Sponsored by: Hosted By:

Welcome to Today’s Web Seminar!

November 17, 2011

2:00PM ET

Mike Perkowski is co-founder and partner of New Reality Media LLC. Mike has

nearly 30 years of experience following the computer industry as a reporter, editor,

publisher and marketing executive. Before co-founding New Reality Media, he was co-

founder and chief operating officer of Microcast Communications, a media company

covering the IT and municipal broadband marketplaces. Previously, he spent 10 years

at Ziff Davis Media in a variety of executive roles, including VP and general manager of

Ziff Davis’ Market Experts Group; vice-president of corporate marketing; publishing

director of Smart Partner, and associate publisher for marketing at PC Magazine. Mike

also spent 13 years at CMP Media in various editorial and publishing leadership roles,

including editor-in-chief and publisher of Computer Systems News. He has directed the

development and implementation of numerous integrated marketing programs for his

clients at Ziff Davis, CMP and as an independent marketing consultant specializing in

new-product launches, and has led such disciplines as market research, customer

event programs and sales training.

Mike also was a member of the Board of Directors for the Computing Technology

Industry Association (CompTIA), the high-tech industry’s largest trade association. He

received a B.A. in Journalism from Rider University (Lawrenceville, New Jersey).

.

Michael Gray is the principal of Gray Consulting, a consulting practice established

in 1991 to develop a number of consulting services designed to assist Healthcare

Systems and Radiology Practice Groups. Gray Consulting has provided consulting

services related to PACS and Enterprise Archiving to over 90 Organizations.

Mr. Gray’s areas of expertise are Market Analysis, Technology Analysis, Strategic

Planning, Needs Assessment, Workflow Analysis and Re-design, Business Case

Modeling, Vendor Analysis/Selection, and Technical Contract Negotiation. Mr. Gray’s

unique perspective has proven invaluable to Radiology and Information System

administrators planning the introduction of new Image Management technologies into

their imaging departments and hospitals. Mr. Gray routinely publishes articles on his

Weblog ( http://www.graycons.com ) on subjects such as workflow design, business case

modeling, system deployment strategies, expansion or replacement of data Storage

Solutions, development of Data Migration strategies from old to new PACS, and the latest

market concepts including Vendor Neutral Archiving and EMR UniViewers.

Mr. Gray has a BS in Biology and Chemistry from Washington University, St. Louis; has

been awarded three US patents; and has an extensive bibliography in medical image

display and electronic information management systems.

Mr. Gray and his family reside in Novato, California.

As WW Strategy and Business Development Executive for Dell’s Unified

Clinical Archive Solution, Dan M. Trott is responsible for guiding the

development and implementation of Dell’s solution for enterprise archiving

of clinical information in the Healthcare and Life Sciences market.

Reporting to Dr. Jamie Coffin, Dan leads a team responsible for identifying

strategies and technologies that will help Dell develop the clinical archiving

market, integrating solutions into the Dell portfolio of healthcare archiving

solutions, and managing relationships with application development

partners who will add these solutions to their own portfolios.

Prior to joining Dell in October of 2010, Dan spent seven and half years at

IBM as part of the healthcare infrastructure team at IBM and more than 30

years in companies addressing the needs of the medical imaging and

healthcare IT markets.

Dan began his healthcare career as a Physicians’ Assistant in Diagnostic

Radiology and holds a Bachelor’s Degree in Biology from the University of

Texas at Austin and an MBA from Rivier College in Nashua, NH.

