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October 27, 2008

Digital Pathology How Digital Imaging is transforming Pathology. Clinical Image Storage Archives & Distribution Enterprise Solutions for Medical Imaging. 1 x. Digital Slides 100 x. October 27, 2008. Richard S. Bakalar, M.D. Chief Medical Officer IBM Healthcare & Life Sciences. 200 x.

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October 27, 2008

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  1. Digital PathologyHow Digital Imaging is transforming Pathology Clinical Image Storage Archives & DistributionEnterprise Solutions for Medical Imaging 1 x Digital Slides 100 x October 27, 2008 Richard S. Bakalar, M.D. Chief Medical Officer IBM Healthcare & Life Sciences 200 x

  2. Agenda • Global Healthcare Trends • Business Drivers for Innovation • Lessons Learned from Radiology • Enterprise Medical Content Storage • Q & A

  3. Distributed High-Throughput Analytics Data and Systems Integration Transformation of Medicine accelerated by a combination of revolutionary technologies and evolutionary practices Personalized Health Care Automated Systems Lifetime Treatment Pre-symptomatic Treatment Cancer Diagnosis Translational Medicine Information Correlation Revolutionary Technology Molecular Medicine Genetic Predisposition Testing Clinical Genomics 1st Generation Diagnosis Health Care Today Digital Imaging Episodic Treatment Electronic Health Records Artificial Expert Sys. Non-specific (Treat Symptoms) Organized (Error Reduction) Personalized (Disease Prevention & Targeted Treatment) Evolutionary Practices

  4. More Data Over the Last 3 Years Than Previous 40,000 years Combined Digital Pathology Digital Radiology E-Health Initiatives/Linkages Electronic Medical Record 40,000 BCEcave paintings bone tools P e t a b y t e s 3500writing Digital Cardiology 0 C.E. paper 105 1450printing 1870 electricity, telephone transistor 1947 computing 1950 Late 1960s Internet 1993 The Web 1999 Source: UC Berkeley, School of Information Management and Systems. 2003

  5. Use Cases for Digital Slides Today • Real-time Integrated Patient Care • Post-Interpretation – Digital Repository • Referred External Studies – Digital Archive

  6. Lessons Learned from Radiology • Enterprise Solutions • Workflow, Capture, Display, Distribution and Storage • Information Technology Support and Sustainment • What is “thought flow” ? • Enhanced Decision Support • Digital Diagnostics on demand • Data Analytics – Automated CAD, 3D, and Image Fusion • Importance Clinical & Technical Standards • Quality Image Display • System interoperability • Clinical Reimbursement

  7. IntroductionWhy providers should care about infrastructure • Speed - Configurable and Reliable Performance • Smart Caching and Data Backups • IT Support: Central Global Storage Dashboard for Dynamic System Administration • Collaboration - Flexible Scalability • Up, Down and across medical specialties • Respond to new data volumes & changes in clinical practice (i.e. CT/MRI protocols) • Diagnostics On Demand supporting Clinical Centers of Excellence • High Availability & Data Integrity • No scheduled downtimes • Automated data migration for hardware upgrades

  8. IntroductionWhat keeps the CIO up at night ! • Affordable system uptime • Eliminate data loss • Scalable without service disruption • Automated data migration for storage and server hardware refresh • Automated disaster recovery

  9. Medical Imaging Storage Challenge • “Always-On” Archive • Mission Critical - Clinical Performance • Reliable Data Integrity • Easy to Manage and Administer • Easy Migration to new hardware • Automated Recovery • Affordable and Scalable Digital Pathology Slide Over 1 GB with compression

  10. Utilization, App Speed & Scalability Data Access, Productivity & Storage Utilization Operating & Mgmt Costs (TCO) Introduction Grids enable three IT functions: • Computation (PC & Server Grids) • Intra and Inter - organizational cycle sharing • Access to computing resources On Demand • Collaboration (Data Grids) • Data Virtualization, Federation & Sharing • Virtual Storage Pooling • Orchestration (Intelligent Provisioning) • Automated SLA management & provisioning • Improved Quality of Service & IT

