emc open systems architecture (osa) solution for healthcare · this white paper describes the emc®...

EMC Open Systems Architecture (OSA) Solution for Healthcare

Enabled by Enterprise Content Management

A Detailed Review

EMC Information Infrastructure Solutions

Abstract

This white paper describes the EMC® Open Systems Architecture (OSA) solution for Healthcare, which enables healthcare providers, particularly in Europe where national health services are the norm, to archive, manage, and share digital medical information while lowering management complexity and cost. The white paper explains how the main component of the OSA solution - EMC Documentum® - interacts to effectively address the IT challenges. This white paper covers EMC Open Systems Architecture and EMC Documentum.

October 2010


Enabled by Enterprise Content Management—A Detailed Review 2

Copyright © 2010 EMC Corporation. All rights reserved.

EMC believes the information in this publication is accurate as of its publication date. The information is subject to change without notice.

THE INFORMATION IN THIS PUBLICATION IS PROVIDED “AS IS.” EMC CORPORATION MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND WITH RESPECT TO THE INFORMATION IN THIS PUBLICATION, AND SPECIFICALLY DISCLAIMS IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

Use, copying, and distribution of any EMC software described in this publication requires an applicable software license.

For the most up-to-date listing of EMC product names, see EMC Corporation Trademarks on EMC.com

All other trademarks used herein are the property of their respective owners.

Part number: H7348

EMC Open Systems Architecture (OSA) Solution for Healthcare Enabled by Enterprise Content Management—A Detailed Review

3

Table of Contents

Executive summary ................................................................................................................. 5

Business case .................................................................................................................... 5

Solution overview ............................................................................................................... 5

Key results ......................................................................................................................... 6

Planned EMC OSA solution with Vblock Infrastructure Packages ..................................... 6

Introduction .............................................................................................................................. 7

Purpose .............................................................................................................................. 7

Scope ................................................................................................................................. 7

Audience ............................................................................................................................ 7

Terminology ....................................................................................................................... 8

EMC vision ............................................................................................................................. 10

Phase 1: Information digitalization ................................................................................... 11

Phase 2: Information sharing ........................................................................................... 11

Phase 3: Information management .................................................................................. 11

Overview of the EMC Open Systems Architecture Solution for Healthcare .................... 12

Pain points addressed by the EMC Open Systems Architecture Solution ........................... 13

EMC Documentum – EMC OSA solution’s core functionality .............................................. 15

Supporting healthcare organization standards .................................................................... 16

High-level architecture of the EMC Open Systems Architecture solution ............................ 18

Use cases ........................................................................................................................ 18

EMC Open Systems Architecture Solution - component description .............................. 19

Current EMC OSA solution (figure) .................................................................................. 19

Planned EMC OSA solution with Vblock Infrastructure Packages (figure) ...................... 20

Component 1: HealthCare Connector ................................................................................. 21

Component 2: Documentum XDS adapter .......................................................................... 23

Component 3: EMC Documentum ....................................................................................... 25

Content Server and repository modules ........................................................................... 25

Trusted Content Services ................................................................................................. 26

Retention Policy Services ................................................................................................ 26

Content Storage Services ................................................................................................ 31

Content Services for EMC Centera .................................................................................. 32

Migration policy ................................................................................................................ 35



Future component: Vblock Infrastructure Packages ............................................................ 37

Data Qualification Services for Healthcare ......................................................................... 38

Managing the medical information storage explosion with OSA ...................................... 39

Conclusion ............................................................................................................................. 41

Summary .......................................................................................................................... 41

Next steps ........................................................................................................................ 41

References ............................................................................................................................. 42

White papers .................................................................................................................... 42

Product documentation .................................................................................................... 42

Other documentation ........................................................................................................ 42

Other information ............................................................................................................. 42


5

Executive summary Business case Healthcare organizations are facing complex, new business challenges. CEOs of healthcare organizations have to adapt their organizations to the changing external environment.

Some of the key business issues that today’s CEOs have to solve are:

• Implementation of new legal and regulatory requirements

• Collaboration capabilities with external healthcare providers

At the same time, CEOs also have to act as chief internal designers of their healthcare organizations, focused on the continuous cost and quality improvement of the internal processes of their organizations.

IT managers need to translate these business strategies into new IT solutions to support the applicable regulatory requirements and the sharing of medical information with external healthcare providers. IT managers also need to consolidate and further simplify the existing internal IT processes while offering more flexibility for the deployment of new IT applications to increase productivity and quality of care.

