Waterloo Think Tank - EMC

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					    Patient Information
  Lifecycle Management:
Healthcare Data Storage Strategies

   Waterloo Health Informatics Think Tank

                February 4, 2004




                                            1
Topics of Discussion

l   Canadian Healthcare Challenges
l   What is Patient Information Lifecycle Management?
l   The Evolution of Patient Information Storage
l   Current Options
l   Today’s Online Information Needs
l   CAS: Next Generation Storage Architecture
l   What is Content Address Storage?
l   Centera Success Stories


                                                        2
Healthcare Organizational Challenges
                          Cost
                     Providing Quality
                      Patient Care at
                       Lowest Cost           Recovery
 Patient Care                                Legislation
   Quality                               Mandates Focus on
 eHealth to Reduce                       Business Continuity
  Medical Errors



                                            Faster Access
                                            speeds treatment
                                               decisions

    Growth                                  Increased
   Explosion of                            Compliance
  EPR and PACS                              Secure, Online
   Information                           Access to Information
                                                                 3
                                                                                                          2003


  Patient Information Growth Projections
  More Over the Next Year Than the Previous 40,000 Combined
                                                                        Digital Radiology




                                                                                                             P e t a b y t e s
                                          Enterprise Business Applications

   40,000 BCE                                         Electronic Medical Record
cave paintings
    bone tools     3500
                 writing
                            0 C.E.                                     Digital Cardiology
                       paper 105
                                             1450
                                          printing
                                                        1870
                                     electricity, telephone
                                                       transistor 1947
                                                      computing 1950
                                                                  Late 1960s
                                                                     Internet       1993
                                                                                The Web
                                                                                            1999
    Digital Radiograph                                                                             2003
        10 MB each
  Source: UC Berkeley, School of Information Management and Systems.

                                                                                                                                 4
Netwo               Traditional Departmental Approach
rk
                IBM3090-
                                                      TM
                                                            IBM RS/6000,
                                                                TM




                                Sun Enterprise              SP2                              HP 3000,
Server/O        600J            Sun                         AIX 4.1, 4.2,                    K460
                MVS/ESA
                                                           TM        TM




S                               ULTRASPARC                  4.3                              HP-UX 10,
                IMS / IBM       Solaris 3.2, 3.4,           DB2/6000                         11.0, 11.2,
Databas         ADABAS AS/400   3.5               Fujitsu                                    MPE
                                                                        Compaq Proliant
e                      OS/400   Oracle 7.5, 8.0   DS90                  2500                 Sybase 11.9,
Applicati     CIC                                 UX P/M                Proliant 5500        12
              S      Batc        CAD/C              Invento             NT 3.5, 4.0                  HR
on                                                            Financi               Lotu
                     h           AM        E-       ry                    Excha
                                                              als                   s
                        OLT                commerc                        nge       Not
Stora                                      e                                        es
                        P
ge
                                                                                                   DK
                          STK                       Legato to                                      tape
            Backup by     Silos Backup              DLT                            Cheye
Back                                                                      ADSM               OmniBa
            FDR                 by                                                 nne to
up          Upstream            tar -                                     to       4mm       ck
                                8mm                                       3490s

  Archiv                         Optical      LTO Tape DASD        Paper
                   Mainframe     Platters
  e                                           Silo
                   OAM Tape Before Standardization: Multiple Functions and
                                                                   Files
                                            Technologies

   Proacti                       Reactive                                         Cyclic Process
     ve
                                                                                                            5
Evolution of Patient Information Storage

                                                                           Patient
                                                                        Information
                                                                          Lifecycle
                                                    Automated           Management
                                                    Networked
                                                     Storage
                                Networked           3rd Wave
                                 Storage            HIPAA
                                 2nd Wave           Expanding digital content
             Enterprise          Managed care       Enterprise systems
              Storage            and risk-sharing   eHealth access to care information
                                 Consolidation/
Department                       M&A
                                 EPR and PACS
 Storage     1st Wave
             Paper records and films
             Stand-alone hospitals
             Departmental systems


