How to Break the VNA Entry Barrier… Building a VNA in Multiple Stages Michael J. Gray
Gray Consulting
www.gnaxhealth.com @ HIMSS12 booth #2875 Cloud Computing Knowledge Center Booth #13642 Objectives • 
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Background PACS History Current Problems VNA Precursor Products VNA Entry-­‐Level Strategies VNA Completion Strategies Economics Frequently Asked Questions Conclusions Introduction to GNAX and Its Technology Learn more @ www.gnaxhealth.com Background Vendor-­‐Neutral Archive… 1. An Enterprise-­‐class data management system that consolidates primarily medical image data from multiple imaging departments into a Master Directory and associated consolidated Storage Solution, thus replacing the individual archives associated with departmental PACS… systems with unfortunate proprietary characteristics that limit their interoperability. 2. A unified image data repository for the Electronic Medical Record system. Learn more @ www.gnaxhealth.com Background This high-­‐level graphic suggests the size and redundancy aspects of a properly configured VNA C-PACS
R-PACS
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Facility A LAN
Enterprise WAN
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Primary VNA Subsystem Data Center A
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Secondary VNA Subsystem Data Center B
Learn more @ www.gnaxhealth.com Background •  VNA Solves 7 of the Top 10 PACS Problems* 1.  Integration – “Sharing images between specialties or loading patient information to other providers' EHRs are common problems” 2.  Downtime – “Business continuity systems are essential…” 3.  Hanging Protocols – “Some success can be found in renaming or normalizing the image series descriptors …” 4.  Interoperability – “Managing the hardware between different vendors” 5.  Support 6.  Training * Top 10 PACS Problems…Health Imaging & IT , July 19, 2011 Learn more @ www.gnaxhealth.com Background •  VNA Solves 7 of the Top 10 PACS Problems 7.  Out with the Old – “The migration of data to the new PACS is often the most challenging part of the process…” 8.  Whose PACS? – “Decision-­‐making for PACS-­‐related purchases has, in some cases, shifted from radiologists to a more central process. The end choice may not be optimized for radiology…” 9.  Ergonomics 10.  Disaster recovery – “Like business continuity, disaster recovery can prevent a painful experience from becoming fatal.” Learn more @ www.gnaxhealth.com Background •  The only workable solution to solving most PACS problems is to deploy a Vendor-­‐Neutral Archive –  Take the “A” out of PACS –  Provide an enterprise class DR and BC solution –  The VNA would accept both DICOM and non-­‐DICOM image data and its related meta data –  Incorporate the tools to dynamically translate between disparate PACS (Bi-­‐directional Dynamic Tag Morphing) –  Bring sophisticated Information Lifecycle Management tools, including Purge mechanism to enterprise image data management Learn more @ www.gnaxhealth.com Background •  Cont. –  Eliminate future data migrations –  Expand choice of storage media –  Easier way for individual and/or dissimilar Departmental PACS to share a long-­‐term “Archive” and effectively exchange data –  Shift Control of the study data from the Vendor to the Organization, making it easier to change PACS, and giving choice of PACS back to the department –  Simplify Enterprise Viewing under one UniViewer Learn more @ www.gnaxhealth.com Background •  How expensive is a VNA? –  Bigger than your biggest PACS, since it will be managing all of the organization’s image data –  Twice again as big, because a DR/BC solution requires a mirrored dual-­‐site configuration –  Big enough to probably require multiple years/budgets… reminiscent of early years of radiology PACS deployments Learn more @ www.gnaxhealth.com PACS History •  