Some of the key issues that IT managers have to solve in order to successfully support the business objectives of today’s healthcare organizations are:

• Cost constraints

• Explosion of digital data

• Lack of interoperability between medical applications

• Lack of capacity to implement complex compliancy rules

• Painful migrations from legacy applications and their supporting infrastructures

Solution overview The EMC® Open Systems Architecture (OSA) solution for Healthcare enables IT managers to respond successfully to these new business challenges.

EMC Documentum® is at the heart of the EMC OSA solution and provides the functionality to archive any type of information and its metadata in an open, non-proprietary format. Medical information and its metadata are archived as specified by the “Integrating the Healthcare Enterprise” (IHE) initiative.

Documentum provides the appropriate retention policies, security policies, and services-oriented management policies to ensure the compliance and availability of medical information during its complete lifecycle. Documentum also provides the functionality to share medical information with other healthcare providers based on the open standards provided by the IHE initiative.



Key results The EMC OSA solution for Healthcare helps IT managers support their organizations’ new, external business demands. The EMC OSA solution offers superior compliancy tools and sharing functionality for medical information.

The implementation of the solution simplifies internal IT processes by providing an integrated, virtualized, and services-oriented IT environment for the management of all the information in the healthcare organization. Superior IT migration tools result in more flexibility to deploy newer and better clinical applications.

The solution helps IT managers control and reduce costs by offering a consolidated and intelligent IT infrastructure to manage, on a very long term, all medical and non-medical information in the organization. This includes a unique, intelligent tool set to curb the cost explosion for storage of the medical information.

Planned EMC OSA solution with Vblock Infrastructure Packages The Virtual Computing Environment (VCE) coalition - a joint partnership formed by Cisco, EMC, and VMware - addresses the challenges of infrastructure virtualization. This unique collaboration in development, services, and partner enablement reduces risk for companies that want to transform their infrastructures for the private cloud.

With Vblock™ Infrastructure Packages, the VCE coalition delivers the industry's first completely integrated IT offering that combines best-in-class virtualization, networking, computing, storage, security, and management technologies with end-to-end vendor accountability.

The EMC OSA solution for Healthcare will incorporate Vblock Infrastructure Packages to:

• Run in a virtualized environment, enabling organizations to implement simplified IT-infrastructure migration strategies

• Further reduce complexity and costs

This combined solution is currently being tested, and the results of this testing will be published in the near future.


7

Introduction This white paper includes the following topics:

Topic See Page

EMC Vision 10

Overview of EMC Open Systems Architecture Solution for Healthcare 12

EMC Open Systems Architecture Solution - Component Description 19

Data Qualification Services for Healthcare 38

Managing the Medical Information Storage Explosion with OSA 39

Conclusion 41

References 42

Purpose The purpose of this white paper is to describe in detail the components of the EMC OSA solution and to explain how the unique functionalities of the EMC OSA solution address and solve the specific IT challenges of the modern healthcare enterprise.

Scope The scope of the white paper includes:

• A functional and architectural overview of the EMC OSA solution for Healthcare

• A detailed description of the solution’s components

• An overview of the solution’s advantages, including a description on how the solution can help healthcare organizations to better manage the medical information storage explosion

Audience This white paper is intended for customers, partners, and EMC employees, including healthcare CIOs, medical IT directors, IT infrastructure directors, medical archiving managers, storage architects, and any others involved in evaluating, acquiring, managing, operating, or designing a more efficient and effective healthcare IT infrastructure.



Terminology This section spells out the acronyms used in this document.

Acronym Term

API Application Protocol Interface

CAS Content Addressed Storage

COS Cloud Optimized Storage

CPOE Computerized Physician Order Entry

CSS Content Storage Services

DFC Documentum Foundation Classes

DICOM Digital Imaging and Communications in Medicine

ECM Enterprise Content Management

EPR Electronic Patient Record

FAST Fully Automated Storage Tiering

HCC HealthCare Connector

HIE Healthcare Information Exchange

HIS Hospital Information System

HL7 Health Level 7

IHE Integrating the Healthcare Enterprise

ILM Information Lifecycle Management

MPI Master Patient Index

OSA Open Systems Architecture

PACS Picture Archiving and Communication System

PIX Patient Identifier Cross-Referencing

RHIO Regional Health Information Organization

RIS Radiology Information Systems

RPS Retention Policy Services

SBO Service-based business object

SMP Symmetric Multi-Processing

SOA Services-Oriented Architecture

TCS Trusted Content Services

WADO Web Access to DICOM Persistent Objects


9

Acronym Term

WS Web Services

XDS Cross Enterprise Document Sharing



EMC vision To optimize patient-care delivery, healthcare organizations are investing in clinical, administrative, and financial applications in order to improve operational and clinical efficiency. Deployment of clinical applications such as PACS, EPR, RIS, HIS, and CPOE helps to capture, generate, and track patient information during an episode of care, then securely retains that information as part of the longitudinal patient record. Often, the information gathered and stored by these systems is not easily shared among caregivers because many of these applications operate in operational domain silos, organizational domain silos, or both.

