From Theory to Reality: Building a Secure Cloud Environment for Diagnostic Imaging

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1 From Theory to Reality: Building a Secure Cloud Environment for Diagnostic Imaging Patrick Koch Business Director, WW Vue Cloud Services Carestream Health Kristina Kermanshahche Chief Architect, Healthcare Intel Corporation February 2012

2 Agenda Intel Secure Healthcare Cloud: Healthcare & Cloud Computing Trends Core Requirements & Design Considerations Strategy for Adoption Technology-Differentiated Services Carestream Cloud-Based Diagnostic Imaging: Challenges & Benefits Industry proof points and usage models Architecture & Infrastructure Demo 2

3 Healthcare & Cloud Computing Trends 3

4 Evolution of the Datacenter Cloud Datacenter Virtualized Datacenter Cloud Infrastructure Discrete Datacenter Management Compute Storage Network VM VM VM VM Mgmt Unified Network Security Network Storage Compute Datacenter facilities (e.g. cooling, power) Consolidation Discrete networks Servers Storage Arrays Flexible Management 10G Unified Network Efficient and Secure Open Architecture Flexible Network 4

5 Cloud Computing Business Drivers Business Benefits High-Level IT Strategies and Goals Efficiency Agility Availability Enormous economies of scale Efficiencies in size; buying power, infrastructure, power consumption Unparalleled resource utilization Improve provisioning time from days to hours Automate workflows to enable consistency, agility and elasticity Pay for the resources you actually use Deliver high availability for all workloads, regardless of location Protect IP, data and differentiated business processes Provide secure, broad network access on authenticated devices Services On demand, self-service portal to streamline business processes Establish measured services for VM utilization, health and usage Apply actual application consumption for IT capacity management Healthcare Utility & Value-Add Services Address scarcity by effective allocation of resources & expertise Leverage ecosystem for non-core competencies, achieve economies of scale Accelerate standards adoption through lower barriers to entry Build the network value model of exchange 5

6 The Rise of Healthcare Big Data Diagnostic Imaging Average hospital requires 175TB for images & clinical records. Consumes additional 15 TB annually 1. Data archive for 20+ years. In 2006, primary copy storage for all U.S. imaging = 24 Petabytes (assumes no duplication for RAID, archive, disaster recovery) 2 By 2014, US primary copy storage expected to reach 100 Petabytes 2 Genomic Data The Human Genome consists of 3 billion base pairs, unannotated, requires 3 Gb of storage uncompressed 3 In 2007, Baylor College of Medicine required 125 TB, with projected 25-fold increase in storage over the following two year period 4 Digital data projected to reach 35 Zettabytes by 2020, a 44-fold increase from John Halamka, CIO, Beth Israel Deaconess, 2 Prepare for Disasters and Tackle Terrabytes When Evaluating Medical Imaging Archiving, 2008 Frost & Sullivan. 3 Human Genome Project FAQs, 4 Baylor College of Medicine, Human Genome Sequencing Center, 5 IDC Digital Universe Study, sponsored by EMC, May 2010

7 7 Core Requirements & Design Considerations

8 Care Coordination Use Case Emergency Room Radiology Intensive Care Operating Room Neurology Patient arrives at ER with complications from brain tumor Cloud Vendor Neutral Archive 8 Radiologist analyzes current MRI, compares with prior imaging study from remote hospital Client-Aware Cloud Trust Broker ICU nurses view imaging studies, update chart with patient vital signs, status Neurosurgeon views imaging studies, latest lab results; consults with Radiologist, Laptop Specialists Shared Workstation Specialists agree on treatment plan with Neurosurgeon & Radiologist Smart Phone

