2.

Pembicara :
Ferry Indriasmoko
Account Leader, Enterprise Digital Solutions GE Healthcare

Integrasi Peralatan
Medis dalam MIS-RS

Seminar Dua Hari bertema:

DIGITALISASI RS TIDAK MAHAL

7 – 8 Agustus 2019, Hotel Sheraton, YOGYAKARTA
 Ferry Indriasmoko
Account Leader, Enterprise Digital Solutions
GE Healthcare
(62) 81230222351
Ferry.indriasmoko@ge.com

OVERVIEW

Having over than 12 years professional work experiences, especially in: Sales and Marketing, Digital
Healthcare Business development and strategy,Customer Relationship Management, Presentation and
Negotiation, Market Analysis and digital service operations Strategic Planning, leadership and strategic
direction to grow business in the market, Project Management.Hobbies Traveling, Reading book, Cycling,
Fishing.

EDUCATION & CREDENTIALS

Graduate from Radiology of Universitas Airlangga
MRI Clinical specialist Training – Singapore
PACS and VNA Training – Shanghai
Enterprise PACS Training – Singapore
Global quality management Training – Jakarta
Impact of anti-Bribery Rule in Healthcare training - Jakarta

RELATED EXPERIENCE
• Account leader – Enterprise Digital Solution, GE Healthcare [2018-present]
Responsibility to provides overall leadership and strategic direction to grow business in the market.
Profit and loss responsibility for the business and will lead the strategy development and execution to bring our
business to the next level.

• Account Manager – Healthcare Digital [2016-2018]

Responsible for creating and winning sales opportunities for GE products/solutions/services in an
assigned territory, or in a list of named accounts or both. Work individually and collaborations with Team in an
account or territory, or where applicable act as part of a One GE Healthcare team

• Product sales specialist HCIT ASEAN [2015-2016]

Product Management, People Management, Understanding the Customer, Product Development,
Requirements Analysis, Pricing, Planning, Competitive Analysis, Sales Planning, Inventory Control, Financial
Planning and Strategy

• Project Manager Attune Technologies [2010-2015]

The Project Manager manages key client projects. Project management responsibilities include the
coordination and completion of projects on time within budget and within scope. Oversee all aspects of
projects. Set deadlines, assign responsibilities and monitor and summarize progress of project. Prepare reports
for upper management regarding status of project.
 What is a VNA anyway?
Enterprise systems
One Industry experts definition:
‡ A Vendor Neutral Archive (VNA) is a medical device that Departmental systems
provides scalable image and information and life cycle PACS/RIS LAB Others
management so that images and related information can be HIS
DICOM, PDF, ECG, EEG, EMR Integrasi Peralatan Medis dalam MIS-RS
queried, stored and retrieved in a manner that is defined by endoscopy, photos,…

open standards at multiple department, enterprise, and

regional level while maintain patient privacy and security.*
DICOM, HL7, IHE-XDS, WADO
Application Neutral Format Neutral
Why are customers typically interested in a VNA?
‡ Consolidation: Need to consolidate multiple PACS, but the
current PACS architecture does not scale, migration costs are Centricity Clinical Archive
high or departments want to keep the discrete solutions.
‡ Patient-centric imaging records: Need for a complete patient- IT Platform Neutral
Objects
centric imaging record from multiple departmental systems
including other ologies, but the current PACS cannot properly
SAN
manage non-radiology content. CAS
NAS
‡ Image enabling the EMR.
‡ Explosion of data.
*See http://www.otpedia.com/entryDetails.cfm?id=475 (By Herman Osterwijk) 3

Centricity Clinical Archive

For physicians and clinicians who Vendor Neutral Archive [VNA]

