Hospital CIOs now recognize that it’s no longer a question of whether vendor neutral archive (VNA) is a technology they should consider, but rather when is the right time to introduce VNA to their IT organization.

More and more areas of today’s health systems are producing patient imaging content, in both DICOM and non-DICOM formats, and image file sizes continue to grow larger. Disparate storage silos are everywhere, organizational security and backup policies for imaging not controlled centrally by IT is near impossible, and the EHR is mandated by meaningful use to display more and more of the patient imaging record.

Some images live in discrete IT systems with their own storage, such as radiology and cardiology PACS. DICOM residing in its own silo often is not sharable across departments or facilities in a healthcare enterprise.

Non-DICOM images can reside on the acquisition devices, shared drives, in desk drawers and even on personal mobile devices. How secure are these imaging records, who is controlling access, are they backed up, and how long are they being kept? These are all questions healthcare IT needs to wrap their arms around.

CIOs have many projects competing for their attention, but VNA is now a necessary part of their strategic future. Their organizations are growing, they need to centralize and have a singular platform for data center storage expansion, business continuance and data backup. They need a socket into which they can quickly plug new departmental imaging areas as a result of mergers and expansions. With the first phase of EHR deployment completed, they are now looking to expand the use and value of their EHR investment and manage the security of patient records, all while operating more efficiently. 

FUJIFILM Medical Systems, Stamford, Conn., convened a panel of ten CIOs on April 14 in Chicago during the annual meeting of the College of Healthcare Information Management Executives (CHIME) to address the maturity and potential of VNA technology to eliminate storage silos, and help address the challenges and opportunities of creating a complete patient imaging record for EHR. While most CIOs have not yet deployed this new and emerging technology, all agreed it’s needed and were eager to discuss potential benefits of VNA to their own health systems

VNA drivers

A VNA is a vendor neutral image/content storage archive.  The technology has been around for more than 10 years, but the adoption of VNA has exploded in the last 12 to 24 months.  The term itself is a bit of a misnomer:  You have got to buy it from one of us, so it's not really vendor neutral—let’s say application, or content, neutral. 

Several drivers are accelerating the adoption rate of VNA, beginning with the adoption of the electronic health record (EHR), meaningful use imaging requirements and physician demand for image access. Our CHIME panelists confirmed that physicians are pushing for access to more imaging beyond the traditional radiology or cardiology DICOM silos, and they want a single, consistent place in which to access and view patient images.

At the same time, CIOs are concerned with the exploding number of images being generated in radiology and cardiology. It is significantly more expensive to scale multiple silos of storage than one scalable storage hardware platform. The VNA enables CIOs to retire expensive disparate storage silos, and often in IDN environments remove storage from individual sites entirely. The benefit to growing a centralized VNA is unending. It’s just a matter of getting started.

Migration expense

CIO panelists discussed the expense of migrations resulting from departmental application replacement. Considering many hospitals and departments are on their second or third PACS for radiology or cardiology, an important question was raised: How many times have hospitals paid to migrate the same data?

There are many returns-on-investment factors that make VNA an easy decision, but the fact that future application vendor replacements will not require a costly migration will yield the largest savings. A fringe benefit of that is the departmental freedom of being able to make application vendor changes in the future without worrying about the cost or complexity of a data migration.

One CIO counted the number of image sources across the enterprise to be at least 50, some of which reside on a disk in the machine that takes the image. Other sources include data that is illustrated in graphs (echocardiographs, cardiograms and lung tests) dermatology, ophthalmology, scanned documents, surgery videos, pathology, scope images, and the list goes on and on. The VNA has matured to be able to capture non-DICOM imaging through all forms of workflow optimized connectors and natively store and display the content from all imaging areas, allowing VNA to truly be an organizational image content management solution.

Knowing that all of the imaging stored to a VNA is accessible in a single patient centric view is also a major driver for many organizations. Not only do physicians now see a more complete imaging record for the patient, but departmental application users have access they’ve never had to all imaging performed on a patient from outside of their department.

Core capabilities

Centralizing patient information around three areas is at the core of creating a true EHR, one CIO observed: the textual record of the patient's history (the EMR), content management (the HIS) and medical images (the VNA). CIOs want to be able to create that true EHR, a goal they can’t achieve until all images acquired in the enterprise are in one central location.

VNA also has three areas that are core to being a complete VNA solution. The first is departmental connectors to automate a workflow for content to get to the VNA and properly associated with the correct patient ID.