                                                                                         6
Patient Information Lifecycle Management Vision

                           Archive
                                     Migrate
                     Protect           Protect

                                      Archive
                    Archive
Patient admitted          Access            Migrate   Patient discharged
                      Access         Protect
                       Migrate
                                Access




       Managing critical information throughout
        a patient’s life at the lowest total cost

                                                                           7
Value of Patient Information Changes throughout
Its Lifecycle
One Patient Episode: Data Stored for 7- 21 Years According to
Healthcare Regulations



            Admittance -     Diagnostic
            EPR created         tests
                                                      Consultations
                                                                           TIME
 VALUE
                                                                      Patient data
                                          Diagnoses                     stored




                           Protect             Migrate                    Dispose
           Create                     Access                Archive



                                                                                     8
Patient Information Lifecycle Management
Implementation
                     EPR   PACS      CIS      HIS   E-Mail

Improved Clinical
   Utilization

   Simplified
  Management
  Cost-effective       An Enterprise Approach
Continuity Options    Integrates all Clinical and
 Non-disruptive         Business Applications
  Compliance
Optimal Service
Levels at Lowest
      TCO




                                                             9
Information Management
Deployment of the Right Solution at the Right Time for the
Right Information Based on Policies
Business Process                               Time
                                               Time
     Create           Protect         Access     Migrate   Archive       Dispose

Business Requirements                          Value
Data value         High                                        Low

Data type          Transactional                               Archive
 Availability      24x7                                        Infrequent
 Recovery          Immediate                                   Days +
 Security          Distribution profile                        Access rights
 Cost              High                                        Low
Compliance         Retention                                   Retrieval

Flexibility        High                                        Low

                                                                                   10
   Healthcare Organization’s Options
  Enabling the Right Service Level at the Right Cost




                         Automated Management




      High End                                 Mid-Tier      “ATA”
      SAN/NAS                                 SAN/NAS         SAN    Silos   Vaults

Approximate industry average acquisition cost per megabyte
                                                                                      11
 EMC’s Networked Storage Platforms
 Scalable, Best-of-Breed Platforms
              Celerra   Celerra
        CX600 NS600      CNS      Centera DMX800 DMX1000 DMX2000   DMX3000



CX200




CX400

 <$10K                     NetWin                                            >$3M
        “Consolidation with DMX has helped us reduce storage costs
         by almost 80%.”
           — EarthLink
        “Centera and CLARiiON are the foundation for our business
         continuity strategy.”
           — Rogers Medical
                                                                                    12
                                    SAN,                     NAS,                  CAS
                                               Application Data Usage
                      High             Moderate                                                      Low
                   Update Rates      Update Rates                                               Update Rates
               ex. TRANSACTIONAL ex. COLLABORATIVE                                              ex. ARCHIVAL

                          SAN                                  NAS          y
                                                                                                     CAS            e
                                        or
                                          s                              wa AS                                    nc
                                      ct                              ate + N                                 pli
                                                                                                                 a
               COST




                                                   COST




                                                                                        COST
                                    re                               G N
                                  Di                                                                    nt Co
                                                                                                             m
                                                                 ted SA                               ge
                         tche
                             s                                gra                                telli ive
                      Swi                                 Inte NAS                             In ch
Networked                                                                                        Ar
                      Fibre Channel Based                      IP Based                           Fixed Content
Access                    SERVICE LEVEL                       SERVICE LEVEL                        SERVICE LEVEL

               For transferring data between     For file sharing and economical     For fast access and assured
Purpose        servers and storage devices       data base connectivity              authenticity of fixed content

Economic       Leverage management cost of a     Lowest cost to connect and share
                                                                                     Best TCO/ROI
Advantage      storage infrastructure            files
Typical                                          Software development, product       E-mail archiving, Content
               OLTP, data warehousing, ERP,
               large databases                   design and development, small       Management, Database Archiving,
applications                                     databases, workgroup applications   Medical Imaging