Challenge of a Best-Of-Breed VNA is Skillful System Integration and

Dedicated Back-end Support

Michael J. Gray

Principal, Gray Consulting

Dan Trott

WW Strategy and Business Development Dell Healthcare

6

Michael J. Gray Principal of Gray Consulting

Challenge of a Best-Of-Breed VNA is Skillful System Integration and

Dedicated Back-end Support

8

Objectives

VNA Challenges & Choices

• Challenges in a Heterogeneous PACS Environment

• Solutions for Data Management, Archive and Distribution

• Architecture and Deployment – Issues and Options

Ideal Solution

• Considerations for Selecting a Solutions Partner

• Ideal Solution

• Requirements to Assure Success

Dell’s Approach

• Dell Healthcare’s Approach to the Enterprise Image Archive

• Conclusion

• The Silo Effect

• Limited Choices

• Proprietary Data Formats

9

Problems

• Lack of Information Lifecycle Management

• Inadequate Disaster Recovery

• Lack of Business Continuity

• Costly Data Migrations

• Data Sharing and Collaboration

10

Problems

• Multiple Vendors

• Non-DICOM Data

Solutions • Not all VNA Solutions are Created Equal

• Fundamental Requirements of the Neutral Archive Application

– Bi-Directional Tag Morphing

– Full DICOM conformance – Methodology for non-DICOM – Organize/Manage by Organization Node

– Intelligent metadata driven ILM – Ability to create/associate Unique patient/study ID – Pre-fetching and Auto-Routing with Relevant prior Algorithm

– Mirrored, dual-sited configuration – Virtualization – Data Integrity and Propagation of HL7 updates

– Data Compression options (negotiating any DICOM-conformant Syntax) – Create/Maintain XDS-I Manifest – Transaction Logging and Reporting

– Security – Comprehensive Pro-active 7/24/365 remote monitoring of all components

11

12

Solutions

• Mirrored configuration supports realistic Disaster Recovery

• Inclusion of the Viewer Application on both sides provides true Business Continuity

Datacenter LAN Datacenter LAN

WAN

Primary Data Center A Secondary Data Center BEMR

Univiewer VNA App

Local Storage

Univiewer VNA App

Local Storage

Solutions

Many options available for the Storage Solution • NAS or SAN solutions managed by the VNA application

• Intelligent Data Management solutions

– Featuring Object Storage Platforms and Storage Virtualization – Interface options: NFS, CIFS, simple HTTP, or custom API – Storage Solution itself uses metadata

› To optimize data storage and data flow across tiers › To apply preservation, retention and deletion policies › Uses thin provisioning capabilities which eliminate the need to pre-allocate

capacity and eliminate the practice of buying capacity before it is required

• The right Storage Solution could store medical images AND emails,

Sharepoint files, videos, pictures, digital documents, etc.

• 5yr TCO for an Intelligent Storage solution better than that of a SAN

13

Solutions

Fundamental Requirements of the UniViewer Application

– Absolute Zero client

– Server-side Rendering

– Cache-less

– Virtualization

– Supports Multiple OS and Browsers

– URL-based Portal Interface

– EMR Authentication

– Auditable Transaction Logging

– Methodology for displaying non-DICOM

– Medium to Advanced Features/Functions

– Optional Web Services interface (to the VNA and/or Storage Solution)

14

Architecture and Deployment… Issues and Options The Organization needs to focus inward in order to establish their position on these Key Considerations… • IT Resources

– Staffing level and skill set

• Second Data Center

– Does it already exist? – Is co-location with a business-class provider an option?

• Storage Utilization

– Can the organization achieve a just-in-time procurement model?

15

Architecture and Deployment… Issues and Options The Organization needs to focus inward in order to establish their position on these Key Considerations…

• Disaster Recovery Strategy – Proper Infrastructure and Professional Services must be established to

assure timely recovery of lost data

• Proximity Requirements for Business Continuity

– True BC requires the Secondary Display Application and the Secondary VNA Application in close proximity

• Funding

– Is the Organization prepared to commit the Capital vs Operational Funds?

– Does the fee-per-study in a Software as a Service model make sense?

16

Architecture and Deployment… Issues and Options Consider the Variations on System Architecture

• Mirrored Configuration

– Dual-sited – Geographic Separation

• Local Facility Cache Servers (multi-facility organizations)

• Virtualization

– VNA application – UniViewer

• Direct Image Acquisition for imaging departments without PACS

– DICOM – non-DICOM

17

Architecture and Deployment… Issues and Options Decisions that determine the Deployment Options

• Economics

– Own the system (Capitalize or Lease)? – Fee-per-Study or SaaS solution? – Are there sufficient funds to support single phase or multi-phase?

