Inside the Data Center of the Future

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The key to progressively managing data across the enterprise

 As the 21st century advances, healthcare stands to gain as new developments promise to improve diagnosis and treatment. At the same time, healthcare remains a fragmented process. Critical information is available to physicians but it is not linked; reviewing images and data from multiple sources is complex and time-consuming, detracting from optimal patient care. For example, an accurate differential diagnosis may hinge on viewing a patient x-ray and pathology reports. But a simple mechanism to enable the physician to review both is a tall order for many state-of-the-art healthcare enterprises.

There are other pain points as well. Redundant data are spread across and beyond the enterprise, which can decrease efficiency and lead to unnecessary duplication of efforts; data management processes can be mercurial and department — rather than enterprise-driven; hardware and software obsolescence complicates the picture and make it difficult to manage legacy data. At the same time, data must remain readable for up to 30 years, and the amount of data is exploding on a near daily basis with 64-slice CT and digital mammography studies generating gigabyte level datasets. More frequent use of PET/CT is contributing, too.

The answer is deceptively simple. As long as 10 years ago, the Institute of Medicine identified the need for a computerized, multi-media patient record to store images and data—an electronic medical record (EMR). The EMR will enable healthcare to move toward a more patient centric approach. Currently, most healthcare enterprises can not deploy a fully patient-centric approach because disparate information systems prevent the physician from readily accessing all of the necessary clinical information. Lab results and x-ray images do not reside on the same system nor can the physician view both at the point of care.

Achieving an EMR and implementing patient-centric care, however, requires some adjustment on the part of health information systems. The systems must adopt a patient-centric view not only at the individual level, but also at the aggregate level across all systems. Thus to be truly viable, the EMR requires a foundation that unites the disparate systems and facilitates a common language and single patient view.

A next-generation data center such as the Agfa HealthCare Clinical Data Center (CDC) that is soon to roll out can provide the architecture needed to consolidate and manage the silos of healthcare data. CDC goes beyond existing storage platforms like storage area networks (SAN) and network attached storage (NAS).

While current-generation storage solutions such as SAN and NAS do address the hefty storage demands of healthcare enterprises, they do not use standards to link data. Consequently, data are not linked for the end-user and physician. With CDC, Agfa HealthCare takes the final step and uses standards to link data and transform storage into a clinically relevant and useful solution. CDC brings intelligence — fully managing the data for the facility. CDC knows what the data are for, who they belong to and what to do with them — all based on software standards like DICOM and HL7.

Agfa HealthCare is uniquely positioned to address the fragmentation challenges of 21st century healthcare. Over the last several years, the company has bolstered its solid expertise in imaging and complemented it with an IT portfolio. Its acquisition of industry leaders such as Heartlab in cardiology image and information management, Mitra in image and information management and GWI in hospital clinical and administrative IT extend and balance its offerings. Plus, its relationship with storage leader EMC Corporation provides the final ingredient needed to optimize storage as the building block for the EMR.

Relevant clinical information with a single login

Agfa HealthCare CDC meets multiple critical purposes. The clinical content hierarchical storage management system not only serves as an archive, it also provides a viewer and query-capable warehouse. CDC streamlines management of the array of data in any modern healthcare enterprise from multimedia datasets like waveforms to documents, medical images and structured reports.

How does it work? CDC connects to all clinical and administrative systems and sources and merges all structured and unstructured data into a single real-time database. Its semantic mapping function aggregates similar data from all of the multiple disparate, specialized systems that characterize modern healthcare. For example, CDC incorporates demographic, clinical, episode and account data with a unique identification number that can span multiple domains. The system allows clinicians to abstract relevant clinical information including lab results, protocols, care plans, reports, images and voice data from either Agfa HealthCare or existing portals. The result is a unified view of the patient across modalities, departments and enterprises with a single login.

The benefits of the approach are significant. For starters, storage consolidation lowers the total cost of ownership by centralizing and optimizing the management of enterprise clinical and administrative data, storage and reporting. This is where EMC Corporation’s intelligent information infrastructure come in. Tiered-networked storage platforms that provide the availability, reliability, scalability and performance needed by a healthcare organization are essential.

The storage aspect is a solid first step. Enterprises gain additional cost benefits as clinicians no longer order duplicate tests. Workflow is facilitated by providing a unified patient view. Physicians can view patients by acuity or easily retrieve data for a single patient, which increases efficiency and can improve and accelerate patient care. The advantages of the new paradigm extend beyond the financial.

