Many radiology administrators remember purchasing their first or second PACS: It was probably no small financial commitment, and justifying the expense might have been a painful process. Just as those older PACS began to collect a little dust—not to mention massive archives—the vendor-neutral archive (VNA) came creeping into the picture. Skeptical equipment purchasers naturally want to know: Why VNAs—and why now?
Jonathan Shoemaker, senior consultant at Ascendian Health Care Consulting, has heard these questions before; their answers stem, in part, from what radiology and cardiology PACS were not designed to do, he says. Software engineers created PACS to run in a structured environment, to address the workflow of radiology and cardiology departments, and to digitize analog processes.
“Outside of the radiology and cardiology ecosystem, it’s the Wild West—because not everyone adheres to DICOM,” Shoemaker says. “As health-care organizations see that imaging is occurring in a lot of other areas within the enterprise, they must address the other departments’ workflow and image capture. If you ask the radiology PACS to ingest these other images, especially if you’re wrapping everything in DICOM, you end up potentially imposing the radiology workflow onto these other departments—and it simply does not fit.”
Data ownership beyond the PACS allows for flexibility, in addition to what Shoemaker describes as building the data flow from the bottom up—essentially, creating a message from the object header, if needed, to support the clinical archiving system’s data flow. He says, “Take dermatology: If the department acquires an image, it may not produce an order in an information system (as radiology does in the RIS for a chest radiograph). Dermatology, however, will charge for the event, on the back end. If the radiology PACS requires an order, you are now forcing dermatology staff to log into a RIS and create an order—just to send the images through an encapsulation device into a PACS.”
As large integrated delivery networks acquire more hospitals and imaging centers every year, things get even more complicated, and the need for a neutral solution becomes more evident. Shoemaker has seen huge efforts from IT to deploy the hospital information system and RIS across a newly created enterprise.
“You also have the need for cost reduction because reimbursements are going down,” Shoemaker says. “It does not make sense to have all these technical silos with different storage devices. In these situations, IT professionals must manage the data and adhere to the data-protection policy of the organization by using image–life-cycle management (ILM). VNAs bring in single storage solutions for all imaging systems across the enterprise, not just radiology and cardiology.”
Shoemaker has helped organizations implement full VNAs, which address the archive needs of DICOM and non-DICOM data. “The full VNAs can drive the data flow that clinical systems require,” he explains. “You also have the functionality and flexibility for self-managed migrations. If a radiology PACS gets replaced for $800,000, the migration can sometimes cost almost as much as the PACS itself.”
The consolidation of the health-care marketplace will only make these migrations more common, particularly as accountable-care organizations (ACOs) must increasingly share data. “VNAs allow hospitals to become more agile, internally, with clinical-system replacement,” Shoemaker adds, “but VNAs also position hospitals to share their image data more easily through health information exchanges (HIEs).” In a more standardized approach, they can use Cross-enterprise Document Sharing (XDS) and XDS for Imaging, or XDS-I, IHE implementations.
Hospitals aren’t the only ones consolidating, as evidenced by Lexmark International’s recent acquisition of Acuo Technologies—a trend that Shoemaker also views as a natural progression. “I expect to see a few more content-management systems acquire VNAs,” he says, “especially as VNAs begin to move out of the radiology/cardiology space. There is a large need for interoperability between enterprise content-management systems and clinical systems to provide a complete record of structured and unstructured content to the EMR systems.”
To achieve these efficiencies—and, ultimately, to be a full VNA—a system must have an interoperable platform for clinical-systems archiving, and that archive must accommodate both DICOM and