The EMC OSA solution for Healthcare improves the role that technology plays in your healthcare information infrastructure. Based on a services-oriented architecture (SOA) and deployable in a modular fashion, this solution aggregates content from clinical, operational, and financial applications. Using IT and healthcare industry standards, the solution provides an open, flexible, and highly scalable information network backed by archival platforms.

This solution represents a set of complementary capabilities to your traditional PACS/RIS integrations, which allows documents, patient records, prescriptions, invoices, and other unstructured content to be easily accessed through a secure, virtual, and federated repository. The solution uses open standard message formats to reduce the expensive point-to-point integrations that are typically required.

The vision for the EMC OSA solution is based on providing an open and integrated infrastructure for the healthcare industry. EMC distinguishes three phases of infrastructure maturity as shown in Figure 1 and offers specific and adapted solutions to healthcare organizations, such as Regional Health Information Organizations (RHIOs) and Healthcare Information Exchanges (HIEs), based on their respective positioning within that maturity model.

Figure 1. Three phases of the EMC information infrastructure maturity


11

Phase 1: Information digitalization In this early phase of the information infrastructure maturity model, individual healthcare organizations focus on the digitalization of their medical applications.

Key investment projects within the first phase are:

• Digitalization of film - Picture Archiving Communications Systems (PACS)

• Digitalization of paper-based patient processes - Hospital Information Systems (HIS), Electronic Patient Record (EPR)

Phase 2: Information sharing Once information digitalization has been realized on an individual healthcare organization level, the next step within the information infrastructure maturity model can be initiated. In this second phase, multiple healthcare organizations, or governmental entities representing a series of healthcare organizations, implement solutions to share the digitized medical information across the represented healthcare organizations.

Driving this investment is the need to:

• Reduce the overall healthcare cost (for example, by avoiding duplicate medical examinations)

• Improve the quality of care (for example, improved outcomes by better informed medical staff)

Phase 3: Information management In the final phase of the information infrastructure maturity model, healthcare organizations focus on the long-term management of the medical information itself. The major information management issues to be solved are:

• Exponential (cost) growth of digital medical information within the organization

• Recurrent appearance of major operational issues around infrastructure and application migration

EMC’s objective is to provide clinical users with long-term availability of all digital information irrespective of the choice of the front-end medical applications and the back-end IT infrastructure.

Key deliverables in the final phase of the EMC information infrastructure maturity model are:

• Intelligent information management strategies built around simplified migration management

• Clinical information lifecycle management

• Cost-effective virtualized infrastructure



Overview of the EMC Open Systems Architecture Solution for Healthcare The EMC OSA solution addresses the needs of healthcare organizations that have evolved to Phases 2 and 3 of the EMC information infrastructure maturity model.

The solution as shown in Figure 2 provides:

• IHE-compliant information sharing between healthcare organizations (Phase 2)

• Intelligent information management of all medical/patient data (Phase 3)

Figure 2. EMC Open Systems Architecture Solution for Healthcare

The EMC OSA solution with content management from EMC Documentum provides a rich integration interface to medical front-end applications (HIS, PACS, LAB, and so on) allowing the sharing of medical information across various applications and organizations using IHE integration profiles (XDS.b, XDS-I.b, as well as through DICOM and HL7).

In addition to the benefits of information sharing and integration standardization, OSA enables healthcare organizations to make use of standard Documentum functionality to implement intelligent clinical lifecycle management strategies. This reduces the cost of managing, securing, and protecting archived medical information.

The EMC OSA solution allows organizations to gradually transition from a non-Cross-Enterprise Document Sharing (non-XDS) environment to an XDS environment using the HealthCare Connector (HCC) component of the EMC OSA solution. HCC provides access to non-XDS-enabled medical applications.


13

Pain points addressed by the EMC Open Systems Architecture Solution The EMC OSA solution for Healthcare was designed to address the following common problems in healthcare organizations:

• Medical information sharing is not possible between different healthcare organizations.

