Can CDMI emancipate an interoperable medical records cloud ecosystem?

PREFACE: This is just a thought, an idea. I am by no means an expert in this area. I have researched this to inspire a thought process of how we can bring together 2 disparate worlds of medical records and imaging with the emerging cloud services for healthcare.

Healthcare has been moving out of its archaic shell in the past few years, and digital healthcare technology and services are booming. And this movement is part of the digital transformation which could eventually lead to a secure and compliant distribution and collaboration of health data, medical imaging and electronic medical records (EMR).

It is a blessing that today’s medical imaging industry has been consolidated with the DICOM (Digital Imaging and Communications in Medicine) standard. DICOM dictates the how medical imaging information and pictures are used, stored, printed, transmitted and exchanged. It is also a communication protocol which runs over TCP/IP, and links up different service class providers (SCPs) and service class users (SCUs), and the backend systems such as PACS (Picture Archiving & Communications Systems) and RIS (Radiology Information Systems).

Another well accepted standard is HL7 (Health Level 7), a similar Layer 7, application-level communication protocol for transferring and exchanging clinical and administrative data.

The diagram below shows a self-contained ecosystem involving the front-end HIS (Hospital Information Systems), and the integration of healthcare, medical systems and other DICOM modalities.

Hospital Enterprise

(Picture courtesy of Meddiff Technologies)

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Solid in the Fire

December 22 2015: I kept this blog in draft for 6 months. Now I am releasing it as NetApp acquires Solidfire.

真金不怕紅爐火

The above is an old Chinese adage which means “True Gold fears no Fire“. That is how I would describe my revisited view and assessment of SolidFire, a high performance All-Flash array vendor which is starting to make its presence felt in South Asia.

I first blogged about SolidFire 3 years ago, and I have been following the company closely as more and more All-Flash array players entered the market over the 3 years. Many rode on the hype and momentum of flash storage, and as a result, muddied and convoluted the storage infrastructure market understanding. It seems to me spin marketing ruled the day and users could not make a difference between vendor A and vendor B, and C and D, and so on….

I have been often asked, which is the best All-Flash array today. I have always hesitated to say which is the best because there aren’t much to say, except for 2-3 well entrenched vendors. Pure Storage and EMC XtremIO come to mind but the one that had stayed under the enterprise storage radar was SolidFire, until now.

SolidFire Logo

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Don’t get too drunk on Hyper Converged

I hate the fact that I am bursting the big bubble brewing about Hyper Convergence (HC). I urge all to look past the hot air and hype frenzy that are going on, because in the end, the HC platforms have to be aligned and congruent to the organization’s data architecture and business plans.

The announcement of Gartner’s latest Magic Quadrant on Integrated Systems (read hyper convergence) has put Nutanix as the leader of the pack as of August 2015. Clearly, many of us get caught up because it is the “greatest feeling in the world”. However, this faux feeling is not reality because there are many factors that made the pack leaders in the Magic Quadrant (MQ).

Gartner MQ Integrated Systems Aug 2015

First of all, the MQ is about market perception. There is no doubt that the pack leaders in the Leaders Quadrant have earned their right to be there. Each company’s revenue, market share, gross margin, company’s profitability have helped put each as leaders in the pack. However, it is also measured by branding, marketing, market perception and acceptance and other intangible factors.

Secondly, VMware EVO: Rail has split the market when EMC has 3 HC solutions in VCE, ScaleIO and EVO: Rail. Cisco wanted to do their own HC piece in Whiptail (between the 2014 MQ and 2015 MQ reports), and closed down Whiptail when their new CEO came on board. NetApp chose EVO: Rail and also has the ever popular FlexPod. That is why you see that in this latest MQ report, NetApp and Cisco are interpreted independently whereas in last year’s report, it was Cisco/NetApp. Market forces changed, and perception changed.  Continue reading

The transcendence of Data Fabric

The Register wrote a damning piece about NetApp a few days ago. I felt it was irresponsible because this is akin to kicking a man when he’s down. It is easy to do that. The writer is clearly missing the forest for the trees. He was targeting NetApp’s Clustered Data ONTAP (cDOT) and missing the entire philosophy of NetApp’s mission and vision in Data Fabric.

I have always been a strong believer that you must treat Data like water. Just like what Jeff Goldblum famously quoted in Jurassic Park, “Life finds a way“, data as it moves through its lifecycle, will find its way into the cloud and back.

And every storage vendor today has a cloud story to tell. It is exciting to listen to everyone sharing their cloud story. Cloud makes sense when it addresses different workloads such as the sharing of folders across multiple devices, backup and archiving data to the cloud, tiering to the cloud, and the different cloud service models of IaaS, PaaS, SaaS and XaaS.

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Oops, excuse me but your silo is showing

It is the morning that the SNIA Global Steering Committee reporting session is starting soon. I am in the office extremely early waiting for my turn to share the happenings in SNIA Malaysia.

And of late, I have been getting a lot of calls to catch up on hot technologies, notably All Flash Storage arrays and hyper-converged infrastructure. Even though I am now working for Interica, a company that focuses on Oil & Gas exploration and production software, my free coffee sessions with folks from the IT side have not diminished. And I recalled a week back in mid-March where I had coffee overdose!

