AT&T Medical Imaging & Information Management

With the Medical Imaging and Information Management solution, we enable the AT&T Cloud Services platform to provide centralized, cloud-based storage of medical images. Our vendor-neutral solution enables any patient, any image access by clinicians. Medical Imaging and Information Management helps you keep up with the demand for increasing storage capacity, medical image exchange between disparate PACS and facilities, interoperability and security.

The service is priced based on the number of studies to be archived, as well as the on-going storage of those studies in the cloud. Your AT&T account representative will be able to help provide pricing based on your individual needs.

Our solution runs on any on-premises hardware that supports Windows 2008 Server R2 or SQL Server 2008, and all servers for the core archive can be virtualized. The solution can use any storage capable of CIFS or NFS mounting, and has multiple API integration into advanced storage platforms, such as EMC Atmos. We use EMC Atmos in our datacenter.

The solution’s VNA software that is used on premises hardware can communicate with the software enabled in the data center. This offers an opportunity for you to manage the volume of local studies by using the cloud for legacy studies or for second copies in a pay-for-use model.

In addition, specific study volume by site and network bandwidth capacity help determine full, specific hardware requirements.

AT&T Medical Imaging and Information Management stores enterprise DICOM archive objects in native format, without modifying image data. You can leither eave header data as is or modified using the Tag Mapper or Reconciliation Service to support local workflow and imaging requirements.  You don’t have to worry about problematic format conversions.

AT&T Medical Imaging and Information Management supports various VNA standards.  AT&T follows a policy to deliver standards-based solutions, and our solution is fully compliant with DICOM v3.0, HL7 v2.0 and above, and IHE profiles such as XDS.a and .b.  DICOM Conformance Statement and IHE Integration Profiles can be found at http://www.acuotech.com/index.php/company/resources.

The release history for AT&T Medical Imaging and Information Management includes releases for the software itself and for the underlying services.  We commercially released the enabling software in 2001. Our AT&T Synaptic Storage as a Service^SM became generally available in 2009, and our hosting platform has been commercially available since 1998.  The current release of vendor neutral software is 5.3.1, and our cloud storage software release is 1.3.4.

The frequency of releases for AT&T Medical Imaging and Information Management varies depending on the different hardware and software platforms.

Our solution comprises several different hardware and software platforms, each with a unique release cycle set by the vendor. Most of the platforms, like the vendor-neutral archive (VNA) software, have 1-2 major releases per year and 3-4 "service pack" roll-ups of features and functionality in between major releases.

We work closely with our technology suppliers to help ensure that we keep our service delivery systems up to date, functional, and performing within our contracted service levels. As part of that due diligence, we consistently test, validate, and distribute software updates to production (during published and/or negotiated) maintenance windows.

You don’t need to purchase any additional software in support of AT&T Medical Imaging and Information Management solution.  As part of the solution, we provide Windows 2008 Server and SQL Server 2008 licenses to support the application.

AT&T and our partner Acuo use an open systems approach to deliver AT&T Medical Imaging and Information Management solutions.

Via this approach, our standards-based solutions are fully compliant with DICOM v3.0, HL7 v2.0 and above, and IHE profiles such as XDS (.a and .b). The open systems software is based on industry standard computing platforms (Windows, SQL) and has open interfaces for authenticated users via DICOM, SQL, and the emerging Open Data Protocol (OData).

AT&T uses industry standard storage access (CIFS, NFS), which allows the solution to use any compliant storage platform. The system stores metadata with the image data on the archive media, as required by DICOM Part 10, and appends historical changes to the metadata with the images. The use of metadata enables full audit trail and disaster recoverability from the stored images.

AT&T Medical Imaging and Information Management solution provides several system security features for user access and usage controls.

We provide end-user access to the cloud storage via a DICOM viewer, PACS application, or EMR. We provide system administrator access via Microsoft Management Console, embedded within the Microsoft operating system. In addition, we use Active Directory for vendor-neutral archive (VNA) user access and password management, and integrate it with your existing Active Directory implementation.

As a result, you get enterprise-wide management of user access and usage controls.

AT&T Medical Imaging and Information Management manages and standardizes data from different picture archiving and communication systems (PACS) by using an intelligent data library.

This library can dynamically convert data from any PACS to a standard format. Because the conversion is dynamic, it occurs without the need for professional services or a statement of work.

When you consolidate data from multiple PACS, you can maintain the data in a format that allows the PACS front-end to change without requiring a future migration.

There is no limit to the number of entities that one AT&T Medical Imaging and Information Management system can support.

We design the solution to virtually have no limit and to support vast scalability in a controlled auditable and cost-effective way. The architecture has no software or hardware limits on number of users, integrated systems, or connected devices.

