October 27, 2008

Clinical Image Storage Archives & Distribution Enterprise Solutions for Medical ImagingEnterprise Solutions for Medical Imaging

Richard S. Bakalar, M.D.Chief Medical OfficerIBM Healthcare & Life Sciences

Digital PathologyHow Digital Imaging is transforming Pathology

DigitalSlides100 x

200 x

1 x

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Agenda

• Global Healthcare Trends

• Business Drivers for Innovation

• Lessons Learned from Radiology

• Enterprise Medical Content Storage

• Q & A

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Transformation of Medicine accelerated by a combination of revolutionary technologies and evolutionary practices

Personalized Health Care

Translational Medicine

Health Care Today Digital Imaging

Episodic Treatment Electronic Health Records Artificial Expert Sys.

Clinical Genomics

Genetic Predisposition Testing

Molecular Medicine

Cancer Diagnosis

Pre-symptomatic Treatment

Lifetime Treatment

Evolutionary Practices

Rev

olu

tio

nar

y T

ech

no

log

y Automated Systems

Non-specific (Treat Symptoms)

Information Correlation

1st Generation Diagnosis

Organized(Error Reduction)

Personalized(Disease Prevention &Targeted Treatment)

Dis

trib

ute

d H

igh

-Th

rou

gh

pu

t A

na

lyti

cs

Data and Systems Integration

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Source: UC Berkeley, School of Information Management and Systems.

0 C.E.

2003

40,000 BCEcave paintings

bone tools 3500writing

paper 1051450

printing1870

electricity, telephone transistor 1947computing 1950

1993The Web

Digital Cardiology

Electronic Medical Record

E-Health Initiatives/Linkages

Digital Radiology

1999

Late 1960sInternet

P e

t a b

y t e s

More Data Over the Last 3 Years Than Previous 40,000 years Combined

Digital Pathology

5 Digital Pathology - How Digital Imaging is transforming Pathology

Use Cases for Digital Slides Today

• Real-time Integrated Patient Care

• Post-Interpretation – Digital Repository

• Referred External Studies – Digital Archive

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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

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Introduction Why 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 DemandDiagnostics On Demand supporting Clinical Centers of

Excellence

High Availability & Data Integrity• No scheduled downtimes• Automated data migration for hardware upgrades

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Introduction What 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

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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 ScalableDigital Pathology Slide

Over 1 GB with compression

10 Think Outside the PACS – Enterprise Medical Imaging Storage Solutions

Introduction

• Computation (PC & Server Grids)• Intra and Inter - organizational cycle sharing• Access to computing resources On Demand

Utilization, App Speed &

Scalability

Data Access,Productivity &

Storage Utilization

Operating &Mgmt Costs

(TCO)

• Collaboration (Data Grids)• Data Virtualization, Federation & Sharing• Virtual Storage Pooling

• Orchestration (Intelligent Provisioning) • Automated SLA management & provisioning• Improved Quality of Service & IT

Grids enable three IT functions:

11 Think Outside the PACS – Enterprise Medical Imaging Storage Solutions

“Siloed” Traditional architecture:• Difficult & expensive to administer• Low utilization of hardware & storage• Vulnerable to failure and downtime• Bandwidth inefficient

• Block level replication

Site 1 Site 2 Site 3

Introduction Why Grid Storage System?

latigid

latigid latigid

After Grid

App 1 App 2 App 3 App 4 App 10...

latigid latigidlatigid latigid latigid

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

Before Grid

Site 1 Site 2 Site 3

latigid latigid latigidlatigid

latigid latigidlatigid

12 Think Outside the PACS – Enterprise Medical Imaging Storage Solutions

Introduction

PACS and Imaging Architecture

Transactional Data Fixed Content Data

Data Store

Application

Infrastructure

PACS Application

StudyDemographics and Metadata

StudyImages

Fixed Content Data has unique & specific requirements

Data Store

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Three Tier Medical Imaging Architecture

Image Management Layer

Clinical FunctionImage Access

Aggregation &Interoperability

APPLICATION LAYER

IMAGE MGMT LAYER

STORAGE LAYERSTORAGE LAYER

e.g. Aperio Spectrum Plus,Apollo PACS

GridGridStorageStorageManagementManagementSystemSystem

Data Protection,

ILMReplication,

Resiliency & Speed

e.g. AcuoMed, Teramedica Evercore

CIS

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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

© 2008 IBM Corporation

IBM Healthcare and Life Sciences

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

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

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

Grid Access Manager (GAM)

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Real World Case Studies

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

IBM Healthcare & Life Sciences

18

ControlNode

Main Datacenter

StorageNode 1 StorageNode 2

Norristown Datacenter

The Children’s Hospital of Philadelphia

ArchiveNodeTSM Server

TapeLibrary

Acuo WorkflowCache

RadiologyAcuo DSG Server

HA Gateway

AdministrativeNode

GMASVirtualized & Automated

Smart File System

Cardiology

LAN/WAN

PACS Server

Migration Server

Other Fixed Content

Server

AcuoMed Image Manager IBM GMAS Storage Manager

Configuration Architecture

Radiology Digital Pathology

Aperio Spectrum

IBM Healthcare

© 2008 IBM Corporation

Aperio Spectrum Application

Aperio Spectrum Application

GMAS 2 TB Cache in GMAS Gateway Node2 TB Cache in GMAS Gateway Node

CIFS mount protocol

TCP/IP NAS attachment

SATADisk

IBM Medical GRID Archive for Digital PathologyTransparent 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

100101000110111000101010101001011010

SATADisk

100101000110111000101010101001011010

4 TB DAS4 TB DAS

Dual Read/Write

The Children’s Hospital of Philadelphia 19

StorageNode #1

StorageNode #2

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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

Thank You !

Questions and Answers