By Jon Shoemaker and Jef Williams
March 2013—If your health system is urgently planning enterprise wide initiatives of interoperability of data, transformation of the organization, and optimization of technology, then Vendor Neutral Archives (VNA) are probably being discussed. As you engage your executive suite, boardroom, and fellow medical imaging colleagues, the dialogue on VNA must focus on the strategy, business plan, and best practices for successful selection and deployment.
What is VNA?
The complexity and costs of storing, securing, and sharing data have intensified for healthcare. The sheer file size coupled with the limitations of clinical/departmental systems that manage image data has led to the advent of VNA solutions. A VNA solution offers much more than simply archiving DICOM studies. Images are acquired across the enterprise in many formats other than DICOM that belong in the patient record and are often held in silos without the availability of PACS, CVIS, or other department specific solutions. A VNA spans these various solutions and consolidates data in one environment.
VNAs, in addition, should be capable of providing the next level of storage management and information dissemination. These include the foundations of the next generation of imaging architecture. These benefits are compounded when healthcare organizations are growing through M&A or participating in emerging HIEs and ACO models.
The full advantages of a VNA solution are still emerging, as this healthcare paradigm is still in development. Key values can be realized and having a central storage architecture 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.
Another key value of VNA is to image management systems – primarily PACS – which manage image data in perpetuity. While some solutions have begun to adopt a model for managing old, outdated, and non-relevant image data for the purpose of purging, there remains no full Imaging Lifecycle Management (ILM) solution on the market at the PACS level with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 which includes disaster recovery as well as compression and other methods to drive down the continuously expanding storage costs.
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 – and 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.
Clinicians that choose to view image data are beholden to the way each clinical system chooses to display this data outside of the department. By adopting a VNA solution with a single viewer (either provided by 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.
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. 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 to the key VNA values described above there are many other advantages associated with a VNA: hardware cost reduction, reducing expansion costs (M&A), and risk aversion to name a few. Deriving your optimal ROI will be dependent on a number of factors such as your legacy architecture and ultimately the ability of your organization to deploy an enterprise solution across the complex nature of people, process, and technology. Know your strategy. Choose your stakeholders, steering committees, subject matter experts, and governance models carefully. And as you embark on adopting and deploying a VNA solution, continue to discover ways to leverage this platform to meet the ever-changing model of healthcare delivery.
Jon Shoemaker and Jef Williams are frequent speakers and writers on healthcare technology topics and Enterprise Imaging solutions. Jon is a Senior Consultant and Jef is Vice President at Ascendian Healthcare Consulting. You can contact them at firstname.lastname@example.org and email@example.com.