                         Choosing the Right Solution                                                                    13
  Evolution of Application and Storage Platforms


                   OLTP,           DSS,    Document Mgmt,
APPLICATION   Data Warehousing    E-mail     Repository

              Application   Application     Application
    SERVER       Locator         Locator
               Filesystem


                BLOCK             FILE        OBJECT
                                               CAS
  STORAGE                        NAS           Locator
                 SAN         Filesystem      Filesystem
                  Block         Block           Block



                                                            14
            Introducing EMC Centera™

The world’s first Content Addressable Storage platform

                                      Simple

                                     Scalable

                                      Secure



                                  Disk Based Content Archiving
                                      and Retrieval Solution


                                                                 15
Content Addressing - The Centera Building Block
               10111011
                                  Content
                 10001010         Address
                                 Calculation


Content addresses are 128-bit digital fingerprints. - 4PJGVL39UEK7ReDN9JM0A2HR3U6

l Assured Content Integrity
    – Unique “fingerprint” is generated from the content itself
    – Constantly validates integrity of data objects and structure
l Location independence
    – Address is globally unique
       • Not a place in a hierarchy (file system)
       • Not a place in a disk array (logical volume)
l Duplicate elimination 10001010
    – Identical addresses means identical objects
       • Stored only once (plus mirrors and replicas)
                                                                                    16
How Centera Works
                                                                         Centera
                             Application       Object is sent
                               Server          to Centera via
                                             Centera API over IP




                                              Content Address
                                           returned to application

                                                                         Centera
                                                                     generates unique
 Object is created or
                                                                     Content Address
used by an application




                         Content Address is
                         retained for future
                              reference

                                                                                        17
EMC Centera
Purpose-Built Magnetic Disk Records Storage to Overcome
Current Media Limitations and Facilitate Records Retention
Compliance

 ü Non-Rewriteable, Non-Erasable

 ü Record-level Retention, Protection and
    Disposition
 ü Assured Content Integrity and Availability

 ü Seamless Content Migration

 ü Record-level Auditability
 ü Faster Record Retrieval

 ü Superior TCO

                                                             18
Centera: for Long-term Archiving
l Stores any kind of content: content cannot be
    updated once stored—non-repudiation
l   Rich metadata is stored: content can be
    “annotated”
l   Easy to deploy: just add repository IP addresses
l   No filesystem or LUNs: easy to manage
l   Continuous object availability: objects are
    mirrored—no single point of failure
l   Low maintenance: non-disruptive self-healing
l   Off-the-shelf: best-of-breed standard
    architecture
l   Scalable: easy to add capacity non-disruptively
l   Performance: internet response time




                                                       19
Centera Advantages

l   Simple management                         (With Centera, your applications no longer
    have to understand and manage the physical location of stored information. Instead,
    Centera creates a unique identifier that applications can use for retrieval)

l   Fast, location-independent access                                  (Centera gives
    you fast, shared, networked access to fixed content at Internet speed. And, access is
    location-independent, greatly simplifying application development and deployment)

l   Assured authenticity, efficient replication
    (Because Centera gives each stored object a unique address, integrity and
    authenticity are assured. Only one copy and one replica of each object is stored, no
    matter how many times the object is used)

l   Scalability without reconfiguration                                   (Centera's
    architecture is based on redundant arrays of independent nodes (RAIN), making it
    highly scalable to hold petabytes of content. To add capacity, just plug in another
    node. Centera auto-discovers and configures the new capacity as it is installed)