• Complex and costly infrastructure and application migrations during the lifecycle of the medical data.

• Applying appropriate information retention policies to comply with legal retention requirements is not possible. Legal retention requirements vary based on the type of medical information, and requirements are often event-driven (as shown in Figure 3).

Figure 3. Legal retention requirements for medical information

• An explosion in the volume and size of files, and the associated costs of storing and managing medical information (as shown in Figure 4) due to:

− Technology advances in medical equipment

− New digitalization projects (OR, Pathology, and so on)

− The absence of clinical decision rules around retention policies – “we archive everything” syndrome

− The need to keep old systems online to facilitate restoring of old archive data



Figure 4. Total data strage versus total storage cost

• Inability to easily identify and move medical data with lesser clinical value to less expensive IT

infrastructure and/or delete it.

• Inability to easily implement service level agreements (SLAs) for the availability of the digital medical information that can differ across organizations within a network, departments within a organization, and the type of medical information itself.

• Difficulty obtaining immediate access to medical information required by general practitioners (GPs) and other non-hospital staff.

• The cost of maintaining IT systems is consuming higher proportions of the IT budget, while pressure to reduce cost is increasing.

These problems are not the only issues existing in healthcare organizations but are the ones that the EMC OSA solution has been designed to address. These issues occur in other industries and have been addressed by Documentum for many years.


15

EMC Documentum – EMC OSA solution’s core functionality EMC Documentum with enterprise content management is at the core of the EMC OSA solution, and provides the following functionality (as shown in Figure 5):

• Stores any type of content (Content Server)

• Stores documents and their metadata in a non-proprietary format (vendor neutral)

• Applies and enforces retention policies based on clinical metadata and events (RPS)

• Performs intelligent lifecycle management based on clinical metadata (CSS)

• Provides encryption, deduplication, and compression without changing the original file (TCS, CSS)

• Accepts connections through IHE standards like DICOM, HL7, and XDS.b

Figure 5. EMC Documentum with enterprise content management



Supporting healthcare organization standards The EMC OSA solution for Healthcare supports the IHE Cross-Enterprise Document Sharing (XDS) standard to enable the exchange of clinical documents between healthcare organizations. The EMC OSA solution is IHE-certified for the XDS registry and XDS repository function. Any healthcare application that is XDS-enabled and acts as an XDS source, an XDS consumer, or both, can store and register clinical documents in an OSA environment, can query the OSA for clinical documents, or both.

EMC’s investment in the IHE XDS standard is a commitment by EMC to provide its customers with open and integrated healthcare solutions. IHE XDS is also a core component within the EMC strategy to help its customers to lower the cost and complexity of application migrations and provide its customers long-term access to medical information independent of the medical applications in use.

Table 1 lists the current IHE integration profiles developed by EMC and certified for the EMC OSA solution. The certification of these profiles was attained by EMC during several IHE Connectathons.

Table 1. Current IHE-certified integration profiles from EMC

Integration profiles implemented Actors implemented Options implemented

Cross-enterprise document sharing (XDS.b)

Document registry Asynchronous web services exchange

HL7v2 patient identity feed

Document repository Asynchronous web services exchange

Cross-enterprise document sharing for imaging (XDS-I.b)

Document registry Asynchronous web services exchange

HL7v2 patient identity feed

Document repository Asynchronous web services exchange

Audit trail and node authentication (ATNA) Secure node

Consistent time Time client

Support of additional IHE profiles for the EMC OSA solution have also been provided by the EMC partner landscape. Table 2 contains a list of the additional supported profiles.

Table 2. Additional IHE-certified integration profiles from partners

Integration profiles implemented Actors implemented

Import Reconciliation Workflow Image Manager

Importer

Mammography Image Image Manager

Scheduled Workflow

Image Manager

Evidence Creator

Image Display

Cross Community Access Initiating Gateway

Responding Gateway


17

Integration profiles implemented Actors implemented

Consistent Presentation of Images

Image Manager

Evidence Creator

Image Display

Access to Radiology Information

Image Manager

Image Display

Report Reader

Report Repository

Key Image Note Image Manager

Simple Image and Numeric Report Report Repository

Evidence Documents

Image Manager

Evidence Creator

Image Display

Mammography Acquisition Workflow Image Manager

NM Image Image Manager

Image Display

Patient Demographics Query Patient Demographics Consumer

Teaching file and Clinical trial Export Export Manager

Export Selector

More information about IHE profiles is available at http://www.ihe.net/profiles/index.cfm.

http://www.ihe.net/profiles/index.cfm�



High-level architecture of the EMC Open Systems Architecture solution At a very high level, the EMC OSA solution’s content management architecture is composed of four components, as shown in Figure 6. The generic repository is the parent object of the other components but can also facilitate regular document management and is the building block for each of the other components.

