1. 1 The Anatomy of a VNA Done Right: The Case for Silo Busting Michael Gray Principal Gray Consulting

2. 2 Most US Healthcare Organizations have heterogeneous mix of PACS, each with dedicated archives. Problems include… -Rising costs associated with data center, staffing, disparate storage solutions -Double-digit growth in data volume is outpacing limited Lifecycle Management capabilities -Outdated Disaster Recovery (DR) solutions -No Purge Mechanism -No Business Continuity (BC) solution -PACS create proprietary data necessitating data migrations Background

3. 3 Vendor Neutral Archive is a More Efficient Way to Manage Enterprise Image Data -VNA effectively becomes the image data repository for EMR -UniViewer becomes the Physician’s single-session Portal Viewer -Interoperability and Image Sharing both inside and outside the enterprise is assured -Mirrored, dual-sited VNA provides robust DR and BC solution Background

4. 4 VNA Architecture

5. 5 Rationale Favoring VNA 1. Consolidates data management operations 2. Assures Interoperability and Data Exchange between departmental PACS 3. Enables Data Sharing with external organizations 4. Delivers sophisticated ILM and Data Purge tools 5. Enables assembly of the Patient’s complete longitudinal Medical Record 6. Transfers ownership of the data to the organization, ending vendor lock-in 7. Total Cost of Ownership models favor the VNA, IF costs of future data migrations are recognized

6. 6 Once it is decided that the VNA is the correct strategy, the next task is determining the best… most optimal Deployment Strategy.

7. 7 Major Considerations Architecture Mirrored, Dual-sited Configuration Two instances of all applications support Business Continuity Virtualization Application Servers and Storage Storage Open, Robust, “Smart” IT Resources Self manage or SaaS? Financial Capitalize or Operationalize? Ratio Of on-premise to off-premise to affect data center and staffing cost Vendor Reputation and Experience

8. 8 System Management Considerations …at the same time, IT is being asked to do more with less Specialized Expertise and New FTEs are Required Administering Tag Mapping Library Creating / Managing Retention Policy Monitoring Security Program Monitoring Multiple System Monitoring Programs Monitoring Storage Consumption / Purchasing Help Desk

9. 9 Complexities Selecting a True VNA Bi-directional dynamic tag mapping engine Tag mapping library (logic) built from field experience Sophisticated ILM including Data Purge Pre-fetch and auto-routing Reconciliation of multiple MRN Methodology to ingest non-DICOM and non-Image data with reasonable workflow Remote Access…authorized user access from off-campus locations Image Sharing…authorized access by remote physicians and organizations

10. 10 Cloud Infrastructure Vendor hosts server and storage power in off-premise Infrastructure shared by multiple organizations (Public Cloud) -Individual organization databases are compartmentalized Vendor supplies some or all system support resources for the configuration Storage space is dynamically adjusted, and user pays for use of the storage according to actual use

11. 11 Once it is decided that the Cloud might play a beneficial role in a VNA, the next task is determining the best, most optimal Deployment Strategy. What is the mix between on-premise and off-premise infrastructure?

12. 12 Technology Considerations On-premise vs. off-premise is driven primarily by Performance Required access times for new and historical image data by the Radiologists and referring Physicians Because of DICOM protocol and need to transfer lossless pixel data, Performance for the [1] PACS and [2] PACS user requires Proximity VNA/Storage requires proximity to the PACS PACS or VNA requires proximity to the Display Station Proximity requirement forces departmental PACS to remain on-premise

13. 13 Technology Considerations UniViewer Servers require Proximity to VNA Servers and Storage Solution for Performance… The display users do not require Proximity to the data center for Performance… -Rendering Servers, VNA, and Storage Solutions can be co-located anywhere…both on-premise and off-premise options -Portal users have nearly equal performance experience whether they are accessing the on-premise or off-premise VNA database

14. 14 Recommendations Deploy a True VNA Beware of fakes Deploy a Mirrored Configuration Duplication of all the applications except Test Server Deploy all of the Primary Data On-Premise Guarantees PACS and PACS user performance Explore all of the Options that Allow Storage of the Secondary Data Off- Premise Eliminates need to build/manage second data center and the Secondary VNA infrastructure Consider Experienced Vendors that Offer a Hybrid VNA Secondary VNA subsystem is in the Cloud and some or all of the VNA application is a Software as a Service solution

15. 15 Hybrid VNA Architecture As Shown: One of several possible configuration options

16. 16 Recommendations Additional Issues to Investigate Virtualized Server Infrastructure and “Smart” Storage Solution HIPAA & HITECH Compliance, Best Practices True Disaster Recovery -Geographic Separation -Meets Recovery Time Objectives, Recovery Point Objectives VNA and its Infrastructure Provided as a SaaS Solution

17. 17 Arguments for the Hybrid VNA and SaaS solution Significantly lower Total Cost of Ownership Substantial reduction in complexity -Only half the system is on-premise -Management and support provided by vendor Easier to deploy…no second data center Better DR and BC solutions Organization has access to advanced professional services required to manage and support a VNA Improved IT resource allocation

18. 18 Financial Considerations On-premise, self-managed VNA can have a lower TCO than Heterogeneous PACS, IF -Current costs associated with data center and IT staffing are accounted for in the model -The PACS are spinning data copy 1, and copy 2 is at least in near-line library Even if the VNA spins both copies, consolidation of all data in new storage solutions has lower TCO than disparate PACS storage solutions -Incremental costs are: VNA/UniViewer software licenses, infrastructure hardware, professional services, maintenance

