VNAs Releasing Radiology Images from ‘PACS Jails’

No matter how efficient your PACS is, there are things it can’t do. It can’t share your images with other departments. It can’t migrate your studies to another facility. And, if you change the system, there’s a good chance you’ll pay between $200,000 and $300,000 for your vendor to migrate the data because the DICOM is different. Vendor neutral archives (VNAs) offer many departments and practices seamless image storing and archiving capability across any PACS.

Diagnostic Imaging spoke with Chris Tomlinson, executive director of Radiology Associates of The Children’s Hospital of Philadelphia, about the hospital’s experience with purchasing and implementing a VNA. He’s scheduled to speak on the topic at this week’s annual meeting of AHRA, the association for medical imaging management, in Orlando.
 

Why did the Children’s Hospital decide to pursue a VNA? 

We really wanted to be in the position where we controlled our data so we weren’t essentially having to rely on a PACS vendor and deal with all their proprietary restrictions. I want to change my PACS if I can and not have to convert all the studies from one vendor to another. Second, we’re taking PACS out of being the center of the universe. Having an institutional archive to store images of all types - radiology, cardiology, all the “ologies” - gives use the ability to have all our images for the enterprise stored in one place that’s not PACS vendor owned. It will serve up all images to a non-diagnostic physician through one viewer that links into the archive. One link into the electronic health record, one way to view images. Diagnostic physicians can choose to use their own PACS viewer, but the institution owns the images centrally.

What strategy was put in place to successfully implement this system?

When we did it in 2008, it hadn’t been done except in one or two small places. We had to get institutional buy in, get the hospital to agree to the right strategy, and find and select the right vendor for the VNA. It’s ironic that you have to choose a vendor for a vendor neutral archive, but what they really are is PACS neutral. The institution can segment ownership from the viewers that you read things in, so this is really like getting out of PACS jail. It really allows the institution to own its images and allows for better interoperability. As we’re moving into health care reform, sharing data with other hospitals to coordinate care will be tough if we have to do it across 10 different PACS vendors.

When it came to choosing a vendor, we looked for experience. They had to be very standards based and have a product that wouldn’t be in a proprietary format. We wanted to be able to work with other hospitals. We thought there would be push back, since everyone does imaging in their own little silo. Radiology can’t see cardiology who can’t see pathology, and on and on. This is a way to get a longitudinal view and link to the electronic health record. We found people had been struggling to deal with this, and they were looking for someone to take the lead. It’s a good place for radiology to step up in the institution.

What challenges and opportunities were there to implementation? What have the outcomes been?

It’s a journey. We’re not all the way there. But we do have our VNA installed, and we’ve gotten radiology and the “ologies” up and going. We also have an enterprise viewer that is linked to our electronic health record. These are big things we done, so we’re a lot further along than most. We’ll save a lot of money doing it this way because we won’t have to pay a premium for PACS storage and archiving. We’ll also be allowed to co-mingle images. Other images, such as emergency department ultrasounds, will be stored in the VNA, and we’ll also have disaster recovery. So far, Children’s has saved $2.8 million using a VNA instead of a traditional PACS.

What benefit does a VNA provide that has not exited before?

The ability to avoid future migrations. Offices change PACS on average every five years - it’s a constant migration pattern. A VNA allows an institution to own that data and store it how they want to. They aren’t dictated by PACS vendors on how they have to store things and link to them. It allows institutions to take advantage of synergies with storage and archive support. Instead of supporting each “ology” with rules around retention and document recovery, you now have an enterprise solution to support everyone at once.

What doors does implementing a VNA open for practices and hospitals?

In recent years, we’ve seen a 50 percent growth in the use of VNAs and only 5 percent with PACS. VNAs open the doors for interoperability. There is also a new emerging protocol called MINT - Medical Imaging Network Transport - that could replace DICOM. This would allow for the exchange of images inside and outside of an institution. This is particularly important to reduce radiation dose for kids. I want to know if that child has had a CT at another hospital so we don’t duplicate that study. This could keep radiation doses as low as we can for kids.

There are many vendors trying to find their way in this space. What roles do they play? What should a practice of hospital keep in mind when considering them?

I don’t meant to demonize PACS, but they have the most to lose by this. Keeping institutions in PACS jails dictates the graphical interface and the workflow. And, this is something they’re very good at, but they have a lot to lose once we all say that while all that is great, we don’t want them archiving and storing our different images. So, everyone is now branding themselves as a VNA. We have GE, Merge, and lots of other PACS vendors selling themselves as VNAs. But we have to recognize what a VNA is and what it isn’t. A VNA isn’t just a storage disk running a freeware PACS application.

What will be the impact of tying a VNA to the other health technologies that exist? Will there be any challenges there? How will it change practice?

VNAs are a new concept, and the market is trying to figure out how to operationalize it. We must figure out how to handle interoperability with video from the operating room or from endoscopy. How will we deal with document management? A VNA is really set up for high-end imaging, not insurance cards and documents. People tend to get that mixed up, so we need to segment what belongs in a VNA, a PACS, or in document management. Organization is also a concern. Radiology uses a RIS to organize, but the other “ologies” don’t have a RIS. How will they organize their data without session numbers?

When we think about VNAs, we must recognize that the studies will outlive the media. Whatever we store images on, it will have a five to 10 year life cycle. But, as pediatricians, we have to keep images for 21-plus years. If you think about it, people are getting crushed by their data storage - the number of studies is growing, the number of images per study is increasing, and resolution is also getting better. People are struggling to keep up as the work exponentially increases. Many are focused on getting their electronic health records up and running, but they’re missing the gathering storm. There’s a tsunami of data that will overwhelm them, and a VNA can help.