Figure 6. EMC OSA solution content management architecture

Use cases The EMC OSA solution has the following main use cases:

• Use Case 1: Single Hospital IHE-Compliant Medical Images Archive Implement the IHE-compliant DICOM archive for all PACS/RIS solutions in use at the hospital, including Retention Policy Services (RPS) and Content Storage Services (CSS), to deliver clinical Information Lifecycle Management (ILM) functionality.

• Use Case 2: Single Hospital Enterprise Archive Enterprise-wide, consolidated archive for all medical information (DICOM, HL7, SAP, e-mail, Microsoft Office, SharePoint, databases, scanned documents, and so on) in use at the hospital, including RPS and CSS, to deliver clinical and non-clinical ILM functionality.

• Use Case 3: Multi-Site Hospital System IHE-Compliant Medical Images Archive Open IHE-compliant centralized DICOM archive for the PACS/RIS solutions in use at multiple healthcare organizations, including RPS and CSS, to deliver the appropriate clinical ILM functionality to the participating hospitals.

• User Case 4: Multi-Site Hospital System Enterprise Archive Enterprise-wide, consolidated archive (DICOM, HL7, SAP, e-mail, Microsoft Office, SharePoint, databases, scanned documents, and so on) for all medical information in use at multiple healthcare organizations, including RPS and CSS, to deliver ILM functionality and IHE data-sharing capabilities based on XDS.


19

EMC Open Systems Architecture Solution - component description Current EMC OSA solution (figure) Figure 7 shows the components of the current EMC OSA solution for Healthcare including EMC Documentum.

Figure 7. Components of the EMC OSA solution for Healthcare



Planned EMC OSA solution with Vblock Infrastructure Packages (figure) Figure 8 shows the combined EMC OSA solution that will include Vblock Infrastructure Packages as a component.

Figure 8. Components of the planned EMC OSA solution with Vblock Infrastructure Packages


21

Component 1: HealthCare Connector The HealthCare Connector (HCC) is a certified EMC Documentum adapter that has been built to understand DICOM, EDIFACT, HL7, and WADO requests. This adapter communicates with the Documentum repository through Documentum Foundation Classes (DFC), the native Documentum-specific Java-based API.

HCC is used to connect the EMC OSA solution with clinical applications that are not yet XDS-compliant but support common IHE standards such as DICOM and HL7. HL7 message feeds are used by the HCC to systemically update the patient information in the OSA. If this was not the case, a situation would occur where the patient information stored in the OSA differed from the patient information stored in the application (PACS). The archive cannot be used separately from the application and cannot be considered as independent and open.

By securing the patient update information, implementation of the EMC OSA solution guarantees that healthcare organizations can migrate from one IHE application to another without complex data migration. The HCC stores DICOM and HL7 information and its metadata into Documentum. These clinical metadata are then used by Documentum to implement the appropriate clinical ILM policies (RPS, CSS) for the medical information.

Figure 9 shows the individual DICOM files of a DICOM (CT) exam stored through the HCC in Documentum.

Figure 9. Individual DICOM files



Figure 10 shows the metadata of an individual DICOM file stored through the HCC in Documentum.

Figure 10. Metadata of an individual DICOM file


23

Component 2: Documentum XDS adapter The Documentum content management platform has been enriched with the XDS adapter. The XDS adapter from EMC uses DFC to communicate with Documentum and enables Documentum to act as a XDS.b registry and XDS.b repository in the IHE XDS environment.

The XDS adapter enables Documentum to act in the following XDS profiles:

• XDS.b

− Acts as a registry, a repository, or both, in line with the IHE XDS.b profile.

− The Documentum repository registers with the designated registry, either the local Documentum registry or a remote XDS registry.

• XDS-I.b

− Acts as an image manager auto-registering through an XDS.b repository that might be the local XDS.b repository.

− Provides standard interfaces for DICOM and HL7.

− Normalizes DICOM headers on receipt and leaves private tags where they are.

− On retrieval, the header information is updated to reflect changes to the patient information that has been received since ingestion on HL7.

The XDS adapter and the HealthCare Connector allow to deploy Documentum as well in an XDS environment as in a non-XDS environment. This is important as currently most of the healthcare applications deployed at healthcare organizations are not acting as XDS sources or XDS consumers.