• System Management – Self-Management vs Contract Management depends on IT Resources

• Storage utilization – Ability to create and execute an on-demand storage procurement

schedule

• On-Premise vs Off-Premise – Is organization willing and able to support the second data center? – Can the vendor be trusted to manage the data in their Cloud?

18

Considerations for Selecting a Solutions Partner

• Many options to weigh

• Building the right VNA should be a process of choosing the right option from a wide range of choices in each of those categories

• So why do so many organizations find themselves choosing from a

very limited number of options?

19

Ideal Solution Partner

Technology

Economics IT

Resources

Logistics

Considerations for Selecting a Solutions Partner

20

• Expertise in Clinical applications and workflow

• Expertise in Data Management solutions

• Expertise in Infrastructure management

• Expertise in professional services

Consultants /Integrators

Hardware Vendors

Any one stakeholder typically lacks depth and breadth to be experts in all areas

and have control of every one of the many options required to constitute the right

VNA

VNA Vendors

PACS Vendors

Considerations for Selecting a Solutions Partner • Most commercial VNA packages are best-of-breed solutions, but the

vendor has chosen each of the specific components in advance

– The configuration options that they are offering suite THEIR requirements

– The sales process focuses on making the argument that their pre-configured system ideally suits the organization’s needs

• WHY is this?

21

Considerations for Selecting a Solutions Partner • Why each of the Stakeholders is focused on their own specifics…

– Limited Core Competence – Limited Integration Experience – Limited Resources (limited staffing with limited experience) – Limited Technology (limited software and hardware choices) – Limited Business Partners (limited by conflicts of interest)

– Complexity working with other vendors

› Technology partners › Local PACS, HIS, RIS, EMR vendors › Modality vendors › Other galaxies of vendors in the HIE

22

23

Stakeholders in an Ideal Solution

Professional

Services

Hardware

Infrastructure

Software

Imaging / Clinical Workflows (PACS)

- Ideal VNA Configuration comprised of choices in all four major categories

- Choices derived from thorough and unbiased analytical process / consulting

- Components of solution integrated, installed and supported by a team with experience with that specific configuration

Ideal Solution

• Software Choices – Vendor Neutral Archive (inclusive of all related multi-vendor applications) – Non-DICOM Source Interfacing (DICOM wrapping/encapsulation) – UniViewer – System Monitoring (umbrella monitoring of all applications/components)

• Hardware Infrastructure Choices – Hardware Infrastructure (Servers, Load Balancers, Network Components) – Storage Solution for both Primary and Secondary subsystems – Organization should seek to ”future proof” its hardware investments

• Professional Services Choices…who will provide the following services software or hardware vendor, reseller, value-added reseller? – Integration Services – Project Management – System Monitoring Support – Hybrid VNA

24

Requirements to Assure Success

• Recognize that “One Solution Does not fit All”…If ever there was an argument for a Best-Of-Breed solution, this is it

• Unfortunately, truly customized, unique solutions comprised of many choices in software, hardware, and service components are extremely difficult to build and then support

• Vendor would have to – Possess a good understanding of many potential components – Have expertise in all three major categories; software, hardware and

services – Demonstrate strong services capability (consulting, design,

implementation) – Ability to offer choice/flexibility in software, hardware, deployment

models – Ability to meet future needs

25

Requirements to Assure Success

Vendor would have to meet all of the following: – Consulting…a substantive process not merely a consultative sales

program – System Design…matching the component options to the organization’s

needs and resources – Financial Modeling…compare projected total cost of ownership (TCO) of

existing heterogeneous PACS environment with TCO for proposed custom VNA

– Flexible Financing…provide range of financing options from fully

capitalized to fully operationalized

26

Requirements to Assure Success

Vendor would have to meet all of the following:

– System Integration…demonstrate extensive past experience in complex system integration in healthcare

– System Monitoring and Support…identify staff that will build the system and subsequently play an integral role in monitoring/ supporting the system

– Meet Future Requirements…Through real-world examples, demonstrate

ability to expand system to meet future requirements › Image enabling other clinical applications › Accommodating non-image data › Electronic image sharing through participation in a Health Information

Exchange

27

28

Any vendor claiming to offer best-of-breed VNA that cannot meet these exacting criteria, would most likely fail to meet required service level agreement…assuming that they could deliver the system in the first place.