are focused on collaboration
and care pathway
Customer Challenges
optimization, Centricity™ 35% Of patient cases Interoperability of systems Lack of insights across the GE Centricity Clinical Archive
Clinical Archive is a Vendor misdiagnosed, contributed to by could save healthcare enterprise to drive workflow
Neutral Archive solution that lack of collaboration and access1 ecosystems $30B/yr2 optimization and revenue
provides 360-degree imaging realization decisions
and multi-media patient
content with seamless access Solution Benefits
through the EMR-integrated
ZFP diagnostic viewer to Seamless EMR embedded access to Interoperability by design; driving Dashboards to drive
empower care coordination a 360-degree multi-media patient reduced cost by consolidating intelligence from stored data
across the enterprise. Based on imaging record that supports departmental archives into one and to provide actionable
industry interoperability efficient clinical collaboration across reliable, scalable, fully insights enabling augmented Ferry Indriasmoko
standards like IHE, DICOM the enterprise interoperable Vendor Neutral clinical, financial, and
web, and XDS GE Healthcare Archive operational decision making GE Healthcare
has a proven record of multi- Outcome
vendor clinical system
integrations and large-scale Drive enterprise clinical Reduce total cost Improve revenue
deployments connecting collaboration and care of ownership for capture opportunities
clinicians across hospitals, pathway optimization enterprise imaging IT with deeper insights
health systems and regions with a holistic patient systems on workflow
record to help improve efficiency needs
care 1 “Types and Origins of Diagnostic Errors in Primary Care Settings,” Journal of American Medicine, 2013
2 http://www.westhealth.org/sites/default/files/The-Value-of-Medical-Device-Interoperability.pdf
 Market Drivers - Is patient care still at the mercy of IT?
IHS (with GE’s input) definition of VNA
Multi-institution
Patient Information
• Exploding demand on imaging
Enterprise Management
• Lack of clinical specialists
Multi-specialty Multi-PID, patient consent, The challenge
gateway • Empowerment of patients
Enterprise Archive
to image exchange • Cost pressure
DICOM Archive Connecting
Departmental to ‘ologies,
Multi-PACS,
Archive enterprise • Connect existing systems, open platforms
cardiology
DICOM Archive registry • Connect people: specialists and patients
The demand
Level 1 (DICOM) Level 2 (DICOM) Level 3 (+XDS) Level 4 (+XDS) • Analyse data and get actionable insights
Independence of PACS Imaging consolidation Enterprise-wide clinical Cross-enterprise patient
application across enterprise data consolidation repository & sharing
• Vendor neutral sharing across departments
The GE solution • Boundaryless collaboration among people
Added Granularity
• Advanced Analytics
‡ Level 2.0 – Multi-department DICOM
‡ Level 2.1 – Multi-Site DICOM
‡ Level 3.0 – Multi-department XDS (Hospital) • Increased efficiency
‡ Level 3.1 – Multi-site XDS (Enterprise/Regions) The outcomes • Improved patient satisfaction
• Increased productivity through visibility

*Source : 2015 IHS Global VNA and IX Market Report www.ihs.com 7

Confidential. Not to be copied, distributed, or reproduced without prior approval. July 31, 2019 5

What a Vendor Neutral Archive is Not!

What really matters?

‡ Departmental PACS in radiology, cardiology or other hospital department

DICOM only VNA ‡ Enterprise PACS deployed across multiple departments, providing the ability to
capture images from all those departments into a single viewing and storage
application
- Or – ‡ DICOM Archive deployed on the back-end of a departmental PACS but
proprietary to the installed PACS

VNA with DICOM AND non-DICOM ‡ A large storage device

16 May 2018 8 6
 VNA - Features at a Glance – What a VNA can and should do
Today’s Healthcare Reality

Media Manager (Visible- Zero Footprint Image Lifecycle Attribute Based Access
light image ingestion) Viewing Management Control (ABAC)

DICOM and Non DICOM

Privacy and Security Archive Vendor Neutral Governance

IT
Ma
na
Ac ge
Isolated Isolated Disconnected Limiting ce meGove
nt
ss rnan
ce

Imaging Tools Collaboration Tools Processes Outcomes Standards Based

Interoperability Dynamic Tag Morphing Master Patient Index IT Management
and Analytics

Confidential. Not to be copied, distributed, or reproduced without prior approval. 12

Data Explosion in Healthcare is happening FAST Today’s Healthcare Transformation

Healthcare systems need:
Growing at
50 Petabytes Configurable tools
Of data per hospital.1 48% per year2 Full integration with EMRs and imaging
Growing at 48% per year.
modalities
NEW DATA

Hi-Res
Cohesive user experiences
202,375,168 KB/genome
Complete patient views across care
Video
5,000,000 KB/movie pathways
3D Images
35,000 KB/study Data management and analytics
Ultrasound
Traditional Data 2D Images 20,000 KB/waveform Better patient, financial and
Numbers Text 1,500 KB/image
5 KB/record 500 KB/record
operational outcomes
Source: IDC & EMC

Confidential. Not to be copied, distributed, or reproduced without prior approval. 13 Confidential. Not to be copied, distributed, or reproduced without prior approval. 11
Zero Footprint Viewer
An un-digital comparison

‡ HTML5 and Mobile Devices

‡ Provides patient centric view with easy to use
timeline bar
‡ Displays DICOM and non-DICOM content in
full quality
50 Petabytes
‡ Cleared for diagnostic use
‡ Navigation and filters based on XDS
=
metadata attributes 8,000,000,000 Books
‡ Zero footprint =
R Web based without client-side installs
R Browser and OS agnostic 25 times the Library of Congress and the British Library combined!
‡ Single sign-on desktop integration with EMR
‡ Dual Monitor support

