Digital Pathology How Digital Imaging is transforming Pathology

Digital Pathology How Digital Imaging is transforming Pathology Clinical Image Storage Archives & Distribution 1 x Enterprise Solutions for Medical Imaging October 27, 2008 Richard S. Bakalar, M. D. Chief Medical Officer IBM Healthcare & Life Sciences Digital Slides 100 x 200 x

Agenda 2 • Global Healthcare Trends • Business Drivers for Innovation • Lessons Learned from Radiology • Enterprise Medical Content Storage • Q&A Digital Pathology - How Digital Imaging is transforming Pathology

Transformation of Medicine accelerated by a combination of revolutionary technologies and evolutionary practices Automated Systems Information Correlation 1 st Generation Diagnosis Distributed High-Throughput Analytics Revolutionary Technology Personalized Health Care Lifetime Treatment Pre-symptomatic Treatment Cancer Diagnosis Translational Medicine Molecular Medicine Genetic Predisposition Testing Clinical Genomics Health Care Today Digital Imaging Episodic Treatment Non-specific (Treat Symptoms) Electronic Health Records Data and Systems Integration Organized (Error Reduction) Evolutionary Practices 3 Artificial Expert Sys. Personalized (Disease Prevention & Targeted Treatment) Digital Pathology - How Digital Imaging is transforming Pathology

More Data Over the Last 3 Years Than Previous 40, 000 years Combined Digital Pathology Digital Radiology P e t a b y t e s E-Health Initiatives/Linkages 40, 000 BCE cave paintings bone tools Electronic Medical Record 3500 writing Digital Cardiology 0 C. E. paper 105 1450 printing 1870 electricity, telephone transistor 1947 computing 1950 Late 1960 s Internet 1993 The Web 1999 Source: UC Berkeley, School of Information Management and Systems. 4 Digital Pathology - How Digital Imaging is transforming Pathology 2003

Use Cases for Digital Slides Today 5 • Real-time Integrated Patient Care • Post-Interpretation – Digital Repository • Referred External Studies – Digital Archive Digital Pathology - How Digital Imaging is transforming Pathology

Lessons Learned from Radiology v Enterprise Solutions ü ü v What is “thought flow” ? ü v Data Analytics – Automated CAD, 3 D, and Image Fusion Importance Clinical & Technical Standards ü ü ü 6 Enhanced Decision Support Digital Diagnostics on demand ü v Workflow, Capture, Display, Distribution and Storage Information Technology Support and Sustainment Quality Image Display System interoperability Clinical Reimbursement Digital Pathology - How Digital Imaging is transforming Pathology

Introduction Why providers should care about infrastructure v Speed - Configurable and Reliable Performance • • Smart Caching and Data Backups IT Support: Central Global Storage Dashboard for Dynamic System Administration v Collaboration - Flexible Scalability • • • Up, Down and across medical specialties Respond to new data volumes & changes in clinical practice (i. e. CT/MRI protocols) Diagnostics On Demand supporting Clinical Centers of Excellence v High • • 7 Availability & Data Integrity No scheduled downtimes Automated data migration for hardware upgrades Digital Pathology - How Digital Imaging is transforming Pathology

Introduction What keeps the CIO up at night ! • • • 8 Affordable system uptime Eliminate data loss Scalable without service disruption Automated data migration for storage and server hardware refresh Automated disaster recovery Digital Pathology - How Digital Imaging is transforming Pathology

Medical Imaging Storage Challenge • “Always-On” Archive • • • Mission Critical - Clinical Performance Reliable Data Integrity Easy to Manage and Administer Easy Migration to new hardware Automated Recovery Affordable and Scalable Digital Pathology Slide Over 1 GB with compression 9 Digital Pathology - How Digital Imaging is transforming Pathology

Introduction Grids enable three IT functions: • Computation (PC & Server Grids) Intra and Inter - organizational cycle sharing Access to computing resources On Demand Utilization, App Speed & Scalability Collaboration (Data Grids) • Data Virtualization, Federation & Sharing • Virtual Storage Pooling Data Access, Productivity & Storage Utilization • • Orchestration (Intelligent Provisioning) • • 10 Automated SLA management & provisioning Improved Quality of Service & IT Think Outside the PACS – Enterprise Medical Imaging Storage Solutions Operating & Mgmt Costs (TCO)

