Systems Supporting Clinical

Gabriel Bartal MDDept Medical Imaging and Interventional Radiology,

Meir MC, Kfar Saba, Israel

Cloud Computing for e-Health. The evolution of the applicationsJerusalem. March 19, 2012

giovedì 22 marzo 2012

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

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

Caught in a web of point to point

Primary CarePhysician

IndependentHealth Facility

Specialty Practice Academic

Medical Center

Payers

Other HIE

CommunityHospital

Government

Patient

Pharmacy

Medical Center

Payers

Other HIE

CommunityHospital

Government

Patient

Pharmacy

Move beyond point to point

The Challenge

The Challenge Most Medical Imaging facilities in Israel use

digital technology for image management

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

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

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

• 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

Fuji9%Philips10%

Carestream58%

Israel – an Opportunity

Inimitable patient ID for each citizen.

Small number of healthcare provider organizations.

Relatively small population. Limited number of PACS

systems.

* Percentage of all Radiology procedures in Israel managed by vendors systems

National Imaging Cloud - Architecture

HMO / Hospital

DICOM Registry & Archive

HMO / Hospital

• Optional opt-in• Long term archive

for interested facilities

• CD Replacement archive

HMO / Hospital

Portal & Collaboration

HMO / Hospital

• Nationwide Access Portal

and Zero Footprint Viewer

• Nationwide Collaboration

Platform

HMO / Hospital

PatientsPatientsPatients Zero FootprintViewer

ReferringCommunity

Zero FootprintViewer

• Nationwide Access Portal

and Zero Footprint Viewer

• Nationwide Collaboration

Platform

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

Architecture Benefits

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

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

Future - Connected Healthcare Communities

Medical Center

Payers

Other HIE

CommunityHospital

Government

Patient

Pharmacy

eHealth

Community Workflow: Digitized

Patient Information: Integrated

Population Information: Insight

Patient Engagement: Web 2.0

Two Paths Towards E-Health

Image Exchange Clinical Exchange

E-Health Image Exchange*

E-Health Information Exchange*

Images &Reports

Documents, medications,

allergies, labs,

Images first,other docs next

Clinical docs first,images next

PACSPACS EMR

Transform Care with E-Health Solutions

Create

Exchange

Collaborate

Perform

EMR PACS Lab Pharmacy Billing

Collaboration Solutions - web-based solutions, including portals, to enable collaboration across the care team

Performance Apps - advanced applications for enhancing workflows and sharing insight and knowledge

Exchange Platform - common platform to manage, collect, translate and share data and images

eHealth Image ExchangeThe best of imaging IT and HIE

Images & Reports

Metrics

GovernmentAgencies

Images & Reports

PatientConsent

General Practitioners

Patient

Specialists

Hospitals

Radiologists

Data Analysis

Prior Studies

ImagingCenters

eHealth Registry

(XDS Registry)

CentricityTM Enterprise Archive 4.0

(DICOM Archive & XDS

Repository)

Master Patient Index

eHealth Clinical Viewer

(XDS Viewer)

Centricity Enterprise

Web (DICOM Viewer)

standards-based solution connects heterogeneous systems

Reporting Tools

FutureCloudServices

VueCloudbyCarestream

Collaboration-as-a-Service

Teleradiology-as-a-Service

CloudPortal

PACS-as-a-Service

Archive-as-a-Service

RegionalHospital

Physician’sOffice

ReadingCenter

RuralClinic

UniversityHospital

VueCloudArchive

• 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 ObsolescenceYour last migration ever

Freedomofchoice+CompleteControl

VueCloudPACS

• No Upfront Investment to benefit from a leading-edge PACSNative reporting and advanced visualization further reduces third party costs

• Committed 99.9% UptimeFocus on your Patient, not your IT

GuaranteedPerformance+PeaceofMind

VueCloudPACS

• No Upfront Investment to benefit from a leading-edge PACSNative reporting and advanced visualization further reduces third party costs

• Committed 99.9% UptimeFocus on your Patient, not your IT

• Diagnostic Reporting AnywhereOn-site or from the cloud, read your studies with your personal desktop

• Unlimited User LicensesFreedom to grow and adjust to your reporting needs

GuaranteedPerformance+PeaceofMind

Nochange VendorNeutralInfrastructure

Hospital

Physician’sOffice

CompanyResponsibilityCustomer’sResponsibility

ServiceBoundary

VirtualPrivateNetwork(VPN)

CloudPortal

CarestreamServiceAccess

Point(localcacheadapted

toneeds)

Remotemonitoring24X7

VueCloudPlatformOperatedbyCarestreamInaTier-3DataCenter

•ActiveArchive•DisasterRecovery•Unlimitedretention

VueCloudByCarestream

DICOM[PACS,modalities]

LocalAccess(LAN)

HL7[RIS,HIS]

IHEXDS-i[ECG,jpg,mpg

RemoteSecureAccess

PROS and CONS of "PACS on cloud”

Pros Cost effective

Pros Cost effective Allows IT to shift focus

Pros Cost effective Allows IT to shift focus Flexibility

Pros Cost effective Allows IT to shift focus Flexibility More mobility

Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage

Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure

Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure Eco Friendly (Green)

Cons Maturity Dependency on internet Security Data migration

Source: javedmati@mokshadigital.com

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 third-party 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

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.

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.

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.

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.

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.

Thank You

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