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VNA for Enterprise Image Management – UnPAC Your Archives
13 April 2015 Trent Conwell, Director of Enterprise Imaging, Sentara Healthcare
Eric Rice, CTO, Mach7 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.
• Trent Conwell, Bachelor of Science • Has no real or apparent conflicts of interest to report.
• Eric Rice, Bachelor of Science • Salary: Mach7 Technologies • Ownership Interest: Mach7 Technologies
Conflict of Interest
© HIMSS 2015
Ignorance may be bliss, but it is the perfect recipe for absolute failure. You will only be as successful as the relationships that you build.
VNA for Enterprise Image Management Ignorance may be bliss, but it is the perfect recipe for absolute failure.
You will only be as successful as the relationships that you build.
• Compare enterprise-level imaging strategies leveraging PACS and VNA systems
• Compare the IT cost impact of PACS and VNA image management solutions
• Analyze imaging informatics process and workflow improvements
• Distinguish image management strategies at the departmental, enterprise and regional/HIE levels
• Evaluate the impact of vendor neutral image management on Health Information Exchanges
Learning Objectives
An Introduction to the Benefits Realized for the Value of Health IT
http://www.himss.org/ValueSuite
Physician Satisfaction – context based viewing across ‘ologies
Patient Satisfaction – a picture is worth 1000 words
Improved patient care – Image Access across the entire continuum of care
Any Image, anywhere, any time - Immediate Context Based Image Access to all images across the Enterprise
Enhanced Patient Physician Relationship – allowing patients a visual understanding of their care
Centralized Archive Platform ILM – Return to the days of owning and managing your images
Value STEPSTM
Satisfaction
Treatment/Clinical
Electronic Information
Patient Education
Savings
S
T
E
P
S
Enterprise Image Management, a journey…
Imaging IT The past 4+ decades…
Cause • PACS proprietary vendor formats • Departmental data silos • Lack of storage management capabilities • Limited ability to communicate and exchange (HIE) imaging
data outside of a single organizational department
Effect
• EMR Image Enabled Disabled • Imaging Growth Inhibited – Exponential growth + rip and replace • Data Integrity…it can be a Liability • Cost of Migration – Not Sustainable • M&A Cost…High • Access & Sharing Challenged: HIE, Image Sharing, MU2+3… • Workflow Efficiencies – unachievable
Medical Imaging Challenges Today
PACS born in the early 1990’s brought enhanced diagnosis, clinical efficiencies, and new challenges…
Imaging IT We have options today
PACS
Options
• Traditional PACS: Status Quo • EMR Image Enablement • Imaging Growth Enabled • Data Integrity Maintained • Eliminate Future Migration Costs • Reduce and/or Defer M&A Cost • HIE, Imaging Sharing, MU2+3… Enabled • Workflow Efficiencies Achieved
VNA Enterprise Imaging Platform
PACS PACS
VNA (Archive) Enterprise Imaging Platform
Enterprise Imaging Platform
Benefits
Traditional PACS Model – Challenges Remain
Option 2 Option 1 Option 3 Traditional VNA Model
PACS PACS PACS PACS PACS PACS
Enterprise Imaging Platform Defined…
The ‘A’ and ‘C’ in P.A.C.S designed for an enterprise
Enterprise Imaging Platform
Vendor Neutral Archive (VNA)
- Standards based storage - Non-DICOM raw format storage - Disaster Recovery - Migration capabilities and target - Storage Management - Imaging Lifecycle Management (ILM) - Change Management Controls
Health Information Exchange (HIE)
- XDS Source - XDS Repository - XDS Registry A C
Communication Workflow Engine
- DICOM routing and prefetching - Imaging translations & transformation - HL7 listener and sender - Non-DICOM services - XDS source enablement workflow - XDS consumer workflow - Patient identify workflow - HIE Enablement
Vendor Neutral Image Management for Archiving + Communication + Exchange
Enterprise Imaging Platform The decomposition of PACS
Options
Deconstructed PACS • On average, 60% lower cost to a diagnostic workflow
Universal Worklist + Diagnostic Viewer + Archive + Reporting • Reduce future migration costs
On average, $100,000 for every 500K procedures. 10 years = $1M • Reduce storage costs
Traditional PACS minimally requires a tier 1 storage cache • Best-of-breed approach with specialist flexibility – buying decision
Enterprise Imaging Platform
Enterprise Imaging Platform
Benefits
Option 3B
Viewer Viewer Viewer
Enterprise Imaging Platform
Enterprise Imaging Platform
Option 3A
PACS PACS PACS
Enterprise Imaging Platform Business Drivers and Strategies
Region Enterprise Department
Enterprise Imaging Platform
PACS PACS PACS
Radiology Cardiology …ology
PACS
…ology
Adv. Vis
Regional Strategies - Connect to State or Private HIE - Provide Regional HIE Infrastructure - Image Sharing - TeleServices
Enterprise Strategies - Image Enable EMR - Consolidating Storage and
Vendors - Reduce Storage Cost - Provide Access to Referring
Physicians and Patients - Reduce Liabilities (data integrity +
data retention)
Departmental Strategies - Optimize Dataflow - Resolve Data Integrity Issues - Reduce Visualization Switching
Costs - Enable TeleServices - Resolve PACS and Modality
Limitations
Costs Differential
Differential Costs
Storage Costs - On average compress storage by 2X compared to default compression algorithms
- With Image Lifecycle Management (ILM), stabilize/stop storage growth today
Migration Costs - Eliminate future migration costs with a VNA - On average 500,000 procedures will cost $100,000 to migrate.
