1. The Challenges of Healthcare Enterprise Image Data Management Image Management Session D1 John S. Koller APIII 2007 Advancing Practice, Instruction, and Innovation through Informatics Restricted Use – Not for Duplication ©2007 Koller Associates, Inc.

2. Introduction & Disclosures John S. Koller - President of KAI Consulting 25+ years experience in secure, highly available IT solutions. Employment & Consulting relationships –Philips Medical Systems –EMC Corporation –Multiple Major Healthcare Imaging & Informatics Vendors –Multiple Major IT Technology Vendors Other Relationships –Contributing Editor ITN & AuntMinnie.com SCAR – Archiving Primers & Security Primer –Board of Directors HealthSphere Corporation –Advisory Board Member Bycast & ITN 2©2007 Koller Associates, Inc.

3. Traditional Healthcare Infrastructure 3©2007 Koller Associates, Inc.

4. The Digital Healthcare Enterprise (DHE) Business Centric –Billing –Accounts Payable –HR, Payroll –Supply-Chain Management Patient Centric –Hospital Information System (HIS) –Electronic Medical Record (EMR, EPR, EHR) –Computerized Physician/Provider Order Entry (CPOE) –Networked Intelligent Devices –Asset Tracking & Management Departmental Systems –Radiology RIS (data) PACS (images) –Cardiology CVIS (data & waveforms) PACS (images) –Radiation Oncology Treatment planning systems (images) –Pathology –Pharmacy –Laboratory –Etc. The Typical Healthcare Enterprise has an average of 100 to 175 Applications. 4©2007 Koller Associates, Inc.

5. Clinical Systems Support Pressures New Accountability for IT –Regulatory & Compliance –Security (CIA) Confidentiality Integrity Availability Usability of the Data Explosive Growth in Connected Devices Lifecycle Data Management Costs 5©2007 Koller Associates, Inc.

6. The Side-Effects of Digital Data in the Healthcare Enterprise 6©2007 Koller Associates, Inc.

7. Importance of Standards HL7 (Health Level 7) –Simple protocol to exchange information Current version of HL7 is Version 2.x Version 3.x compliant with XML – Extensible Markup Language CCOW (Clinical Context Working Group) –Simplify and improve workflow and functionality between applications DICOM (Digital Image and Communication in Medicine) –A true standard dealing with objects – images > series > study>patient –Deals with images, waveforms and structured reports IHE (Integrating the Healthcare Enterprise) –Focuses on the interoperability within & between departments in the enterprise. 7©2007 Koller Associates, Inc.

8. Challenges of Image Management Very Large Datasets –Storage –Communications Very Large Annual Volumes –Data Protection Requirements Variable Retention Periods –Lifecycle Management Variable Locations –Communication Delays 8©2007 Koller Associates, Inc.

9. Path & Other Radiology –Tens of TBs Cardiology –2-3X of Radiology Pathology –Tens / Hundreds of TBs to PBs Usually no way to age studies out of storage Rad Cardio Growth in Departmental Imaging 9©2007 Koller Associates, Inc.

10. Evolving Imaging Architectures Film & Processors Proprietary Interfaces Dedicated Print Networks Closed Mini-PACS Enterprise PACS PACS xIS 10©2007 Koller Associates, Inc.

11. Pathology Imaging Models Image Acquisition & Workflow Management Slide Scanning Image Server Whole Slide Imaging Scanner (WSI) WSI Analog to Digital Acquisition 1.System Calibration 2.Robotic slide positioner 3.Special light & filters (Fluorescence) 4.Camera for Digital Image acquisition Physical Slide StorageArchive Digital Image Diagnostic Workstation Analog-Digital Conversion in Scanner (Camera) Digital Image Storage & Management Digital-Analog Conversion in Display (LCD) Laboratory Information System (LIS) Automated Preparation System Image Acquisition & Display Chain Finished Slide Images & Reports 11©2007 Koller Associates, Inc.

12. Lessons & Landmines from Radiology Modality PACS - Standards “Grey” Areas –Limited inter-vendor compatibility in early years ROI –Can we really eliminate film? Installation of xIS prior to or with PACS –The installation of Image Management prior to Workflow Management introduces potential for errors and lost studies. The 2 nd PACS Challenge –Was it truly stored in a standard format? –How is all the data migrated when changing vendors? 12©2007 Koller Associates, Inc.

13. Technology Obsolesce & Data Migration Technology Obsolesce –12” & 14” Optical Disk –9 - Track Tape Data Migration –Usually Application Vendor Dependant –Long Migration Times (Can be Years) How long do you have to keep data? 13©2007 Koller Associates, Inc.

14. Enterprise Storage Consolidation Staff Data and Records Patient Accounts Billing Radiology and Cardiology All Ancillary Dept. Data E-Medical Records Standardized Testing & Change Control. Consolidated Backup/Restore Centralized Management Prod Test Financial Data CommonDisasterRecovery Cyclic Process Reactive Proactive Data Mart High Availability High Performance 14©2007 Koller Associates, Inc.

