Taking the “A” out of PACS Standards Based VNA Concepts

Agenda Current State Market Research Vendor Neutral Archiving The “next” PACS Vendors considered for VNA Reasons for Considering a VNA Vendor Neutral Archiving Requirements for a VNA Providers of VNA Architecture of a VNA Next Generation VNA Strategy for deploying a VNA 2012 Acuo Technologies® Proprietary and Confidential

Current State

Tsunami of Data Digital Pathology Digital Radiology E-Health Initiatives/Linkages Electronic Medical Record 40,000 BCE cave paintings bone tools P e t a b y t e s 3500 writing Digital Cardiology 0 C.E. paper 105 1450 printing 1870 electricity, telephone transistor 1947 computing 1950 Late 1960s Internet 1993 The Web 1999 2003 Source: UC Berkeley, School of Information Management and Systems. 2012 Acuo Technologies® Proprietary and Confidential

What are the drivers for Healthcare IT Growth of Data Size of Studies Increasing CT – Cath – Path Number of Studies Increasing Access to Data Number of Users Requesting Data Big data sets moving across the wire Complex Business Models Association and integrations of healthcare providers EMR enablement – images critical Requirements Are Constantly Changing Government Mandates Compliance with Current and Future Rulings Dynamic Vendor Environment Standards Become More Important Biggest next offender in growth of data on acquisition side is Digital Pathology The desire by physicians that historically were not image users to see full imaging studies is driving greater access and transfer of images EMR’s are both demanding imaging access and providing a reason to ask for it – point out the lack of imaging in the medical record The Explosion of viewing and acquisition across department boundaries is forcing standards to the forefronts 2012 Acuo Technologies® Proprietary and Confidential

What is Current Situation in Imaging? Applications Own The Data PACS control Data Format and often the Storage Hardware, OS, and Networks PACS Proprietary Format Makes It Difficult To: Replace a PACS Add New Applications To Existing Storage System Share Data Between Applications Add New HW or IT Strategies, i.e. Business Continuity Integrate with HIS, EMR and other IS systems Data Migration Is Required When: Selecting A New Vendor Upgrading - Either Replacing Storage or PACS SW Upgrade Adds Cost, Reduces Flexibility and Increases Complexity Same old song and dance – PACS is a departmental system, PACS locks down your images, PACS doesn’t play well with others – sometimes even their next upgrade. 2012 Acuo Technologies® Proprietary and Confidential

Market Research

Notice the number of respondents that are interested in migration avoidance!!!

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Vendor Neutral Archiving

What a VNA MUST Do BREAK the Proprietary Link to YOUR data Eliminate Custom Engineering Integrate via Configuration Must be GUI driven by the customer Require full Standards-based Interoperability Manage Storage as an Enterprise Resource Enable PACS as Applications, Not Storage Systems Provide Efficient Access and Administration VNA’s are an abstraction between the clinical viewing systems and the storage. VNA’s are the business rules layer of enterprise image management. VNA’s free and therefore release the full capabilities of both clinical systems (PACS) and storage. Results: Higher Quality of Service - BC – Dedicated Viewer Streamlined Operations/Improved Productivity Effectively Lower TCO In All Areas 2012 Acuo Technologies® Proprietary and Confidential

Vendor Neutral Archiving VNA January 2010 Vendor Neutral Archiving A True Vendor Neutral Archive solution is a single set of software tools to centralize all medical imaging systems into one perpetual repository. Simpler management Seamless migrations Independent of PACS deployment Scales to meet all your capacity needs After Before What is the Vendor Neutral Archive ? The VNA is a software solution designed to virtualize medical imaging using the industry standard DICOM method. This fundamentally new approach is clinically relevant, operationally efficient and financially attractive. Lets review the key features Discovers all sources of medical imaging Consolidates all medical imaging silos Complete application vendor transparency Strict Adherence to Open industry standard DICOM and HL-7 Protocols High Speed Imaging option Eliminates future migrations And the related benefits See all medical imaging for a patient More efficient management Improves flexibility and choice Assured compliance and interoperability with your applications Twice as fast the basic system Saves money 2012 Acuo Technologies® Proprietary and Confidential

Any-ology What is expected now Radiology – CT, MRI, PET, Diagnostic Radiology, Fluoroscopy, Ultrasound, Nuclear Medicine, Breast Imaging, Interventional Radiology, DEXA Dermatology - Visible Light Imaging Cardiology – Cardiac Cath, Echocardiology, Nuclear GI Lab Ophthalmology Pathology Wound Care Otorhinolaryngology Neurosurgery Oncology 2012 Acuo Technologies® Proprietary and Confidential

