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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
Caught in a web of point to point
Primary CarePhysician
Labs
IndependentHealth Facility
Specialty Practice Academic
Medical Center
Payers
Other HIE
CommunityHospital
Government
Patient
Pharmacy
giovedì 22 marzo 2012
Primary CarePhysician
Labs
IndependentHealth Facility
Specialty Practice Academic
Medical Center
Payers
Other HIE
CommunityHospital
Government
Patient
Pharmacy
Move beyond point to point
giovedì 22 marzo 2012
The Challenge
giovedì 22 marzo 2012
The Challenge Most Medical Imaging facilities in Israel use
digital technology for image management
giovedì 22 marzo 2012
The Challenge Most Medical Imaging facilities in Israel use
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
giovedì 22 marzo 2012
The Challenge Most Medical Imaging facilities in Israel use
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
giovedì 22 marzo 2012
The Problem – Examples
giovedì 22 marzo 2012
The Problem – Examples
• No access to patient priors if they reside in another facility
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
• No platform for fast transfer of emergency exams between institutions
giovedì 22 marzo 2012
Fuji9%Philips10%
GE23%
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
giovedì 22 marzo 2012
National Imaging Cloud - Architecture
giovedì 22 marzo 2012
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive
giovedì 22 marzo 2012
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive
• Optional opt-in• Long term archive
for interested facilities
• CD Replacement archive
giovedì 22 marzo 2012
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive
Portal & Collaboration
• Optional opt-in• Long term archive
for interested facilities
• CD Replacement archive
giovedì 22 marzo 2012
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive
Portal & Collaboration
• Optional opt-in• Long term archive
for interested facilities
• CD Replacement archive
• Nationwide Access Portal
and Zero Footprint Viewer
• Nationwide Collaboration
Platform
giovedì 22 marzo 2012
National Imaging Cloud - Architecture
HMO / Hospital
PatientsPatientsPatients Zero FootprintViewer
ReferringCommunity
Zero FootprintViewer
DICOM Registry & Archive
Portal & Collaboration
• Optional opt-in• Long term archive
for interested facilities
• CD Replacement archive
• Nationwide Access Portal
and Zero Footprint Viewer
• Nationwide Collaboration
Platform
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
Future - Connected Healthcare Communities
Primary CarePhysician
Labs
IndependentHealth Facility
Specialty Practice Academic
Medical Center
Payers
Other HIE
CommunityHospital
Government
Patient
Pharmacy
eHealth
Community Workflow: Digitized
Patient Information: Integrated
Population Information: Insight
Patient Engagement: Web 2.0
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
©2011,CarestreamHealth
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
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
pdf]
RemoteSecureAccess
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus Flexibility
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus Flexibility More mobility
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure Eco Friendly (Green)
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
Pros Cost effective Allows IT to shift focus Flexibility More mobility Increased Storage High tech infrastructure Eco Friendly (Green)
Cons
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
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
giovedì 22 marzo 2012
PROS and CONS of "PACS on cloud”
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: [email protected]
giovedì 22 marzo 2012
Will the Next Generation of PACS be Sitting on a Cloud?
giovedì 22 marzo 2012
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.
giovedì 22 marzo 2012
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.
giovedì 22 marzo 2012
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
giovedì 22 marzo 2012
Some fundamental issues are not purely technical and the following must be counted: data latency, data ownership, cost effectiveness, data security issues.
Will the Next Generation of PACS be Sitting on a Cloud?
giovedì 22 marzo 2012
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.
Will the Next Generation of PACS be Sitting on a Cloud?
giovedì 22 marzo 2012
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.
giovedì 22 marzo 2012
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.
Shortening of access time to patient records, imaging reports and other info improves the quality,
improves the efficiency of healthcare delivery,
reduces costs.
giovedì 22 marzo 2012
Not just data sharing across multiple sites, but the workflow share.
Cloud Computing Policies for Clinicians
giovedì 22 marzo 2012
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.
Cloud Computing Policies for Clinicians
giovedì 22 marzo 2012
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.
Data share based on the Workflow distribution one of the greatest challenges in Healthcare IT today, may become the key for effectiveness.
Cloud Computing Policies for Clinicians
giovedì 22 marzo 2012
Thank You
giovedì 22 marzo 2012