9 Barriers to Healthcare Cloud Adoption Business Concerns Security & Privacy Data Transparency High-Level IT Areas of Concern Must protect sensitive information at rest and in transit Costs associated with data breach are rising Cloud services and virtualization break traditional perimeteroriented security techniques Data protection and regulatory compliance require data transparency May prevent PHI from being hosted in another country May restrict or prohibit trans-border flow of information Auditability & Compliance Onsite data centre audits may be impractical for cloud providers SAS 70 Type II/SSAE16 certification, ISO/IEC EU Directive 95/46/EC or HIPAA-compliant cloud providers Vendor Lock-in Service-model dependent Provisioning & automation software built against proprietary APIs Cost of entry may be low, cost of exit may be high 9

10 General Deployment Considerations Availability Service Level Agreements, Recovery Time Objective (RTO), Recovery Point Objective (RPO) Application Architecture, Fault Tolerance, Network Design Business Continuity / Disaster Recovery plans Network Design Network dependency / carrier diversity Suitable, geographically-dispersed, failover data centers Performance Workload peak/min sizes & variability, network bandwidth, performance constraints Monitoring, Notifications & Alerts Start-up costs (cloud on-boarding) & risks of vendor lock-in Regulatory Data Protection Regulations & Locale Constraints Data Loss Prevention, Breach Notification Independent Attestation Security Defense-in-depth, boundary controller, secure perimeter requirements Multi-tenancy risks & benefits, application security, end-to-end security model Isolation vs. efficiency (security vs. cost tradeoff) Administrative, Physical and Technical Controls Governance Availability of IT expertise, Training & Employee Policy Security & Privacy policies, governance Risk Assessment & Mitigation 10

11 Secure Healthcare Cloud: Strategy for Adoption 11

12 What is Secure Healthcare Cloud? Strategy for adoption with phased implementation Best practices, standards and technologies Design principles, deployment considerations, and governance models Worldwide program, key learnings, virtualization labs Industry alliances including: Intel Cloud Builders Open Data Center Alliance (ODCA) European Network & Information Security Agency (ENISA) Cloud Security Alliance (CSA) Comprehensive set of latest security technologies & solutions covering end-to-end cloud deployment models Robust set of ecosystem partners to deliver complete solutions 12

13 Secure Healthcare Cloud Defining Characteristics Highly Available Designed for failure, mitigate risk of data loss, minimize potential for business disruption, tiered service levels, mutually contracted SLAs Geo-dispersed data centers, redundant and diverse network carriers Failover/load balancing, stress testing for scalability and performance Highly Secure End-to-end security design, assess the risk profile of backend systems, the network, identity assurance levels, and potential endpoint devices Multi-Tenancy by design. Designed for breach and other failures, establishing a multilayer and defense-in-depth approach Physical, technical and administrative controls including application security and identity management, encryption at rest and in transit, provisioning, and backup, loss recovery, and secure destruction Compliance with international regulations on safe handling of protected information Highly Transparent Data federation services which isolate, secure, enforce sensitive workloads, as well as establish evidence of consistent management practices Independent attestation of security profile of underlying hosting environment, evidence of consistent policy and security enforcement Compliance with international audit standards 13

14 Adopting Secure Healthcare Cloud Private Networks Current Build/Grow Network of Private Clouds Business Core Utility Interim Private + Limited Public Cloud Federated Query/Identity Trading Networks Utility + Service Future Ubiquitous Hybrid Health Cloud Network Effect Drives Innovation Trading Networks Value-Add Data Services Legacy Environments Internal Clients Legacy Environments Internal Clients Legacy Environments Internal Clients External Clients External Clients External Clients External: Internet External: Internet External: Internet Utility Identity Service Controlled Terminology Service Clinical Data Repository Transformation & Normalization SaaS Scheduling/Triage EHR Care Coordination eprescribing epathology Life Sciences private / academic Utility Service Directory Record Locator Trust Fabric with trading partners EHR Portals Orchestration Mediation SaaS Claims Processing, Adjudication Disease Registries Knowledge Base Public Health Diagnostic Imaging Quality Reporting Utility Master Consent & Authorization Broad Deployment Trust Fabric SaaS Clinical Decision Support Disease Mgmt Secondary Use Clinical Trials Translational Medicine Overcome scarcity by leveraging expertise and capacity in the cloud 14

15 Technology-Differentiated Services 15

16 Architect for the Cloud Today Secure Data protected at rest and in transit Simplified Flexible IA infrastructure and unified networking Efficient World class energy efficiency Refresh with Intel Xeon 5600 and Node Manager Intel Trusted Execution and Virtualization Technologies Intel Xeon for servers & storage Deploy 10GbE Open Multi-vendor innovation with compatibility of solutions Deploy interoperable solutions and support standards Driving Technology Leadership to Enable the Cloud 16 * Other names and brands may be claimed as the property of others. Copyright 2009, Intel Corporation.