How are non-DICOM objects handled? XDS DICOM Wrapping File System Interface Native Content Management Standards based – IHE driven Standardized Information Model for store / retrieve / display Standardized Information Model for store / retrieve / display Normally existing integration through CIFS/NFS Web Services Integration Application Neutral Middleware Direct Application Read/Write Custom API XDS Enterprise Storage Platform Can facilitate ILM Requires deployment across entire enterprise Expected to emerge in HIE projects Can facilitate ILM Uniform Image Viewer Portability Established use in healthcare Additional DICOM SOP’s being added all the time Does not easily support non-image content types Normally lower cost integration Proprietary file format Proprietary Information Model Doesn’t solve data mobility issues Many systems store content in database directly Costs associated with integration Adapter development Portability (compatibility with other systems) Accessibility challenges Increases migration liability Go-to-Market Alternatives, Launch Timing CONSIDER: If this route is chosen use an XDS information model 15 2012 Acuo Technologies® Proprietary and Confidential

Additional Expectations of a VNA Enables a Clinical viewer for the EMR that allows viewing of all images Provide one integration point for images Move to a rendering viewer strategy with no image cache End of Migrations It is a replacement market in PACS Robust support of next generation storage Business continuity Cloud Hosting 2012 Acuo Technologies® Proprietary and Confidential

Who provides VNA Pure Play VNA Vendors Software only – smaller - innovative No Diagnostic Viewer Infrastructure Providers Often already providing enterprise storage solution Often use Pure Play VNA Vendors for software Solution Providers Combine software, hardware, network and service Offer “one-throat-to-choke” PACS Providers Send us everything, we can manage it. Many deployments, few if any without their PACS Will require future migration Solution providers are the real win here for customers. To my knowledge, only Dell is doing this currently. 2012 Acuo Technologies® Proprietary and Confidential

Enterprise Archive Strategy Choice Image Enabled RIS / HIS / EMPI Future Imaging DICOM DICOM DICOM / WADO HL7 ??????? Enterprise Image Archive (VNA) EMR CIFS, NFS, API Custom Interfaces Radiology PACS Cardiology PACS Storage Management Software SATA TAPE OTHER Proprietary File Access HTTP/REST iSCSI CIFS, NFS, API CAS Cloud based SAN SCSI DISASTER RECOVERY SITE MAIN FACILITY

Next Generation VNA’s Multiple Patient ID’s Universal Viewer PIX (Patient Identifier Cross Referencing) Universal Viewer Provide one integration point for images Separate the PACS viewer from EMR viewer Ensure that the clinical viewer is robust XDS Registry and Repository XDS provides standards support for management of non-DICOM without locking customers into vendor proprietary technology VNA’s should provide simplified Web Services for ease of non-DICOM compliancy the create XDS context automatically within the VNA 2012 Acuo Technologies® Proprietary and Confidential

Commit to Make it Your Last Migration! Develop the Strategy Build a Plan to Gain Control Sever the Proprietary Link Between Applications (PACS, CPACS) and Storage Require Applications to Interoperate in a High Performance, Standards-based Format Identify PACS as a Valuable Departmental Workflow Application, NOT Storage Systems Decide on an Infrastructure Solution Storage/Network Business Continuance Strategy Bring DICOM Skills into IT Come to Terms With the Inevitable Migration Commit to Make it Your Last Migration! Changing to a VNA is a BIG change (but a good one), and therefore needs to be planned. 2012 Acuo Technologies® Proprietary and Confidential

The Solution! Take the “A” out of PACS There are a number of strategic approaches to building a Vendor-Neutral Enterprise Archive Take the “A” out of PACS Migrate to VNA platform BEFORE PACS replacement Put out RFP for the non-archiving portion of PACS Connect new PACS directly to VNA Shut Down Legacy PACS quickly after new PACS is up 1 2 3 4 5 Putting in a VNA makes migration between PACS smoother, both now and forever more. PACS B Lifetime PACS A Lifetime Data Migration phase VNA Lifetime 2012 Acuo Technologies® Proprietary and Confidential

Questions?

Gillian Ryan – Director of Sales (773) 368 – 6899 gryan@acuotech.com Thank you Gillian Ryan – Director of Sales (773) 368 – 6899 gryan@acuotech.com