Next Generation PACS: Design & Architecture (Standards based VNA concepts) November 8, 2010

Next Generation PACS: Design & Architecture (Standards based VNA concepts) November 8, 2010

Choice Agenda! Current State! Market Research How customer view their next PACS Top Reasons for Considering a VNA! Vendor Neutral Archiving Requirements for a VNA Providers of VNA Architecture of a VNA Strategy for deploying a VNA! What is Next for PACS 2

Choice Current State 3

What is Current Situation in Healthcare? Applications Own The Data PACS control Data Format and often the Storage Hardware, OS, and Networks PACS Proprietary Format Makes It Difficult To: o Replace a PACS o Add New Applications To Existing Storage System o Share Data Between Applications o Add New HW or IT Strategies, i.e. Business Continuity o Integrate with HIS, EMR and other IS systems Adds Cost, Reduces Flexibility and Increases Complexity Choice Data Migration Is Required When: o Selecting A New Vendor o Upgrading - Either Replacing Storage or PACS SW Upgrade

Migrations PACS to PACS Transition Choice PACS 2.0 Last Migration Migration PACS 1.0 Legacy Continues Archive Shutdown 5

Choice Market Research 6

Choice 7

Choice 8

Choice Vendor Neutral Archiving 9

What a VNA MUST Do! BREAK the Proprietary Link to YOUR data Choice! Eliminate Custom Engineering Integrate via Configuration! Require full Standards-based Interoperability! Manage Storage as an Enterprise Resource! Enable PACS as Applications, Not Storage Systems! Provide Efficient Access and Administration Results: " Higher Quality of Service - BC Dedicated Viewer " Streamlined Operations/Improved Productivity " Effectively Lower TCO In All Areas 10

Before Choice Vendor Neutral Archiving! A True Vendor Neutral Archive solution is a single set of software tools to centralize all medical imaging systems into one perpetual repository.! Simpler management! Seamless migrations! Independent of PACS deployment! Scales to meet all your capacity needs After

What is expected Control Any-ology Radiology CT, MRI, PET, Dermatology - Visible Cardiology Cardiac Diagnostic Radiology, Fluoroscopy, Ultrasound, Nuclear Medicine, Breast Imaging, Interventional Radiology, DEXA Light Imaging Cath, Echocardiology, Nuclear Pathology Wound Care Otorhinolaryngology GI Lab Ophthalmology Neurosurgery Oncology

Non-DICOM Handling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

Choice Additional Expectations of a VNA! Enables a Clinical viewer for the EMR that allows viewing of all images Provide one integration point for images Move to a rendering viewer strategy with no image cache! End of Migrations It is a replacement market! Robust support of next generation storage Business continuity Cloud Hosting 14

Who provides VNA Choice! Pure Play VNA vendors Software only No Diagnostic Viewer Smaller innovative! Infrastructure Providers Often already providing enterprise storage solution See it as next phase in the evolution of PACS! PACS Providers Send us everything, we can manage it. Many deployments, few if any without their PACS Will require future migration 15

Choice 16

Enterprise Archive Strategy Choice 6+,=$' >0,9.$8' <67'C'A67'C' >:56' D2&2#$' '6+,="0=' ;15<=# ;15<=# ;15<=#Y# >P;<# VDW# [[[[[[[# >:<' $%&'()(*+'#103:'#P(4H*O'#QJ6PR# Custom Interfaces 51,.L#6,.L#P71# <,8"*.*=;'' 5417' 1,#8"*.*=;' 5417'.&9(3:'#=3%3:'0'%&#.9XE3('# Proprietary File 51,.L#6,.L#P71# Access 74B' 7176' 147'!"#$%&"'#(#)*% VZZ7Y T$.Z# 1.*28' 9,3$8' *.5.1#?45>' @?A><' 74?4' +#,",)-.%.-'/0-.*%,#)-% 17

Choice

Develop the Strategy Build a Plan to Gain Control of Your Data Sever the Proprietary Link Between Applications (PACS, CPACS) and Storage # Require Applications to Interoperate in a High Performance, Standards-based Format # Identify PACS as a Valuable Departmental Workflow Application, NOT Storage Systems Decide on an Infrastructure Solution # Storage/Network # Business Continuance Strategy Bring DICOM Skills into IT Come to Terms With the Inevitable Migration Choice Commit to Make it Your Last Migration! 19

The Solution! Choice There are a number of strategic approaches to building a Vendor-Neutral Enterprise Archive Take the A out of PACS Migrate to VNA platform BEFORE PACS replacement Put out RFP for the non-archiving portion of PACS Connect new PACS directly to VNA Shut Down Legacy PACS quickly after new PACS is up PACS A Lifetime 1 2 3 4 5 Data Migration phase PACS B Lifetime VNA Lifetime

Choice What is Next for PACS 21

NEXT: Virtualized PACS Deploy/Integrate PACS by Department Eliminate the islands Radiology/Cardiology/Any Ology Build strategy for non-dicom Skin the PACS Department specific workflow tools Global worklists, across department/facility Integrated reporting PACS becomes the visualization engine only Archive is an IT domain and the clinical departments are a contributor and user Choice 22