Thursday, March 27, 2008

Cool Technology of the Week

I have an "-ology" problem.

Radiology, Cardiology, Pulmonology, Gastrology, Gynecology, and Endocrinology all have image management needs that require high bandwidth networks, short term high speed storage, and long term archival storage.

Radiology has a industrial strength GE Centricity PACS. The other "ologies" have heterogeneous applications from multiple vendors. As a CIO, I can no longer let 1000 wildflowers bloom in the world of image management. Why?

1. Each department would use its own image viewing software
2. Each department would need its own disaster recovery strategy
3. Each department would use its own records management/image retention rules
4. Each department would need its own capital budget for storage
5. Clinicians would not be able to have unified list of all imaging studies for patient or consolidate images across multiple institutions using different medical record numbers

How do I solve this problem? The answer is Long Term Archiving that is standards compatible and supports all the ologies. Teramedica's Evercore is one solution. IBM's Grid Medical Archive Solution is another. This concept is the cool technology of the week.

The idea behind these systems is simple. Each department can purchase the applications which interface to its imaging devices and support its workflow. The Departments own the "front end"

Each of these imaging systems supports a DICOM exchange to a long term archive. In the past, I've used content addressable storage with a proprietary API and DICOM broker for radiology, DVDs for echo, CDs for vascular, MODs for radiation oncology, etc.

All of this will be replaced with an enterprise image archiving approach which can

1. Provide one place for all images in the enterprise to be stored. IS can provide any storage hardware it wants - NAS, SATA disk, Data Domain archiving appliances etc.

2. Provide unified metadata for every image which can support a single application for consolidated image viewing of all studies from all the "ologies" at different institutions

3. Provide records management rules which enable deletion, information lifecycle management, and compression based on image type or department. For example, digital mammography needs to be kept 10 years, but we can move it from fast storage to slow storage when appropriate. CT images could be compressed after a year and deleted after 5 years.

Having unified storage, unified viewing, and unified management means that IS can now own the backend of image management and treat it as a utility, just as we do with other central file architectures.

The end result of this utility approach to long term image management is a win/win. Departments select the applications they need and the workflow they want. IS manages the security, integrity, and cost of storage centrally. The total cost of operating an enterprise image infrastructure is lower, the service levels are higher, and compliance with records retention policies are simplified.

I've been pursuing this concept for the past 5 years, but now the products are mature enough to make it a reality and I plan to do this as an FY09 project.


Johnnysmooth said...
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Johnnysmooth said...

Speaking of letting 1000 wildflowers bloom...

Any thoughts on Philips' acquisition of cardiovascular IS company TOMCAT this week. Looked at TOMCAT and it appears to be an EMR child for cardio that taps into a hospital's parent EMR/PM system. Certainly Philips will look to combine this with the rest of the cardio portfolio as a full solution sell but was wondering as a CIO, does this issue/potential raise concerns?

Mike C said...

I think John H is right on. Focusing on DICOM as a standard and virtualizing Content Management will help solve huge issues with desperate imaging systems which can lead to real savings and better clinical care.

Any thoughts on EMC's Documentum product? EMC has been long serving the end to end Enterprise Content Management/Records Management market.

The Documentum platform has been installed in many Ambulatory and Inpatient Records scanning areas as well as electronic forms to automate signed forms (consent, addmission, etc). With Documentum's Medical Information Transformation services you can scrape the DICOM header off of the image and place it in the database which will categorize based on predetermined taxonomies with the Content Intelligence Services tool.

What EMC has been doing with Documentum (applying it to medical IT) and integrating it to the storage subsystems (NAS, CAS, SAN from any vendor) while incorporating the back up and recovery environments addresses the challenges John talks to.


Unknown said...

Since the DICOM Standard has become stable in its native format more confidence is forming on using enterprise storage for image files. As the other -ologies move to native DICOM you will start to see more organizations migrating to the enterprise storage grid/cloud. Your organization will benefit tremendously once you install this new application in 2009 for all image formats and other data parameters. Best Wishes on this endeavor.

P.S. - The first native DICOM cloud was installed at The Cleveland Clinic Department of Cardiology in 2000 by Philips Medical for cardiology image files with an average file size of 500MB's each.

John Halamka said...

Documentum is a great product for non-structured data, but it is not optimized for DICOM exchange.

Philips acquired Stentor a few years ago, which was a proprietary standalone system. Tomcat seems to embrace a more open standards/interoperable approach. This could indicate a new desire for Philips to better integrate its products. I'll review it and add more detail.

Johnnysmooth said...

Thanks John for the reply and how TOMCAT may be a signal that Philips is looking to "open-up" their system.

This gets back to my original question regarding 1000 flowers. Are specialized, dept/procedure specific EMRs that are "open" (such as TOMCAT) integrating readily to a parent EMR something that CIOs, such as yourself willing to support/look favorably upon?

Anonymous said...

I read that this was an FY09 project ... how did you go with it? Have you achieved Enterprise Image Management nirvana?