When is the right time to introduce a VNA?

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 - Jim Smith
Jim Smith, Director, Radiology Services, DCH Health System, Tuscaloosa, Ala.

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 offset by reduced operating and service-related costs for a single system rather than two.”

An additional bonus is a third PACS administrator whose salary is paid by the cardiology department. Having three PACS administrators rather than two is very helpful, as they are being cross-trained to be equally conversant with each system.

The VNA was not implemented in what would be the most ideal manner, due to the time frame of the opening of the EP lab. It was imperative that the new cardiology PACS and related systems be operational and supported by the VNA. This was done very rapidly over several months during the spring and summer of 2014.

Expedited implementation

Rather than a sequential series of projects, multiple ones were being undertaken at the same time, which added to the complexity of the project and stress levels of hospital IT and department staff.  In the midst of everything was the scheduled Synapse PACS software update. The PACS upgrade was pushed forward two months—to January 2015—to alleviate some pressure and simplify the logistics of working around holiday vacations.

Smith observes that in a perfect world, the implementation time frame should be longer, and projects should be done sequentially. But the multi-vendor and hospital implementation team worked hard, resolved problems harmoniously and successfully pushed through the challenges.

The hospitals made a strategic decision to transfer all of the images on the multiple archives, and then purge them from the VNA. Smith said that while this might seem like more work and added expense, an automated purge using the hospitals’ custom rule-set on the VNA would be much more staff labor-efficient, streamlined and, therefore, economic. The cardiology PACS images were transferred first, and PACS archive image transfer is ongoing.

“Moving to a VNA takes a lot of time, preparation and input from a lot of people,” Smith says. “Ideally, this planning process should not be rushed; the project director needs to make sure that all the right people are participating. Getting input during the planning stage makes implementation easier.

“Do not rush the planning process, and if at all possible, be realistic about a timetable. We didn’t have the luxury of the timeline that we wanted, because we needed to go live with a new EP lab. We did achieve our objectives, but other hospitals implementing a VNA will benefit from these recommendations.”