17 Healthcare Big Data Moves to the Cloud encryption algorithm Medical Imaging data upload compression algorithm erasure coding algorithm data store dedupe algorithm 10TBs of Diagnostic Images for one type of test No encryption No data protection No Federation Forklift for capacity Intel Xeon Enables: Dynamically Available Capacityscale to the cloud Added Data Protection & Sophisticated Capabilities Federated Data Access Across Medical Networks Efficiency & Scalability 79% Disk Savings 1 Compression 50% savings 1 Erasure code 29% savings 1 Deduplication capabilities savings up to 70% 1 The cloud provides cost efficient capacity scaling 17 1 Intel calculations based on industry numbers for compression & erasure code

18 Ubiquitous Data Protection with Intel AES New Instructions 1 Secure transactions used pervasively in e-commerce, banking, etc. 2 Full-disk encryption protects data on hard disks 2 3 Full disk encryption software protects data automatically during saving to disk Most enterprise applications offer options to use encryption to secure information 1 Secure transactions on Internet and Intranet Internet Intranet 3 Application-level encryption for automation and granularity Name: J.Doe SS# ζ χ Allows broader use of encryption for better protection of sensitive health information 18

19 Carestream Cloud-Based Diagnostic Imaging 19

20 (Some of) CIO s issues with their imaging IT Ensure Availability of Patient Data over a Lifetime Manage Unpredictable TCO with Unexpected CAPEX Enable Physicians Collaboration across Sites & Systems 20

21 How Do You Care For Your Data? Is Your Infrastructure capable of hosting your data securely on-premises? (power redundancy, air/con, security, fire detection & extinction, etc) Is Your IT Team adequately skilled and staffed to adapt to ever changing retention and security requirements? Is Your Architecture protected against technology obsolescence across the lifetime of data?(software, servers, storage, etc) , Carestream Health

22 Does Your PACS [Archive] Cost You Too Much? Continuous expansion of storage capacities to absorb the exploding production of imaging data Upfront capital investment in capacities which stay unused and idle during most of their lifetime Unpredictable Total Cost of Ownership over the lifetime of data (Investment, Maintenance, Expansion, Migration, Replacement) 22

23 Are Your Physicians Able to Share & Collaborate? Ever frequent demand to get faster results on-site or on-the-go Integrate radiology workflow between disparate legacy imaging systems across multiple distant locations. Simple single-point of access to patient s imaging record across the continuum of care for the community 23

24 Now Introducing Vue Cloud LIBERATING TECHNOLOGY , Carestream Health

25 p.25 A New Delivery Model for Software Cloud-based Services Ownership Usage Do-it-Yourself Service Level Agreement Point-to-Point Access Cloud-based Access , Carestream Health

26 A Portfolio of Innovative Cloud Services Collaboration-as-a-Service PACS -as-a-service Rural Clinic Teleradiology-as-a-Service Regional Hospital Vue Cloud by Carestream Reading Center Archive-as-a-Service Physician s Office Cloud Portal University Hospital 26

27 Physician s Office Hospital Service Boundary Remote Secure Access Active Archive Disaster Recovery Unlimited retention Cloud Portal Local Access (LAN) DICOM [PACS, modalities] HL7 [RIS, HIS] Carestream Service Access Point (local cache adapted to needs) Virtual Private Network (VPN) Vue Cloud By Carestream Vue Cloud Platform Operated by Carestream In a Tier -3 Data Center IHE XDS-i [ECG, jpg, mpg pdf] No change Remote monitoring 24 X 7 Vendor Neutral Infrastructure Customer s Responsibility Carestream s Responsibility 27