15. Backup Vs. Archiving Backup When to Use? –Variable Content Data –Transactional w/ Small to Medium Records –Commercial Database Examples –HIS / RIS / LIS Databases –Image Pointer Database Backup Management –Create Regular Backups –Manage & Rotate Multiple Generations –Database Snapshots & Replication Archiving When to Use? –Fixed Object Based Content –Long-term Retention Requirements –Large Volume of Objects Examples –PACS Image Database –Other Large / Fixed Content Objects Archive Management –Create Data Protection & Retention Policies –Automate Everything Possible 15©2007 Koller Associates, Inc.

16. Image Data Management How can your image data be managed? Let your Image Application (PACS) vendor decide. –Dependent on vendor for all storage & future migration. Use an all disk solution with multiple copies managed by vendor. –No real intelligence –Not responsive to conditions affecting individual data objects –Still potentially dependent on applications vendor for future migration. Use an HSM to archive your images. –Better control, but minimal metadata for policy-based automation. –No Linkages Back to Application System for Aging of Studies –Still potentially dependent on vendor for future migration. Use an Information Lifecycle Management (ILM) strategy. ILM – What is it? 16©2007 Koller Associates, Inc.

17. Definition of ILM Information Lifecycle Management is comprised of policies, processes, practices and tools used to align the business value of information with the most appropriate and cost effective IT Infrastructure from the time information is conceived through its final disposition… Source: SNIA Data Management Forum 17©2007 Koller Associates, Inc.

18. ILM – What is it? What ILM is not! –Hardware, –Software, –A product! Depends on the Vendor – DLM? ILM? xLM? All Solutions Should be Standards-based (if possible) ILM = DLM + Awareness of Business Value of the Data The Entire Life of a Information Object is Pre- destined at Time of Creation, But … 18©2007 Koller Associates, Inc.

19. DLM vs. ILM Data Lifecycle Management –Focus is to make efficient & cost effective use of storage resources –Based on basic characteristics of the data and data access –Basic Metadata Date/Time, Last Access, Owner Object Size, System Watermark Information Lifecycle Management –Requires information about business processes (application aware) –Holistic view of managing information –Robust Metadata DICOM, Derived from HL-7, Other –Uses functions of data lifecycle management Excerpted from Storage Industry Primer by Dennis Martin RMWTUG – Fall ‘05 ILM Application & Business Process DLM Processing Storage Tier 1 Storage Tier 2 Storage Tier 3 19©2007 Koller Associates, Inc.

20. Image Data Management Workflow Aware Routing Pre-fetching Other departmental specific features Basic Metadata Date/Time Access Size Watermark Location Manages any storage type Application Aware Robust Metadata PACS / RIS / xIS HL-7 DICOM XDS Web Services Departmental Workflow Policies Clinical Archive Policies (PACS Virtualization) Storage Archive Policies (Storage Virtualization) DLM Clinical ILM Clinical ArchiveStorage HW & SWPACS & xIS Business Value 20©2007 Koller Associates, Inc.

21. DLM Policy Engine Rad PACS Fast DiskSlow DiskLong-Term DR DLM vs. ILM – An Imaging Example DLM (Typical HSM) 30 Days1 yr.7 yrs. 21©2007 Koller Associates, Inc.

22. Clinical ILM Policy EngineDLM Policy Engine xIS (s) Rad PACS Fast DiskSlow DiskLong-Term DR Intelligent Enterprise Image Archive DLM vs. ILM – An Imaging Example ILM – Negative 7 yrs. ControlData ILM – Positive 6 mo.2 yr.+++ yrs. 22

23. Clinical ILM Policy EngineDLM Policy Engine xIS (s) Rad PACS Fast DiskSlow DiskLong-Term DR Intelligent Enterprise Image Archive DLM vs. ILM – An Imaging Example Cardiac PACS ILM – Cardiology ControlData 23

24. Clinical ILM Policy EngineDLM Policy Engine xIS (s) Rad PACS Fast DiskSlow DiskLong-Term DR Intelligent Enterprise Image Archive DLM vs. ILM – An Imaging Example Cardiac PACS ILM – Pathology 7 days30 daysKey Images – 7 yrs WSI SACS ControlData 24

25. Benefits of an Automated Clinical ILM Provides an integrated BC & DR platform Maximizes storage infrastructure utilization Provides opportunity to address location based performance requirements Addresses current and future technologies Can provide application independent data migration 25©2007 Koller Associates, Inc.

26. Summary Images are Very Different to Manage Departmental Silos are Not Cost Effective to Acquire or Manage New Accountability for Clinical IT Solutions Requires Enterprise Data Management Effective Enterprise Image Management Requires Intelligence in the Infrastructure No Single Imaging or Informatics Vendor Provides an Effective Single Source of Scalable True Clinical ILM 26©2007 Koller Associates, Inc.

27. Questions ? Contact Information John S. Koller Email: JSKoller@KAIconsulting.comJSKoller@KAIconsulting.com Office: 303.681.2854 APIII 2007 Support Page (Private Event Page) www.kaiconsulting.com/conferences/apiii2007/index.htm Password:given at conference