Systems Supporting Clinical
Gabriel Bartal MD
Dept Medical Imaging and Interventional Radiology,
Meir MC, Kfar Saba, Israel
Cloud Deployment Models
Private clouds – operated for one organization and may
be managed by
organization itself or by a third party may reside on-premises or off it.
Public clouds - managed by a Cloud service provider. Hybrid clouds combine two or more clouds (private or
public) that remain unique entities but are bound
together by technology that enables data and application portability.
Community clouds feature infrastructure that is shared by
several organizations and supports a specific community.
What is a Cloud-based Service?
Application as a service
Delivered via Internet
From Multi-tenant Data Centers
Fully Managed by a Service provider
Pay as you use
Operating expense
Caught in a web of point to point
Primary Care Physician Labs Independent Health Facility Specialty Practice Academic Medical Center Payers Other HIE Community Hospital Government Patient PharmacyPrimary Care Physician
Labs
Independent
Health Facility Payers
Other HIE
Government Patient
Pharmacy
The
Challenge
Most Medical Imaging facilities in Israel use
The
Challenge
Most Medical Imaging facilities in Israel use
digital technology for image management
No convenient process for sharing medical
imaging studies and reports between:
Healthcare providers
Providers and their referring community Providers and patients
The
Challenge
Most Medical Imaging facilities in Israel use
digital technology for image management
No convenient process for sharing medical
imaging studies and reports between:
Healthcare providers
Providers and their referring community Providers and patients
The Problem – Examples
The Problem – Examples
• No access to patient priors if they reside in another facility • CDs, that are most commonly used to deliver images to
referring physicians, are cumbersome and hard to use:
Are not always given (unless requested) Patients lose them
No common user-interface for embedded viewers
The Problem – Examples
• No access to patient priors if they reside in another facility • CDs, that are most commonly used to deliver images to
referring physicians, are cumbersome and hard to use:
Are not always given (unless requested) Patients lose them
No common user-interface for embedded viewers
Take long time to launch Cumbersome to import into local PACS
• No platform for fast transfer of emergency exams between
Fuji 9% Philips 10% GE 23% Carestream 58%
Israel – an Opportunity
Inimitable patient ID for
each citizen.
Small number of healthcare
provider organizations.
Relatively small population.
Limited number of PACS
systems.
National Imaging Cloud - Architecture
HMO / Hospital
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive
• Optional opt-in • Long term archive
for interested facilities • CD Replacement
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive Portal & Collaboration
• Optional opt-in • Long term archive
for interested facilities • CD Replacement
National Imaging Cloud - Architecture
HMO / Hospital
DICOM Registry & Archive Portal & Collaboration
• Optional opt-in • Long term archive
for interested facilities • CD Replacement archive • Nationwide Access Portal and Zero Footprint Viewer • Nationwide Collaboration Platform
National Imaging Cloud - Architecture
HMO / Hospital
PatientsPatients
Patients Zero FootprintViewer Referring
Community
Zero Footprint Viewer
DICOM Registry & Archive Portal & Collaboration
• Optional opt-in • Long term archive
for interested facilities • CD Replacement archive • Nationwide Access Portal and Zero Footprint Viewer • Nationwide Collaboration Platform
Provides cost effective imaging storage for
smaller facilities
Images are only transferred as needed for
facilities opting not to store all their images in the
Central Archive
A fast zero-footprint viewer eliminates the need
for CDs
No issues with Data ownership
Source for data mining and national statistics
Nationwide Zero-Footprint Viewer
Can run from
most popular
Internet browsers
Can run from any
computer and popular mobile devices
Does not require
installation
Very simple to
use and intuitive user interface
Making National Imaging Cloud a Reality
• Such venture requires Government guidance and intervention
• Several European countries have started down this path
• Denmark • France • Scotland
• Potential partial financing can come from:
Money saved from reducing or eliminating CD burning operations
Facilities who use the Central Archive for backup and disaster recovery Users of the Collaborative Platform
Future - Connected Healthcare Communities
Primary Care Physician Labs Independent Health Facility Specialty Practice Academic Medical Center Payers Other HIE Community Hospital Government Patient PharmacyeHealth
Community Workflow: Digitized
Patient Information: Integrated Population Information: Insight Patient Engagement: Web 2.0
Two Paths Towards E-Health
Image Exchange Clinical Exchange
E-Health Image
Exchange* E-Health Information Exchange*
Images & Reports Documents, medications, allergies, labs, Images first, other docs next
Clinical docs first, images next
PACS
Transform Care with E-Health Solutions
Create Exchange Collaborate
Perform
EMR PACS Lab Pharmacy Billing
Collaboration Solutions - web-based solutions, including portals, to enable collaboration across the care team
Performance Apps - advanced applications for enhancing workflows and sharing insight and knowledge
Exchange Platform - common platform to manage, collect, translate and share data and images
