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Symposium Brief

Navy Medicine Clinical Imaging Archive (NCIA). Michael Fortier. Symposium Brief. 4-6 June 2012. BRIEFING OUTLINE. History Current Methodology A New Approach to Imaging Timeline Benefits of a NCIA Challenges Future Possibilities Conclusion.

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Symposium Brief

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  1. Navy Medicine Clinical Imaging Archive (NCIA) Michael Fortier Symposium Brief 4-6 June 2012

  2. BRIEFING OUTLINE History Current Methodology A New Approach to Imaging Timeline Benefits of a NCIA Challenges Future Possibilities Conclusion PURPOSE: Information briefing to provide and update and roadmap of the current lifecycle replacement of the Navy imaging archives. Slide 2 of 18 - 15 September 2014 – FOUO –

  3. Current Methodology PACS with individual archives Slide 3 of 18 - 15 September 2014 – FOUO –

  4. Command Centric PACS Specialty Specific Systems – Radiology, Cardiology, Dental, etc… Silos of image data – each system has it’s own (usually proprietary) archive. Sharing relevant image data between specialty systems is manual and problematic. Some PACS allow images taken from within the command to seen throughout the command. Viewing images between commands requires manual sending and receiving of images, or patients with CD. Migrate all the data to the new system (even with the same vender sometimes) TBs of data, years to complete, every time, every region, at a huge cost This is just going to get worse ~8 million radiology studies currently being stored (100+ TBs) ~1.2 million radiology new studies a year (10+ TBs) All the other imaging types are starting to be captured Current Methodology Slide 4 of 18 - 15 September 2014 – FOUO –

  5. Current End State Opthalmology Dental Cardiology Radiology Dental Radiology Cardiology Opthalmology Dermatology Clinical applications Endoscopy Dermatology Endoscopy Separate the archive from the PACS / Workflow Engine Individual clinical workflow engines specific to specialty needs Workflow management separate from medical image archive management Move away from proprietary standards to open standards VNA (vendor neutral archive) PNA (PACS neutral archive) IHE compliant archive (Integrating the Healthcare Enterprise) XDS, XDS-I, PIX, DICOM part 10 A New Approach to Imaging Pre-decisional – FOUO – Pre-decisional Slide 5 of 18 - 15 September 2014

  6. A New Approach to Imaging FOR OFFICIAL USE ONLY Slide 6 of 18 - 15 September 2014

  7. One Global Archive All images in the archive are viewable at all sites Images are federated across multiple facilities and sent to the primary Navy archive A New Approach to Imaging Slide 7 of 18 - 15 September 2014 – FOUO –

  8. A NEW APPROACH TO IMAGING • One Global Archive All images in the archive are viewable at all sites Images are federated across multiple facilities and sent to the primary Navy archive The nodes will automatically propagate studies Slide 8 of 18 - 15 September 2014 – FOUO –

  9. A NEW APPROACH TO IMAGING One Global Archive All images in the archive are viewable at all sites Images are federated across multiple facilities and sent to the primary Navy archive The nodes will automatically propagate studies Disaster recovery internal to the solution Slide 9 of 18 - 15 September 2014

  10. Significant Milestones May 2012 - RFP released Sep 2012 - Award Oct 2012 - Begin Global Archive project Nov 2013 - Begin specific site projects / migration ongoing Timeline from one vender Timeline Slide 10 of 18 - 15 September 2014 – FOUO –

  11. End State Opthalmology Dental Radiology Cardiology Dermatology Clinical applications Endoscopy All completed images are viewable Completed status is based on workflow Appears to be one archive Allow multiple IHE-complaint COTS workflow systems to use the archive Radiology PACS Cardiology PACS Optometry iOR Document Management Medical Photos Dental Imaging Reserve Health Readiness Record Benefits of a NCIA Slide 11 of 18 15 September 2014 – FOUO –

  12. CAS/COS NAS Built-in disaster recovery The system can self-replicate across multiple sites and/or the two Global Archives No Migration Data stored in a standards-based system (DICOM part 10) Huge cost savings ~15% of the cost of a new system is migration The old system has to be maintained during migration Years after it is not used by providers Hardware agnostic Benefits of a NCIA Interface Level Storage Management Level OTHER TAPE SAN SCSI SATA Slide 12 of 18 - 15 September 2014 – FOUO –

  13. Multiple CHCS hosts (Multiple Patient IDs) The new DEERS ID/MPI (Master Patient Index) will correct this VNA solutions can do cross-domain patient identifications Bandwidth The local sites will store 3-5 yearsof local images in FIFO Cache After 3 years, less than 1% ofimages are viewed again Enterprise Workflow Support Does not support enterprise workflow The retrieval of images drops significantly after the first year Challenges Views 1st 2nd 3rd 4th 5th Age Slide 13 of 18 - 15 September 2014 – FOUO –

  14. Management Paradigm shift: Radiology images to medical images / artifacts System administrators are already in place Separating archives from workflow components enables easy transfer of responsibilities of archive management Potential for additional resources based upon policy decisions Policy VNA technology is mature Need policy and guidance for MTFs Compression policy Retention policy Management policy Integration policy Challenges Slide 14 of 18 - 15 September 2014 – FOUO –

  15. The VNA can also be used as an imaging repository Add a zero download clinical viewer Can store multiple formats (jpg, pdf, mp4, wav) Provides XDS registry/repository Any number of XDS/IHE-compliant COTS workflow / ingestion systems can flow into it Document scanning, video recording, photography, dental HAIMS would only need one touch point for all images / artifacts within the Navy Simplify deployment Smaller footprint of HAIMS within MTFs Less hardware Smaller sustainment costs Future Possibilities Slide 15 of 18 - 15 September 2014 – FOUO –

  16. Interoperability with other Services Army heavily involved in the contract requirements generation, pursuing the same strategy System can integrate and query other archives Other Services’ archives (Air Force, AGFA IDCs) with implementation of network connections Theater Image Repository (TIR) Flexibility in infrastructure Scalability provided through increasing node storage capacity or adding nodes Reduction in number of nodes possible without migration requirements Future Possibilities Pre-decisional – FOUO – Pre-decisional Slide 16 of 18 - 15 September 2014

  17. The initial driver for this effort is the projected savings on migration time and costs Maturity of Vendor Neutral Archives results in unprecedented capability to share information across the enterprise BUMED guidance and policy required to facilitate complete paradigm shift Can be accomplished within 18 months using COTS products Conclusion Slide 17 of 18 - 15 September 2014 – FOUO –

  18. Questions • Questions Slide 18 of 18 - 15 September 2014 – FOUO –

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