Mma For Turkey V1

An Alternative Approach to Managing the Massive Growth in
Unstructured Healthcare Data - in an Oracle Database
David Hancock – Director, Healthcare and Life Sciences Industry Business Unit

Slide 1

Agenda
• How Healthcare manages unstructured
content today
• Issues with today’s solutions
• Oracle infrastructure for multi-media
medical archive
• Benefits of Oracle Infrastructure
• References
• Conclusion

Multiple Data Sources, 100’s of file
types Image Manager -
Video Endoscopy C-Arm Images
Monitor Report
MD’s
Staff
RN, Tech

EEG Monitoring

MRI Image -
PACS

C-Arm
Left side of OR Fluoroscopy

Laser
generator

EMG
Image view Monitoring
Teleconferencing -
boxes Patient in Operation Theatre telesurgery

Classic Architecture for DICOM1 Objects
X-ray MR Scanner

Files Server for storage

DB used for Metadata Repository

1. DICOM = Digital Imaging and Communications in Medicine Slide 5

Classic Architecture for other Unstructured
Content
Video
Photographs Audio

Files Server for storage

All stored on File System

Slide 6

Unstructured Content stores replicated
across organisation
Video Video Video
Photographs Photographs Photographs
Audio Audio Audio

Files Server for storage Files Server for storage Files Server for storage

All stored on File System All stored on File System All stored on File System

Cardiology Endocrinology Neurology

Video Video Video
Photographs Photographs Photographs
Audio Audio Audio

Files Server for storage Files Server for storage Files Server for storage

All stored on File System All stored on File System All stored on File System

Obstetrics Paediatrics Geriatrics

Unstructured Content Data Management
Challenges
• DICOM
• Scalability
• Scale to large information networks – Health Information Exchange is
coming to images too!
• Handle massive increase in data volume – new modalities and
diagnostics
• File based solutions are inadequate v DBMS. Big issues including:
• Security and privacy while sharing and accessing medical images
• Business Continuity and Disaster Recovery
• Losing images
• Information Life Cycle Management is only as good as the weakest link
by the vendor
• Costs
• Storage (hardware) – PACS are most expensive spinning discs in the
world running on proprietary hardware
• Development, deployment and maintenance (labor)
• Significant issues with emerging (changing) DICOM standard and
handling images with no DICOM standard defined

Unstructured Content Data Management
Challenges
• DICOM - continued
• Data Integrity – Change of Patient Data and Image mismatch as they are
stored separately
• No interoperability - storage solutions are proprietary making it impossible to
share data cross other PACS solutions and across care continuum
• Cannot link images into Healthcare Records
• Fast access to local, remote, and archived medical images
• Other Unstructured Content
• Critical clinical data managed in a very ad hoc way
• Inadequate security
• Poor back-up
• No archiving or records management
• Today’s solutions mean it is always separate to DICOM image archive
• Images not linked to Healthcare Records

Managing All Your Information in One
Place
Oracle SecureFiles
High Performance, Secure LOBs

• Uniform Management of XML DB
Integrated Native XML Database
content and metadata
Oracle Text
• Scalable Text Indexing and Classification
• Secure Location & Spatial
• Highly Available Location Enabled Databases
Semantic Database
• Integrated Ontologies, OWL, RDF
• Robust Multimedia
Audio, Image and Video
• Available on all platforms New with 11g: DICOM Medical Imaging
Relational
Characters, Numbers, Dates

Oracle Multimedia DICOM: Native DICOM
Support
• Search based on any DICOM attribute
• Extract all 2028 standard and vendor-specific extensions
• Automate DICOM data quality verification
• Include data from any source
• Open data model
• Ensure privacy
• Mask specified DICOM attributes
• Include DICOM content in reports and display in
browsers
• Convert DICOM to web-friendly formats
• Create DICOM images from non-DICOM images
• Reduce development and management costs
• APIs for rapid development and deployment
• Model driven architecture

Oracle Multimedia DICOM for Managing
Medical Images
• Vendor-neutral DICOM storage and DICOM data
model
• Supports networked systems for sharing images
• Performance: As fast as underlying hardware device
• Faster than file systems
• Ex: Read 850 CT images/sec, Write 550 CT images/sec
(published benchmark)
• Reduces Risk
• Protect images against loss with backup and recovery
• Facilitate image-enabled EHRs
• Complete and non-fragmented view of data to clinicians

Oracle SecureFiles
Breaking the performance barrier…

File Read Performance File Write Performance
(MB/second) (MB/second)

