Cisco's 'Medical Data Exchange' (MDES) Solution

© 2009 Cisco Systems, Inc. All rights reserved. 1

Cisco’s‘Medical Data Exchange’

(MDES) Solution

Hal Gilreath & John VossGlobal Healthcare SolutionsMarch 2009


Market Drivers & Current Environment

DriversCost reductions and avoidanceLost productivityPatient data exchange between or within healthcare organizationsData is needed locally but stored centrallyImportation of unstructured data into structured data

Current EnvironmentManual fax, copyBurn and transport CD ($10/CD)Multi-system log-inPoint to point proprietary interfacesProprietary health information exchanges (HIE)


Solution Benefits

Cost reductionEliminate $10/CDCD burner maintenance costs

Improve productivity Interoperability between systems reduces efficient record accessReduce retests & rescans

Improve Quality of CareReduce delays in patient careAddress incomplete information for treatment decisionsReduce delays in patient care


• 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

Medical Data Exchange Enables Patient Centric Integration & Access of Records


What is theMedical Data Exchange Solution?

+Cisco AXP

Network moduleCisco ISR

Router

Globally leadinng SW solution forIHE based medical data exchange


Interoperability is based on a federated conceptAvoids 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 theregions (red) or countries (white)

Federated Data Distribution Enables Scaling


Medical Data Exchange – Enabling TheMethod Patient Centric Access

Folie 7

System A

DICOMHL7 v 2

ISO 10781

EDI

SOAP

System B

HL7 v 2.5

HL7 v 3

IETF

XML

IHENetwork Broker Network Broker


Example: Selectpatient with examsin different PACS

Exams located in PACS2Exams located in PACS1

Interoperability - IHE Based Medical Data Exchange

Without IHE, the PACS workstation from PACS 1 would normally only be able to access the imgesof a patient from PACS 1. The images from that patient produced in PACS 2 could not be seen easily from the GUI of PACS 1.

Enable patient centric view

Eliminate need for manual transport

Reduce exam & scan repeats

Lower operating expenses

Improve data confidentiality


Internet

Cisco IntegratedServices Router +

ServicesEngine

GEGESFPSFPHWICHWIC HWICHWIC HWICHWIC HWICHWIC

NMENME NMENMENMENME NMENME

USBUSBUSBUSB GEGE

AXP Services Engine Overview

Router integrationBlade control protocol between Cisco IOS and service module

Hardware efficienciesEliminates separate appliance and preserves rack spaceOffloads processing/memory to application-specific platform

Lower total cost of ownershipSimplifies deployment/maintenance/management

Service Engines Enable Services Integration at the Branch While Preserving Router CPU/Memory for Critical Connectivity and Cisco IOS

Service Engine Hardware Offerings

AIM: integrated into base routers (1841, 28xx, 38xx)

NM: slot-based module (28xx, 38xx)


MDES Architecture Blue Print: Sub Regional Level: Hospital Chains

GP1

GP2GP5

GP3

GP4

Document consumer

GP

Document source &Document Consumer

i.e. Imaging Centre

Hosp.

Document source &Document Consumer

10 K patients /Year/GP

10 K patients /Year

50 K patients /Year

WAAS blade (502)

AXP (502) Spirit blade

3825 Router

WAAS blade (WAE 522 or512 or 612 or

674?)


3825 Router

WAAS blade (WAE 502 or612 0r 674)


3825 Router

WAAS blade (WAE 522 or512 or 612 or

674?)


3825 Router

Data Center.Document source

Document consumer to next level DC hirarchy

5 GPs per AXP solution

WAAS client

• Typical Cisco DC components• Catalyst 6500• ACE• MDS• NAPPA• FCoIP•Etc....•Etc.•etc


