SUNY Upstate: Taking the VNA Route to an Image-enriched EMR

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Steve RobertsPurchase a vendor-neutral archive (VNA). Design it to store DICOM and non–DICOM images. Integrate it seamlessly with electronic medical record (EMR) system. Watch its users visually enrich their patients’ medical records.

That’s the experience that the State University of New York (SUNY) Upstate Medical University is having, but not before doing its due diligence and building a support infrastructure to ensure success, according to Steve Roberts, SUNY’s director of host systems. The VNA not only is providing a centralized repository for patients’ images, but has helped improve the quality of medical records, has eliminated some security risks, and has dramatically slashed data-migration costs for images.

SUNY Upstate is central New York’s largest medical center and the only academic medical center in the region. On its main campus in Syracuse, it operates Upstate University Hospital, with more than 400 beds (and with the region’s only level I trauma and burn center); Upstate Golisano Children’s Hospital; and both adult and pediatric cancer centers. In July 2011, it purchased 306-bed Community General Hospital, which has been renamed Upstate University Hospital Community Campus. Together, these facilities perform approximately 350,000 imaging exams each year.

With the acquisition, the IT department found itself operating two different PACS and two different software versions of the same RIS. The desire to merge the archives was one factor contributing to a decision to acquire a VNA, but the IT department had investigated this option at least four years earlier and concluded that technology was still emerging and implementation would be premature.

“In late 2011, several months after the acquisition of Community Hospital, a consulting company was retained to conduct an enterprise imaging assessment,” Roberts says. “The company recommended that IT operations be centralized and recommended that we take a fresh look at VNA technology.”

Another factor that spurred interest in considering a VNA was the implementation of an electronic health record (EHR) system for both inpatient and ambulatory-care use. When IT staff started to discuss this project with various departments, a decision was made to implement this first for ambulatory care.

“With many departments we visited, the reaction was the same: Everybody said great, we can get rid of our charts—but what do we do with our images?”

—Steve Roberts, SUNY Upstate Medical University, Syracuse, New York

The EHR software selected did not have an imaging module. The main Upstate University Hospital PACS had been storing all sorts of patient-related images in addition to radiology exams. Its archive served as the repository for all cardiac images; endoscopy images; ultrasound exams performed outside the radiology department (such as those originating in the perinatal center); and images from departments that happened to have a modality, but no storage. Would it have the capacity to store additional DICOM and non–DICOM images from all the other sources at SUNY Upstate?

VNA Reconsidered

When the IT staff took a fresh look at VNA offerings, it liked what it saw. It began a selection process that started in January 2012. Nine months later, the VNA was operational. The ambulatory-care EHR had been implemented. Images from the Community Campus PACS archives were in the process of being transferred to the main FUJIFILM Synapse PACS archive. A major software upgrade (version 4.2) to the PACS was being planned.

The vendors all worked together to develop a transparent EHR–PACS–VNA integration, Roberts says. He was impressed with their performance, and with the deliverable: An enterprise imaging link from the VNA, embedded in the EMR, provides the user with access to diagnostic images.

The ability to add and access DICOM images was first made available at SUNY Upstate. The rollout was very basic; people were informed that the link was there. There was practically no training. It really wasn’t necessary, according to Roberts; he says, “The software was integrated so well that when users wanted to see images in a patient’s file, they clicked on the link, and that was that. They didn’t realize that they were opening another application, namely access to images contained in the VNA.”

The next step was to add non–DICOM images to the mix. The rollout for this application was slower and more cautious. The software-development team wanted to verify that it worked well and wanted