16
Confidential. Not to be copied, distributed, or reproduced without prior approval.

Media Manager
Data Explosion in Healthcare is happening FAST & VAST
Key capabilities
Key benefits
‡ “Click and push” images with EMR(s)1 Sensors/RPM2
‡ Designed with security top of mind
mobile devices Lifestyle and
‡ Enhance staff efficiency Lab Systems Behavior Data mHealth Apps
‡ Automated patient identification
‡ Reduce documentation time compared 50%
‡ Pictures uploaded to VNA as an
to manual workflows Pharmacy Systems Patient-Reported Outcomes
XDS document
‡ Enhance enterprise wide access to Data Sources
‡ EMR notifications Medical Imaging
pictures by Influence
‡ Access images via Zero Footprint Care Data Human
‡ Standardize documentation on Health 10%
(ZFP) viewer Medical Claims Biology Data Genetics
Outcomes 20%
‡ Wound Care, ED, PT, Burn Unit,
Audiology and others Prescription Drug Claims

Social and Socioeconomic Data

Billing and Supply Chain
Environmental
Example Wound Care Work Flow: Data
Scheduling Systems 20% Patient Questionnaires
Evaluate Scan Capture Document Physician
Patient ID Image Access

1) EMR = Electronic Medical Record Source: Nash DB, “Population Health: Why It Matters,” Essentials in Population Health, Children’s Hospital
2) RPM = Remote Patient Monitoring Association, Thomas Jefferson University, October 2016; Health Care IT Advisor research and analysis

Confidential. Not to be copied, distributed, or reproduced without prior approval. 15

 Centricity Clinical Archive consolidates siloes of Converged Collaboration Tools
data and helps deliver a unified patient record 1 Tool Ň 4 Applications Ň Advanced Workflows Ň Customer ROI Ň Better Patient Outcomes

Radiology Cardiology Pathology Endoscopy

Multi-Disciplinary Team
Case Exchange Physician Access Patient Access
Meeting

DICOM .pdf,
Easily share and collaborate on Simple organization and Provide both affiliated and non- Enable patient ownership of their
.pdf .avi patient images and data management of care team affiliated physicians access to own reports and data
.doc
meetings longitudinal patient imaging data
‡ Easy to dynamically share and ‡ Set-up, schedule and run multi- ‡ Access to patient results, ‡ Easy and secure access to
collaborate on patient images disciplinary care teams images and reports images & reports
and data ‡ Centralized, easy-to-navigate ‡ Collaboration with peers ‡ Download capabilities
Centricity Clinical Archive with XDS/XDS-I Registry and Repository
‡ Automated workflows and case lists with connectivity ‡ Connect with patient ‡ Control of access rights for
advanced 3D visualization tools to PACS other physicians
to share images ‡ Summarize meeting
‡ Secure, standards based foreign outcomes and notes for efficient
Unified Patient Record study management follow up
(EMR/Image Access)
20
18

Enterprise EMR (Clinical Record) + Enterprise VNA (Imaging Record) = EIR (Enterprise Imaging Record) “Imaging” Related content per Specialty Area
Specialty Area DICOM A/V, MPEG, JPG, PDF Other Sources
WAV Clinical
Full EMR, Data
Warehouse; ED, Amb, Endoscopy Cardiology ; ; ; ; CVMR, CVCT, CV Cath, CVIS, CVECG/HOLTER/STRESS/PACE, photos
OP Dermatology ; ; ; ; Photos, Dermatological Reports
Emergency Medicine ; XRAY, CT, ECG, Triage Reports, photos
Structured Templates, ; ; ; ;
Pathology Endocrinology SPECT/CT, PET CT, Physician Reports, Voice Dictation Files
CDSS
Family Medicine ; ; Physician Notes, Reports
Gastroenterology ; ; ; ; Barium XRAY, CT, NM, Endoscopes, US, Reports, Voice Dictation, photos
Closed-loop
Hematology ; ; ; HT Reports, Voice Dictation Files
medication
Oncology
Nephrology ; ; ; US & MRI, NM, Reports, Dictation Files, photos
25% of total ENTERPRISE ENTERPRISE 75% of
CPOE, CDS EMR IMAGING Neurology ; ; ; ; Renal Scans, SPECT/CT, PET CT, Physician Reports, Renal Grams, strips, video
data total data Nuclear Medicine ; ; ; US, Physician Reports, Voice Dictation Files
Radiology Obstetrics ; ; ; XRAY, CT, US, Reports, Voice Dictation Files, Fetal Strips
Flow sheets, CDSS