  11. IntroductionWhy Grid Storage System? Before Grid After Grid Site 3 Site 3 Site 1 Site 2 Site 1 Site 2 ... ... App 1 App 2 App 3 App 4 App 10 App 1 App 2 App 3 App 4 App 10 Grid Storage Platform • “Virtualized” Grid infrastructure: • Smaller, shared & more cost effective storage environment • Adaptive, self healing & self managing • High availability & speed • Enables infrastructure to be managed independent of the application • “Siloed” Traditional architecture: • Difficult & expensive to administer • Low utilization of hardware & storage • Vulnerable to failure and downtime • Bandwidth inefficient • Block level replication

  12. IntroductionPACS and Imaging Architecture PACS Application Study Demographics and Metadata Study Images Application Infrastructure Transactional Data Fixed Content Data Data Store Data Store Fixed Content Data hasunique & specific requirements

  13. Three Tier Medical Imaging Architecture CIS APPLICATION LAYER e.g. Aperio Spectrum Plus, Apollo PACS Clinical Function Image Access IMAGE MGMT LAYER e.g. AcuoMed, Teramedica Evercore Aggregation & Interoperability Image Management Layer STORAGE LAYER Data Protection, ILM Replication, Resiliency & Speed Grid Storage Management System

  14. Centralized Management • Web-based administration • Proactive monitoring • Fault detection & alerts • Real time and historical reports • Multi-tier and multi-site mgmt • Across all storage tiers • Enterprise wide Single operational dashboard for medical image storage across the enterprise

  15. IBM Grid Medical Archive Solution (GMAS) – An enterprise platform that optimizes enterprise storage resources by leveraging automation, grid and virtualization features across all storage brands, tiers and locations Grid Access Manager (GAM) Grid Access Manager Value Proposition: • Protects Data for Life: Digital signatures, Proactive Checking, No Data Loss • Enterprise Solution: All sites (LAN/WAN), All applications, All Storage Tiers and Competitive Storage • Improves Availability and Uptime • Automates Storage Data • Real time failover, automated rebuild, self healing • Challenges: • Affordable system uptime • Eliminate data loss • Ensure data integrity • Scalable without service disruption • Automated data migration for storage and server hardware refresh • Automated disaster recovery

  16. Real World Case Studies

  17. Videoclip in Bob Thompson’s own words: http://in.youtube.com/watch?v=p3k17RAs2OM

  18. Radiology Digital Pathology Cardiology AcuoMed Image Manager IBM GMAS Storage Manager Configuration Architecture Aperio Spectrum Acuo Workflow Cache Other Radiology Fixed Content Acuo DSG Server PACS Server Migration Server Server GMAS Virtualized & Automated Smart File System HA Gateway ControlNode Administrative Node LAN WAN / Tape StorageNode 1 StorageNode 2 ArchiveNode TSM Server Library Main Datacenter Norristown Datacenter The Children’s Hospital of Philadelphia

  19. IBM Medical GRID Archive for Digital Pathology 100101000110111000101010101001011010 100101000110111000101010101001011010 Transparent Actions Performed by the GRID • Each file is protected with digital fingerprint • Validated on access, replication and rebuild • Proactively verified in background • Corrupted files are quarantined and replaced with a known good file • Grid is both content-aware and resource-aware Aperio Spectrum Application Dual Read/Write 4 TB DAS CIFS mount protocol TCP/IP NAS attachment 2 TB Cache in GMAS Gateway Node GMAS Storage Node #1 Storage Node #2 SATA Disk SATA Disk 19 The Children’s Hospital of Philadelphia

  20. Summary • Healthcare has unique and challenging storage and information integration requirements • Traditional approaches are not scalable, affordable and reliable Enterprise proven technology with proven results

  21. Thank You !Questions and Answers

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