Developing an Enterprise Imaging Strategy with VNA April 15, 2015

Transcription

1 Developing an Enterprise Imaging Strategy with VNA April 15, 2015 Lynn A. Gibson, M.B.A./Vice President and CTO/CHRISTUS Health Larry Sitka/Principal Solution Architect-Lexmark Healthcare/Founder of Acuo Technologies DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Lynn A. Gibson, MBA has no real or apparent conflicts of interest to report Larry Sitka conflict of interest disclosure includes his role as founder of Acuo Technologies and now an employee of Lexmark, a provider of healthcare IT solutions for vendor neutral archiving and other related processes HIMSS 2015

3 Learning Objectives Explain which criteria are most important when selecting a VNA platform as the foundation for image sharing and clinical content interoperability Evaluate VNA capabilities for addressing specific clinical and business challenges, including unexpected benefits that can be realized and examples of creative solutions to clinical and business problems using VNA technology Discuss recommendations and lessons learned implementing an enterprise VNA platform: the good, the bad and the ugly

4 Vendor Neutral Archive Value STEPS Satisfaction Increases satisfaction for clinicians Avoids duplicate exams when priors are more easily located Treatment/Clinical Enables a more complete picture of the patient at the point of care Electronic Information/Data For large organizations it can function as if in a single archive for all sites Prevention & Patient Education Enables patient images to be easily available to patients Providing greater awareness of health issues Savings Enables ability to reduce costs when migrating to new platforms

5 CHRISTUS Overview 40 Locations in U.S., Mexico and Chile Texas, Louisiana, New Mexico PACS environment domestically 9 Radiology PACS Instances 9 Cardiology PACS Instances Active storage of 4 Petabytes User Support Base of 30,000 Staff: 20,000 Physicians: 9,000 Assets of more than $4.6 billion

6 CHRISTUS Challenges Multiple instances on varying versions Inconsistent clinical content storage Different identifiers between regions Varying patient information captured Growth in the images was and is geometric Mammography is expected to change significantly Difficulty sharing images beyond radiology Varying radiology groups across enterprise Ability to share outside of the enterprise Preparing for meaningful use requirements

7 Unprecedented Demand for Information Genomics Zettabytes Oncologist Patient Neurologist Pathologist Digital Pathology Exabytes VNA Era Business Analyst Referring Physician Supporting Content Radiologist Radiology/Cardiology Imaging Petabytes PACS Era Terabytes

8 Solution Approach Priorities Eliminate imaging silos Neutralize proprietary image storage problem Create an interoperable imaging infrastructure Normalize data Optimize image management Streamline image access across facilities VNA selection criteria Truly neutral (no ties to PACS or storage vendor) Ability to cross technical boundaries Handle DICOM and non-dicom Support for XDS standards Flexibility for future growth HIE participation

9 Implementation Approach Walk Run Fly Establish team of key stakeholders Create migration plan and timeline Determine temporary migration storage requirements Identify data standards Train VNA platform administrators Begin first migration Direct all new studies to the VNA Connect other DICOM content Integrate non- DICOM content Integrate non-dicom content Implement a universal viewer Implement worklists/workflow Plan for integration of all other silos into VNA

10 Creative Solutions to CHRISTUS Challenges Single patient view Disparate PID schemas Universal viewer platform access Consolidated storage NO more charges for migrations Acquisitions/mergers with other hospitals Federation services Mapping of PIDs Image and object services bus Consolidated into two floor tiles from 12 Migrated six separate regions into one separate but distinct VNA More hospitals and more PACS coming online

11 Solution Details/Diagrams Web-Based Claron Diagnostic Viewer Worklist Web-Based Single Image Source (HIE) Storage Agnostic Retention Policies Image Ownership Scalable

12 Solution Details/Diagrams

13 Healthcare Content Management vendor neutral archive enterprise content management CAS/Cloud SAN NAS

14 VNA Solution Implemented Vendor Neutral Archive to provide a single set of software tools that centralize all medical imaging systems into one perpetual repository: Simplify image management Independent of PACS deployment Enable seamless migrations Scale to meet capacity needs Before Opthalmology After Pathology Cardiology Radiology Radiology Pathology Cardiology Opthalmology Endoscopy Dermatology Dermatology Endoscopy Clinical applications

15 Today s Environment: Silos of Vendor-Owned Information EMR Custom Interfaces Radiology/Cardiology PACS OTHER Ologies ECM PDF, JPG, TIFF, TXT,.RAW ETC. Proprietary File Access Individual Departmental Storage Silos DR Plan? PHI Exposure? $$?

16 Healthcare Content Management DICOM World NON-DICOM World Radiology PACS Cardiology PACS Image-Enabled Referential and Enterprise UniViewer EMR RIS/HIS/EMPI Image Exchange Patient Centric Imaging ECM Clinical Apps (JPG, TIFF, PDF,.RAW, ETC.) Other Content with ECM BPM Back Workflow Office Management Apps HR,AP,DAM,DM DICOM DICOM DICOM / WADO / QIDO / STOW RESTful Webservices MINT Dynamic Encrypted URL via HL7 HL7 WebServices XDS Web Services User Based ACL MSAD Workflow Services Web Services Federation and Morphing Enterprise Image Archive (Med) XDS.b Reg/Rep (XDS) EMR VNA Semantix VNA HA XDS/XDS-I VNAMed VNA IHE Audit Custom DICOM Interfaces HL7 Supplement-95 Business Continuity DICOM & Perceptive neutral Image and Object Services Bus content DICOM Learning DICOM Virtualization Assisted Clinical Healthcare non-dicom Information Lifecycle Management System Support IHE ITI Radiology PACS ADAM vendor Migrations Storage Management Software (Store) Cardiology Archive Integration PACS (api) EVE enterprise Migrations ECM Verification Store Migration archive Storage Utility Virtualization Data Lifecycle Management Extraction Utility Managed Shares management Database Intelligence Layer Proprietary File Access CIFS, NFS, API HTTP/ REST iscsi SAN SCSI CAS/COS MAIN FACILITY CLOUD NAS SATA TAPE OTHER DISASTER RECOVERY SITE

17 VNA Benefits Streamlined migration of images from PACS to VNA Image federation, access and workflow DICOM tag mapping and morphing Ability to easily share images across facilities Universal viewer enablement Prepared to participate in HIEs and other initiatives

18 Lessons Learned/Recommendations Examine your image metadata for standards and anomalies Establish your standards before you start conversions and institute those for all new imaging Learn from your existing image vendors what they will charge and require in order to migrate If you have a large volume of history to convert--expect to dedicate significant amounts of time in data cleanup Ensure the storage frame has growth that will go more than three years

19 Questions?