Requirements to Assure Success

29

Dell’s Approach to Enterprise Archive

Professional Services: In-House expertise with Perot Systems

Hardware

Infrastructure: Dell’s broad portfolio of

enterprise solutions

Software: Partnerships with leading VNA ISVs and InSite One

Imaging / Clinical Workflows (PACS):

Integrations with leading PACS

Dell’s Unified Clinical Archive

The Unique 5th Stakeholder: A vendor that can effectively build and support a VNA that is customized to meet the needs of the healthcare organization

Healthcare and Life Sciences 30

Dan Trott WW Strategy and Business Development Executive for Dell’s Unified Clinical Archive Solution

Healthcare and Life Sciences 31 Confidential

Dell Unified Clinical Archive Helping Healthcare providers efficiently store, manage and share medical image data

11/16/2011

Radiology Oncology Cardiology Women’s

health Pathology

Medical

Record

Unified Clinical Archive

Dell On-Premise Clinical Archive Object based storage platform

Dell Cloud Clinical Archive Managed Enterprise Archive

Dell Clinical Data Management Data Consolidation and Information Life cycle Management

Dell Clinical Collaboration Portal Cross Enterprise Data Access and Distribution

Unified Clinical Archive

UCA – Portfolio At a Glance

* To be included in future

Unified Clinical Archive Portfolio

Dell On-Premise Clinical Archive Hardware deployed on-site to store and manage medical images

• Long Term Archive: DX6000 Series

• Compellent*, EQL*

• Capital Expense model

• Automated replication

• Data protection

• Seamless scaling

Dell Clinical Data Management: Software layer to consolidate images from multiple PACS modalities

• All Major VNA providers

• DICOM, HL7,

• Non-DICOM

• CIFS/NFS, HTTP

• XDS/XDSi

Dell Clinical Collaboration Portal: Tools to enable data sharing and collaboration

• Multiple Universal Viewers

• InDex Passport*

• Image Enablement of EMRs

• HIE, XDS Registry

• Web Distribution

Dell Cloud Clinical Service Integrated solution for Cloud based managed enterprise archive

• Dell Cloud Clinical Archive

• Dell Cloud Clinical Recovery

• Utility / Managed Service Model

• DR / BC

• DICOM, HL7, XDSi

• IHE Compliant

Dell Services: Consulting, Implementation, Integration, Global Support

Secure – FDA Certified – Supports Compliance

Healthcare and Life Sciences 33

Dell’s – Integration and Support Services

• #1 in Worldwide Healthcare IT Services – Pre-sales Consultative Services

– Dell/Perot Enterprise Solutions Group (ESG)

• Skilled solution architects: – Automated tools, analysis, and industry best practices

– Modular, flexible approach

– Regulatory compliance

– Tested and Validated integrations with partners

– Single point of contact for Implementation and support

Healthcare and Life Sciences

Dell’s Unified Clinical Archive

Flexible and integrated end-to-end solution for medical image management, distribution and archiving

34

Conclusion

• Concept of the VNA is straightforward, but Configuration of the VNA can be Complicated

• There are fully integrated single vendor solutions worth consideration, but if there ever was a situation that argues for a Best-Of-Breed solution, this is it

• Pre-configured solutions with limited options may suite the vendor’s requirements, but they may not suite the Organization’s Needs

• Unfortunately, the end-to-end solution based on choices from multiple technologies from individual vendors will require – Experienced system integration – Ability to work with a galaxy of other vendors that all have some stake in

the organization – Very sophisticated back-end support

35

Conclusion

36

• If a single-vendor solution, or one of the limited option solutions doesn’t quite fit the Organization’s Requirements… Don’t give up looking for a real Best-Breed Solution

37

Questions & Answers