Ready to consolidate your PACS systems into an enterprise imaging solution? Experts share their advice
Survey health systems across the U.S. and you will find many packed with PACS (picture archiving and communication systems). Why so many? Typically, hospitals acquire new systems through mergers and acquisitions, which then become yet another piece of their technology stacks. They add more to the stack over time as siloed departments implement their own systems.
Then, when something changes, those same organizations soon discover just how costly and time consuming it is to manage multiple systems and technologies, and they start to explore other options.
“It always starts with a compelling event,” says Cheryl Petersilge, founder and CEO, Vidagos Advisors. “The organization is at a transition point. The radiology PACS contract needs to be renewed, for example, or they know they need to get their arms around point of care ultrasound and they don’t know where to begin.”
The answer is often consolidation. Healthcare organizations understand the value of merging multiple PACS into an enterprise imaging solution. It reduces complexity and saves both time and money.
But consolidation seems like a daunting task. Stakeholders want to know, where do we begin?
Consolidation
To shed some light on the process, Petersilge, along with Jeff Agricola, enterprise imaging IT manager, UNC Health; Brad Cook, applications developer, UNC Health; and Karen Maynard, ITS radiology applications manager, Yale-New Haven Health, sat down during Hyland’s virtual Enterprise Imagine Forum to share some advice.
Here are some highlights:
HYLAND: What seems to lead healthcare organizations toward consolidating multiple PACS with a single PACS or with a VNA?
Cheryl Petersilge (CP): Think about what we’ve done with the EMR (electronic medical record). We’ve taken the emergency department EMR and the cardiology EMR and oncology EMR and we’ve merged them into a single, centric system that manages the subspecialty workflows, but all in one location. That’s exactly what we’re trying to do with enterprise imaging.
Enterprise imaging is patient-centric. It’s no longer department-centric, or even hospital-centric. We want to start developing that patient-centric view.
When organizations start to think this way, they realize they need to manage their images in a new architecture and in a new way. That’s when they see the real value of moving to a vendor neutral archive (VNA).
Karen Maynard (KM): Building off your patient-centric viewpoint, Dr. Petersilge, you are absolutely correct. We were very siloed before. Now (those systems) are all pulled together.
Clinicians can view the entire patient imaging record. Radiologists can see ophthalmology or cardiology images if they want. We have even implemented a process that allows patients to see medical images via NilRead through Epic MyChart. We’re giving patients the ease and ability to see their own images – and possibly to upload their own medical images to MyChart, as well.
Jeff Agricola (JA): The driver is more than continuity of care. We’re moving toward population-based healthcare models and at-risk payer contracts, in which payments are tied to outcomes rather than services.
For these reasons, you just can’t work in a silo anymore. You need that longitudinal patient view to enable continuity of care.
HYLAND: What drove your organization’s decision to move to a VNA? What department advocated for it? 
JA: Market pressures drove us to become an integrated delivery network, have patients transfer across the system, and develop “a vision of one.”
We started by combining all the disparate EMR applications into one Epic system for the entire organization – one chart, complete continuity of care. But we were missing one longitudinal view of the patient imaging record via a common viewer that would deliver the same experience to all clinicians.
We wanted improved access of images across the enterprise, compliant and secure data sharing, and reduced management complexity. We also wanted to have sophisticated lifecycle management policies, lower total cost of ownership, and regain control of our data.
When you move to a VNA, which is truly neutral, and work with a company with open standards, it allows you to take back data control, and you’re no longer held hostage by any particular product or company. You have the flexibility to switch to a best-of-breed solution.
Brad Cook (BC): What I think is an important footnote, when you decide to consolidate with a VNA, you’re really giving yourself an integration engine. You can do a lot of creative things with your imaging, from how you route the data to where you put the VNA – in front of a PACS or behind a PACS or both – you’re getting lots of robust new functionality and flexibility.
KM: Just to build off Brad’s thoughts, our routing system is so complex because our VNA has given us the ability to become agile and creative. We have images going to so many different systems, from teleradiology groups that read at night to downstream systems for 3D post-processing. The benefits with the routing system are so great, I could talk for hours about that alone.
HYLAND: What’s your advice for organizations trying to decide whether to replace multiple PACS with a VNA and a move to enterprise imaging?
CP: The move to enterprise imaging and to a VNA is not an IT project. It’s a strategy. It’s a long-term program. It’ll take three to five years or more to fully implement. The enormity of what enterprise imaging is can overwhelm some organizations.
So you start by developing a strategy and framework for what’s important with respect to your enterprise imaging program. Then develop a roadmap of everything that’s going on in your organization, including imaging systems you likely will replace in the next couple years.
Take it one bite at a time. That often saves organizations from becoming overwhelmed. And you don’t have to start with DICOM studies, either. You can start with something outside traditional imaging and work into the more voluminous imaging departments.
Just make sure every department has an equal voice. Bring everyone on board from the beginning, even if they won’t reap the benefits for a couple years.
HYLDAND: What have been the results of your decision to move to a VNA and enterprise imaging?
KM: We embarked on this journey nearly five years ago. After much research and due diligence, we decided to go with the Acuo VNA, which put us in a great position to lay best-of-breed applications on top of it.
When we merged over to the VNA, it was so seamless, our radiologists didn’t even know we had merged. We hooked up all our modalities to the VNA routers and an older PACS system, and they didn’t even know we’d performed that step. Only IT knew we performed that enormous change.
We also added a true disaster recovery instance, which is enormously valuable. We now have a dual-mirrored instance of the VNA that we have transitioned when needed – just our routing system or just our archive or both. We can perform those steps ourselves, and it doesn’t impair our providers at all. They have no idea know this is going on in the background.
We are definitely more innovative. The agility we have to automatically, from the modality, move images downstream to third-party processing and viewers saves time for radiologists from query retrieving, which is what they had to do in our old PACS system. They are more productive, which only enhances patient care. It’s been super valuable for us.
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