Introduction Why Grid Storage System? Before Grid Site 1 App 1 Site 3 Site 2 App 3 After Grid App 4 . . . Site 1 App 10 App 1 Site 3 Site 2 App 3 App 4 . . . App 10 Grid Storage Platform “Siloed” Traditional architecture: • Difficult & expensive to administer • Low utilization of hardware & storage • Vulnerable to failure and downtime • Bandwidth inefficient • Block level replication 11 “Virtualized” Grid infrastructure: • Smaller, shared & more cost effective storage environment • Adaptive, self healing & self managing • High availability & speed • Enables infrastructure to be managed independent of the application Think Outside the PACS – Enterprise Medical Imaging Storage Solutions

Introduction PACS and Imaging Architecture PACS Application Study Demographics and Metadata Application Study Images Infrastructure Transactional Data Fixed Content Data Store Fixed Content Data has unique & specific requirements 12 Think Outside the PACS – Enterprise Medical Imaging Storage Solutions

Three Tier Medical Imaging Architecture CIS APPLICATION LAYER e. g. Aperio Spectrum Plus, Apollo PACS Clinical Function Image Access IMAGE MGMT LAYER e. g. Acuo. Med, Teramedica Evercore Image Management Layer Aggregation & Interoperability STORAGE LAYER Grid Storage Management System 13 Digital Pathology - How Digital Imaging is transforming Pathology Data Protection, ILM Replication, Resiliency & Speed

Centralized Management • Web-based administration • • Proactive monitoring Fault detection & alerts Real time and historical reports Multi-tier and multi-site mgmt • • Across all storage tiers Enterprise wide Single operational dashboard for medical image storage across the enterprise 14 Digital Pathology - How Digital Imaging is transforming Pathology

IBM Healthcare and Life Sciences IBM Grid Medical Archive Solution (GMAS) – An enterprise platform that optimizes enterprise storage resources by leveraging automation, grid and virtualization features across all storage brands, tiers and locations Grid Access Manager (GAM ) Grid Access Manager • Affordable system uptime Value Proposition: • Protects Data for Life: Digital signatures, Proactive • Eliminate data loss Checking, No Data Loss Challenges: • Ensure data integrity • Scalable without service disruption • Automated data migration for storage and server hardware refresh • Automated disaster recovery • Enterprise Solution: All sites (LAN/WAN), All applications, All Storage Tiers and Competitive Storage • Improves Availability and Uptime • Automates Storage Data • Real time failover, automated rebuild, self healing © 2008 IBM Corporation

Real World Case Studies 16 Digital Pathology - How Digital Imaging is transforming Pathology

Videoclip in Bob Thompson’s own words: http: //in. youtube. com/watch? v=p 3 k 17 RAs 2 OM 17 Digital Pathology - How Digital Imaging is transforming Pathology

IBM Healthcare & Life Sciences Radiology Cardiology Acuo. Med Image Manager IBM GMAS Storage Manager Configuration Architecture Acuo Workflow Cache Radiology Acuo DSG Server PACS Server Migration Server Control. Node Storage. Node 1 Other Fixed Content Server Virtualized & Automated Smart File System Storage. Node 2 Main Datacenter 18 LAN WAN / Aperio Spectrum GMAS HA Gateway Administrative Node Digital Pathology Archive. Node TSM Server Tape Library Norristown Datacenter The Children’s Hospital of Philadelphia

IBM Healthcare IBM Medical GRID Archive for Digital Pathology Transparent Actions Performed by the GRID Aperio Spectrum Application Dual Read/Write § Each file is protected with digital fingerprint § Validated on access, replication and rebuild § Proactively verified in background § Corrupted files are quarantined and replaced with a known good file § Grid is both content-aware and resource-aware 4 TB DAS CIFS mount protocol TCP/IP NAS attachment GMAS 2 TB Cache in GMAS Gateway Node 100101 000110 111000 10101001 011010 SATA Disk 19 Storage Node #1 SATA Disk Storage Node #2 The Children’s Hospital of Philadelphia © 2008 IBM Corporation

Summary v Healthcare has unique and challenging storage and information integration requirements v Traditional approaches are not scalable, affordable and reliable Enterprise proven technology with proven results 20 Digital Pathology - How Digital Imaging is transforming Pathology

Thank You ! Questions and Answers