19. 19 Financial Considerations Incremental Costs are Mitigated by Savings -Storage Consolidation…reduced hardware costs -Older PACS storage can be decommissioned reducing numerous data center costs -Data Purge reduces VNA storage requirement -Cost of Future Replacement PACS will be less, due to elimination of Data Management and Enterprise Distribution responsibilities -Cost of future data migrations avoided

20. 20 Financial Considerations Hybrid VNA (VNA Secondary subsystem in the Cloud) can Have 30% Lower TCO than On-Premise, Self-Managed VNA -Costs associated with the second data center are avoided -Storage delivered on an “as needed” basis -Capital Expenses of Secondary subsystem converted to Operational expenses -Automation of back-up and System Management reduces support costs -Software and Hardware upgrades spread over multiple users of multi- tenant infrastructure

21. 21 Third-party Model and Methodology provided through Iron Mountain Cost Models Comprehensive TCO Model Compares On-Premise, Self-Managed VNA with Hybrid VNA Model # Major Facilities (Hospitals) Annual Procedures Ave. Study Size (MB) Annual Growth Historicals (TB) (uncompressed) A1 (Community)200,0001004%82 B2 (Community)188,244823%73 C1 (University)163,0101003%81 D2 (Community)556,595784%189 E18 (Ambulatory)295,842681%55 Five Organization profiles were created for this exercise

22. 22 Cost Models VNA (on-premise, self managed)Year 1Year 2Year 3Year 4Year 5 Storage Hardware Expansion (Years 2-5)$0$61,440 Storage Hardware Initial Purchase (Year 1)$307,200$0 Storage Hardware & Software Maintenance Contracts (Years 1-3 Included) $0 $73,858$82,831 Storage Power and Cooling Costs$12,587$14,993$17,398$19,804$22,210 Storage Data Center Facilities$12,426$14,801$17,176$19,551$21,926 Storage Administration$21,152$25,196$29,239$33,282$37,326 Annual VNA Software License Fees$34,500$35,880$37,315$38,808$40,360 Software UniViewer, General Software, & Test System $131,100$0 Server Hardware and Infrastructure$306,538$0 Data Migration Fees (Report & Study)$258,300$0 Implementation Costs (Hardware, HL-7, DICOM, UniViewer, PM & Training) $299,406$0 Hardware Maintenance VNA & UniViewer$55,177 VNA Software Maintenance$0$24,996 UniViewer Software Maintenance$0$13,600 Totals$1,438,386$246,083$256,341$340,516$359,866 Profile A - 5 year TCO for Capital VNA (on-premise, self-managed)

23. 23 Cost Models Hybrid VNAInitialYear 1Year 2Year 3Year 4Year 5 Total Storage cost$0$84,130$140,756$161,734$182,318$202,525 Storage Power and Cooling Costs$0$6,294$7,497$8,699$9,902$11,105 Storage Data Center Facilities$0$6,213$7,401$8,588$9,776$10,963 Total VNA cost$0$67,572 Gateway Rental fee$0$5,100 Onboarding costs$0$6,684 Migration costs$0$2,412 UniViewer license & Hardware$0$200,331$0 UniViewer Implementation$0$114,752$0 UniViewer Maintenance License & Hardware$0$12,462$26,062 Totals:$0$505,950$263,483$286,851$309,826$332,423 Profile A - 5 year TCO for Hybrid VNA

24. 24 Third-party Model and Methodology provided through Iron Mountain Cost Models Profile # Major Facilities (Hospitals) Capital VNAHybrid VNASavings% Change A1 (Community)$2,641,192$1,698,532$942,66036% B2 (Community)$2,542,475$1,774,422$768,05430% C1 (University)$2,663,262$1,918,597$744,66528% D2 (Community)$5,300,505$3,458,356$1,842,14935% E18 (Ambulatory)$2,860,199$1,957,844$902,35632% Comparisons - 5 year TCO for Capital VNA and Hybrid VNA

25. 25 Conclusions Strong Technical and Business arguments Favor deployment of a VNA over the current Heterogeneous PACS environment TCO for the VNA Compare favorably with TCO for Heterogeneous PACS -If organization has deployed a responsible DR solution for its PACS -If all operating costs are accounted for in the model -If costs of future data migrations avoided are recognized

26. 26 Conclusions Key technologies make it possible to move entire Secondary subsystem into the Cloud -Smart Storage Solutions -UniViewer based on Zero Client, Server Side-rendering Display application Recommendation is to deploy a Hybrid VNA, especially if IT resources are thin and organization does not already have a second data center Hybrid VNA can save 30%+ in TCO over on-premise, self-managed VNA

27. 27 Conclusions Reminders -Select a True VNA with a mirrored, dual- sited configuration -Select the right partner/vendor, one that -Can demonstrate HIPAA and HITECH conformant Security and Data Protection, -Has both presence and experience in the Medical Imaging world. -A believable Cost Model is only as good as the accuracy of the numbers…seek help

28. 28 Iron Mountain Iron Mountain remains a technology services company Autonomy has acquired our digital business Iron Mountain has entered into an agreement with Autonomy to resell certain data backup and archiving solutions just acquired by Autonomy Iron Mountain Digital Record Center® for Medical Images was not affected by the divestiture of our digital business. An Information Management Company

29. 29 More Information Visit: www.ironmountain.com/VNA Call: 866-922-7226 Iron Mountain VNA Solutions and TCO Model