The management of patient information has taken a turn toward complexity with the advent of the new healthcare delivery models as proposed by the Office of the National Coordinator (ONC), meaningful use (MU) and healthcare reform — specifically: Portability and interoperability. The silo and proprietary system model that has served providers for years has been demolished and replaced with a paradigm that requires the sharing of information with affiliated and nonaffiliated providers. The solutions to manage this interoperability are as vast as the HIMSS exhibit hall.
The complexity of sharing data intensifies as we look toward sharing image and object data. File size, coupled with the limitations of clinical/departmental systems that manage image data, has led to the advent of vendor neutral archive (VNA) solutions. These are growing in both technological advancement as well as industry-wide adoption.
As organizations continue down the path of VNA discovery and analysis, and the industry continues to adopt VNA as a solution for imaging storage management and security, as well as for interoperability, it is wise to consider the value points. These have become some of the key decision-making factors for many organizations in whether to embark on a VNA solution. As with any technology solution, it is imperative that each organization determine the priority of each point and let that drive the vendor selection process.
There are many articles describing the various types of VNA solutions. Knowing the functional capabilities of each vendor is imperative to a successful adoption. Following is a recap of five main points to consider:
Value Point One:
Central Storage Architecture
This is perhaps the most obvious value of a VNA. An enterprise archive that manages all image and object data, regardless of its originating clinical system or specialty, allows an organization to consolidate storage (hardware and software) and reduce the silos that exist within the organization.
Reducing silos in clinical systems and data leverages the management of storage platforms and independent archives. The key question, however, is how the data is managed in the VNA. Some choose to “wrap” all data in DICOM, that is, converting all other file types to DICOM. This solution works for many organizations.
The question that must be answered is whether that stored data will ever be accessed by the originating clinical system. If so, that data must be “unwrapped” from DICOM back to its originating format for use. This can lead to agility, latency and technical issues. It is important to know the departmental workflow and system configuration for every system that will utilize the VNA.
Value Point Two:
Image management systems, primarily picture archiving and communication systems (PACS), manage image data in perpetuity. While some solutions have begun to adopt a model for managing old, outdated and nonrelevant image data for the purpose of purging, there remains no full imaging lifecycle management (ILM) solution on the market at the PACS level with the functionality provided by some VNA vendors.
Image lifecycle management is much more than just identifying data for purging. True ILM provides the ability to use storage tiers to reduce the overall cost of archiving data long-term. By creating rules specific to the organization, including technical and clinical rules, many VNA adopters are leveraging cheaper storage to manage data that includes disaster recovery as well as compression and other methods to drive down the continuously expanding storage costs.
It is ultimately the decision of each organization — and the policy environment within which it operates — to determine the rules of how data is archived. It is, however, at a true option with the appropriate VNA.
Value Point Three:
Single Point of Integration
The rush to adopt electronic health record/electronic medical record (EHR/EMR) solutions as well as health information exchanges (HIEs) is well documented. The challenge many organizations are facing with the shortage of resources associated with the design, build and implementation of these solutions is the ongoing support for integration to these system-wide and region-wide solutions.
For any large entity there can be as many as 25 disparate systems that are managing clinical images and objects. As these larger systems are adopted, then undergo upgrades and updates, each disparate system integration must be managed, adapted and tested.
A robust VNA can become the platform that serves as the integration point for all data stored. Redirecting the integration point away from each disparate clinical system and onto the VNA there becomes a single point of integration to system-wide solutions (EHR, EMR, HIE). This reduction in interfaces and integration simplifies the support model, reduces costs and speeds the testing and support to adoption.
Value Point Four:
Data Viewing is Simplified
Clinicians who choose to view image data are beholden to the way each clinical system chooses to display this data outside of the department. Many systems use Web viewers that have varying levels of compatibility to the market-available browsers and versions (i.e., Internet Explorer, Google Chrome, Firefox, Safari, etc).
It is common for clinicians to have ongoing challenges with using these viewers, as each clinical system uses a proprietary viewer that requires launching multiple windows — and as they upgrade their computer to differing browser versions, it may or may not “break” the viewer. Calls to the helpdesk with the response that “downgrading” the browser or worse, switching from a Mac to a PC, causes frustration and physician dissatisfaction across the provider community.
For referring physicians, we strive to make doing business easy. By adopting a VNA solution with a single viewer (either provided by the VNA vendor or utilizing a third-party solution), many are finding a way to reduce the complexity of managing multiple image viewers. This single viewer solution improves the experience for the referring clinical community as well as the support model within IT.
Value Point Five:
Reduces or Eliminates Future Migration Costs
Every one of us who has replaced a clinical imaging system knows that data migration is both laborious and expensive. The migration costs associated with system replacement are most often higher than the cost of the replacement system. While data migration has improved significantly over time with faster and cheaper solutions, it remains one of the highest components of any imaging system replacement.
A true VNA solution will mitigate future migrations associated with system replacement or consolidation. The philosophy of a true VNA is that the user is able to manage data, which includes migration efforts, going forward. Rather than vendor-dependent efforts for any data management or conversion initiatives, VNA users are able to take control of the data. This makes system replacement a much easier, and cheaper, option.
In addition, this provides the customer freedom from the imaging system vendor and from the heavy lifting historically associated with system replacement. The VNA can be leveraged so that clinical systems can become primarily a workflow engine within the department, and replacement is a much more viable option when older systems fail to meet evolving requirements and optimization for the primary users.
There are, of course, many other values associated with a VNA: hardware cost reduction, reducing expansion costs (mergers and acquisitions ) and risk aversion, to name a few. But the five value points discussed are proving to be the most widely identified benefits of an appropriate VNA.
As with any vendor solution, it is important to first determine what your organization is seeking to achieve. Each of these benefits, while important, is not equally important for every entity. Know yourself. Know your strategy. And as you embark on choosing and adopting a VNA solution, continue to discover ways to leverage this platform to meet the ever-changing model of healthcare delivery. itn
Jef Williams is a frequent speaker and writer on healthcare technology topics and enterprise imaging solutions. He is vice president at Ascendian Healthcare Consulting, www.ascendian.com