28 Behind the Cloud Hospital Service Boundary Remote Secure Access Cloud Portal Local Access (LAN) Cloud Services Platform DMZ DICOM [PACS, modalities] HL7 [RIS, HIS] Service Access Point (local cache adapted to needs) Virtual Private Network (VPN) Application Servers Primary copy Vue Cloud By Carestream Disaster Recovery copy Vue Cloud Platform User Mgt Operated Statistic by Carestream Audit & In a Tier Reporting -3 Data Center Security Database Servers Proactive Monitoring IHE XDS-i [ECG, jpg, mpg pdf] No change Remote monitoring 24 X 7 Vendor Neutral Infrastructure Customer s Responsibility Carestream s Responsibility 28

29 Vue Cloud A Proven Global Platform Tufts Medical Center, Boston Long Beach Memorial, CA CHR Orleans, France Nij Smellighen, Netherlands Schwarzer Baer, Hannover CMS Tokyo Group 29

30 p.30 Community Hospital Going Cloud Archive Long Beach Memorial Medical Center, Long Beach CA Customer Profile Busy 200 bed community Hospital Doing over 200,000 Diagnostic Radiology Studies per year Needed increased IT infrastructure for medical imaging Needed additional IT staff Wanted archive solution that was vendor neutral Wanted simple yet effective Disaster Recovery Achievements Decided to subscribe to Vue Cloud Archive Service in 2007 Currently have over 25TB stored in Carestream Cloud Currently have approx 1,000,000 studies stored in Carestream Cloud All images stored are in a standard DICOM Vendor Neutral Format 30 Back 2011, Carestream Health

31 p.31 Teleradiology Services Imadis, France Customer Profile 1st Private Teleradiology Service Provider in France Delivering on call reading services to independant hospitals, for emergency cases, outside business hours Growing rapidly, and therefore need scalable and vendor-neutral infrastructure to connect its clients and radiologists Achievements Partnering with Actibase to deliver a teleradiology infrastructure as a service Grown from 1 hospital to currently 12 connected to the service in 18 months, all being widely dispersed across France Reading Center located in Lyon gets on-call studies automatically pushed from any customer locations Planning to connect 3 additional hospitals in coming quarter , Carestream Health

32 p.32 Image Exchange Across A Community Rochester RHIO, New York, US Customer Profile Multiple independent hospitals & private imaging centers members of RHIO covering the Rochester County Looking at exchanging patient history available from other institutions to reduce retakes and improve quality of care Achievements Partnering with Axolotl and ehealth Global Technologies to deliver an image exchange infrastructure as a service 8 Rochester healthcare institutions connected to the service 35,000 studies collected every month Hosted in CARESTREAM data center in Rochester (Frontier) Meta-data consolidated and images kept on-line for 2 months Radiology studies available on-demand from any institution 32 Back 2011, Carestream Health

33 p.33 National Diagnostic Services National Radiology System, Scotland 33 Customer Profile 39 hospitals across 16 health boards with legacy IT environment 3 millions studies per year, approx 120 TB 8,000 users across 2,000 wards Limited IT skilled within NSS Achievements Private cloud with PACS/RIS/Archive (4 yrs) 2 fully redundant data centers with hot fail-over integrated to National EMPI Priors automatically pulled out of the national patient imaging record Radiology from multiple hospitals acting as a single department 2011, Carestream Health Achievements Partnering with Actibase to deliver a teleradiology infrastructure as a service Grown from 1 hospital to currently 12 connected to the service in 18 months, all being widely dispersed across France Reading Center located in Lyon gets on-call studies automatically pushed from any customer locations Planning to connect 3 additional hospitals in coming quarter