AT&T Medical Imaging and Information Management uses multiple interfaces to populate its archives within the customer’s environment.

Interfaces between the archive and customer systems can be DICOM (for PACS), web service interface (for non-DICOM applications outside radiology), and/or XDS (for XDS-compliant environments). These interfaces distribute imaging studies between source applications and the archive datacenter in real time. The ingest of images can occur when you acquire them, or when the status of an image changes within the PACS, such as when an imaging study has been signed.

As a result, we keep your archives current at all times.

The turnaround time for us to configure the AT&T Medical Imaging and Information Management vendor neutral archiving (VNA) solution depends on the components and complexity of the solution.

In most cases, we can schedule the custom configuration as soon as we receive your requirements. We use a highly configurable, yet repeatable, deployment model, and we can set up and configure the VNA software remotely.

The most common setup requests include

• Configuring new routes or destinations
• Creating new database queries
• Providing tag mapper support
• Resolving DICOM related issues with non-standard devices

Turnaround time for software design and configuration is three to six weeks, assuming the hardware is in place and operational. Software interfaces can require additional time, and integration of non-DICOM sources to the Web service adapters requires additional analysis and time.

Users can access multiple instances of AT&T Medical Imaging and Information Management solution via DICOM or the inherent web services.  Each instance would appear as a distinct entity, or, with the federated database capabilities, separate nodes can be federated into a grid that associates all nodes. Via the grid, the system transparently distributes user requests at one node across all federated nodes, and returns the aggregated response to the requestor. You can restrict access to a single node or grant access to the unified archive.

AT&T Medical Imaging and Information Management handles errors via various mechanisms to help ensure high data integrity.

Out reconciliation feature automates restoring DICOM Header information to upstream HL7 values (for example Study Description). We also support HL7 merge and update messages.

Our robust Patient Manager Utility, available as a standalone application or integrated with the Archive Management Console, enables clinical users with proper permissions to update, merge, split, or deleted images, series, or studies.

You can manage duplicates according to pre-defined configuration rules, including options to:

• Keep First
• Keep Last
• Keep All
• Keep Higher Quality Asset

In addition, settings are available to lock an asset from being overwritten or replaced based upon certain DICOM attributes. You can define these configuration options for each specific database or apply them globally. Lastly, you can use the tag mapper to automate the modification of inbound or outbound studies to conform to destination requirements.

AT&T Medical Imaging and Information Management system provides access to a wide range of database reporting tools, including links to popular reporting products that run under Windows.

Via these tools, end users have full access to the database tables. Users can build queries and export results via XML or ODBC to commercial spreadsheets or to report generation packages.

AT&T Medical Imaging and Information Management solution uses several methods to allow users to extract data in real time in a standardized format.  We receive inbound data and normalize it for user-configurable DICOM conventions for name complex and delimiter syntax.

AT&T Medical Imaging and Information Management can reconcile inbound data with corresponding order or scheduling information, and modify it to conform to upstream HIS/RIS data. In addition, the solution can modify both inbound and outbound DICOM metadata to conform to standards or to enable cross-vendor interoperability. These methods allow all archived data to be available for extraction via real time SQL Queries or via the exposed OData web service.

You can request support for AT&T Medical Imaging and Information Management by phone, email, or online using the customer portal.

AT&T Medical Imaging and Information Management scales to meet multi-tenant environments in the following way.

Our federated database model supports multiple tenants with logically distinct databases for each tenant. You can configure each database with its own AE title and restrict access to a single database or enable it across multiple databases. You can track usage and storage metrics for each database and define workflow, retention/purge. and DICOM normalization for each distinct database.

So, all databases can share common storage, or use separate physical storage.

AT&T Medical Imaging and Information Management maintains patient privacy and security in support of HIPAA regulations via information technology.

We encrypt data in motion between edge devices and the archive. We provide multiple security measures, including DICOM authentication between DICOM nodes, SQL Database user ID authentication, and user access control to specific databases.

AT&T Medical Imaging and Information Management uses Microsoft Active Directory natively to provide and manage unique passwords.

We use Active Directory for vendor-neutral archive (VNA) user access and password management, and integrate it with your existing Active Directory implementation. You may also choose to deploy and manage your own multiple architectures, but our main integration for services and user access is via Active Directory.

AT&T Medical Imaging and Information Management system provides an audit trail based on a journalized file system.

The file system tracks all changes to each and every image and records who made the changes, the location and time of the changes, the original data, and the changed data. The system maps this information to the changed attribute sequence defined inside Digital Imaging and Communications in Medicine (DICOM), and it tracks all entries on a tag-by-tag basis. The system never changes the original tags inside the original part of the asset.