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

2. 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

3. Current State

4. 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

5. 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

6. 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

7. Market Research

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

9. Gray Consulting P.O. Box 972 Novato, CA Phone: Cell: Fax:

11. Vendor Neutral Archiving

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Questions?

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