Transcript CTN Cloud VNA - Go/No Go meeting - 2/6/2012

CTN Cloud VNA
Feasibility Review and Go/No Go
Decision
Project Coordination Team:
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Toria Thompson, CTN Strategic Consultant (Project Coordinator)
Debby Farreau, CTN Program Director
Owen Hathaway, CTN Architecture Consultant
Michael Gray, VNA Consultant
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Project Objectives:
 House a secondary (archived) copy of medical images
from health care organizations across Colorado.
 Enable sharing of these images among providers in
partnership with CORHIO and QHN.
 Enable access and sharing of these images through a
hosted Universal Viewer.
 Provide disaster recovery and business continuity based
on these copies.
 Be totally vendor-managed and provided under a master
Fee-per-Study pricing model. CTN will receive
sustainability revenue for each study stored in the CTN
Cloud VNA.
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Benefits
 Reduced Cost: Reduction of unnecessary imaging exams reduces
likelihood of denied claims for duplicate tests.
 Patient Health: Reduction of unnecessary imaging exams minimizes
patient radiation exposure.
 Improved Coordination of Care: Immediate access to images when
and where they are needed, allows physicians to provide faster
diagnosis and treatment, tighter care coordination and improved
outcomes.
 Reduced Hassle: The hassle of reproducing, transporting and
attempting to view CDs and DVDs will be removed from patients and
caregivers, allowing them to focus on the important priorities of
recovery and wellness.
 Timing: Many organizations are investigating VNA solutions. If we
instead create a Cloud VNA, the archived data can serve multiple
purposes and eliminate duplicate data stores and cost.
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Current State
R-PACS
C-PACS
X-PACS
Organization A LAN
R-PACS
C-PACS
Organization B LAN
R-PACS
C-PACS
Organization C LAN
CTN WAN
Current State Individual Heterogeneous PACS Environments, each with on-site Primary
and Secondary (DR) copy of the image data
DICOM communication of image data in individual PACS formats
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Proposed CTN Cloud VNA
R-PACS
C-PACS
R-PACS
X-PACS
R-PACS
C-PACS
Gateway
Gateway
Organization A LAN
Organization B LAN
C-PACS
Gateway
Organization C LAN
CTN WAN
Cloud Data Center LAN
UniViewer
VNA
Storage Network
Storage
Server
Remote (Cloud-based) PACSNeutral DR/BC Solution, where
Gateway servers pass individual
PACS Data (in original data
formats) to Vendor-Neutral
Archive in the Cloud, and
UniViewer app image-enables the
EMR with normalized data
Cloud Data Center
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Answer: Not exactly
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HIE Image Exchanges
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Image Exchange in the UK:
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“On Demand” Image Exchange
Model:
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An entrepreneurial venture in India
Today, I have added
an ondemand medical
Image management.
Sankar
A cloud based service
to myCloud Solutions
Portfolio.
I live in Chennai, India.
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Michael J. Gray, Gray Consulting
[email protected]
Owen Hathaway, CTN Architecture Consultant
[email protected]
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Dell
Wallingford, CT & Phoenix, AZ
InsiteOne
iConnect
Merge
GNAX Health
Atlanta, GA & Dallas, TX
ACUO
eUnity
Client Outlook
Iron Mountain
DeJarnette
eUnity
Client Outlook
TeraMedica
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1.
Bi-Directional, Dynamic Tag Morphing to facilitate data exchange (on-the-fly
conversions of data formats in support of data exchange between disparate PACS)
2.
Fundamentally a manager of DICOM Objects…but must support methodologies for
accepting/managing non-DICOM Objects (DICOM-wrapping, DICOM encapsulation,
Web Services)
3.
Sophisticated Information Lifecycle Management driven by patient/study meta data
 Including policy-based, automated Study Deletion
 Separate ILM policies defined for each organizational node
4.
Embedded Master Patient Index (MPI) that will support MRN matching capabilities
5.
Optional Automated / scheduled Pre-fetching and Auto-routing
using user-defined Relevant Prior Algorithm
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6.
Logical Segregation of Data by Organizational Node
 Configurable access rules
 Granularity from Health System down to imaging departments within individual hospitals
7.
Creation of XDS-I Manifest and Optional XDS-I Registry and Repository
8.
Flexible, Auditable Transaction Logging per organizational node
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Disaster Recovery / Business Continuity configurations with automated Failover
and post-recovery Reconciliation
10. Guaranteed
compatibility with local VNA from another vendor
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1.
2.
3.
4.
5.
6.
Zero or Near-Zero Client, Server-Side Rendering
Cache-less operations (dynamically retrieves image data from local image
repositories such as PACS, VNA) based on web services interface to
VNA/Storage Solution
Supports multiple OS, multiple Browsers
URL-based Interface to EMR (Physician Portal)
Utilize the organization’s existing LDAP Directory or similar User identity
Architecture
Accepts Single sign-on user Authentication
 From EMR
 From UniViewer (users aggregating data across authorized organizational nodes)
7.
8.
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Auditable Transaction Logging for outside physician access
Basic to Advanced display features/functions
Compatible with both DICOM and non-DICOM image objects
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Architecture Questions:
 VNA Application Questions:
o How will software handle…
o Duplicate AE titles across multiple organizations
o Deletion of daily QC image/studies
o HL-7 feed for updated information or resend necessary
o Will application support compressed file transfer?
o Will application support .JPG files?
o Can outside studies be transferred to cloud without being stored on
PACS?
o What is DICOM Header Tag Morphing and why do we need it?