Equates to $1M for 10 years of data
Service Contracts - Eliminate expensive service contracts on storage and PACS systems.
- Standardized to a single Archive and Communication vendor
New Revenue Channels - Host an Archive as a Service, HIE Enablement, PACS as a Service, or … with your Enterprise Imaging Platform
Cost to Diagnose - On average, a Deconstructed PACS costs 60% less than a traditional PACS
Reduce Liabilities - With Image Lifecycle Management (ILM), purge old studies and remove clinical liabilities
The following table highlights cost benefits with moving forward with an Enterprise Imaging Platform.
The Sentara Journey
2014: Enterprise Imaging Business Case Approved
2015: Sentara Implements Enterprise Imaging Platform
2016: Defined HIE model
2017: PACS Agnostic with multiple ‘ology's implemented
2009: 1st VNA Business Case Failure
2010: 2nd VNA Business Case Failure
2014: 11th & 12th Hospital - using Merge & McKesson PACS
2002: Implementation of AGFA PACS - Serving 5 Hospitals
2004: 6th Hospital
2008: 7th Hospital
2011: 8th Hospital - FUJI PACS 2012: 2 AICs - using Carestream & Viztek PACS
2013: 9th & 10th Hospitals – using GE PACS
• Become PACS Agnostic
• Improve Image Retrieval Response Times
• Image Migration Plan (Too many PACS systems to support)
• Business Continuity Model (for imaging systems)
• Decrease Imaging Storage Costs
• Flexible M & A Strategy
• Solution must support other ‘ology's
• PACS system stabilization
The Sentara Journey Setting Objectives
Primary Goals • Improve Image Retrieval Response Times • PACS system stabilization • Decrease Imaging Storage Costs • Need for a more robust Clinical Viewer
Secondary Goals • Solution must support other ‘ology's • Flexible M & A Strategy • Business Continuity Model (for imaging systems) • Image Migration Plan (Too many PACS systems to support)
Roadmap • Become PACS Agnostic • Imaging HIE Strategy
The Sentara Journey Organizing Objectives
The Sentara Journey Creating the Business Case
Storage 16%
Education RFP Development
Business Case Development
Vendor Selection Process 3%
Hardware 8%
Enterprise Imaging Platform
31%
Implementation 2%
Image Migration 40%
The Sentara Journey Generating a Positive ROI
0
1,000
2,000
3,000
4,000
5,000
6,000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
TB
Storage Growth Acquisitions
Department Inclusions
Technology Advances
Increased Business
Standard Growth
Growth with ILM
Projected Savings with ILM 2,600 TB
The Sentara Journey Enterprise Imaging Design Strategy
• Patient Identity • EMR Integration • Enterprise Imaging Solution • Other Ology’s • Mobile • HIE Strategies
Sentara Healthcare PACS to VNA to HIE
• PACS • Generally radiology images within the organizations network
• VNA
• Brings in other ology’s images and provides: • Management, Control & Ownership of the images • Greater accessibility to contextually view images • Mobile viewing & collaboration capabilities
• HIE Strategy
• Waiting for a government solution is not practical • Design strategy should incorporate a federated approach • Peer to peer integration as a subscription model delivered
by the vendor community
Sentara Healthcare Museum
Mona Lisa, c. 1503-1519
By: Leonardo da Vinci
This painting depicts Lisa del Giocondo whose expression is well-known for the enigmatic aura emanating from it. The Mona Lisa is possibly the most famous painting in the world of all time.
The Starry Night, 1889
By: Vincent van Gogh
Considered to be the best and most famous work of Vincent van Gogh, The Starry Night was created from memory and portrays the sight outside the window of his sanitarium room at night.
American Gothic, 1930
By: Grant Wood
American Gothic was inspired by the Dibble House in Iowa. Wood saw its Gothic architectural style and decided to paint the house along with the kind of people he imagined might live in it. The painting depicts a farmer and his daughter, both modeled by his dentist and his sister. Each element of the painting was done separately; the models sat separately and were never at the house.
Girl with a Pearl Earring c. 1665
By: Johannes Vermeer
One of Vermeer’s masterpieces, this painting utilizes a pearl earring as a focal point. It is sometimes known as “the Dutch Mona Lisa” or “the Mona Lisa of the North.”
Questions?
Trent Conwell Director – IT
757.252.0158
Eric Rice CTO
802.861.7745
