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The Anatomy of a VNA Done Right: The Case for Silo BustingMichael GrayPrincipalGray Consulting

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Most US Healthcare Organizations have heterogeneous mix of PACS, each with dedicated archives.

Problems include…- Rising costs associated with data center, staffing, disparate storage

solutions- Double-digit growth in data volume is outpacing limited Lifecycle

Management capabilities- Outdated Disaster Recovery (DR) solutions- No Purge Mechanism- No Business Continuity (BC) solution- PACS create proprietary data necessitating data migrations

Background

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Vendor Neutral Archive is a More Efficient Way to Manage Enterprise Image Data

- VNA effectively becomes the image data repository for EMR- UniViewer becomes the Physician’s single-session Portal Viewer- Interoperability and Image Sharing both inside and outside the

enterprise is assured- Mirrored, dual-sited VNA provides robust DR and BC solution

Background

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VNA Architecture

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Rationale Favoring VNA

1. Consolidates data management operations

2. Assures Interoperability and Data Exchange between departmental PACS

3. Enables Data Sharing with external organizations

4. Delivers sophisticated ILM and Data Purge tools

5. Enables assembly of the Patient’s complete longitudinal Medical Record

6. Transfers ownership of the data to the organization, ending vendor lock-in

7. Total Cost of Ownership models favor the VNA, IF costs of future data migrations are recognized

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Once it is decided that the VNA is the correct strategy, the next task

is determining the best…most optimal Deployment Strategy.

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Major Considerations

Architecture

Mirrored, Dual-sited Configuration

• Two instances of all applications support Business Continuity

Virtualization

Application Servers and Storage

Storage

Open, Robust, “Smart”

IT Resources

Self manage or SaaS?

Financial

Capitalize or Operationalize?

Ratio

Of on-premise to off-premise to affect data center and staffing cost

Vendor

Reputation and Experience

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System Management Considerations

…at the same time, IT is being asked to do more with less

Specialized Expertise and New FTEs are Required

Administering Tag Mapping Library

Creating / Managing Retention Policy

Monitoring Security Program

Monitoring Multiple System Monitoring Programs

Monitoring Storage Consumption / Purchasing

Help Desk

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Complexities

Selecting a True VNA

Bi-directional dynamic tag mapping engine

Tag mapping library (logic) built from field experience

Sophisticated ILM including Data Purge

Pre-fetch and auto-routing

Reconciliation of multiple MRN

Methodology to ingest non-DICOM and non-Image data with reasonable workflow

Remote Access…authorized user access from off-campus locations

Image Sharing…authorized access by remote physicians and organizations

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Cloud Infrastructure

Vendor hosts server and storage power in off-premise Infrastructure shared by multiple organizations (Public Cloud)

- Individual organization databases are compartmentalized

Vendor supplies some or all system support resources for the configuration

Storage space is dynamically adjusted, and user pays for use of the storage according to actual use

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Once it is decided that the Cloud might play a beneficial role in a VNA, the next task is determining the best,most optimal Deployment Strategy.

What is the mix between on-premise and off-premise infrastructure?

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Technology Considerations

On-premise vs. off-premise is driven primarily by PerformanceRequired access times for new and historical image data by the Radiologists and referring Physicians

Because of DICOM protocol and need to transfer lossless pixel data, Performance for the [1] PACS and [2] PACS user requires ProximityVNA/Storage requires proximity to the PACS

PACS or VNA requires proximity to the Display Station

Proximity requirement forces departmental PACS to remain on-premise

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Technology Considerations

UniViewer Servers require Proximity to VNA Servers and Storage Solution for Performance…

The display users do not require Proximity to the data center for Performance…

- Rendering Servers, VNA, and Storage Solutions can be co-located anywhere…both on-premise and off-premise options

- Portal users have nearly equal performance experience whether they are accessing the on-premise or off-premise VNA database

