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MemarianNo health-care enterprise wants to make an enormous investment in technology for image storage, only to find it outdated and in need of an upgrade.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; the vendor does, and you are at its mercy. An advantage of Mach 7 is that the archives really lay out the images and the data in a simple way, so you avoid that vendor lock-in, and you can really take control of your data.” O’Malley and his colleagues are now collaborating with Mach 7 to develop a mammography prefetching feature. Currently, a full-time employee must manually prefetch mammography images. “We are working closely with Mach 7 to prefetch this information automatically,” O’Malley says. “The mammography prefetching is one example of freeing up individuals for higher-level tasks by plugging in automation.” Looking Forward Keystone Suite will empower UVA Health System with a sophisticated routing engine to handle its volume of about 450,000 studies per year. A feature called centralized lifecycle management tracks and audits image data and archive-segmentation options. All these features can help the health system achieve elusive meaningful-use markers, and Memarian keeps the incentive program in mind when developing and adding to the Mach 7 Keystone Suite, though he says that there is still a long way to go. “Stage 1 of meaningful use is just ending, and some people have not finished that,” he says. “As the government rolls out stages 2 and 3—where radiologists are going to be involved—we, as manufacturers, must continue to react to these (and other) market forces.” Calling this a collaborative developmental relationship with an agile international company, O’Malley says Mach 7’s software and user interface allow UVA Health System’s nontechnical, nonprogrammer staff to perform sophisticated image routing and manipulation. IT personnel can help to customize, change, and adapt the Keystone Suite software, but O’Malley observes that Mach 7’s transparency means that fewer IT personnel are needed. “With a lot of solutions, you are writing code and dealing with syntax, and it’s not very clear,” he notes. “An advantage for Mach 7 is its visual workflow interface for users. You don’t need to code. You just plug in the workflow adapters and you can follow things in the flowchart. You have processes and results, and you can point and click to connect these things.” Greg Thompson is a contributing writer for ImagingBiz.com.