34 Benefits of Vue Cloud Services SCALABILITY Add and remove data, users, sites, and tools freely as your workload ebbs and flows without giving up any functionality PREDICTABILITY Predictable total cost of ownership eliminate unexpected costs from outdated internal support systems CONTROL Carestream follows the precise directions of your designated internal expert and you always own your data PERFORMANCE Your contract defines all the services we will provide, including availability, performance, data restitution and regular reports on usage and activity SECURITY Increased quality and security leave IT to an expert team and redirect your time, money and resources toward core competencies RELIABILITY 24x7x365 proactive monitoring and remote support to provide guaranteed uptime on standardized tested platform , Carestream Health

35 Vue Cloud Community Connect + Collaborate University Hospital Shared Workflow Share Expertise Expert Consultation Town Hospital Referring Physician Shared Data Imaging Center Radiologist Teleradiology Rural Clinic 35

36 Cloud Delivers Integrated Diagnostics at the Point of Care 36

37 p.37 Patient Portal Search Screen , Carestream Health

38 , Carestream Health p.38

39 , Carestream Health p.39

40 Coming soon: MyVue, a Portal for Patients Patient completes exam Checks out with Imaging Admin Patient receives from hospital staff Logs on with info from Patient shares results with specialists Continues with own treatment/care Hospital Ownership: Consent Management Security / Sharing protocols Unlimited expansion EHR Patient Portal Services Patient owns his imaging record, shares on-demand when needed 40

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49 p , Carestream Health More on

50 Summary Overcome scarcity by leveraging expertise and capacity in the cloud Focus on innovation, rely on the ecosystem for services outside your core competency Adopt standards and best practices leveraging worldwide models 50

51 Additional Sources of Information: Intel Cloud Builders Open Data Center Alliance (ODCA) Cloud Security Alliance (CSA) European Network and Information Security Agency (ENISA) Healthcare Blogs Intel Healthcare IT Professionals Whitepapers CARESTREAM * Increasing the Scalability of Medical Imaging Solutions Secure Healthcare Cloud (TXT whitepaper) VMware * and Intel 10GbE Best Practices Securing the Enterprise with Intel AES-NI Enhanced Cloud Security with HyTrust * & VMware * Taking Control of the Cloud for your Enterprise Unified Networking with Cisco * Virtualized Multi-Tenant Data Center * Videos Cloud Security: Built from the Ground Up Trusted Execution Technology Virtualization Demo/Animation CARESTREAM * SuperPACS architecture at Clalit Health Services 51

52 Intel Technologies Intel Virtualization Technology (Intel VT) Provides flexibility and maximum system utilization by consolidating multiple environments into a single server, workstation, or PC Intel vpro Technology Designed specifically for the needs of business, notebooks and desktops with Intel vpro technology have security and manageability built right into the chip Intel Trusted Execution Technology (Intel TXT) Protect confidentiality and integrity of business data against software-based attacks. Intel Anti-Theft Technology (Intel AT) Providing the option to activate hardware-based clientside intelligence to secure the PC and its data in the event the notebook is lost or stolen Intel AES New Instructions (Intel AES-NI) The Advanced Encryption Standard (AES) algorithm is now widely used across the software ecosystem to protect network traffic, personal data, and corporate IT infrastructures Intel Identity Protection Technology (Intel IPT) Two-factor authentication directly into the processors of select 2nd generation Intel Core processor-based PCs Intel Cloud Access 360 Protection Enterprise Access to Cloud and Protecting Enterprise Applications in the Cloud Intel Expressway Service Gateway High performance security, xml acceleration and routing. Cross-domain service mediation, threat prevention, policy enforcement. Interoperable ESB gateway McAfee Cloud Security Platform * Consistent security policies, reporting, and threat intelligence across all cloud traffic now available from a single platform Intel Scale-out Storage Tackle your data center s challenges with enterprise storage solutions powered by the world s most advanced multi-core architecture Intel Solid State Drives High performance, Self-Encrypting Solid State Drives for protecting sensitive data at rest Intel Unified Networking Unified Networking enables cost-effective connectivity to the LAN and the SAN on the same Ethernet fabric 52

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