The advent of the true VNA, part 1

The medical imaging needs of healthcare delivery organizations are evolving. As more clinical specialties incorporate medical images into their practices, the ability to access, manage, and share medical image studies from a variety of different enterprise systems becomes all the more critical.

Historically, departments like Radiology, Cardiology, and Nuclear Medicine were the hubs for medical imaging within HDOs. And picture archiving and communication systems provided the features, functionality and workflow necessary to access, manage and interpret those images.

Traditional PACS: Image sharing difficulties

However, traditional PACS are built using proprietary code sets that are unique to a chosen vendor. As a result, these proprietary and departmentally based PACS solutions facilitate departmental solutions rather than organizing medical imaging to support the broader enterprise with an integrated solution. This makes image sharing within and outside the enterprise complicated and costly, especially when trying to incorporate sharing of specialty images (e.g., Dermatology, Gastroenterology, Pathology, etc.) that fall outside of traditional PACS parameters.

Traditional PACS also put HDOs into a constant state of flux when it comes to features, enhancements and quality of service. For example, the storage infrastructure of a traditional PACS is built on a disruptive technical and financial model. As a result, it is not uncommon that significant hardware changes are required on an ongoing basis to maintain or reduce the cost of ownership of enterprise storage solutions.

Also, each departmental PACS solution typically requires its own approach to security maintenance for the HDO – further driving cost and complexity. These factors often force HDOs into a high storage abandonment and upgrade rate in order to gain the increased flexibility and capabilities they desire from their PACS.

Image sharing solutions

Patients are increasingly seeking care from one provider before moving on to another. Medical images of patient studies are an increasingly important component of the patient record required by caregivers.

In addition, the cost of medical imaging studies is expensive for both the patient and the HDO. HDOs are addressing this by extending their organizational affiliations and networks to share medical imaging information, gain better control over the shared management of this information, and facilitate even greater cost saving initiatives.

The growth of both enterprise medical imaging solutions and the development of extended HDO delivery networks are pushing the need for quick medical image sharing while securing that information across disparate HDO delivery networks.

After all, the purpose of imaging exchange is not only streamlining and coordinating clinical workflows, but also improving patient care by ensuring access to previous studies and reports. Imaging exchange should also reduce the cost of medical imaging among HDO participants in a shared medical imaging network.

Integrating medical imaging content

Today, HDOs need a true vendor neutral archive that can integrate medical images on an enterprise basis and allow the HDO to participate in an extended HDO delivery network when required. A true VNA is an intelligent, enterprise system for managing all medical imaging content – from DICOM and non-DICOM medical images to clinical documents and photos.

The true VNA offers a more effective way to integrate medical imaging content within the EHR to improve security, reporting and access to medical imaging studies – both internally within the HDO enterprise and between extended healthcare networks.

A true VNA also addresses emerging reimbursement and information management drivers by delivering a host of important attributes that help HDOs enhance patient care, standardize workflows, and achieve important cost savings. As such, a true VNA must provide many functions that don’t exist in traditional PACS technology.

Aspects of a true VNA

The most important of these functions include the following aspects.

1. The VNA should be capable of pre-fetching relevant and filtered prior studies. Also, the VNA should be able to automatically route data to any functional PACS system to support the ongoing use of that application if required.

The VNA should also support post-fetching that allows a query to both the VNA and the final destination to assure that the VNA doesn’t have studies that exist in the destination system.

2. Dynamic DICOM Tag Morphing is the process of mapping or remapping data elements that exist within the DICOM image. Dynamic Tag Morphing is an important feature as it allows migration of studies from PACS that are either being migrated or decommissioned into the VNA for future access. The ability to morph this data within DICOM can be critical to providing access to a previous PACS study in the future.

3. A true VNA provides built-in software for the support and management of data migrations. During these migrations, the VNA should allow unfettered access to prior studies within the legacy PACS system, essentially federating this system as the new VNA comes online.

A true VNA supports on-demand migration of the entire imaging jacket for all patients. Having a solution that provides healthcare software and experience with both study and media direct migrations is critically important to HDOs wishing to take ownership of their imaging information.

4. A true VNA can also support the important architectural elements that are necessary for improving overall management to provide image sharing, collaboration, and extended networks. Components will support low-bandwidth connected sites to dynamically support synchronization and multi-tenancy functionality, allowing shared entities to handle medical imaging separately when needed. A true VNA is a highly scalable, high-availability platform that supports business-continuance, which is critical for medical imaging data sharing and operational support.

5. Finally, and most importantly, a true VNA is vendor neutral, even to the point of being vendor neutral to itself. A true VNA supports multiple viewing technologies using a variety of protocols. It allows the viewing experience to be customized to meet the needs of each clinical specialty area. It also supports cache-less zero-footprint viewing technologies so that imaging studies can be obtained directly from the VNA essentially allowing the elimination of traditional PACS, if desired.

There are many VNA solutions available, but not all VNAs are created equal. By following the above guidelines, you can ensure the VNA you select allows you to optimize your imaging environment today and well into the future.

Nick Flor Johansen is an intern in Hyland’s Quality Assurance department. He was born and raised in Denmark. He moved to the U.S. to attend college and live the American dream.
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Nick Flor Johansen

Nick Flor Johansen is an intern in Hyland’s Quality Assurance department. He was born and raised in Denmark. He moved to the U.S. to attend college and live the American... read more about: Nick Flor Johansen