Flash storage and hyperconvergence are HOT! Despite the hypes and frenzies of both flash storage and hyperconvergence, I still believe that integrating either or, or both, still have an effect that many IT managers overlook. The effect is a data silo.

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The reverse wars – DAS vs NAS vs SAN

It has been quite an interesting 2 decades.

In the beginning (starting in the early to mid-90s), SAN (Storage Area Network) was the dominant architecture. DAS (Direct Attached Storage) was on the wane as the channel-like throughput of Fibre Channel protocol coupled by the million-device addressing of FC obliterated parallel SCSI, which was only able to handle 16 devices and throughput up to 80 (later on 160 and 320) MB/sec.

NAS, defined by CIFS/SMB and NFS protocols – was happily chugging along the 100 Mbit/sec network, and occasionally getting sucked into the arguments about why SAN was better than NAS. I was already heavily dipped into NFS, because I was pretty much a SunOS/Solaris bigot back then.

When I joined NetApp in Malaysia in 2000, that NAS-SAN wars were going on, waiting for me. NetApp (or Network Appliance as it was known then) was trying to grow beyond its dot-com roots, into the enterprise space and guys like EMC and HDS were frequently trying to put NetApp down.

It’s a toy”  was the most common jibe I got in regular engagements until EMC suddenly decided to attack Network Appliance directly with their EMC CLARiiON IP4700. EMC guys would fondly remember this as the “NetApp killer“. Continue reading

Praying to the hypervisor God

I was reading a great article by Frank Denneman about storage intelligence moving up the stack. It was pretty much in line with what I have been observing in the past 18 months or so, about the storage pendulum having swung back to DAS (direct attached storage). To be more precise, the DAS form factor I am referring to are physical server hardware that houses many disk drives.

Like it or not, the hypervisor has become the center of the universe in the IT space. VMware has become the indomitable force in the hypervisor technology, with Microsoft Hyper-V playing catch-up. The seismic shift of these 2 hypervisor technologies are leading storage vendors to place them on to the altar and revering them as deities. The others, with the likes of Xen and KVM, and to lesser extent Solaris Containers aren’t really worth mentioning.

This shift, as the pendulum swings from networked storage back to internal “direct-attached” storage are dictated by 4 main technology factors:

  • The x86 server architecture
  • Software-defined
  • Scale-out architecture
  • Flash-based storage technology

Anyone remember Thumper? Not the Disney character from the Bambi movie!

thumper-bambi-cartoon-character

When the SunFire X4500 (aka Thumper) was first released in (intermission: checking Wiki for the right year) in 2006, I felt that significant wound inflicted in the networked storage industry. Instead of the usual 4-8 hard disk drives in the all the industry servers at the time, the X4500 4U chassis housed 48 hard disk drives. The design and architecture were so astounding to me, I even went and bought a 1U SunFire X4150 for my personal server collection. Such was my adoration for Sun’s technology at the time.

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Convergence data strategy should not forget the branches

The word “CONVERGENCE” is boiling over as the IT industry goes gaga over darlings like Simplivity and Nutanix, and the hyper-convergence market. Yet, if we take a step back and remove our emotional attachment from the frenzy, we realize that the application and implementation of hyper-convergence technologies forgot one crucial elementThe other people and the other offices!

ROBOs (remote offices branch offices) are part of the organization, and often they are given the shorter end of the straw. ROBOs are like the family’s black sheeps. You know they are there but there is little mention of them most of the time.

Of course, through the decades, there are efforts to consolidate the organization’s circle to include ROBOs but somehow, technology was lacking. FTP used to be a popular but crude technology that binds the branch offices and the headquarter’s operations and data services. FTP is still used today, in countries where network bandwidth costs a premium. Data cloud services are beginning to appear of part of the organization’s outreaching strategy to include ROBOs but the fear of security weaknesses, data breaches and misuses is always there. Often, concerns of the weaknesses of the cloud overcome whatever bold strategies concocted and designed.

For those organizations in between, WAN acceleration/optimization techonolgy is another option. Companies like Riverbed, Silverpeak, F5 and Ipanema have addressed the ROBOs data strategy market well several years ago, but the demand for greater data consolidation and centralization, tighter and more effective data management and data control to meet the data compliance and data governance requirements, has grown much more sophisticated and advanced. Continue reading

No Flash in the pan

The storage networking market now is teeming with flash solutions. Consumers are probably sick to their stomach getting a better insight which flash solution they should be considering. There are so much hype, fuzz and buzz and like a swarm of bees, in the chaos of the moment, there is actually a calm and discerning pattern slowly, but surely, emerging. Storage networking guys would probably know this thing well, but for the benefit of the other readers, how we view flash (and other solid state storage) becomes clear with the picture below: Flash performance gap

(picture courtesy of  http://electronicdesign.com/memory/evolution-solid-state-storage-enterprise-servers)

Right at the top, we have the CPU/Memory complex (labelled as Processor). Our applications, albeit bytes and pieces of them, run in this CPU/Memory complex.

Therefore, we can see Pattern #1 showing up. Continue reading