Evercore Clinical Enterprise Suite

The TeraMedica Evercore - Clinical Enterprise Suite of software modules can connect and manage the digital image infrastructure of a healthcare system from the imaging device or PACS to the electronic health record (EHR) and the clinical desktop.

                       

Connect Manage Store Retrieve. . .Evercore

Evercore is a modular, customer-centric software system, designed to solve the problems of the modern Healthcare Enterprise.

• Evercore - SmartStore - Clinical Storage Rules
• Evercore - Univision - Enterprise Lightweight Image Viewing  
• Evercore - Remote - Connecting Remote Institutions
• Evercore - Data Controller - Data Migration Tool

Evercore works through an enterprise archive serving as a central repository for clinical information (DICOM and non-DICOM alike). From a DICOM perspective, this enterprise 'Network' scales from several thousand imaging procedures per year to more than 6 million. Enterprise Image & Information management allows healthcare providers to fully realize the benefits of digital imaging while

• Evercore is an open, Java-based system that is not dependent on proprietary server or storage technologies. It is fully leveraged to the commodity storage benefits of Moore's Law with migration features to manage the process of moving data across storage technologies.
• The system configures to support an N-tier storage architecture where management protocols match media (RAID, optical disk, DVD, tape) to the retrieval characteristics of the study and the management policies of the imaging department. It reserves higher cost, high speed RAID structures for high value studies with high reference frequency. Evercore assigns studies with lower retrieval characteristics to lower cost, slower speed tape or optical disk and uses compression to minimize cost.
• Evercore organizes media in pools and assigns them to specific organizations or facilities. The system also supports business continuity where remote back-up is in place.
• The system bases image retrieval on demographic profiles describing a specific study or group of studies responding to any combination of these descriptors.
• Evercore secures access to digital images to authorized viewers through an electronic health record (EHR), diagnostic work stations or clinical desktops.
• Evercore scales to meet needs ranging from those of a single department or clinic to those of multiple facilities with multiple imaging specialties.

Breakthrough Architecture
The Evercore architecture is designed and built to handle patient data storage and distribution requirements of large health care systems. These multi-department, multi-facility healthcare providers generate tens of terabytes of data annually. In most cases this data is fragmented across departmental PACS systems without the IT infrastructure needed to manage the data.

The Evercore core architecture scales to match user requirements ranging from Intel-based configurations processing a few thousand procedures per year to multi-processor arrays of enterprise scale Unix servers configured to hundreds of terabytes of working storage. Evercore offers healthcare systems massive scalability in server, storage capacity and parallel application services providing a solution to today's requirements and an orderly path to accommodate tomorrow's growth.

Architectural features include:

• Massively scalable database.
• Massive parallel application services across enterprise scale server configurations.
• N-tier storage configurations featuring multiple media (disk, optical, tape) addressing hundreds of terabytes of storage.
• An Intelligent SmartStoreTM Rules Engine that establishes storage and distribution protocols that optimize image management based on the clinical profile of the study, management policy, enterprise work flow and regulatory requirements.
• Legacy data migration tools to preserve older image datasets and integrate this data into the enterprise image management infrastructure.

TeraMedica has long been a proponent for the development and advancement of industry standards for the open integration of clinical and diagnostic imaging systems within the healthcare enterprise. TeraMedica continues to be at the forefront of adopting and supporting standards including DICOM, HL7, HIPAA and IHE.

DICOM - Digital Imaging and Communications in Medicine
The DICOM 3.0 standard enables diverse medical imaging devices to exchange images and associated patient information in a digital format. The National Electrical Manufacturers Association (NEMA) and the American College of Radiology (ACR), in co-operation with other organizations, have sponsored the standard. TeraMedica products are DICOM 3.0 compliant to support connectivity with other DICOM 3.0 medical devices.

HIPAA - Health Insurance Portability and Accountability Act
TeraMedica is proactive with respect to HIPAA and is actively addressing HIPAA in the design of all current and future product releases.