100 60
80 50
40
60
30
40
20
20
10
0 0
0.01 0.10 1 10 100 0.01 0.10 1 10 100

SecureFiles
File Size File Size
(MB) Linux Files (MB)
LOBs

Oracle Multimedia DICOM for Managing
Medical Images
• Oracle Database 11g provides native and complete
support for storing and managing medical images and
other unstructured content
• Scalable to petabyte and exabyte medical image
archives
• Guaranteed security and privacy
• Uniform security policies across all types of data and all tiers
of data
• Lower costs
• Unified management of images and patient data
• Eliminates maintenance of specialized code for image stores
• Flexible choice in hardware
• Information Lifecycle Management
• Archive images based on clinical tags, have online access to
archive

“…the easiest way to break system
security is often to circumvent it
rather than defeat it”

Oracle Database Vault
Compliance and Insider Threats

• Controls on privileged
users Realms
– Restrict DBA access to
application data Reports
– Provide Separation of Duty Multi-Factor
– Security for database and Authorization
information consolidation
• Enforce data access
security policies
Command Separation
– Control who, when, where
and how is data accessed Rules of Duty
– Make decision based on IP
address, time, auth…

Oracle Audit Vault Overview
Trust-but-Verify

• Collect and Consolidate Audit Data
– Oracle 9i Release 2 and higher
• Simplify Compliance Reporting Monitor Policies
– Built-in reports
– Custom reports Security
Reports
• Detect and Prevent Insider Threats
– Alert suspicious activity
• Scale and Security
– Robust Oracle Database technology
– Database Vault, Advanced Security (Future)
Oracle 9iR2 Other Sources,
– Partitioning 10gR2 Databases
10gR1
• Lower IT Costs with Audit Policies
– Centrally manage/provision audit settings

Key Platform Components for Maximum
Availability Architecture
MAMA
DICOM MAA (RAC, Data Vault, Grid, HA,
EM, Partitioning, DataGuard)

Facilitate access to image data Dicom
Comprehensive DICOM Support: Full DICOM Part 10 format support
Standard Support
Metadata extraction of all 2028 attributes and vendor-specific attributes, validation for quality, anonymization
for privacy Benefit
Support for all content: DICOM image, video, audio, non DICOM images using same Database capability
Mining and knowledge discovery: To suggest “other” or “hidden” perspectives
Open access to interface with any existing systems

Allow clinicians to very quickly and accurately come to a correct, more Dicom
informed diagnosis Search Features
Enhanced search: Fast and comprehensive search based on all DICOM metadata and device vendor-specific
metadata, can link in medical ontologies

Faster delivery of medical imaging leading to speedier availability of results Dicom
Speed: As fast as or faster than file systems to give “immediate” access to results
Storage Benefits
Lower Costs: Automatic storage management, compression, partitioning, information lifecycle management for
lower cost per byte

Distribute image data in a secure and interoperable way MAA
Business Continuity and Disaster Recovery: Scalable, fault tolerant solutions with grid architecture and other large
database technologies to deliver Maximum Availability and Manageability Architecture &
Security: Secure storage for privacy and auditing requirements and strict regulation support MAMA

Differentiators
• Equal or better performance with same hardware and larger datasets
than todays architectures
• Lower Costs:
• DICOM capability is available in Standard Edition for iSVs
• Allows commodity hardware to be used
• All benefits of Oracle Information Life Cycle Management which lowers
total cost per byte stored
• Guaranteed data integrity at no cost – image and metadata stored in
one place
• Scalability and MAMA
• Model driven definition of DICOM objects supports evolving DICOM
standard and use of private (vendor-specific) tags
• Security - Images and metadata are subject to the same access and
control capabilities in the database including the auditing of access
• Simplifies and facilitates consolidation and sharing of DICOM Content
• iSVs who use 11g DICOM and Secure Files can jointly go to market
with Oracle.

A perfect integrated & secured clinical
environment
All Other Content -For ISVs : decrease workload development
in integrating file systems and dbms,
concentrate development staff on
interpretation functionalities, offer a better Radiology
MRI Scanner image/data integrity
-For customers, decrease storage costs by
Data acquisition by modalities

accessing to low cost hardware solutions

Results viewing & distribution
as image volume increase, benefit of
OracleDB security and safety options, unify
multimedia information storage
CT Scanner
Orthopedics

Collect, organize and distribute
clinical imaging data and
UltraSound
other content in- and
in-
Nuclear outside the hospital Operating
Medicine Multimedia: Room
DICOM

X-ray
Web Distribution Emergency
Department

Film
Digitizer
Ward
Referring Physician Internet/Intranet
Internet/Intranet
Patient