First Generation Radiology PACS required large investments, and there was doubt about being able to successfully replace film •  Early PACS deployment strategies focused on solving small problems with entry-­‐level products at manageable cost –  Properly designed (DICOM conformant) Mini-­‐PACS and teleradiology systems were PACS precursors –  Typical PACS deployments from late 80’s to mid 90’s were phased over several years/budgets) Learn more @ www.gnaxhealth.com Current Problems •  Small, more Manageable Problems that many Organizations face today –  PACS media replacement (requiring media migration) –  PACS replacement (requiring DICOM data migration) –  Electronic Image Data Sharing •  PACS to PACS (problematic CD/DVD exchange) •  Internet Access (secure image access by outside physicians) –  Image-­‐enabling the EMR –  Bona-­‐fide, geographically-­‐dispersed, Disaster Recovery and back-­‐up –  Business Continuity (access to priors when PACS is down) Learn more @ www.gnaxhealth.com Corresponding VNA Precursor Products •  Media Replacement –  Replace old media with open Storage Solution that has broader upgrade path and can be shared by multiple PACS •  Data Migration Engines –  Replace DR solution with VNA-­‐fronted Open Storage converting Proprietary copy to Neutral copy –  Replace DR solution with VNA-­‐fronted-­‐Cloud Infrastructure •  DICOM Routers –  Facilitate PACS to PACS image sharing without CD/DVD –  Rules-­‐based Auto-­‐routing –  Automatic Tag Mapping Learn more @ www.gnaxhealth.com Corresponding VNA Precursor Products •  UniViewer…Zero-­‐Client, Server-­‐side Rendering Display Application –  Image-­‐enable EMR with single viewer that can aggregate patient image data across multiple PACS –  Secure Internet image access for both inside and outside physicians –  UniViewer + bona-­‐fide geographically dispersed DR Solution is Business Continuity Solution Learn more @ www.gnaxhealth.com VNA Entry-­‐Level Strategies •  Level 0…Data Sharing and Interoperability –  Deploy local DICOM Router to facilitate both local and remote PACS -­‐ PACS data exchange •  Features –  Rules-­‐based Auto-­‐routing based on metadata –  VNA-­‐like dynamic, automated Tag Morphing •  Rationale –  Efficient data transfers –  Guaranteed compatibility Learn more @ www.gnaxhealth.com VNA Entry-­‐Level Strategies •  Level 1a…Data Storage –  Deploy Open Storage Solution on site and migrate Primary copy of data to Open Storage, as PACS media is retired –  Retain most recent 3yrs on site, transfer balance to Cloud Infrastructure •  Features –  Performance matched to PACS requirements •  Rationale –  Improve price/performance ratio –  Protection against obsolescence –  Transferring older data to Cloud reduces support costs Learn more @ www.gnaxhealth.com VNA Entry-­‐Level Strategies •  Level 1b…Data Storage –  Create / Transfer Secondary (DR) copy of data entirely to the Cloud –  This step does not require investment in VNA technology therefore does not modify data •  Features –  Geographically-­‐dispersed, HIPAA-­‐conformant DR solution •  Rationale –  Secures data integrity –  Reduces capital costs and operational expenses Learn more @ www.gnaxhealth.com VNA Entry-­‐Level Strategies •  Level 2…Vendor Neutral Data Management –  Deploy Migration Engine (subset of VNA) on-­‐site –  Pro-­‐active DICOM migration to the VNA-­‐fronted Cloud Infrastructure –  Retire PACS-­‐driven DR Solution when migration is completed •  Features –  Tag mapping to create Neutral DR Solution –  Pay only for data migration and managed storage costs –  HIPAA-­‐conformant, geographically-­‐dispersed DR Data Center •  Rationale – 