The second aspect is true neutrality. A best-of-breed VNA has the capability of storing DICOM and native non-DICOM images, as well as extensive life-cycle management tools by department/area.

The third requirement is a zero footprint enterprise viewer capable of displaying any image object in the VNA with acceptable clinical tools based on the physician type.

One little discussed topic when a VNA is considered is the neutrality of the technology in managing storage hardware. Not only can third-party application vendors be replaced within departments without expensive data migrations, but VNA can also manage OEM storage changes, moving the data from one storage hardware platform to the other without expensive migration professional services. So, VNA is neutral on the front and back ends.

Trigger points

Our panelists identified a handful of triggers that are causing VNA adoption, including a merger or acquisition. Consolidation in the hospital market means many health systems have multiple PACS to manage, and as they are able, CIOs are tasked with consolidating all system sites on standardized application platforms. Migrations are required, data cleansing is often involved and phasing over time is typically more desirable. VNA is a great tool to accommodate these consolidation needs.

A PACS replacement—whether due to a hospital acquisition or a system’s end of life—means an image data migration, one of the most significant and costly that a hospital will face. In fact, a PACS data migration today can cost as much as the license for the new PACS and take up to a year to complete.

Since hospital’s now see VNA in their near term plan, the migration of millions of studies from one or more applications is a major trigger point. Choose the right VNA partner, and the migration of the radiology or cardiology data to the VNA will be the last migration of that data a hospital makes.

Even if a customer is not involved in a major departmental application replacement, upgrading or changing their physical storage environment can be a trigger for VNA. This can also be driven by a consolidation effort to remove storage silos, enhance business continuance capabilities, or be part of a data center expansion. These are all well-timed opportunities to introduce VNA in advance of departmental replacements.

A VNA can be triggered by a simple need to share storage across two departmental systems. Often there is either an upgrade or an addition to an existing radiology PACS and cardiology environment for example, which creates a desire to share storage and virtual architecture, creating a VNA entry point opportunity.

All of the triggers discussed would establish a VNA that can be grown to support more and more departments and organizational growth. Often, however, a VNA is started to support a small need, such as dermatology or wound care, and then grown at a logical, later trigger point to support the larger study volumes of radiology and cardiology applications.

Surprisingly, the federal MU program has not been as significant a factor to date in VNA adoption as many would think. One CIO called image access the most ignored objective of meaningful use, primarily because it wasn’t clear up front what was needed on the part of providers.

Next steps

A great deal has been said about what the VNA can store, but much less has been said about the workflow that should be established to get content into the VNA. While VNA supports all types of standards for data exchange, application vendors are still catching up.

FUJIFILM is using its experience as a point of care ultrasound vendor and endoscopy vendor to optimize workflow of patient association and image storage, and really focusing on the image capture workflow. As more areas of healthcare imaging become standard VNA workflow connections, VNA adoption will only accelerate.

CIOs must begin to consider what content they want to include in the VNA. Do you want to limit inclusion to images for which there is not a code and a charge, or would you prefer to make everyone aware that if they create imaging that is associated with patient care, it should be maintained as part of the record? Will you establish security and life cycle management policy for all image content, even if created in a department not yet connected VNA? These are the questions early adopters are asking.

VNA is a part of the big-data equation, as the potential to store the entire patient imaging record opens up the opportunity to utilize analytics to drill down into multiple levels of data, at the department, facility, patient or health-system level. FUJIFILM is exploring the potential benefits of this new consolidated data repository as it relates to analytics.

Shared architecture will continue to be an expectation, as will hyper convergence IT platforms, and VNA will continue to drive neutrality by embracing new IT technology leading the way to a more open sharable environment.

Best of breed

Today, the question the CIO has about VNA is not if, but when. When that time comes, we invite you to consider Synapse® VNA from Fujifilm. We are unique as a VNA vendor in that we are in so many imaging areas with 50+ years of medical imaging workflow experience. We have a best-of-breed VNA archive capability, and we are one of the leading enterprise viewer vendors. Our product development for our Synapse Informatics portfolio is headquartered in Raleigh, North Carolina.

VNA is still an emerging technology, and we are actively looking for the environments willing to expand VNA, especially in the non-diagnostic spaces, so that we can help paint the entire patient picture. Our vision for VNA encompasses more than an archive; we see a useful tool for importing and storing image data and correctly associating content with patients, while also presenting the user with a fast and complete patient-centric view of the imaging record.

William Lacy is Division Vice President, Informatics Marketing and Enterprise Sales, FUJIFILM Medical Systems U.S.A., Inc, Stamford, Conn.