Cisco s Medical Data Exchange (MDES) Solution

Transcription

1 Cisco s Medical Data Exchange (MDES) Solution Hal Gilreath & John Voss Global Healthcare Solutions March Cisco Systems, Inc. All rights reserved. 1

2 Market Drivers & Current Environment Drivers Cost reductions and avoidance Lost productivity Patient data exchange between or within healthcare organizations Data is needed locally but stored centrally Importation of unstructured data into structured data Current Environment Manual fax, copy Burn and transport CD ($10/CD) Multi-system log-in Point to point proprietary interfaces Proprietary health information exchanges (HIE) 2009 Cisco Systems, Inc. All rights reserved. 2

3 Solution Benefits Cost reduction Eliminate $10/CD CD burner maintenance costs Improve productivity Interoperability between systems reduces efficient record access Reduce retests & rescans Improve Quality of Care Reduce delays in patient care Address incomplete information for treatment decisions Reduce delays in patient care 2009 Cisco Systems, Inc. All rights reserved. 3

4 Medical Data Exchange Enables Patient Centric Integration & Access of Records Enables interoperability between disparate systems Enables the network as the platform for secure & standards based access & exchange Eliminates the need for manual transport of records & images Standards based (IHE) based PACS & EMR access Common patient identifier with network based IHE Cross Reference Manager & XDSi 2009 Cisco Systems, Inc. All rights reserved. 4

5 What is themedical Data Exchange Solution? Cisco AXP Network module Cisco ISR Router + Globally leadinng SW solution for IHE based medical data exchange 2009 Cisco Systems, Inc. All rights reserved. 5

6 Federated Data Distribution Enables Scaling Interoperability is based on a federated concept Avoids copying all data centrally (Cross Reference Manager) Retains data where it was produced originally. Data is kept as well on a regional level for redundancy purposes (orange level) IHE Cross Reference Manager enables communications between the regions (red) or countries (white) 2009 Cisco Systems, Inc. All rights reserved. 6

7 Medical Data Exchange Enabling The Method Patient Centric Access System A DICOM HL7 v 2 ISO EDI System B HL7 v 2.5 HL7 v 3 IETF XML Network Broker SOAP IHE Network Broker Folie Cisco Systems, Inc. All rights reserved. 7

8 Interoperability - IHE Based Medical Data Exchange Enable patient centric view Eliminate need for manual transport Reduce exam & scan repeats Lower operating expenses Improve data confidentiality Example: Select patient with exams in different PACS Exams located in PACS2 Exams located in PACS1 Without IHE, the PACS workstation from PACS 1 would normally only be able to access the imges of a patient from PACS 1. The images from that patient produced in PACS 2 could not be seen easily from the GUI of PACS Cisco Systems, Inc. All rights reserved. 8

9 AXP Services Engine Overview Service Engines Enable Services Integration at the Branch While Preserving Router CPU/Memory for Critical Connectivity and Cisco IOS Cisco Integrated Services Router + Services Engine Internet USB USB HWIC HWIC HWIC HWIC GE GESFP NME NME NME NME Router integration Blade control protocol between Cisco IOS and service module Hardware efficiencies Eliminates separate appliance and preserves rack space Offloads processing/memory to application-specific platform Lower total cost of ownership Simplifies deployment/maintenance/management Service Engine Hardware Offerings AIM: integrated into base routers (1841, 28xx, 38xx) NM: slot-based module (28xx, 38xx) 2009 Cisco Systems, Inc. All rights reserved. 9

10 MDES Architecture Blue Print: Sub Regional Level: Hospital Chains Document consumer GP1 GP2 GP5 GP GP3 GP4 10 K patients /Year/GP Document source & Document Consumer i.e. Imaging Centre WAAS client 5 GPs per AXP solution 10 K patients /Year 3825 Router AXP (502) Spirit blade WAAS blade (502) 3825 Router AXP (502) WAAS Spirit blade blade (WAE 522 or 512 or 612 or 674?) Data Center. Document source Document consumer to next level DC hirarchy 3825 Router AXP (522) WAAS Spirit blade blade (WAE 522 or 512 or 612 or 674?) Document source & Document Consumer Hosp. 50 K patients /Year 3825 Router AXP (502) Spirit blade WAAS blade (WAE 502 or 612 0r 674) Typical Cisco DC components Catalyst 6500 ACE MDS NAPPA FCoIP Etc... Etc. etc 2009 Cisco Systems, Inc. All rights reserved. 10

11 MDES Architecture - DICOM Data Workflow EPR WS PACS STS Radiology 5 5 SAN/NAS 5 Diagnostic WS 2 1 DICOM data routed from STS to local AXP, DICOM KOS Objects generated and stored in Local router 2 DICOM KOS Objects and DICOM data routed To 2nd level AXP. DICOM KOS stored in second level AXP. 4 DICOM Kos objects to be viewed in EPR 5 PACS in hospital queries DICOM Data from LTA back to PACS STS or Diagnostic WS 3 DICOM Data routed to SAN/NAS 2009 Cisco Systems, Inc. All rights reserved. 11