eHealth Image Exchange
The best of imaging IT and HIE
Images & Reports Metrics Government Agencies Images & Reports Patient Consent General Practitioners Patient Specialists Hospitals Radiologists Data Analysis Prior Studies eHealth Registry (XDS Registry) CentricityTM Enterprise Archive 4.0 (DICOM Archive & XDS Repository)
Master Patient Index eHealth Clinical Viewer (XDS Viewer) Centricity Enterprise Web (DICOM Viewer) Reporting Tools
Future Cloud Services
Vue Cloud by Carestream Collaboration-as-a-Service Teleradiology-as-a-Service Cloud Portal PACS -as-a-Service Archive-as-a-Service Regional Hospital Physician’s Office Reading Center Rural Clinic University Hospital © 2011, Carestream HealthVue Cloud Archive
• No more silo`s with an XDS repository
•DICOM, HL7, XDS-i, and other document formats such as JPG, MPG, PDF, ECG, EKG, etc
• Pay Only for What You Use
•No upfront investment, no idle server and storage
• Protect Your Data with an off-site Disaster Recovery
•Secure, highly availability archive with active monitoring and remote management
• Freedom To Expand Without the Worry of Technology Obsolescence
Vue Cloud PACS
• No Upfront Investment to benefit from a leading-edge PACS
Native reporting and advanced visualization further reduces third party costs
• Committed 99.9% Uptime
Focus on your Patient, not your IT
Vue Cloud PACS
• No Upfront Investment to benefit from a leading-edge PACS
Native reporting and advanced visualization further reduces third party costs
• Committed 99.9% Uptime
Focus on your Patient, not your IT
• Diagnostic Reporting Anywhere
On-site or from the cloud, read your studies with your personal desktop
No change Vendor Neutral Infrastructure Hospital Physician’s Office Company Responsibility Customer’s Responsibility Service Boundary Virtual Private Network (VPN) Cloud Portal Carestream Service Access Point (local cache adapted to needs) Remote monitoring 24 X 7 Vue Cloud Platform Operated by Carestream In a Tier -3 Data Center • Active Archive • Disaster Recovery • Unlimited retention
Vue Cloud
By Carestream DICOM [PACS, modalities] Local Access (LAN) HL7 [RIS, HIS] IHE XDS-i [ECG, jpg, mpg pdf] Remote Secure AccessPROS and CONS of "PACS on cloud”
PROS and CONS of "PACS on cloud”
Pros
PROS and CONS of "PACS on cloud”
Pros
Cost effective
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
More mobility
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
More mobility
Increased Storage
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
More mobility
Increased Storage
High tech infrastructure Eco Friendly (Green)
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
More mobility
Increased Storage
High tech infrastructure Eco Friendly (Green)
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
More mobility
Increased Storage
High tech infrastructure Eco Friendly (Green)
Cons
Maturity
Dependency on internet Security
PROS and CONS of "PACS on cloud”
Pros
Cost effective
Allows IT to shift focus Flexibility
More mobility
Increased Storage
High tech infrastructure Eco Friendly (Green)
Cons
Maturity
Dependency on internet Security
Will the Next Generation of PACS be
Sitting on a Cloud?
Will the Next Generation of PACS be
Sitting on a Cloud?
Medical Imaging Clouds provide on demand
medical imaging information technology (IT)
services from remote or remotely managed
third-party platforms over a network.
Will the Next Generation of PACS be
Sitting on a Cloud?
Medical Imaging Clouds provide on demand
medical imaging information technology (IT)
services from remote or remotely managed
third-party platforms over a network.
The core technologies of the cloud computing
Will the Next Generation of PACS be
Sitting on a Cloud?
Medical Imaging Clouds provide on demand
medical imaging information technology (IT)
services from remote or remotely managed
third-party platforms over a network.
The core technologies of the cloud computing
Some fundamental issues are not purely technical
and the following must be counted:
data latency,
data ownership, cost effectiveness, data security issues.
Will the Next Generation of PACS be
Sitting on a Cloud?
Some fundamental issues are not purely technical
and the following must be counted:
data latency,
data ownership, cost effectiveness, data security issues.
These factors argue against remotely hosted
clouds.
Will the Next Generation of PACS be
Sitting on a Cloud?
Cloud Computing Policies for Clinicians
We are looking at extended applications like
Tablet PCs and smart-phones,
place critical information at the fingertips of Clinicians
Cloud Computing Policies for Clinicians
We are looking at extended applications like
Tablet PCs and smart-phones,
place critical information at the fingertips of Clinicians
at the point of care.
Shortening of access time to patient records,
imaging reports and other info
improves the quality,
improves the efficiency of healthcare delivery,
Not just data sharing across multiple sites, but
the workflow share.
Not just data sharing across multiple sites, but
the workflow share.
Workflow share designation:
users in different locations participate in a single,
common workflow across multiple systems and sites.
Not just data sharing across multiple sites, but
the workflow share.
Workflow share designation:
users in different locations participate in a single,
common workflow across multiple systems and sites.
Data share based on the Workflow distribution
one of the greatest challenges in Healthcare IT today, may become the key for effectiveness.