Slide 23

Oracle Multimedia DICOM is a Platform for
Several Applications

• Image management for multi-disciplinary
medical research
• Clinical research image management at
Pharmaceutical Companies
• Image-enabled EMRs
• Content management for all types of content
• Multi-Media Medical image archives
• Storage for PACS systems

Multi-disciplinary Medical Research: BioGrid
Australia
• Simplifies research
• Integrates health research data collated by clinicians in
different institutions
• Links data from multiple institutions in disparate silos
• 12 years of MRI images was scattered on 1000 tapes,
taking weeks to months for retrieval
• Multi-terabyte Archive
• Consolidates 32 databases from 14 institutions across 4
Australian states
• Intranet based solution with 7 million images
• Image retrieval in seconds
• Continues to grow

BioGrid Australia
Oncology
Authorised researchers query
n=1,265 the federated research
Tissue Bank repository & download data to
n=1,764
their workstations for computer
uArray
n=80 test
aided diagnosis.
PeterMac

Extract Transform & Load
Nightly updates De-identified data
Oncology
n=965 RMH– LRR
(Inc WH Data)
Tissue Bank
n=1,663 Oracle
Biomarkers PMC-LRR
n=0
Database
Austin 11g
Austin- LRR
Oncology
n=3,600
Tissue Bank
Researchers’
n=454 feedback is
Familial Ca GenBank input back to
n=3,758 the system
Surveillance Institute specific data UniProt LocusLink
n=3,541 loaded into institute
Growing Epilepsy
specific Local Research PubMed
research data n=1,823
Diabetes Repository
n=21,048 Public Data Sources
Biomarkers
n=50
Melbourne

Courtesy: Naomi Rafael, BioGrid Australia

BioGrid Australia

• Chose Oracle Multimedia DICOM because:
• Simplified IT requirements through native
processing of DICOM images
• Accelerated development and deployment
• Preserved patient privacy by anonymizing
DICOM images without losing the link between
the image and patient record
• Reduced storage requirements
• Superior functionality at lower cost
• Re-use implementation for future projects
• Skilled programmers readily accessible

Clinical Research at Novartis
• Problem: Clinical trial images managed by third party
Clinical Research Organizations (CROs)
• Poor Quality Management
• Difficult Cost Control
• Direct access to images limited and expensive for pharmas

• IBIS solution on Oracle 11g Multimedia DICOM enabled:
• Efficient, lower-cost solution
• Improved data quality
• Security to restrict access to authorized users
• Compliance
• Data validation
• Quick deployment of standard Oracle Database-based solution

Clinical Research Image Management:
IBISimg
IBISimg
User Systems Adm. Reports

Image/data Viewer
Presentation
User
User
Authentication
User Target
Synchronized metadata Systems
Security with images
Archive Oracle Data Export CDMS
Backup Multimedia
Site DICOM
Migration Data
Study Data Integration
Module Archive
DICOM Image Data
DICOM Image Files
CRO Data Acquisition Interface
Study
Management
Systems
Rules Engine
Site

Courtesy: IBISWorks

Image-enabled EHR: I-Engineers Health
Engine
• Customer case study with Health Engine:
• Spitalnetz Bern hospital (Bern Health Network,
Switzerland)
• Universal archive for all content (images and patient data),
will be used by 2000+ users
• Content management solution in hospital administration
office
• Built a DICOM node using Oracle Multimedia DICOM
platform
• Receive images from DICOM-enabled applications
• Extract image metadata to include in patient health record
• Convert DICOM images to JPEG for viewing using web
clients

AstraZeneca
Clinical Image Repository Helps AstraZeneca
Integrate, Manage and Protect Images to
Improve Data Integrity and Advance Regulatory
Compliance

“Our desire was to build a scalable system for managing images that
is as robust as our system for managing clinical data. Oracle helped
us plan for the future by creating a centralized repository to serve our
needs today and moving forward. It also allowed us to create a
singular back end for data storage, giving us the flexibility to support
multiple workflows in AstraZeneca's various practice areas."
Dr. Goutham Edula, Business Lead for Clinical Imaging Informatics, AstraZeneca

Conclusion
• Today’s DICOM and Unstructured Content
solutions are inadequate for today’s 21st Century
Healthcare
• Oracle is unique in being able to store DICOM
images and other Unstructured Content within a
single repository and read/write faster than file
systems
• Oracle is the leading database for Maximum
Availability, Manageability Architecture (MAMA)
and Security
• This technology is proven in key partners and
customers

6.ŞĐFRE
6. ŞĐFRE

YAŞINDA

Mma For Turkey V1

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