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Recommendations

Deploy a True VNA

Beware of fakes

Deploy a Mirrored Configuration

Duplication of all the applications except Test Server

Deploy all of the Primary Data On-Premise

Guarantees PACS and PACS user performance

Explore all of the Options that Allow Storage of the Secondary Data Off-Premise

Eliminates need to build/manage second data center and the Secondary VNA infrastructure

Consider Experienced Vendors that Offer a Hybrid VNA

Secondary VNA subsystem is in the Cloud and some or all of the VNA application is a Software as a Service solution

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Hybrid VNA Architecture

As Shown: One of several possible configuration options

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Recommendations

Additional Issues to Investigate

Virtualized Server Infrastructure and “Smart” Storage Solution

HIPAA & HITECH Compliance, Best Practices

True Disaster Recovery- Geographic Separation- Meets Recovery Time Objectives, Recovery Point Objectives

VNA and its Infrastructure Provided as a SaaS Solution

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Arguments for the Hybrid VNA and SaaS solution

Significantly lower Total Cost of Ownership

Substantial reduction in complexity

- Only half the system is on-premise- Management and support provided by vendor

Easier to deploy…no second data center

Better DR and BC solutions

Organization has access to advanced professional services required to manage and support a VNA

Improved IT resource allocation

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Financial Considerations

On-premise, self-managed VNA can have a lower TCO than Heterogeneous PACS, IF

- Current costs associated with data center and IT staffing are accounted for in the model

- The PACS are spinning data copy 1, and copy 2 is at least in near-line library

Even if the VNA spins both copies, consolidation of all data in new storage solutions has lower TCO than disparate PACS storage solutions

- Incremental costs are: VNA/UniViewer software licenses, infrastructure hardware, professional services, maintenance

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Financial Considerations

Incremental Costs are Mitigated by Savings

- Storage Consolidation…reduced hardware costs- Older PACS storage can be decommissioned reducing numerous data

center costs- Data Purge reduces VNA storage requirement- Cost of Future Replacement PACS will be less, due to elimination of

Data Management and Enterprise Distribution responsibilities- Cost of future data migrations avoided

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Financial Considerations

Hybrid VNA (VNA Secondary subsystem in the Cloud) can Have 30% Lower TCO than On-Premise, Self-Managed VNA

- Costs associated with the second data center are avoided- Storage delivered on an “as needed” basis- Capital Expenses of Secondary subsystem converted to Operational

expenses- Automation of back-up and System Management reduces support costs- Software and Hardware upgrades spread over multiple users of multi-

tenant infrastructure

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Third-party Model and Methodology provided through Iron Mountain

Cost Models

Comprehensive TCO Model Compares

On-Premise, Self-Managed VNA with Hybrid VNA

Model# Major Facilities(Hospitals)

AnnualProcedures

Ave. Study Size (MB)

Annual Growth

Historicals (TB) (uncompressed)

A 1 (Community) 200,000 100 4% 82

B 2 (Community) 188,244 82 3% 73

C 1 (University) 163,010 100 3% 81

D 2 (Community) 556,595 78 4% 189

E 18 (Ambulatory) 295,842 68 1% 55

Five Organization profiles were created for this exercise

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Cost Models

VNA (on-premise, self managed) Year 1 Year 2 Year 3 Year 4 Year 5Storage Hardware Expansion (Years 2-5) $0 $61,440 $61,440 $61,440 $61,440

Storage Hardware Initial Purchase (Year 1) $307,200 $0 $0 $0 $0

Storage Hardware & Software Maintenance Contracts (Years 1-3 Included)

$0 $0 $0 $73,858 $82,831

Storage Power and Cooling Costs $12,587 $14,993 $17,398 $19,804 $22,210

Storage Data Center Facilities $12,426 $14,801 $17,176 $19,551 $21,926

Storage Administration $21,152 $25,196 $29,239 $33,282 $37,326

Annual VNA Software License Fees $34,500 $35,880 $37,315 $38,808 $40,360

Software UniViewer, General Software, & Test System

$131,100 $0 $0 $0 $0

Server Hardware and Infrastructure $306,538 $0 $0 $0 $0

Data Migration Fees (Report & Study) $258,300 $0 $0 $0 $0

Implementation Costs (Hardware, HL-7, DICOM, UniViewer, PM & Training)