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Transfers control of data from PACS vendor to organization Eliminates future DICOM data migrations Reduces capital costs and operational expenses for DR Returns choice of next PACS to imaging departments Learn more @ www.gnaxhealth.com VNA Entry-­‐Level Strategies •  Level 3…Neutral Data Management/Distribution –  Activate UniViewer in the Cloud Infrastructure after first 6 months of new and most recent data is migrated to Cloud (Level 2) –  Image-­‐enable the EMR with UniViewer and Cloud-­‐based Secondary copy of data •  Features –  Zero-­‐client, Server-­‐side Rendering Viewing application –  3 second delivery of first screen image content –  Operations performed on loss-­‐less Secondary copy of image data •  Rationale –  Reduces capital cost and operational expenses associated with BC, Image-­‐enabling EMR, Internet Image Sharing Learn more @ www.gnaxhealth.com VNA Completion Strategies •  What is required to get from Level 3 to full VNA –  Deploy Primary instance of VNA and UniViewer in Organization’s primary data center –  Perform media-­‐media migration of organization’s Secondary copy of data to Primary Storage Solution in Cloud vendor’s data center –  Ship Primary Storage Solution to Organization’s primary data center –  Establish local PACS, EMR and HL7 interfaces –  Upgrade DR/BC-­‐level VNA license to full-­‐functionality VNA license –  Reduce local PACS storage to 12 -­‐ 18 months Learn more @ www.gnaxhealth.com R-­‐PACS C-­‐PACS Organization LAN X-­‐PACS Gateway Organization WAN Cloud Data Center LAN Uni-­‐
Viewer VNA Storage Network Cloud Data Center
Storage Server Storage Server Organization Data Center LAN VNA Uni-­‐
Viewer Storage Network Organization Data Center
Learn more @ www.gnaxhealth.com Economics •  One example of cost comparison for Level 1a –  Replacing 3+ year-­‐old, on-­‐site, self-­‐managed, long-­‐term Storage Solution with a new high-­‐end, mirrored Storage Solution Versus –  Keeping most recent 24 months on-­‐site and migrating all data from the old, long-­‐term storage solution to a Cloud-­‐based Storage Solution. Learn more @ www.gnaxhealth.com Economics Profile A Ave. Study Historical Annual Size (MB) Study Descrip-on Procedures 2.5:1 Volume 1 Hospital 200,000 40 820,000 Total TB (New + Historical) in Year 1 (Raw) RAID (Mirrored) Years 2-­‐5 (Raw) Years 2-­‐5 (RAID) Total TB Needed (RAID) 41 82 32 64 146 Cost of Storage Hardware Purchase Cost of Hardware Maintenance (yr 2-­‐5) $750,000 $600,000 Cost of Power & Cooling (5 yrs) Cost of Data Center FaciliRes (5 yrs) Cost of Storage AdministraRon (5 yrs) Five year Total Cost Ownership* $91,800 $90,000 $112,500 $1,644,300 *Excludes cost of media migration Learn more @ www.gnaxhealth.com Economics •  Three examples of the cost of a DICOM Migration conducted in Year 1, 3, 5 and 7 are compared to the cost of a Pro-­‐active DICOM migration conducted in Year 1 –  Migration is conducted by a Service Provider at the average cost of $0.21/study –  Data is migrated to a VNA-­‐fronted Storage Solution managed on-­‐site by the organization Learn more @ www.gnaxhealth.com Economics Ave. Study Historica Year 1 Year 3 Year 5 Year 7 Annual Size l Study MigraRon MigraRon MigraRo MigraRon cost cost n cost cost Profile DescripRon Procedures (MB) Volume A 1 Hospital 200,000 100 820,000 Cost of VNA license* to manage both new and historical data (5 years) Cost of VNA Server/Storage Hardware Purchase Cost of Hardware Maintenance (yr 2-­‐5) Cost of Power & Cooling (5 yrs) Cost of Data Center FaciliRes (5 yrs) Cost of Storage Admin (5 yrs.) Five year Total Cost Ownership $214,200 $298,200 $382,200 $466,200 $650,000 $145,000 $116,480 $91,800 $90,000 $112,500 $1,420,580 * Price for simply managing data at Rest (no access) Learn more @ www.gnaxhealth.com Economics Ave. Study Historical Year 1 Year 3 Year 5 Year 7 Annual Size Study MigraRon MigraRon MigraRon MigraRon cost cost cost cost Profile DescripRon Procedures (MB) Volume B 1 Hospital 160,000 82 987,805 $241,039 $308,239 Five year Total Cost Ownership C 2 Hospitals 560,000 $375,439 $442,639 $1,264,200 80 2,362,500 $613,725 $848,925 $1,084,125 $1,319,325 Five year Total Cost Ownership $2,997,925 Learn more @ www.gnaxhealth.com Economics •  In all three examples… –  The cost of a Pro-­‐active Data Migration to a self-­‐managed VNA-­‐fronted Storage Solution is more than the projected costs of migrating all of the image data at a future date when the PACS are replaced. –  So what is the economic argument? •  Migration from one proprietary format to another is a waste •  VNA Data is ready for use by the next PACS, there are no future DICOM migrations •  Existing VNA infrastructure will off-­‐set Archive infrastructure of the next PACS •  Pro-­‐active migration to a Cloud-­‐based VNA Infrastructure offers same advantages at significantly lower operational cost Learn more @ www.gnaxhealth.com Economics Radiology Clinical Viewer Cardiology "X"-­‐Ology Clinical Clinical Viewer Viewer Uni Viewer Hardware and Soaware ≥100 Concurrent Users $135,000 $110,000 $125,000 $111,638 ImplementaRon and Training $10,000 $10,000 $10,000 $7,000 Viewer Maint @20%/yr $81,000 $66,000 EMR Interface $20,000 $20,000 $20,000 $20,000 Interface Maint @20% $12,000 $12,000 $16,000 $16,000 Admin costs (assumes .2 FTE/yr. @
$80K) $48,000 $48,000 $80,000 $80,000 $141,000 $126,000 $351,000 $323,948 Totals: % Savings $618,000 $323,948 47.58% Totals: $100,000 $89,310.40 Single UniViewer vs Multiple PACS Viewers Learn more @ www.gnaxhealth.com Economics Radiology Clinical Viewer Cardiology "X"-­‐Ology Clinical Clinical Viewer Viewer Uni Viewer Hardware and Soaware ≥100 Concurrent Users $135,000 $110,000 $125,000 $111,638 ImplementaRon and Training $10,000 $10,000 $10,000 $7,000 $108,000 $88,000 EMR Interface $20,000 $20,000 $20,000 $20,000 Interface Maint @20% $16,000 $16,000 $16,000 $16,000 Admin costs (assumes .2 FTE/yr. @
$80K) $80,000 $80,000 $80,000 $80,000 $369,000 $324,000 $351,000 $323,948 Totals: $1,044,000 % Savings $323,948 68.97% Viewer Maint @20%/yr Totals: $100,000 $89,310.40 Single UniViewer vs Multiple PACS Viewers Learn more @ www.gnaxhealth.com Economics •  On-­‐site vs Off-­‐site? Capitalized, self-­‐managed, on-­‐premise, mirrored, dual-­‐sited VNA vs Hybrid VNA, where Secondary VNA subsystem is hosted in Cloud Infrastructure and managed by the vendor •  Issues? –  IT Resources? –  Geographically disparate Second Data Center? –  Storage Procurement –  Funding? •  Cost Models repeatedly suggest that 5 year TCO of Hybrid VNA ≈ 30% lower than Capitalized on-­‐site Learn more @ www.gnaxhealth.com Frequently Asked Questions Will Cloud-­‐based Vendor Neutral DR/BC solution (Level 3) effect my choice of next PACS? Learn more @ www.gnaxhealth.com R-­‐PACS C-­‐PACS Organization LAN X-­‐PACS Gateway Organization WAN Cloud Data Center LAN Uni-­‐
Viewer VNA Storage Network Storage Server Level 3 – Cloud-­‐based, Vendor Neutral, DR/BC Solution Cloud Data Center
Learn more @ www.gnaxhealth.com Frequently Asked Questions Will Cloud-­‐based Vendor Neutral DR/BC solution (Level 3) effect my choice of next PACS? ü  Significantly ü  Current vendor has much less leverage ü  Next PACS ü  Has to meet interoperability requirements ü  Does not require long-­‐term Archive or enterprise Viewer, thus lowering cost ü  Will focus entirely on department operations ü  Choice shifts to back to imaging department (clinical criteria) Learn more @ www.gnaxhealth.com Frequently Asked Questions How does this eliminate conventional Data Migration to my next PACS? ü  Only most recent 18 to 24 months of image data needs to be migrated from the VNA to the short-­‐term Storage Solution of the next PACS ü  VNA modifies data headers to meet PACS requirements ü  Department-­‐specific VNA Directory is copied to next PACS Directory, making it “aware” of all historical studies ü  These are simpler, faster, less expensive migrations Learn more @ www.gnaxhealth.com Frequently Asked Questions Does Deploying a Level 3 solution lock me into that vendor’s VNA technology? ü  No ü  Data can be moved to another VNA solution w/o costly migration (contractual guarantee) ü  You can choose any other legitimate VNA solution for an on-­‐