What is H.I.P.A.A.?
H.I.P.A.A.(HIPAA) is the Health Insurance Portability and Accountability Act - passed into law in 1996. The act is responsible for major healthcare reforms. One portion of HIPAA is called Administrative Simplification. This section of the act sets out several standards intended to streamline administration of the U.S. Healthcare system. Using and standardizing electronic communications is one of the key ways to reduce administrative cost. It was realized however that mandating electronic transactions for privileged healthcare information included a responsibility to protect the privacy of the information and ensure that the systems storing the data had implemented at least minimal security safeguards. The act required congress to enact laws protecting this data within a proscribed time period. When this time period expired the responsibility fell to the U.S. Dept. of Health and Human Services (D.H.H.S.). The D.H.H.S. then proposed rules for each of the sections of Administrative Simplification.

Why is H.I.P.A.A. important?
The D.H.H.S. has issued or will issue standards. Two of the subsections of the Administrative Simplification section of the act are Security and Electronic Signature Standards and Privacy Standards. These standards dictate how confidentiality will be maintained with respect to patient data that is stored or transmitted electronically. The D.H.H.S. has issued a final rule for Privacy Standards but only a proposed rule for Security and Electronic Signature Standards.

Who needs to comply?
Health care providers that store patient data electronically or transmit health care information electronically need to comply with HIPAA. Practically, this means almost all Health Care Providers.

When are the standards to come into effect?
Health Care providers that perform over $5 million in medicare treatment will be required to attain compliance within 2 years from the effective date of issue of the Final Rule of a given standard. The D.H.H.S. has issued a final rule on the Privacy Standard that will have an effective date of issue of April 16, 2001. The D.H.H.S. has neither issued a Final Rule on the Security and Electronic Signatures standards nor announced a target date by which they will have issued the Final Rule.

What does HIPAA mean to the Healthcare Organization?
HIPAA, specifically the Security and Electronic Signature standards, will have many effects on the Health Care Organization. There are administrative, physical security, technical services, and technical communications requirements that must be met by the Healthcare Organizations. This will result in changes in business practices and day-to-day routine as well as technical measures to meet the requirements.

IHE - Integrating the Healthcare Enterprise
The IHE initiative is a project designed to advance the state of data integration in healthcare. Its' fundamental objective is to ensure that in the care of patients all required information for medical decisions is both correct and available to healthcare professionals. IHE demonstrates that imaging and other healthcare information and management systems can be successfully integrated and highlights the ways that this integration will benefit patients and health professionals.

IHE is sponsored by the Radiological Society of North America (RSNA) and the Healthcare Information and Management Systems Society (HIMSS). The organization brings together the major vendors in the healthcare information and imaging systems industry to agree upon and demonstrate standard interfaces and data architectures.

HIMSS and RSNA have joined together to carry out a series of showcases to demonstrate connectivity between vendors. In these demonstrations, established standards were used to communicate images and patient information among dozens of systems from a variety of vendors. Vendors of PACS, modalities and HIS/RIS etc. demonstrate their ability to exchange messages in an open environment based on existing standards such as DICOM and HL7.

Currently in its fifth year, IHE has put together a team of experts and leaders in health care to develop a practical approach to communicating patient data effectively throughout the healthcare enterprise.

Why is IHE Needed?
We're undergoing an explosion in medical information and increasing amounts of data are available and needed to make the best decisions for patient care. Physicians need access to information in order to deliver optimal care. Systems need to share information seamlessly for the enterprise to operate efficiently. Administrators need to know they can integrate systems in a cost-effective manner. IHE is working to meet these needs.

What is the goal of IHE?
IHE's goal is to encourage enterprise-wide sharing of information by imaging and information systems used in healthcare. The goal is also to remove barriers to optimal patient care by making all relevant data accessible on demand to care providers.

What are IHE Integration Profiles and Actors?
IHE Integration Profiles organize the integration capabilities defined by IHE to address specific patient care needs. Integration Profiles offer a convenient way for vendors and users to reference the functionality detailed in the IHE Technical Framework without having to restate all of the details regarding IHE actors and transactions defined there. They describe clinical information and workflow needs and specify the actors and transactions required to address them. A single vendor system might support one or more than one Integration Profile.

IHE Actors
Information systems or applications that produce, manage, or act on information are represented as functional units called IHE Actors. Each actor supports a specific set of IHE transactions. A given information system may contain support for one or more than one actor.