mobile device Universal Viewer Acuo VNA GNAX DOES TM

46 GNAX DOES TM VNA Logical view Universal Viewer Radiology Acuo VNA GNAX DOES TM WAN Private Line WAN Acuo enabled Local cache GNAX DOES TM VNA Edge Cardiology Any- ology EHR

47 Partner: SourceHOV $400M company 30 years in radiology image management Film > digital conversion services

48 Questions & Discussion VNA HIMSS12 booth #2875 Cloud Computing Knowledge Center Booth #13642

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