MDES Architecture - DICOM Data Workflow

RadiologyRadiology

PACSSTS

1

5

1 DICOM data routed from STS to local AXP,DICOM KOS Objects generated and stored inLocal router

2 DICOM KOS Objects and DICOM data routedTo 2nd level AXP. DICOM KOS stored in second level AXP.

2

3

3 DICOM Data routed to SAN/NAS

DiagnosticWS

EPRWS

4

4 DICOM Kos objects to be viewed in EPR

5 PACS in hospital queries DICOM Datafrom LTA back to PACS STS or Diagnostic WS

5

SAN/NAS5


MDES Architecture - HL7 Data Workflow

1

5

1 Updates to patient records are sent to AXP as HL7Messages

2 AXP processes HL7 messages and sendsDemographics to central AXP for indexing

2

3

3

Healthcare Provider 1

HIS Server

HISWS 4

4

5 AXP processes request and returns patient record from healthcareprovider premise via SSL.

5

SAN/NAS5

HISWS

HISWS

EPRWS

Physician at healthcare provider 2 reviews patient recordsand requests particular records for viewing

Index data stored in SAN/NAS

Healthcare Provider 2


Architecture Guidelines

ScalabilitySeveral 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 thelocal units and not remotely or centrally.

Cost-effectiveAvoids complex & expensive high availability solutions forcentralized repositories.

RoadmapIncrease capacity per single MDES unit with solid state disks


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

MDES Reference in Wels Healthcare (Austria)

Folie 14

“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


Wels Configuration

Folie 15


Spirit MDES Reference MeDIswiss - Hospital St. Gallen /Switzerland and connected GPs

Reports and referals RadiologyReferrals

Radiology Report

Referal to cardilogyspecialist

Cardiology Report

Hospital admission

Pre-operative exams and results

Surgery report

Patient Summary afterhospital discharge

Labor reportsDischarge summary

Exam ResultsImages (X-Ray, MR/DICOM)Static ECGLong Term ECGErgometry


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.


Application eXtension Platform

AIM-102256MB, 1GB, Intel Celeron

Light-Weight Applications

NME-302/502/522512MB-2GB, 80/160GB,

Intel Celeron Pentium M General-Purpose Applications

SDK and Development

Portal

AXP Partner

Program

AXP DeveloperServices

AXP Advanced Services

Complete Ecosystem

Linux-based integration environment with downloadable SDKMulti-app support: segment and guarantee CPU, memory, disk Extensible Cisco CLI with Cisco IOS APIs Cisco ISR 1841, 2800, 3800 series support

www.cisco.com/go/axp


Architecture and Components

Cisco AXPPacket

MonitoringCisco IOS Information

Event Trigger

Cisco IOS Config.

Serial Device

IOS

Interface

Logging/Debugging

Facilities

AXP-based Application Appears as a Router Extension

Virtualized OS

JAVA

OSGI

3rd Party Applications

Cisco Linux OS

Extensible IOS-like CLI

Virtualized OS

Perl/Python

C/C++ App

Custom Network Services

Java Application


Security Services:Linux:

SW Trust ChainHardened Linux OS

Rogue SW Protection

Cisco IOS:ACLs

Stateful FWIPS

Network Security:Self-Defending NW

Management Services:AXP Services Model

Cisco AXP:ApplicationeXtensionPlatform

Software:Virtualized hosting environmentCisco Linux OSMonitor/Configuration API’s

Hardware:Standalone CPU, HD, MemoryNM, AIM service-modulesISR 3800, 2800, 1800 support

Application-LevelAXP-LevelISR-Level

Inst

all /

U

pgra

de

Adm

in /

Con

figur

atio

n

Mon

itorin

g

Rep

ortin

g A

naly

sis

Inte

grat

ion

Wor

kflo

w

Not

ifica

tion

Integrated Services


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 AdapterPatient Management (PIX, PDQ)Document Management (XDS)Image Management (XDS-I / DICOM)

HospitalInformation

System

PatientIdentitySourceAdapter

DocumentSourceAdapter

ImagingDocument

SourceAdapter

PIXManager

DocumentRepository

PDQSupplier

Patient Identity Feed

Provide and RegisterDocument Set

PatientDemographics

QueryForward

Patient Demographics Query

Acquisition Modality /Image Archive

(DICOM)

Patient Demographics Query

HL7 v2.x Message (e.g. ADT)

HL7 v2.x MDM T^xx Message

Store Images (C-STORE)

SpiritEHR SLA

Hospital IHE compliantElectronic Health

Record


Documents

Cisco's 'Medical Data Exchange' (MDES) Solution