Systems Supporting Clinical

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1 Systems Supporting Clinical Gabriel Bartal MD Dept Medical Imaging and Interventional Radiology, Meir MC, Kfar Saba, Israel Cloud Computing for e-health. The evolution of the applications Jerusalem. March 19, 2012

2 Cloud Deployment Models Private clouds operated for one organization and may be managed by organization itself or by a third party may reside on-premises or off it. Public clouds - managed by a Cloud service provider. Hybrid clouds combine two or more clouds (private or public) that remain unique entities but are bound together by technology that enables data and application portability. Community clouds feature infrastructure that is shared by several organizations and supports a specific community. Source: NIST Cloud Computing Reference Architecture

3 What is a Cloud-based Service? Application as a service Delivered via Internet From Multi-tenant Data Centers Fully Managed by a Service provider Pay as you use Operating expense Not a Capital expense

4 Caught in a web of point to point Primary Care Physician Other HIE Labs Patient Independent Health Facility Payers Pharmacy Government Specialty Practice Academic Medical Center Community Hospital

5 Move beyond point to point Primary Care Physician Other HIE Labs Patient Independent Health Facility Payers Pharmacy Government Specialty Practice Academic Medical Center Community Hospital

6 The Challenge

7 The Challenge Most Medical Imaging facilities in Israel use digital technology for image management

8 The Challenge Most Medical Imaging facilities in Israel use digital technology for image management No convenient process for sharing medical imaging studies and reports between: Healthcare providers Providers and their referring community Providers and patients

9 The Challenge Most Medical Imaging facilities in Israel use digital technology for image management No convenient process for sharing medical imaging studies and reports between: Healthcare providers Providers and their referring community Providers and patients No platform that allows handy communication between the above 3 entities

10 The Problem Examples

11 The Problem Examples No access to patient priors if they reside in another facility

12 The Problem Examples No access to patient priors if they reside in another facility CDs, that are most commonly used to deliver images to referring physicians, are cumbersome and hard to use: Are not always given (unless requested) Patients lose them No common user-interface for embedded viewers Take long time to launch Cumbersome to import into local PACS

13 The Problem Examples No access to patient priors if they reside in another facility CDs, that are most commonly used to deliver images to referring physicians, are cumbersome and hard to use: Are not always given (unless requested) Patients lose them No common user-interface for embedded viewers Take long time to launch Cumbersome to import into local PACS No platform for fast transfer of emergency exams between institutions

14 Israel an Opportunity Inimitable patient ID for each citizen. Small number of healthcare provider organizations. Relatively small population. Carestream 58% Limited number of PACS systems. Fuji 9% Philips 10% GE 23% * Percentage of all Radiology procedures in Israel managed by vendors systems

15 National Imaging Cloud - Architecture

16 National Imaging Cloud - Architecture DICOM Registry & Archive HMO / Hospital

17 National Imaging Cloud - Architecture HMO / Hospital DICOM Registry & Archive Optional opt-in Long term archive for interested facilities CD Replacement archive

18 National Imaging Cloud - Architecture Portal & Collaboration HMO / Hospital DICOM Registry & Archive Optional opt-in Long term archive for interested facilities CD Replacement archive

19 National Imaging Cloud - Architecture HMO / Hospital Portal & Collaboration DICOM Registry & Archive Nationwide Access Portal and Zero Footprint Viewer Nationwide Collaboration Platform Optional opt-in Long term archive for interested facilities CD Replacement archive

20 National Imaging Cloud - Architecture Zero Footprint Viewer Referring Community HMO / Hospital Patients Zero Footprint Viewer Portal & Collaboration DICOM Registry & Archive Nationwide Access Portal and Zero Footprint Viewer Nationwide Collaboration Platform Optional opt-in Long term archive for interested facilities CD Replacement archive

21 Architecture Benefits Provides cost effective imaging storage for smaller facilities Images are only transferred as needed for facilities opting not to store all their images in the Central Archive A fast zero-footprint viewer eliminates the need for CDs No issues with Data ownership Source for data mining and national statistics

22 Nationwide Zero-Footprint Viewer Can run from most popular Internet browsers Can run from any computer and popular mobile devices Does not require installation Very simple to use and intuitive user interface

23 Making National Imaging Cloud a Reality Such venture requires Government guidance and intervention Several European countries have started down this path Denmark France Scotland Potential partial financing can come from: Money saved from reducing or eliminating CD burning operations Facilities who use the Central Archive for backup and disaster recovery Users of the Collaborative Platform

24 Future - Connected Healthcare Communities Primary Care Physician Community Workflow: Digitized Patient Engagement: Web 2.0 Other HIE Patient Information: Integrated Labs Population Information: Insight Patient Independent Health Facility ehealth Payers Pharmacy Government Specialty Practice Academic Medical Center Community Hospital

25 Two Paths Towards E-Health Image Exchange Clinical Exchange Images first, other docs next PACS PACS EMR Images & Reports E-Health Image Exchange* Clinical docs first, images next Documents, medications, allergies, labs, E-Health Information Exchange*