Image Enabled EMR

(error chk) Oncology ; ; ; FDG-PET, CT, XRAY, Treatment Plans, Densitometry, Biograph

Structured Content
Ophthalmology ; ; ; Laser Images, Physician Reports, Voice Dictation Files
Cardiology Oral Surgery ; ; ; Dental XRAYS, Surgeon Reports

Unstructured Content
CDR, CDS, HIE capable
Pathology ; ; Digital and Scanned Pathology, Pathology Reports, Voice Dictation Files
(Images, Reports, Documents) Pediatrics ; ; ; Nuclear VCUG, DMSA Scans, Reports, Voice Dictation Files
Wound Care Pulmonology ; ; ; ; CT Gamma, SPECT, PET Reports, Voice Dictation Files
Lab, Rad, Pharmacy
Radiology ; ; ; MR, CT, US, NM, XRAY, Radiology Reports, Voice Dictation Files
Surgery ; ; ; ; C-Arm, JPG, TIFF, PDF
Interoperability Urology ; ; ; ; Ultrasound, video, reports, labs
Plastics – Cosmetic Surgery ; ; ; ; JPG, TIFF, PDF, video, vascular ultrasound, reports
n EMR aggregates department o VNA aggregates department ; ; ;
Orthopedics C-ARM (DICOM), JPG, TIFF, PDF
‘structured’ content ‘unstructured’ content Burn Center ; ; ; JPG, TIFF, PDF, video, reports
21 19
Wound Care ; ; ; JPG, TIFF, PDF, video, reports
Operating with siloes of data is not sustainable Outcomes: Empower your health system:
A holistic 360° multi-media imaging patient record
Multi ‘Ologies
Patients Patients
Patients
Radiology Cardiology Pathology Endoscopy MDT

DICOM .pdf .pdf, .avi GPs & Referrer

.doc
Imaging Imaging Imaging Imaging
systems systems systems systems
Analytics

PACS PACS Archive Archive CentricityTM Clinical

Archive Solution
Clinical Collaboration Case
(Enterprise DICOM + Non-DICOM Data)
Exchange

Connect systems Connect people

Optimize care quality & productivity Develop care collaboration networks

24 22

Success Stories Storage??

‡ Hospital Corporation of America Wrap your brain around 1 PB
‡ 180+ hospitals, 17M DICOM per year, XDS
‡ UPMC .5 PB = Library of Congress
‡ 35 hospitals, DICOM/XDS, Media Manager
745 M Floppy Disks
‡ University of Washington
‡ 5 Hospitals, DICOM, XDS, Burn 20 M four-drawer filing cabinets
‡ Adventist Health West filled with text Do you think
CIO/IT Dept cares
‡ 20 hospitals, DICOM, XDS
20 PB = The amount of data about this data
‡ Partners Boston MA explosion?
processed by Google daily
‡ 5 Hospitals, 190M Agfa exams + 4 more sites
50 PB = Entire written works of
mankind from beginning of
recorded history (all languages)

25
VNA - Image Lifecycle Management (ILM) Why GE and Centricity Clinical Archive ?

World’s VNA1 20 years

Highest Market Share1 of experience providing

+1000 sites globally2 archiving services3
Move Compress Delete

‡ Do-it-yourself ‡ Rule-based lossy ‡ Rule-based Demonstrated higher

storage migration: compression with deletion with
easily replace aging flexibility in configurable data Connected 5 Interoperability
storage configurable rules retention rules to to most 3rd party PACS readiness than any other vendor4
‡ Storage tiering to to save valuable regain valuable solutions
optimize storage storage space storage space
costs
1 Market share ranking published by IHS Technology Medical Enterprise Data Storage Market – 2015
2 Regional CCA L1/2/3/4 site count as of May 2015
3 1998 first Archive install
28 4 2015 global IHE Connectathons participation scores reveal GE has the highest number of profiles successfully tested
26

VNA - Dynamic Tag Morphing

DICOM tag morphing engine
Additional Data
PACS A VNA PACS B
DICOM C-Store DICOM C-Store

CT_ABDOMEN CT_ABD CT_ABDO

Tag morphing for data quality
‡ Repair corrupt incoming DICOM objects
before they are archived
‡ Add missing identifiers, e.g. “Issuer of
Patient ID“
‡ Prefix/postfix identifiers in foreign
DICOM objects, e.g. Patient ID, Accession
Number
Tag morphing for data neutrality
‡ Make proprietary information in private
DICOM tags openly available in public
DICOM tags, e.g. rejected image,
significant image, confidential patient
‡ Change value of DICOM tags to
commonly used terminology