 UniViewer Questions:
o LDAP integration?
o Who will handle security and authentication?
 Vendor Questions:
o Do we go through CTN to get support from vendor?
o Can we have a private line to data center or do we have to use CTN?
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Toria Thompson, CTN Strategic Consultant
[email protected]
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Most Highly Ranked Responses:
Internal Image Sharing:
Forwarding priors from other imaging
departments to each PACS.
External Image Sharing:
Access to outside physicians for images &
reports.
Operational Benefits:
Migrating from old media without
PACS interruption
Internal Image Sharing:
View other Imaging departments
on each PACS
External Image Sharing:
Operational Benefits:
Lower cost for migration when
changing PACS
-- and -Purge in cloud matches
local ILM policy
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Considerations:
 Does it provide additional capabilities to your organization?
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Disaster Recovery
Business Continuity
Image enabling the EMR
Zero footprint, web-based image viewer for all PACS images.
Puts control of PACs selection back in the hands of radiologists.
 Does it make sense to move to the cloud?:
 Security: CTN Cloud VNA will be a virtual private cloud.
 Sunk Cost: How recent was your Tier 2 hardware refresh?
 Back-Out Plan: Requirement of CTN Cloud VNA partner is minimal
or no migration costs to get out of the cloud.
 Image sharing:
 Search, view and share images from any PACS on any device using
common viewer.
 Leverage CORHIO and QHN MPI, access and authentication without
need to build another repository.
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Sample TCO–Hospital/Large Clinic
Annual Studies Growth
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Increase -Growth of 8% per year
Existing Storage Environment
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Primary Storage – Clarion CX 340 SAN Replicated retain for 12 months
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Secondary Storage- Centera mirrored- retained
Indefinitely
Storage Assumptions
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Average uncompressed study size
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Radiology 30 MB
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Mammography 150 MB
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Compressed 2:1 lossless
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Storage has an overhead of 80%
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Storage cost decreasing of 15% / year
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Primary storage hardware and software cost at
$9500/TB
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Secondary and Tertiary hardware and software
cost at $5500TB
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Service and maintenance of storage solution at
15% of original purchase price
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Migration service cost at 5% of original purchase
price
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Technology refresh and hardware migration in the
2nd and 7th year.
Migration of approximately 6.5 TB or 380,000 studies
Courtesy of Dell/InsiteOne
250,000
200,000
150,000
100,000
50,000
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Year Year Year Year Year Year Year
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2
3
4
5
6
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Radiology
127,00 137,16 148,13 159,98 172,78 186,60 201,53
Mammography 10,000 10,800 11,664 12,597 13,605 14,693 15,869
Annual Storage Growth
5.0
4.0
3.0
2.0
1.0
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Year
1
Volume in TBs 2.7
Year
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2.9
Year
3
3.1
Year
4
3.3
Year
5
3.6
Year
6
3.9
Year
7
4.2
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Sample TCO–Hospital/Large Clinic
Annual Cost of Infrastructure
$300,000
$250,000
$200,000
$150,000
$100,000
$50,000
$Incremental Storage Cost
Migration Cost
Service and Maintenance Cost
Technology Refresh Cost
Energy Consumption
Total
Year 1
$159,530
$$23,930
$$15,972
$199,432
Year 2
$$12,080
$30,804
$205,362
$20,019
$268,265
Year 3
$34,701
$$36,009
$$24,389
$95,100
Cost
BAU Radiology and Mammography
Incremental Study Growth
Cost/Study
1,602,424
Incremental Storage Cost
Hardware Migration Cost
$
280,679
$
30,987
Service and Maintenance Cost
$
250,612
Technology Refresh Cost
$
373,142
Energy Consumption
Total Cost of Ownership
$
209,068
$
1,144,488
Courtesy of Dell/InsiteOne
Year 4
$31,313
$$40,706
$$29,109
$101,129
$
0.71
Year 5
$28,746
$$45,018
$$34,207
$107,971
Year 6
$26,389
$$48,977
$$39,713
$115,078
Year 7
$$18,907
$25,167
$167,780
$45,659
$257,513
Infrastructure Summary does not
include the cost of the following
Labor and Management Tasks:
Move, Migrate, Archive Data
Backup & Restore Activities
Capacity & Performance Mgt
Data Placement & Security Policies
Disaster/Continuity Planning
Plan or Perform Copy Services
Mgt Overhead, General Administrative,
other General Standard Infrastructure Mgt
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160K Radiology Studies: Implementation
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160K Radiology Studies: Annual Cost
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500K Radiology Studies: Implementation
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500K Radiology Studies: Annual Cost
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1M Radiology Studies: Implementation
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1M Radiology Studies: Annual Cost
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Pricing Comparison
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CTN Logical Network Overview
CTN is a member
run
non-profit
organization
• 200+ sites from large, metro hospitals
to rural safety net clinics
• 17 behavioral health care centers
• CORHIO and QHN
• and growing….
#1 – So CTN can maintain and grow the network so smaller providers can
take advantage of the VNA.
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#2 – So CTN can maintain governance of
the “cloud” on behalf of members.
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CTN Sustainability Model
#3 – So CTN can facilitate implementation of IT projects on behalf of
the collective Colorado Health care community.
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