When is the right time to add a vendor-neutral archive (VNA)? For DCH Health System, a Tuscaloosa-based hospital enterprise serving West Alabama, the decision coincided with an ambitious expansion of the cardiology department of its flagship hospital, 600-bed DCH Regional Medical Center.
The hospital department operated four cardiac catheterization labs and was adding an electrophysiology (EP) lab in 2014. The existing cardiology PACS was at end-of-life with no option for upgrades, and DCH recognized that a unique opportunity existed to eliminate the existing specialty imaging archive silos by adopting a unified image archival approach using VNA technology.
The radiology departments of all the system hospitals—including Northport Medical Center located five miles away and Fayette Medical Center in Fayette—did not want or need a new PACS. Synapse PACS from FUJIFILM (Stamford, Conn.) had been in use since 2003 and a major software upgrade was planned for November 2014.
But the cardiology department needed a new cardiology PACS, one that would efficiently serve the expanded department and include a hemodynamic system and an EKG system. Regardless of which vendor was selected for the cardiology PACS, both departments wanted it to operate on the servers of the radiology PACS to improve IT efficiency and reduce costs.
All roads lead to VNA
Several requirements pointed in the direction of a VNA. The size and projected volume of cardiology images suggested that a VNA would be the most practical and cost-effective archive solution.
The VNA also would enable DCH to realize its strategic plan to incorporate access to patient images for physicians and clinical staff through its electronic health record (EHR). Finally, with a VNA, users would be able to access both DICOM and non-DICOM images through the EHR using any computer or mobile device via a zero-footprint viewer.
Providing easy and immediate access to patients’ images for physicians was the primary objective for switching to a VNA, according to Jim Smith, director of radiology services for the hospital enterprise. “It will help streamline workflow, and that is of paramount importance,” he notes.
Smith expects to be able to provide this capability by May 2015, when clinicians will be able to access the VNA through its Synapse Mobility zero-footprint viewer. Until then, all users must access images on hospital workstations that provide login access to the radiology or cardiology PACS. “When they are able to use the universal viewer of the VNA, they will not have the restriction of needing to sequentially access images through the PACS,” Smith explains. “Clinicians will have fast and easy access to the images they need.”
The key elements required of the VNA by the hospital included the ability to acquire, display and store all types of patient images, both DICOM and non-DICOM. A very important additional requirement was the ability to manage image storage easier and more economically than what a conventional PACS archive is capable of doing.
After 12 years of image acquisition, the ability to establish customized storage rules to enable intelligent purging was very compelling. Approximately 275,000 imaging exams are performed at the DCH Regional and Northport hospitals alone. The number of exams performed each year has been steadily increasing by 2% to 5%, and this is expected to continue. So the ability to intelligently purge the archive in an automated manner also contributed to the decision to implement a VNA.
Accommodating the choice
A number of vendors were considered, but DCH Healthcare ultimately decided to purchase a Synapse VNA from Fujifilm. In order to accommodate the VNA, first it was necessary to expand the network between the radiology department and the cardiology department at DCH Regional Medical Center. Next, DCH expanded server capacity of the Synapse PACS to support the third-party vendor cardiology PACS selected by the cardiology department. This third-party system needed to be integrated with the radiology virtual server farm, a process that started in May 2014.
Smith said that he was very pleased with the merger of the systems on a single virtual server farm. “Both vendors worked well together with a hospital team representing radiology, cardiology, biomedical engineering and hospital IT staff,” he reports. “While there was the additional cost of adding capacity to the radiology servers and incorporating the VNA server, we expect that this will be