An enterprise archive and data warehouse strategy centered on CDC delivers a common data infrastructure, which translates into improved communications across the enterprise. Caregivers across the enterprise can connect with each other to collaborate and make patient care decisions based on aggregate data available in CDC. Because CDC facilitates fully-informed collaboration patients receive optimized care. “In the paper-based patient record environment, it’s difficult to access two-year-old lab results in a four-inch-thick chart. In an electronic world, previous results are readily available. That means a physician could trend lab results on a diabetic patient over time to determine the effect of changing medication dosage. In other words, the EMR enables informed decision-making based on evidence,” explains Sandra Cascadden, CIO of Nova Scotia Department of Health. The Nova Scotia Department of Health, which supports 34 hospitals in that region, is one system that’s deployed an integrated Agfa HealthCare and EMC image and data management solution.

Finally, CDC allows healthcare facilities and entire enterprises to integrate data on a patient-centric basis, which provides a firm and essential foundation for the EMR. Use can transition from clinical content to clinical content management, and both clinical and administrative data mining are enabled. For example, physicians can determine which course of treatment enabled a shorter hospital stay for a particular disease path, while administrators can determine the associated costs with that disease path and/or treatment methodology. Measuring both these factors ensures the best treatment for the patient at a cost-effective rate.

The Agfa HealthCare storage model utilizes multi-disciplinary standards, making it easier for providers to view the entire patient continuum of care rather than a single, episodic snapshot. All physicians can access a complete, current, multi-disciplinary patient record and the entire patient history to make informed decisions about diagnosis and treatment.

Agfa HealthCare further streamlines the process. The company deploys professional services to integrate clinical, patient and administration portals and provide a single login with a consistent user interface across the enterprise. As a result, the physician experience is simplified and efficient.

The Imaging Component: IMPAX Data Center

Images and diagnostic reports are the core of the medical record and key to optimum patient care. The CDC component that provides a multimedia repository for images and diagnostic results is IMPAX Data Center. IMPAX Data Center consolidates information in a central clinical data structure and provides storage for multiple departments. Equally important, as imaging and image management move beyond the borders of the radiology department, IMPAX Data Center supports all types of medical images and diagnostic results including images, video, structured reports and visible light objects. It supports multiple departments like orthopedics, pathology and dermatology. Because IMPAX Data Center consolidates data from multiple sources, it provides a solid platform for the EHR. The solution is engineered for the future and incorporates the muscle to manage new image-intense technologies like 64-slice CT. Thus, as the organization adds new imaging modalities, IMPAX Data Center enables its growth, allowing the EHR initiative to support growth rather than stumble as new technologies are added.

What’s more, Agfa HealthCare’s standards-based, open-architectured system operates in either a best-of-breed or single-vendor environment, allowing facilities and health systems to choose the model that works best for them while facilitating regional health information initiatives. Finally, the data center is scaleable to hospital groups or regional healthcare organizations.

As a key building block for the EHR, IMPAX Data Center provides a single point of integration to support the multimedia patient health record. It allows the organization to develop a central, longitudinal archive of clinical data. Agfa HealthCare had demonstrated the validity and value of the approach in Europe, where more than 800 sites including the United Kingdom’s National Health Systems rely on Agfa HealthCare ORBIS to achieve integration and link patient data across organizations.

Data center requirements

The move to a paperless EMR system is complex and must be approached carefully. Traditional 99.999 percent uptime may not suffice in the paperless world, says Cascadden. Without paper records, healthcare providers start from the ground up. If a system is down, the physician be forced to operate from a disadvantage — without a patient name or history. “Thus, [excellent] uptime with multiple built-in redundancies is important to enable providers to view the EMR at any time it’s needed,” sums Cascadden.

In addition, the data center of the future carries massive storage requirements; storage must be efficient at all levels in real-time, near real-time and in the archive, says Cascadden.

IMPAX Data Center models

Facilities can deploy IMPAX Data Center in a number of configurations to meet their needs. It can serve as the standards-based archive in a variety of situations from a new DICOM PACS to an existing Agfa HealthCare or multi-vendor operation. It also can provide a repository for regional, state or national access to patient data. The system also offers the flexibility to function as a primary, long-term or disaster recovery archive for an existing DICOM PACS or a multi-facility DICOM PACS.

Agfa HealthCare takes a comprehensive approach to security by addressing both reliability and data sharing considerations. IMPAX Data Center eliminates the single point of failure, shares data across multiple servers, divides processing tasks among all available servers and integrates with Oracle RAC for automated database failover. Detailed audit trails facilitate data sharing between various entities, and access rights can be configured at the individual study level.

Conclusion

Healthcare is in a state of evolution. The need for an EMR is clear. An EMR addresses data fragmentation to enhance and accelerate patient care. At the same time, the EMR in and of itself is not a complete solution. It requires a solid framework to connect disparate systems and data. To be effective and efficient for end-users, the framework must translate data from disparate sources and provide a common language and user interface across the enterprise.

