Hu's Blog

I recently participated in a briefing for a health care provider with Dave Wilson who works with our partners in the Health and Life Sciences Industry Solutions group. While I was there to present our products and roadmaps, Dave made some very good points about the challenges for health care providers and helped to put our products in perspective. I thought I would capture his thoughts in an interview for my blog.

What is the state of the medical environment today when it comes to applications?

Most facilities today have hundreds of applications, and many of these are departmentally driven – each department decides what they will buy. As such, despite departments claiming to be hardware agnostic, each department has their “preferred” vendor and what results is a plethora of vendor silos of applications and archives. Many of these applications generate data in different formats that prevent physicians from other departments from being able to access the data. The end result is that hospitals have years of unused storage sitting idle while the data they generate lacks interoperability – the inability to share the data with other applications. This makes them perfect candidates for storage virtualization and Hitachi Clinical Repository customers.

What is “Meaningful Use” and what impact does it have on providers and their reimbursement?

Meaningful use is essentially meant to help providers adopt technologies that will improve patient outcomes. Part of this means that providers will need to be able to share data with physicians so that accurate and timely treatment can be administered to patients. The challenge is interoperability – many of the applications generating data do so in different formats making it very difficult to share the data. For example, medical imaging uses DICOM but other systems such as the Electronic Medical Record (EMR) require a DICOM viewer to be integrated in order to see these images. When you consider how many applications behave in this way the costs of integration will be enormous, and without this capability providers will not be able to take advantage of the reimbursement funds available.

If hospitals recognize the need to share data and “Meaningful Use” provides the incentive, an integrated Electronic Health Record (EHR) would seem to make sense. Is this something providers are embracing?

Absolutely. Providers are moving forward by integrating their systems together in order to be able to share the data across the enterprise. Many of these facilities have embarked on a long road, integrating their applications into their EMR vendor’s system. This will get the result they need, but at a huge cost. Think about what integrating to a database requires – adding rows and columns and tables to the database and then adapting the viewing application to be able to read these new entries. Then the source applications need to route their results to the database in a timely manner so that the source application and the EMR are in sync. This is a costly and time-consuming exercise.

What barriers do you see providers facing with respect to getting a fully integrated EHR?

Aside from what I just mentioned, providers are faced with the ongoing costs of managing these point-to-point integrations. When one application changes its database it could require weeks of testing and validation. Additionally, many small departments that have niche applications (maybe even home-grown) will not be integrated because of the cost. The end result is an incomplete EHR, which then starts to affect adoption. If the EHR does not have the complete patient longitudinal record then physicians will not utilize the application as it is missing data. They are back to having to go to multiple systems in order to find out the true patient condition. Think about how you would feel if you had to go to multiple web sites to find out how much money you had in the bank? Physicians face that very problem every day.

It sounds like there is an argument for a single vendor to do all the integration and standardize all the data into their format? This would solve the integration problem wouldn’t it?

You would think so but this would be short-term thinking for a few reasons. First, no one vendor does everything well so to deny them a “best of breed” approach not only denies the physicians but may actually impact patient care. Secondly, as we move towards Health Information Exchanges (HIE) we will need to be open architecture and open standards-based. Being tied to one vendor may solve the local problem but the regional problem will grow in magnitude. Third, with small departments that don’t see many patients each year it becomes a cost driven decision whether to integrate or not. As I mentioned before, anything short of the complete patient record is doing an injustice to physicians and patients. Simplifying the integration of these departments into the EHR would be a better answer.

Tell me about the Vendor Neutral Archive (VNA) movement? How is that playing a role in healthcare?

VNAs are the next step in the evolution of Picture Archiving and Communications (PACS). Over time providers have found that their PACS are proprietary in nature and that there are huge challenges in sharing the data and in migrating away from their current provider. Because data is stored in a proprietary format, it becomes very difficult for other vendors to query and retrieve the data from a third party. It also becomes a way for facilities to consolidate their imaging data and share the resources of a single storage device. This is attractive as it drives cost savings but is somewhat short sighted because in reality a VNA is simply a larger silo. Organizations should consider how to leverage the sharing of resources into sharing of information and sharing of workflow – the ultimate driver for healthcare. Providers need to consider how they can provide information of the entire patient longitudinal record to the physicians and caregivers. The challenge we have seen around the world is that investments have been very discipline focused and yet patients are treated in a patient-centric way, which conflicts with how we have become organized.

Let me explain this better. Today, investment has been into large medical imaging repositories, laboratory information systems and other “silos” of data warehouses. Consolidating all the medical images I have had over the years is important but irrelevant to my treatment should I go to an emergency room with chest pains. The ER doc needs to see my chest x-ray, blood work and EKG in a single view. What we have are 3 different silos where my data resides. An EHR is intended to pull all this data together, but interoperability of this data is lacking. Add to that the fact that my chest x-ray is combined with my head MRI and ankle x-ray, and now we have information overload for the physician trying to treat my chest pains.

How does Hitachi Data Systems propose to deal with this issue? Is there a solution?

Hitachi Clinical Repository (HCR) provides some of the answers to this issue. Hitachi Data Systems can provide the infrastructure that will enable the ingesting of multiple data formats that come from different application sources into a single metadata repository. This enables facilities to begin sharing resources through the consolidation and aggregation of data. HCR then indexes the metadata associated with these objects and enables interoperability by creating XML metadata files associated with the patient data. This enables the sharing of information between different applications as the data can be rendered from the XML file. HCR then provides access to the information in such a way that the information can be shared with other applications and users, consolidating the patient record and providing a physician a complete view of the entire patient record. This in turn, enables the workflow to also be shared between physicians, facilities and regions. It’s about ingesting, indexing and accessing the data to provide a longitudinal view of the patient record.

HCR can then be expanded into EHR, portal and analytical applications, as the data is now easily accessible. Analytics in particular are a key benefit to HCR as facilities can leverage HCR to access financial, clinical and operational data all at once, thus driving answers to previously undeterminable questions. And remember, we’ve only really talked about how the provider space has been impacted. The life sciences and pharmaceutical companies have the same issue on a grand scale and HCR can help in these situations as well.

Dave, thanks for explaining the challenges that our healthcare providers face and how important it is to be able to share data across different applications to provide better patient outcomes. Since application vendors do not provide solutions that use standard configurations and standard formats, virtualization becomes key to solving the VNA problem. While storage and server virtualization can mask the differences in infrastructure, we need to virtualize the data in order to share it across different applications. Your explanation of how HCR provides this ability to share healthcare information is very helpful.

Dave is also a frequent blogger for HDS. You will be interested in his post on how the ability to correlate data that is seemingly unrelated led to a very successful pharmaceutical product.

About Dave Wilson:

Dave Wilson has been in healthcare his entire career, seeing things from the front lines and working through the different aspects of the system. Today, Dave heads up the Health & Life Sciences business development strategy at HDS. Previously, as a technologist in nuclear medicine and magnetic resonance imaging, Dave experienced the demands on healthcare professionals first hand. Learning from this experience Dave moved to the vendor side of the industry in product management, marketing, and sales and service. Before coming to HDS, Dave served as vice president, Agfa Canada, responsible for sales and service focused mainly on the radiology business. Dave’s travels have taken him all over the world to experience healthcare on a global scale, bringing a wealth of knowledge to the Storage STAT blog.