                                                                                            20
More Centera Advantages

l   Self-healing             (Centera continuously monitors to detect and repair soft
    errors. It also automatically reconfigures itself and replicates objects as necessary,
    in the event of hardware failures such as disks or nodes. These incidents are
    automatically reported through EMC's remote monitoring system)


l   Business continuity protection                               (All information objects
    are synchronously mirrored within a local Centera cluster to support automatic
    recovery from component failures. Centera can also be configured to maintain
    duplicate copies of fixed content at a remote site to guard against site disaster)

l   Easy installation and non-disruptive
    upgrades (Centera systems can be installed or upgraded in less than an
    hour, without disrupting content access. Centera's software operating environment,
    CentraStar, can also be upgraded non-disruptively as new versions are released)

l   Future-proof architecture                         (Long-term data often outlives the
    technology on which it is stored. Because Centera is designed to accommodate new
    technology without costly and disruptive conversion or migration, it eliminates this
    problem)


                                                                                             21
Key Centera Innovations

            l   Content addressing
                 – Content authenticity
            l   RAIN implementation
                 – Scalability and manageability
            l   Distributed content
                 – Business continuity
            l   Compliance Edition module
                 – Enables regulatory compliance




                                                   22
EMC PACS Solution
Improving Physician Workflow: After EMC

                                           Images
                   Acquisition Station    acquired   Short-Term Online
                    • Procedure Room         and     Image Cache
                                           moved      • Most recent studies
                                                        accessible in
                                                        milliseconds




                   Image Review and                  Long-Term Online
                   Analysis on Multiple              Image Archive
                   Workstations                       • Entire patient
                    • Viewing room                      history accessible
                                                        in seconds
                    • Onsite office
                    • Surgical suite
                    • Offsite




                                                                              23
      The Next Generation:
      Centera Enterprise Archive Platform
                                       TM




                   Sun Enterprise
                                                   TM

                                                                             Compaq Proliant
                   Sun                                                       2500
    IBM3090-       ULTRASPARC               Fujitsu
                                              TM        TM
                                                                             Proliant 5500
    600J           Solaris 3.2, 3.4,        DS90                             NT 3.5, 4.0
    MVS/ESA        3.5                                       IBM RS/6000,
    IMS / IBM                               UX P/M
    ADABAS         Oracle 7.5, 8.0                           SP2
          AS/400                                             AIX 4.1, 4.2,
          OS/400                                             4.3                               HP 3000,
                                                             DB2/6000                          K460
                                                                                               HP-UX 10,
Mainframe Tape Emulation,                                                                      11.0, 11.2,
SAP, Peoplesoft, Oracle,                                             IP Based                  MPE
                                                                                               Sybase 11.9,
Microsoft Exchange, Lotus                                            Archiving                 12
                                                                     Platform
Notes, Medical Images,
Documentum, Filenet,
Hummingbird, OpenText,
Audio Archiving, Mobius,
ImagePlus, TVS, IBM Content
Manager, Homegrown Apps                                                 Cyclic          1:400 TB
all on one platform                                                    Process

           After: Enterprise Archive Standardization
                                                                                                              24
Partnering with Top Tier PACS Application
Providers
PACS Partners
 l Agfa
 l Algotec Systems
 l Amicas
 l DR Systems
 l Eastman Kodak Health Systems
 l Emageon
 l Fujifilm Medical
 l GE Medical Systems
 l Merge Technologies
 l McKesson Imaging Group
 l Philips Medical Systems
 l Siemens
                                            25
More than 90% of the World’s Largest Healthcare
Organizations Deploy EMC Infrastructure
EMC Customers Include:
l Partners Healthcare
l Yale-New Haven Hospital
l Columbia Presbyterian-Cornell Medical Center
l UCLA Medical Center
l Cleveland Clinic
l Children’s Hospital Boston
l University of Chicago Hospitals
l Stanford Medical Center
l Johns Hopkins Medical Center
l Memorial Sloan Kettering Cancer Center
                                                  26
Customer Quote on the Benefits of EMC Solutions



“Speed of data access is the key. What this means for
 the clinical management of the patient is that the
 referring physician is better able to make decisions
 earlier in the patient’s care. What this can do financially
 for the hospital is reduce the inpatient length of stay
 which translates to lower overall costs.”
   — Dr. Robert DeLaPaz, CIO and Clinical Director of PACS, New York
     Presbyterian Hospitals




                                                                       27
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