Figure 11 shows the high-level overview of the EMC Documentum architecture in an XDS environment using Web Services (WS).

Figure 11. High-level overview of EMC Documentum architecture in an XDS environment



Figure 12 shows the high-level overview of the EMC Documentum architecture in a mixed XDS (through WS) and non-XDS environment. The HCC is used to connect non-XDS applications to the Documentum XDS architecture and communicates with the Documentum repository through Documentum Foundation Classes (DFC), the native Documentum-specific Java-based API.

Figure 12. High-level overview of EMC Documentum in a mixed XDS/non-XDS environment


25

Component 3: EMC Documentum The EMC Documentum product suite offers a large amount of standard products, of which a selected subset (content server, trusted content services, retention policy services, and content storage services) are required for the standard EMC OSA solution. Documentum offers standard functionality with additional functionality in the form of licensed add-on products.

Services, such as output management, document capture (paper patient record scanning with Captiva), formal patient records management, physical records management, case management, web experience management, and so on, can be added to the EMC OSA solution if required.

Content Server and repository modules The Documentum Content Server governs the Documentum content repository containing the data and metadata. Content Server gives you a rich set of content management services and a comprehensive infrastructure for all content applications.

Content Server provides the scalability, robust functionality, and service orientation for global enterprise deployments. With Content Server, you can store, manage, and deploy all types of content including HTML and XML, graphics, multimedia, other types of rich media, and traditional documents created with desktop applications. Content Server can easily store billions of objects, which makes Documentum a truly enterprise-wide repository for medical information.

Content Server can be built to size from a small repository on a single machine to a multi-tiered highly available, high-volume architecture using the standard scalability features of Documentum. Figure 13 shows the Symmetric Multi-Processing (SMP) and clustering capabilities of Documentum.

Figure 13. Content Server scalability



Trusted Content Services The Trusted Content Services (TCS) of Documentum allows medical information to be encrypted in the file stores. This prevents administrators from accessing sensitive information while still allowing them to perform backups or other administrative tasks.

TCS allows the communications between the Archive Services and Documentum to be encrypted.

Digital shredding can be activated on the file stores. When a medical document reaches its retention end date, it is not just soft deleted, but binary 0 and 1 are rewritten on top of the file multiple times to make sure no signature of the file remains on the storage system.

TCS helps healthcare organizations to organize and reach compliancy around the important patient information privacy topic.

Retention Policy Services The Retention Policy Services (RPS) of Documentum allows you to comply with the different legal regulations around the retention and disposal of medical information. RPS attaches the appropriate lifecycle policies to the different types of medical information (DICOM, HL7, SAP, scanned documents, and so on) stored in the Documentum repository.

Legal retention requirements vary based on the type of medical information and are based on clinical metadata, event-driven conditions, or both. This enables healthcare organizations to be compliant with complex medico-legal regulations, for example, keeping the imaging data (type) up to 10 years after the death of the patient (event).

RPS helps healthcare organizations to:

• Achieve compliancy of the medical information in complex legal retention and disposal environments.

• Implement and automate diverse retention policies based on the type of information (medical image, scanned patient record, invoice, lab result, and so on).

• Define more granular and therefore more cost-effective retention policies. This enables the controlled deletion of information and helps to reduce the data explosion of medical information.

Retention policies are defined in the repository using the Administration interface and can contain multiple phases. Figure 14 shows how to use RPS to define the properties of a defined retention policy.


27

Figure 14. Defining retention policy properties in RPS

Each phase can be defined with a specific duration. Some conditions can be added to enter a specific phase (for example, a patient must be deceased before you can enter the final phase of retention of his/her medical records). Actions can automatically be triggered for each phase to synchronize. For example, with the EPR system, content is deleted from the repository when the content has reached its retention end date.

At the end of an asset’s retention period, it can either be destroyed, moved away from the repository to another system, or reviewed to start a new retention period.

All deletions are tracked for auditing. Retention and deletion reports can be generated on a regular basis or on demand at any time.



Figure 15 and Figure 16 show the different phases that apply to a retained image as the patient ages.

Figure 15. Retention policy administration Phase 1


29

Figure 16. Retention policy administration Phase 1



RPS defines retention policies using clinical metadata information. These metadata, delivered by the IHE standards like DICOM and HL7, enable healthcare organizations to implement the appropriate retention policies for the different types of medical information based on clinical information, such as study type, study date, patient ID, provider ID, and so on.

Figure 17 shows how different content types (XML, MPEG, TXT, JPEG, DICOM study) belonging to a single patient are being stored in Documentum. RPS allows you to define different retention policies for the different content types.