$299,406 $0 $0 $0 $0

Hardware Maintenance VNA & UniViewer $55,177 $55,177 $55,177 $55,177 $55,177

VNA Software Maintenance $0 $24,996 $24,996 $24,996 $24,996

UniViewer Software Maintenance $0 $13,600 $13,600 $13,600 $13,600

Totals $1,438,386 $246,083 $256,341 $340,516 $359,866

Profile A - 5 year TCO for Capital VNA (on-premise, self-managed)

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Cost Models

Hybrid VNA Initial Year 1 Year 2 Year 3 Year 4 Year 5Total Storage cost $0 $84,130 $140,756 $161,734 $182,318 $202,525Storage Power and Cooling Costs $0 $6,294 $7,497 $8,699 $9,902 $11,105

Storage Data Center Facilities $0 $6,213 $7,401 $8,588 $9,776 $10,963

Total VNA cost $0 $67,572 $67,572 $67,572 $67,572 $67,572

Gateway Rental fee $0 $5,100 $5,100 $5,100 $5,100 $5,100

Onboarding costs $0 $6,684 $6,684 $6,684 $6,684 $6,684

Migration costs $0 $2,412 $2,412 $2,412 $2,412 $2,412

UniViewer license & Hardware $0 $200,331 $0 $0 $0 $0

UniViewer Implementation $0 $114,752 $0 $0 $0 $0

UniViewer Maintenance License & Hardware $0 $12,462 $26,062 $26,062 $26,062 $26,062

Totals: $0 $505,950 $263,483 $286,851 $309,826 $332,423

Profile A - 5 year TCO for Hybrid VNA

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Third-party Model and Methodology provided through Iron Mountain

Cost Models

Profile # Major Facilities (Hospitals)

Capital VNA Hybrid VNA Savings % Change

A 1 (Community) $2,641,192 $1,698,532 $942,660 36%

B 2 (Community) $2,542,475 $1,774,422 $768,054 30%

C 1 (University) $2,663,262 $1,918,597 $744,665 28%

D 2 (Community) $5,300,505 $3,458,356 $1,842,149 35%

E 18 (Ambulatory) $2,860,199 $1,957,844 $902,356 32%

Comparisons - 5 year TCO for Capital VNA and Hybrid VNA

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Conclusions

Strong Technical and Business arguments

Favor deployment of a VNA over the current Heterogeneous PACS environment

TCO for the VNA

Compare favorably with TCO for Heterogeneous PACS-If organization has deployed a responsible DR solution for its PACS-If all operating costs are accounted for in the model-If costs of future data migrations avoided are recognized

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Conclusions

Key technologies make it possible to move entire Secondary subsystem into the Cloud

- Smart Storage Solutions- UniViewer based on Zero Client, Server Side-rendering Display

application

Recommendation is to deploy a Hybrid VNA, especially if IT resources are thin and organization does not already have a second data center

Hybrid VNA can save 30%+ in TCO over on-premise, self-managed VNA

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Conclusions

Reminders

- Select a True VNA with a mirrored, dual-sited configuration

- Select the right partner/vendor, one that - Can demonstrate HIPAA and

HITECH conformant Security and Data Protection,

- Has both presence and experience in the Medical Imaging world.

- A believable Cost Model is only as good as the accuracy of the numbers…seek help

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Iron Mountain

• Iron Mountain remains a technology services company

• Autonomy has acquired our digital business

• Iron Mountain has entered into an agreement with Autonomy to resell certain data backup and archiving solutions just acquired by Autonomy

• Iron Mountain Digital Record Center® for Medical Images was not affected by the divestiture of our digital business

 

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An Information Management Company

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More Information

Visit: www.ironmountain.com/VNA

Call: 866-922-7226

Iron Mountain VNA Solutions and TCO Model