Kasier

1
Digital PathologyHow 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
2
Agenda

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

3
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
Health Care Today
1st Generation Diagnosis
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
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 Demand supporting Clinical Centers
  of Excellence
• High Availability Data Integrity
• No scheduled downtimes
• Automated data migration for hardware upgrades

8
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

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
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
Introduction Why Grid Storage System?
After Grid
Before 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 has unique 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
Aggregation Interoperability
e.g. AcuoMed, Teramedica Evercore
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 Thompsons own
words http//in.youtube.com/watch?vp3k17RAs2OM
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 Childrens Hospital of Philadelphia
19
IBM Medical GRID Archive for Digital Pathology

• 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 Childrens 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