Figure 17. Content types for a single patient


31

Content Storage Services The Content Storages Services (CSS) of Documentum stores each medical document in a file store when it reaches the repository. CSS provides:

• Deduplication and compression without changing the original file

• Automated and policy-based storage and migration of data across tiered storage layers of the corporate network

CSS is the basis of clinical ILM. CSS goes beyond traditional hierarchical storage mechanisms by providing the ability to define and execute ILM policies based on the rich clinical metadata provided by HCC and the XDS adapter to Documentum in addition to the more typical identifiers such as file or disk-level information.

The advantages of CSS for the healthcare organizations are:

• Simplicity Automated migration management to new storage platforms over the lifecycle of the medical information.

• Better services The possibility to move different types of medical information to different tiers of storage dependant on the value of the information for the organization.

• Cost savings The possibility to seamlessly move medical information, which lowers costs of storage tiers.

Figure 18 shows how, by using the clinical metadata stored in Documentum, appropriate storage management and storage migration policies over the lifecycle of various types of medical information can be implemented.

Figure 18. Content lifecycle



Content Services for EMC Centera A file store can be any storage system that is identified by the Documentum server as a storage resource. This includes SAN, NAS, and local disks.

The Content Services for EMC Centera® (CSEC) license adds support for EMC Centera storage hosts and provides content storage with guaranteed retention and immutability. If you install Content Server with a CSEC license, you can use content-addressed storage areas, the repository representation of an EMC Centera storage host. These storage areas are particularly useful if the repository is storing large amounts of relatively static data that must be kept for a specified interval.

Note It is possible to apply retention to content without a CSEC license if you have installed Content Server with an RPS license. A CSEC license is required only if you also want to store the content in a content-addressed storage area.

The EMC Centera content addressed storage (CAS) system stores medical data. Content addressing eliminates the need for applications to understand and manage physical location of information on storage media. The CAS system operates with objects as a whole and ensures absolute authenticity, integrity, disambiguity, retention, and fast search.

For EMC Centera CAS systems, Documentum provides a specific native integration that makes any EMC Centera system a viable file store for Documentum. In this case, the retention date calculated by Documentum RPS can automatically be synchronized with EMC Centera, which ensures the file can be removed seamlessly from the EMC Centera system.

Figure 19 shows how CSS is used to define EMC Centera as a file store for medical information.


33

Figure 19. EMC Centera file store



Based on assignment rules, CSS can decide which file store will handle the original file, and how this file might move across file stores during its life in the system. Assignment rules can be based on any of the classification and categorization information.

For example, if the object type is DICOM study, and the study date is less than 12 months old, the file can be assigned to a specific file store that will enable a very fast access time. After 12 months, CSS can move the study to a slower and less expensive storage infrastructure.

Figure 20 shows how DICOM Tier 1 storage is defined as the specific storage tier for all DICOM exams with CSS.

Figure 20. Tier 1 storage definition


35

Migration policy A CSS license allows you to create and use content storage and migration policies. These policies automate the assignment of content to storage areas, eliminating manual, error-prone processes and ensuring compliance with company policy in regards to content storage. With CSS, healthcare organizations can more effectively manage the migrations of the storage infrastructure during the lifecycle of the medical information. CSS acts as a virtualized storage layer, moving the medical information from the old file store to the new file store with minimal impact on the availability of the medical information.

Migration rules are also based on any of the classification and categorization information (metadata) and are usually performed asynchronously. They enable medical information to be moved from one file store to another, overnight most of the time.

Figure 21 shows how CSS can be used to organize an automated migration policy from an old file store (storage device to be discontinued) to a new EMC Centera system.

Figure 21. Migration from Tier 1 to Tier 2 Storage



Figure 22 shows the migration from old stores to EMC Centera of all files that have not been accessed during the previous three years.

Figure 22. Migration policy from all stores to EMC Centera


37

Future component: Vblock Infrastructure Packages The journey to the private cloud will help healthcare organizations build services-driven business models by archiving and sharing medical information. It will also significantly reduce the cost of infrastructure migrations during the lifecycle of the medical information.

Vblock Infrastructure Packages Vblock Infrastructure Packages are extensible platforms for building solutions. These pre-integrated, pre-tested, and validated IT offerings combine best-of-breed technologies from Cisco, EMC, and VMware.

Vblock Infrastructure Packages redefine the foundation of data center virtualized infrastructure—from virtualization, networking, compute, storage, security, and management. An integrated solution with end-to-end vendor accountability, Vblock Infrastructure Packages represent a new way to deliver IT to business.