Agfa HealthCare Clinical Data Center provides a model for the next-generation data center. It transcends storage to offer the critical building block for the EMR and improved, patient-centric care. More than 800 European installations have demonstrated the validity of Agfa HealthCare’s approach. Now, Agfa HealthCare aims to bring the model to North America to enable healthcare enterprises to fully realize the promise of the EMR and next-generation storage.

IHE at a Glance
Integrating the Healthcare Enterprise (IHE) is a multi-year, industry initiative designed to improve information sharing among healthcare information systems in a growing number of clinical departments. IHE encourages vendors to facilities interoperability and connectivity by adopting established standards such as HL7 and DICOM to streamline systems communication and seamlessly transfer data across the enterprise. IHE, radiology departments and healthcare enterprises share a common goal. That is, IHE is designed to improve service to patients and referring physicians while boosting efficiency and workflow.

To realize the benefits of IHE, facilities need to determine vendor compliance with IHE. HIMSS attendees can observe IHE in action at the Interoperability Showcase as they create an electronic health record (EHR) and track it through patient care episodes.

Agfa HealthCare Clinical Data Center, for example, serves as the foundation for smooth transactions across multiple, disparate hospital systems including the HIS, ADT and clinical care applications, PACS, imaging reporting and modality systems, EMR viewers and other third-party applications.

Beyond IHE demonstrations, healthcare enterprises should ask vendors several key questions. Be sure to determine which IHE Actors a product provides and which Integration Profiles it supports. IHE Actors consist of information systems or applications, and Integration Profiles describe clinical functions and workflows. Equally important, facilities should determine if and how the product was tested at the IHE Connectathon — an annual event that occurs in January in Chicago and that this year brought together 77 vendors, breaking down into 350 testers and 150 applications. Finally, buyers should assess vendor support for IHE transactions and use IHE Integration Profiles when writing RFPs and purchasing specifications.

The end results warrant the investment and include improved data accuracy across the enterprise, greater access to information, reduced study loss, reduced data entry, fewer imaging retakes, increased patient throughput and increased flexibility with component acquisitions.

Southern Ohio Medical Center: Synergy for Success
Southern Ohio Medical Center (SOMC) of Portsmouth, Ohio, is poised for the future and looks to become the leading medical center in the region. SOMC includes a 232-bed primary-care hospital, five satellite centers, an urgent care center, 70-bed long-term care facility, 40-bed transitional care unit and a 106-apartment retirement center. Aggressive growth plans include an additional 100 beds and new cardiac wing.

The healthcare system relies on a number of vendors to support its ambitious goal and facilitate superior patient care while reducing costs. For nearly eight years, an alliance among SOMC, Agfa HealthCare and EMC Corp. has improved and accelerated patient care. A combination of the Agfa IMPAX PACS, EMC CLARiiON storage area network (SAN), Symmetrix DMX Series SAN and Centera content-addressed storage (CAS) archive deliver access to images and enhance collaboration among caregivers. CLARiiON CX optimizes performance and scalability, while Symmetrix DMX meets the most demanding SLA requirements. Centera active archiving components protect secure and rapid recall of historical images and patient information.

“We’re very pleased with the interplay of the technologies and the way Agfa and EMC work together,” reports RIS/PACS Administrator Howard Stewart. For example, when the medical center was ready to expand the archive, both companies sent sales and support experts to onsite meetings. “Both companies are open and flexible,” continues Stewart. “Instead of pushing a fixed configuration, they modified their offerings to meet our needs.”

At SOMC, the modification entailed transitioning from a small local RAID (redundant array of inexpensive or independent disks) and MOD (magneto-optical disk) drives to an EMC infrastructure with Symmetrix SAN and Centera archive and most recently to a CLARiiON SAN and Centera archive. SOMC realized migrating to a higher reliability EMC RAID environment would provide the capacity to accommodate rapid growth and deliver virtually instantaneous record retrieval. EMC Centera delivers content-addressed storage for redundancy and HIPPA compliance.

The IMPAX/EMC solution is complemented by EMC ControlCenter software for streamlined administration and EMC PowerPath software for redundant pathways and load-balancing. 

The digital solutions have delivered significant cost-savings while providing key imaging data to physicians, says Stewart. In addition, the synergistic technologies serve as the platform for an enterprise-wide EMR initiative that allows the center to avoid the cost of a separate EMR solution.

“We’re 50 percent of the way to the EMR. The archive is deployed, and we’ve migrated document imaging and medical records to the EMC solution,” states Stewart. In addition, the system is prepped to handle upcoming phases of the PACS deployment  — cardiac cath lab and pathology image archiving.

The combination of an EMC intelligent information infrastructure, Agfa HealthCare digital image management and both companies’ commitment to successful solutions engineered to meet the unique needs of the customer have made it possible for SOMC to deploy a cost-effective and robust solution that can carry the medical center into the future.