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The Challenges of Healthcare Enterprise Image Data Management
Image ManagementSession D1
John S. Koller
APIII 2007Advancing Practice, Instruction, and Innovation through Informatics
Restricted Use – Not for Duplication
©2007 Koller Associates, Inc.
Introduction & DisclosuresJohn 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.
Traditional Healthcare Infrastructure
Pharmacy, Laboratory and Ancillary Data
Financials
Disaster Recovery plan(mainframe only)
DK tape
E-Medical Records
Backup by FDR Upstream
Employee DataImagingCenter
HSM to Tape
ADSM to
3490s OmniBack
FinancialRecords
PACSCICS
Ambulatory DataHospital Data
HR
STKSilos
Batch
OLTP
Exchange
Backup by tar—8mm
Billing e-commerce
Server/OS
Network
Application
Storage
Test
Backup
Disaster Recovery
DatabasePatient Care
Billing
Cheyenne to 4mm
Lotus Notes
Physician Practice Data
Cyclic Process Reactive Proactive
Operations
3©2007 Koller Associates, Inc.
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.
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.
The Side-Effects of Digital Data in the Healthcare Enterprise
6©2007 Koller Associates, Inc.
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.
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.
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
Growth in Departmental Imaging
9©2007 Koller Associates, Inc.
Evolving Imaging Architectures
• Film & Processors
• Proprietary Interfaces
• Dedicated Print Networks
• Closed Mini-PACS
• Enterprise PACSPACSxIS
10©2007 Koller Associates, Inc.
Pathology Imaging ModelsImage Acquisition & Workflow Management
Slide Scanning
Image Server
Whole Slide
Imaging Scanner
(WSI)
WSI Analog to Digital Acquisition1. System Calibration2. Robotic slide positioner3. Special light & filters (Fluorescence)4. Camera for Digital Image acquisition
Physical Slide
Storage Archive
Digital Image
Digital Image
Diagnostic Workstation
Analog-Digital Conversion in
Scanner (Camera)
Digital Image Storage &
Management
Digital-AnalogConversion inDisplay (LCD)
Laboratory Information System (LIS)Automated Preparation
System
Image Acquisition & Display Chain
Finished Slide
Images & Reports
11©2007 Koller Associates, Inc.
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 2nd PACS Challenge – Was it truly stored in a standard format? – How is all the data migrated when changing vendors?
12©2007 Koller Associates, Inc.
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.
Enterprise Storage Consolidation
Staff Data and Records
Patient AccountsBilling
Radiology and CardiologyAll Ancillary Dept. Data
E-Medical Records
StandardizedStandardizedTesting & Change Testing & Change
ControlControl.
Consolidated Consolidated Backup/RestoreBackup/Restore
Centralized Centralized ManagementManagement
Prod
Test
FinancialData
Common Common Disaster Disaster RecoveryRecovery
Cyclic Process Reactive Proactive
DataMart
High AvailabilityHigh AvailabilityHigh PerformanceHigh Performance
14©2007 Koller Associates, Inc.
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.
Image Data ManagementHow 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.
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.
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.
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 MartinRMWTUG – Fall ‘05
ILM
Application & Business Process
DLM
Processing
StorageTier 1
StorageTier 2
StorageTier 3
19©2007 Koller Associates, Inc.
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 Archive Storage HW & SWPACS & xIS
Business Value
20©2007 Koller Associates, Inc.
DLM Policy Engine
Rad PACS
Fast Disk Slow Disk Long-Term DR
DLM vs. ILM – An Imaging Example
DLM (Typical HSM)
30 Days 1 yr. 7 yrs.
21©2007 Koller Associates, Inc.
Clinical ILM Policy Engine
DLM Policy Engine
xIS (s)
Rad PACS
Fast Disk Slow Disk Long-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
Clinical ILM Policy Engine
DLM Policy Engine
xIS (s)
Rad PACS
Fast Disk Slow Disk Long-Term DR
Intelligent Enterprise Image Archive
DLM vs. ILM – An Imaging Example
Cardiac PACS
ILM – Cardiology
ControlData
23
Clinical ILM Policy Engine
DLM Policy Engine
xIS (s)
Rad PACS
Fast Disk Slow Disk Long-Term DR
Intelligent Enterprise Image Archive
DLM vs. ILM – An Imaging Example
Cardiac PACS
ILM – Pathology
7 days 30 days Key Images – 7 yrs
WSI SACS
ControlData
24
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.
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.
Questions?Contact Information
John S. Koller
Email: [email protected]
Office: 303.681.2854
APIII 2007 Support Page (Private Event Page)
www.kaiconsulting.com/conferences/apiii2007/index.htmPassword: given at conference