Vblock Infrastructure Packages will be included in the EMC Open System Architecture solution.

More information about the VCE coalition and Vblock Infrastructure Packages can be found at http://www.vcecoalition.com/solutions.htm.

http://www.vcecoalition.com/solutions.htm�



Data Qualification Services for Healthcare Healthcare organizations implementing the EMC OSA solution need to have a very good understanding of the value of the clinical information that they want to share, archive, and manage. It requires an in-depth investigation into the business requirements of the hospital users, leading to the correct categorization and classification of the medical information.

This classification has to be transferred into the correct SLAs. These SLAs have to be transferred ultimately into an appropriate clinical ILM policy within the EMC OSA solution for each class of medical information.

EMC can help healthcare organizations by delivering proven knowledge and procedures and specific tools, for example, the EMC Web tool, to facilitate the necessary data collection into the healthcare organizations’ systems.

Figure 23 shows how you can use the EMC Web tool to set up and correctly categorize or classify data.

Figure 23. EMC Web tool


39

Managing the medical information storage explosion with OSA A major challenge for all IT directors in healthcare organizations is containing the cost of storage and management of the medical information while providing more and more digital information services requested by the clinical users.

There is no single and simple technical answer to overcome that challenge, but the EMC OSA solution, in combination with the Vblock Infrastructure Packages, provides healthcare organizations with a wide range of sophisticated tools to temper the medical information storage explosion and help IT departments offer more digital services within a restrained budgeting environment.

Figure 24 shows an example of how the EMC OSA solution can help healthcare organizations manage an increasing amount of information.

Figure 24. Information growth management



Figure 25 shows the functionality contained within the EMC OSA solution that can help healthcare organizations manage their storage growth requirements.

Figure 25. Managing store growth with the EMC OSA solution for Healthcare


41

Conclusion Summary The EMC Open Systems Architecture Solution offers healthcare organizations superior compliancy tools and sharing functionality for medical information. At the same time the implementation of the EMC OSA solution simplifies internal IT processes by providing an integrated, virtualized, and services-oriented IT environment for the management of all the information in the healthcare enterprise including superior storage and server migration tools, resulting in more flexibility to deploy newer and better (medical) applications. Finally, the EMC OSA solution reduces costs by offering a consolidated and intelligent IT infrastructure to manage all medical and non-medical information in the organization over a very long term.

The following table describes the industry problems addressed and solved with the EMC OSA solution:

Industry problem EMC OSA solution

Data share and manage application migrations IHE compliance (XDS, HL7, DICOM)

Manage infrastructure migrations Automated storage environment

Meet different legal and regulatory patient data archive requirements

Rich metadata model to implement correct retention policy

Contain storage volume explosion Rich metadata model to identify and delete patient data with limited legal value, clinical value, or both

Contain storage cost explosion • Fully automated storage tiering • EMC Data Qualification Services

There are many solutions on the market for medical information data sharing. There are also many solutions on the market for intelligent information management. However, there are no solutions on the market that combine the functionality for medical information sharing with the functionality of intelligent information management. This combination is what makes the EMC OSA solution unique.

Next steps The EMC Open Systems Architecture Solution for Healthcare transforms data into actionable knowledge to become the cornerstone of your healthcare enterprise content management strategy. For more information, contact your local EMC account manager or visit http://www.EMC.com/healthcare.

http://www.emc.com/healthcare�



References White papers For additional information, see the white papers listed below.

• Cloud Computing and the Economics of Enterprise IT

• Enhanced Business Continuity with Application Mobility Across Data Centers

Product documentation • EMC Documentum Content Server 6.6 Fundamentals

Other documentation For additional information, see the documents listed below.

• EMC Information Infrastructure Solutions for Healthcare Providers (brochure)

• Enterprise Content Management: Sophisticated Tools for Modernized Healthcare Delivery

Other information For additional information, see the links listed below.

• VCE Coalition - Solutions

• EMC Centera

http://media.vceportal.com/documents/WhitePaper_CloudComputing.pdf�

http://media.vceportal.com/documents/WhitePaper_Application_Mobility.pdf�

http://www.emc.com/collateral/industry-overview/h6104-hc-provider-bro.pdf�

http://www.emc.com/collateral/analyst-reports/csg7618-ecm-healthcare-wp.pdf�

http://www.vcecoalition.com/solutions.htm�

http://www.emc.com/products/family/emc-centera-family.htm