26 Transform Care with E-Health Solutions Perform Performance Apps - advanced applications for enhancing workflows and sharing insight and knowledge Collaborate Collaboration Solutions - web-based solutions, including portals, to enable collaboration across the care team Exchange Exchange Platform - common platform to manage, collect, translate and share data and images Create EMR PACS Lab Pharmacy Billing

27 ehealth Image Exchange The best of imaging IT and HIE Government Agencies Metrics Data Analysis Reporting Tools ehealth Clinical Viewer (XDS Viewer) Centricity Enterprise Web (DICOM Viewer) Patient Consent Patient Radiologists Hospitals Prior Studies Images & Reports ehealth Registry (XDS Registry) Centricity TM Enterprise Archive 4.0 (DICOM Archive & XDS Repository) Images & Reports General Practitioners Imaging Centers Master Patient Index standards-based solution connects heterogeneous systems Specialists

28 Future 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 2011, Carestream Health

29 Vue Cloud Archive Freedom of choice + Complete Control No more silo`s with an XDS repository DICOM, HL7, XDS-i, and other document formats such as JPG, MPG, PDF, ECG, EKG, etc Pay Only for What You Use No upfront investment, no idle server and storage Protect Your Data with an off-site Disaster Recovery Secure, highly availability archive with active monitoring and remote management Freedom To Expand Without the Worry of Technology Obsolescence Your last migration ever

30 Vue Cloud PACS Guaranteed Performance + Peace of Mind No Upfront Investment to benefit from a leading-edge PACS Native reporting and advanced visualization further reduces third party costs Committed 99.9% Uptime Focus on your Patient, not your IT

31 Vue Cloud PACS Guaranteed Performance + Peace of Mind No Upfront Investment to benefit from a leading-edge PACS Native reporting and advanced visualization further reduces third party costs Committed 99.9% Uptime Focus on your Patient, not your IT Diagnostic Reporting Anywhere On-site or from the cloud, read your studies with your personal desktop Unlimited User Licenses Freedom to grow and adjust to your reporting needs

32 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 Customer s Responsibility Remote monitoring 24 X 7 Company Responsibility Vendor Neutral Infrastructure

33 PROS and CONS of "PACS on cloud Pros

34 PROS and CONS of "PACS on cloud Pros Cost effective

35 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus

36 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus Flexibility

37 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus Flexibility More mobility

38 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage

39 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure

40 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure Eco Friendly (Green)

41 PROS and CONS of "PACS on cloud Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure Eco Friendly (Green) Cons

42 PROS and CONS of "PACS on cloud Pros Cons Cost effective Maturity Allows IT to shift focus Dependency on internet Flexibility Security More mobility Data migration Increased Storage High tech infrastructure Eco Friendly (Green)

43 PROS and CONS of "PACS on cloud Pros Cons Cost effective Maturity Allows IT to shift focus Dependency on internet Flexibility Security More mobility Data migration Increased Storage High tech infrastructure Eco Friendly (Green) Source:

44 Will the Next Generation of PACS be Sitting on a Cloud?

45 Will the Next Generation of PACS be Sitting on a Cloud? Medical Imaging Clouds provide on demand medical imaging information technology (IT) services from remote or remotely managed thirdparty platforms over a network.

46 Will the Next Generation of PACS be Sitting on a Cloud? Medical Imaging Clouds provide on demand medical imaging information technology (IT) services from remote or remotely managed thirdparty platforms over a network. The core technologies of the cloud computing model are clearly attractive for medical imaging.

47 Will the Next Generation of PACS be Sitting on a Cloud? Medical Imaging Clouds provide on demand medical imaging information technology (IT) services from remote or remotely managed thirdparty platforms over a network. The core technologies of the cloud computing model are clearly attractive for medical imaging. J. Philbin, F. Prior and P. Nagy from Journal of Digital Imaging, August 2010

48 Will the Next Generation of PACS be Sitting on a Cloud? Some fundamental issues are not purely technical and the following must be counted: data latency, data ownership, cost effectiveness, data security issues.

49 Will the Next Generation of PACS be Sitting on a Cloud? Some fundamental issues are not purely technical and the following must be counted: data latency, data ownership, cost effectiveness, data security issues. These factors argue against remotely hosted clouds.

50 Cloud Computing Policies for Clinicians We are looking at extended applications like Tablet PCs and smart-phones, place critical information at the fingertips of Clinicians at the point of care.

51 Cloud Computing Policies for Clinicians We are looking at extended applications like Tablet PCs and smart-phones, place critical information at the fingertips of Clinicians at the point of care. Shortening of access time to patient records, imaging reports and other info improves the quality, improves the efficiency of healthcare delivery, reduces costs.

52 Cloud Computing Policies for Clinicians Not just data sharing across multiple sites, but the workflow share.

53 Cloud Computing Policies for Clinicians Not just data sharing across multiple sites, but the workflow share. Workflow share designation: users in different locations participate in a single, common workflow across multiple systems and sites.

54 Cloud Computing Policies for Clinicians Not just data sharing across multiple sites, but the workflow share. Workflow share designation: users in different locations participate in a single, common workflow across multiple systems and sites. Data share based on the Workflow distribution one of the greatest challenges in Healthcare IT today, may become the key for effectiveness.

55 Thank You

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