Optimizing the Vendor-neutral Archive for Enterprise Use: UVA Health System

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John MemarianNo health-care enterprise wants to make an enormous investment in technology for image storage, only to find it outdated and in need of an upgrade. The vendor-neutral archive has been proposed as a natural antidote to this problem, but an archive alone is, increasingly, not enough—particularly for large academic institutions that intend to improve workflow and access dramatically. The UVA Health System (Charlottesville, Virginia) was facing just such an issue: It needed to boost efficiency and consolidate storage for imaging across the enterprise, and it wanted to move and monitor images across its multiserver network.

Because a high volume of incoming studies caused multiple problems, Daniel O’Malley, UVA Health System’s director of informatics and support services, specifically went looking for better routing capabilities. “We had PACS tools that were able to move images based on certain DICOM tags,” he says. “We had outgrown them, however, particularly with our added teleradiology capabilities and our new cloud-based image-transfer mechanisms.”

To solve the problem, O’Malley and his colleagues selected the Keystone Suite from Mach 7 Technologies. It includes a routing engine to improve imaging workflow, based on customer-defined instructions; a multiarchive prefetching engine that ensures that relevant prior studies are available to reading physicians, regardless of where those prior studies reside; a scalable, hardware-agnostic, vendor-neutral image archive; a multispecialty Web viewer that easily integrates with upstream electronic health record systems; and accessory desktop applications that improve workflow and productivity.

John Memarian, general manager of sales and marketing for Mach 7, explains, “This is a growing problem facing many facilities like UVA Health System, which find their PACS platforms falling short of meeting their enterprise IT imaging needs. Whether in radiology or any other department, a clinical image is acquired, the physicians review, read and analyze the study, the report is finalized, and then it is stored to the archive,” he says. “If the institution has a true enterprise clinical imaging archive, the final report can be made available and linked to the organization’s electronic medical record (EMR). The community physicians and referring doctors can then launch the stored images from their local EMR.

"Unfortunately, for years the market has been trying to see VNA as the solution, rather than the end result," he continues. "The vendor’s commercial strategy has been to focus on PACS and DICOM systems, with very little attention to other departments with non-DICOM images.”

In contrast, Memarian says, the Mach 7 Keystone Suite solution is an intelligent, innovative software solution that facilitates rules-based automated workflow, creating clean imaging data that can be stored, shared and monitored with optimal efficiency. “Innovations and advances in technology are being developed by Mach 7 Technologies to capture, store and share images, regardless of their format,” he notes. “Additionally, we keep track of imaging modalities being introduced, because at the end of the day, a true vendor-neutral archive must be able to seamlessly receive and host these images. The vendor-neutral archive is the end result and should not be placed in the forefront as the entire solution.”

Customized Criteria

After seven months of working with the Mach 7 technology, O’Malley reports that the Keystone Suite products are able to do complex image routing based on “almost any criteria you can think of,” he says. No longer limited to certain preset DICOM tags, UVA Health System can now use public or private tags. “Many vendors will use private tags to store information that is really valuable to us,” O’Malley explains. “If the mechanism you are using for routing happens to be on a private tag, you are kind of locked into that vendor’s technology. Mach 7 allows us to expand beyond that.”

For image routing, especially with some of the cloud-based image-transfer mechanisms, O’Malley needed a more intelligent system for both internal and external images. On the archive side, he again sought to avoid being locked into a vendor’s system.

“We were using proprietary application programming interfaces to talk to our long-term storage,” he explains. “You try to mitigate those problems, and you want to own your own data. When you are in a vendor lock-in situation, you really do not own your own data;