29
VNA - Security & data protection VNA - Enterprise Master Patient Index (eMPI)

‡ Access Control Policies (RBAC) Consent Creator CCA eMPI architecture

‡ Patient Consent ‡ Queryable eMPI based on IHE PIX and
‡ Emergency Access IHE PDQ
‡ Retrospective Access Control (Audit) Hospital 1
‡ Assign multiple local patient IDs to a
Share all during
treatment only single enterprise or community ID
eMPI ‡ Single enterprise ID is used as patient ID
Hospital 5 Hospital 2
Query + role + department Vendor Neutral Archive throughout CCA
1. Check patient consent ‡ Easily scalable to additional source
Document resultset limited by 2. Check authorization of
customized policies user based on policies systems
2015 Roadmap: Reason for breakglass 2015 Roadmap:
Hospital 4 Hospital 3 ‡ IHE profiles: PIX, PDQ, ATNA
1. Check breakglass request
2. Log user + time + reason for
breakglass
2015 Roadmap: Unlimited documentset

Technology in development that represent ongoing development efforts. These technologies are not products and may never
become products. Not for sale. Not CE marked. The information contain herein is confidential and proprietary to GE Healthcare.
Don't distribute or discuss this information with others.
32 30

VNA - Audit Trail Repository Privacy and Security: Role Based Access Control

‡ Captures audit trails from multiple CCA components and CCA component
(e.g. EMPI, XDS Each document has a confidentiality code
external products in a single repository provided by the XDS Document Source ‡ Authorized access to CCA
Registry, EA, CCG,
‡ Application neutral – supports IHE actor ATNA Audit Record Universal Viewer ZFP)
content with different levels
Repository (ATNA = audit trail and node authentication) of confidentiality
Record Audit Normal
‡ Supports TLS for secure communication ‡ Authorization based on
Event [ITI-20]
‡ Stores audit records in relational database for fast queries pre-defined roles
‡ Web-based user interface for Audit Trail ‡ Role is passed from Universal
search and display of audit records Repository Restricted Viewer ZFP to XDS Registry
‡ User authentication based on
Active Directory
‡ Centralized access control
decision in XDS Registry
Very Restricted
‡ Available for other XDS
consumers that support
Each user has a role provided by the XDS Document IHE XUA++
Consumer.

33
VNA - Architecture and Dependencies VNA - High Availability / Disaster Recovery (HA/DR)
‡ Disaster Recovery: Automated orchestration and Use Case Solution
non-disruptive testing of centralized disaster
Predictability Key IHE Profiles for recovery plans for all components
‡ Measurable and reproducible results Centricity Clinical of the VNA High Availability: Protect CCA against
pre-tested at IHE Connectathons Archive physical server or operating system VMware vMotion
failure
Specialization
‡ More vendors can play in the solution ‡ High Availability: Protection against physical server,
operating system or component application failure
Flexibility PIX/PDQ High Availability: Protect CCA against Symantec Application
‡ Maximize Common solution for all components of component application failure HA
‡ Easy to address future requirements XDS the VNA
Cost control XDS-I ‡ Support for multiple storage vendors
Disaster Recovery: Automated failover of VMware Site
‡ Faster implementations ATNA the whole CCA solution to another data Replication Manager
BPPC center (SRM)
XCA

36 34

VNA - Importance of IHE XDS / XDS-I for VNA
Common challenges
Variety of data formats
Images, documents, videos
VNA - Vendor neutral
Application Neutrality (DICOM, HL7, IHE)
How XDS can help ‡ Leverage healthcare interoperability standards
Departmental Enterprise
‡ Ingest information from departmental systems through standards systems systems
based interfaces: DICOM, HL7, IHE XDS
Native support for many
different file formats ‡ Access information with viewers through standards based
interfaces: DICOM, IHE XDS, WADO
DICOM, CDA, PDF, JPEG, and more

DICOM, HL7, IHE-XDS, WADO-RS & more

Security & access control
Across departments and facilities
Multiple data models
Different sets of terminology
Role-based access control IT Platform Neutrality (Storage, Virtualization)
& consent management Application Neutral Format Neutral
‡ Leverage the continuous improvement in infrastructure technology
Across departments and facilities to lower cost
‡ Leverage standards-based storage interfaces VNA
Normalized coding schemes
Format Neutrality (DICOM Part 10, CDA) IT Platform Neutral
XDS metadata Objects
‡ Store DICOM and non-DICOM information in native open formats

SAN NAS CAS

Limited accessibility Patient centric model
No unified view of images and documents Central index, accessible anywhere

37 35
16 May 2018 38

16 May 2018 39