12 MDES Architecture - HL7 Data Workflow HIS WS Healthcare Provider 1 EPR WS 4 Healthcare Provider 2 HIS WS 1 3 HIS WS HIS Server SAN/NAS 1 Updates to patient records are sent to AXP as HL7 Messages 2 AXP processes HL7 messages and sends Demographics to central AXP for indexing 4 Physician at healthcare provider 2 reviews patient records and requests particular records for viewing 5 AXP processes request and returns patient record from healthcare provider premise via SSL. 3 Index data stored in SAN/NAS 2009 Cisco Systems, Inc. All rights reserved. 12

13 Architecture Guidelines Scalability Several GP s may use one MDES Locator and up to 4 AXP could be put into 1 ISR Router. Host up to 100,000 Patients or 100 GPs. Performance Automatically load Balances with data normally accessed in the local units and not remotely or centrally. Cost-effective Avoids complex & expensive high availability solutions for centralized repositories. Roadmap Increase capacity per single MDES unit with solid state disks 2009 Cisco Systems, Inc. All rights reserved. 13

14 MDES Reference in Wels Healthcare (Austria) Prior Environment 64 sub-systems in one hospital Organizational environment constantly changing Unscalable Difficult to integrate GP s into the hospital environment 1500 proprietary data interfaces Multiple patient Indexes Tiani Spirit software, based on Cisco and Intel technology has enabled us to substantially raise the level of information where it is needed and when it is needed, to help our doctors in their effort to provide the best care possible for our patients. Dr. Walter Aichinger, Chief Physician of the Klinikum Wels-Grieskirchen Folie Cisco Systems, Inc. All rights reserved. 14

15 Wels Configuration Folie Cisco Systems, Inc. All rights reserved. 15

16 Spirit MDES Reference MeDI swiss - Hospital St. Gallen /Switzerland and connected GPs Reports and referals Radiology Referrals Radiology Report Referal to cardilogy specialist Cardiology Report Hospital admission Pre-operative exams and results Surgery report Patient Summary after hospital discharge Labor reports Discharge summary Exam Results Images (X-Ray, MR/DICOM) Static ECG Long Term ECG Ergometry 2009 Cisco Systems, Inc. All rights reserved. 16

17 MDES Value Proposition Improve productivity - a clinician can access records from different institutions in a simple and straightforward manner Lower cost - avoid redundant clinical tests or procedures w/ access to this data Improve patient care - diagnosis and treatment plans w/ a more holistic view of a patient's record Avoid Costs - eliminate the need for production of CD's to transport images The net benefit is better and more cost-effective care Cisco Systems, Inc. All rights reserved. 17

18 Application extension Platform SDK and Development Portal AXP Partner Program AIM MB, 1GB, Intel Celeron Light-Weight Applications AXP Developer Services Complete Ecosystem AXP Advanced Services NME-302/502/ MB-2GB, 80/160GB, Intel Celeron Pentium M General-Purpose Applications Linux-based integration environment with downloadable SDK Multi-app support: segment and guarantee CPU, memory, disk Extensible Cisco CLI with Cisco IOS APIs Cisco ISR 1841, 2800, 3800 series support Cisco Systems, Inc. All rights reserved. 18

19 Architecture and Components Packet Monitoring Cisco IOS Information Event Trigger Cisco IOS Config. Serial Device IOS Interface Cisco AXP Custom Network Services C/C++ App Perl/Python Virtualized OS Cisco Linux OS 3 rd Party Applications Java Application OSGI JAVA Virtualized OS Extensible IOS-like CLI Logging/Debugging Facilities AXP-based Application Appears as a Router Extension 2009 Cisco Systems, Inc. All rights reserved. 19

20 AXP Services Model Management Services: Application-Level AXP-Level ISR-Level Integrated Services Install / Upgrade Admin / Configuration Monitoring Notification Integration Workflow Reporting Analysis Security Services: Cisco AXP: Application extension Platform Software: Virtualized hosting environment Cisco Linux OS Monitor/Configuration API s Hardware: Standalone CPU, HD, Memory NM, AIM service-modules ISR 3800, 2800, 1800 support Linux: SW Trust Chain Hardened Linux OS Rogue SW Protection Cisco IOS: ACLs Stateful FW IPS Network Security: Self-Defending NW 2009 Cisco Systems, Inc. All rights reserved. 20

21 Use Case: Spirit Local Adapter (SLA) The Spirit Local Adapter is used to connect a non IHE environment to an IHE compliant environment for Patient Identity Source Adapter Patient Management (PIX, PDQ) Document Management (XDS) Image Management (XDS-I / DICOM) HL7 v2.x Message (e.g. ADT) Patient Identity Source Adapter Patient Identity Feed PIX Manager Hospital Information System Patient Demographics Query Patient Demographics Query Forward Patient Demographics Query PDQ Supplier Acquisition Modality / Image Archive (DICOM) HL7 v2.x MDM T^xx Message Store Images (C-STORE) Document Source Adapter Imaging Document Source Adapter Provide and Register Document Set Document Repository Hospital IHE compliant Electronic Health Record 2009 Cisco Systems, Inc. All rights reserved. SpiritEHR SLA 21

22 2009 Cisco Systems, Inc. All rights reserved. 22