site deployment ü  You can choose a different UniViewer for on-­‐site deployment Learn more @ www.gnaxhealth.com Frequently Asked Questions At what Level could I participate in an HIE? Level 2 -­‐ Cloud-­‐based Vendor Neutral Data Management Learn more @ www.gnaxhealth.com R-­‐PACS C-­‐PACS Organization LAN X-­‐PACS Gateway Organization WAN Cloud Data Center LAN Uni-­‐
Viewer VNA Storage Network Storage Server Level 2 – Cloud-­‐based, Vendor Neutral, Data Management Cloud Data Center
Learn more @ www.gnaxhealth.com Frequently Asked Questions At what Level could I participate in an HIE? ü  Level 2 with XDS-­‐I and companion eMPI upgrade options activated in Cloud Infrastructure ü  No requirement to add XDS-­‐I functionality to each local PACS and deploy a local eMPI ü  Non-­‐DICOM and non-­‐Image Data can also be uploaded to and managed by VNA / Cloud Infrastructure Learn more @ www.gnaxhealth.com Frequently Asked Questions What level of performance is supported by the UniViewer in the Cloud? ü  Assumptions ü  Rendering Server and VNA are on the same LAN ü  Interface between the two is web services or the rendering server has a 30-­‐60 day image cache ü  Typical zero-­‐client, server-­‐side rendering UniViewer can deliver first images / display screen in 3 seconds over modest Internet connection (commercial broadband) ü  User directed (server-­‐side rendered), basic display operations like W/L, Zoom, etc. are delivered in typically < 1 sec. Learn more @ www.gnaxhealth.com Conclusions •  Conclusions –  Vendor Neutral Archive can solve 7 of top 10 PACS problems –  VNA is large, complex, capital-­‐intensive project that will probably require multiple years and budgets to deploy –  Similar to early Radiology PACS deployments, there are small VNA precursor products that solve small problems that plague many organizations Learn more @ www.gnaxhealth.com Conclusions •  Conclusions –  Precursor products/strategies include •  PACS Media Replacement •  Pro-­‐active Data Migration to the Cloud •  DICOM Routers to simplify data exchange •  UniViewer to image-­‐enable the EMR –  A step plan that utilizes VNA precursor products can build-­‐out a full VNA over time, using a pay-­‐as-­‐
you-­‐go strategy Learn more @ www.gnaxhealth.com VNA Introducing GNAX HIT Ecosystem Colocation Archive, Backup & DR Offload base, non-­‐core IT functions: Tier IV, SSAE 16 Type II data center Complete infrastructure reliability, Geo redundant, VNA Application Delivery Offload 2nd tier apps, APM, private cloud SaaS HIE, PACS, E-­‐prescribe, EHR Learn more @ www.gnaxhealth.com GNAX DOESTM • 
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Distributed Object Elastic Storage GNAX DOESTM Dallas GNAX DOESTM Atlanta Learn more @ www.gnaxhealth.com GNAX DOESTM VNA Acuo Technologies •  Globally deployed since 2001 •  Over 660 installs of Acuo solution for archiving, routing and migrations •  Interoperability with every major PACS •  Frost & Sullivan Product Leader Acuo VNA GNAX DOESTM Learn more @ www.gnaxhealth.com GNAX DOESTM VNA •  Stream studies to any workstation or mobile device Universal Viewer Acuo VNA GNAX DOESTM Learn more @ www.gnaxhealth.com GNAX DOESTM VNA Logical view Radiology Universal Viewer Acuo VNA Private Line WAN GNAX DOESTM Cardiology WAN Acuo enabled Local cache Any-­‐ology GNAX DOESTM VNA Edge EHR Learn more @ www.gnaxhealth.com Partner: SourceHOV •  $400M company •  30 years in radiology image management •  Film > digital conversion services Learn more @ www.gnaxhealth.com Questions & Discussion VNA www.gnaxhealth.com @ HIMSS12 booth #2875 Cloud Computing Knowledge Center Booth #13642