What You Need to Know About PACS and VNA

Image management in radiology isn’t just about the PACS anymore. For more than a decade, the vendor neutral archive (VNA) has solidified its market share, shifting the way facilities and practices store and handle patient data. But some questions still vex radiology leaders when it’s time to upgrade their PACS or invest in a VNA.

The choices are vast – many long-time PACS vendors now offer VNA-like products, and there is a growing number of solely VNA vendors popping up. But how are they different, and how can hospitals decide what’s best?

“When I look at the VNA and PACS space, I see a shift going on,” said Eric Rice, chief technology officer for Mach7, an enterprise image management system and services vendor. “Some PACS vendors are looking to become everything, but their main emphasis has been on improving work flow. With VNAs, however, the focus has been on back-up and archives.”

VNAs might be a relatively new technology, appearing in the 2000s, but their popularity is growing fast. As facilities face demands for greater information sharing, Meaningful Use compliance, and increased efficiencies, VNAs are on track to become indispensable utility players. And, sales data proves it – according to an October 2013 Research and Markets report, the global VNA market is set to balloon from $165 million to $335 million by 2018.

Consequently, facilities leaders must educate themselves about their institution’s needs and about all available technologies and options. Do they need a new PACS, a re-vamped PACS or a VNA?

What Hospitals Want
Technology changes quickly, and the cost of keeping up are high. So, when hospital administrators face heavy investment purchases, such as a PACS or VNA, they must consider how the facility’s needs might change over time.

“What hospital leaders want is a solution they can implement today for the initial needs and grow, evolve and solve the future needs they either don’t know about or that are really distant on the horizon,” said Greg Strowig, chief operating officer for VNA manufacturer TeraMedica. “The industry needs to provide them with the tool set and capabilities to implement something or have something that will meet their immediate today needs and tomorrow needs.”

And, those current and future needs vary. Many hospitals want to veer away from data migration because it is expensive and time consuming. Others want to create an internal image-enabled electronic health record or a regional health information exchange that includes medical images.

Additional facilities want to include imaging from a greater number of specialties, such as dermatology, gastroenterology, wound care or ophthalmology. In fact, a January 2014 Mach7 Technologies whitepaper showed many hospitals are opting for a new PACS or VNA solution specifically because multiple specialty areas want to use the same image store and archiving system.[[{"type":"media","view_mode":"media_crop","fid":"27487","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4584250245544","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2690","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Although high-quality customer service isn’t a tangible feature of any PACS or VNA system, it’s a must for the selection process, said Marjorie Calvetti, Director of Medical Imaging at Memorial Medical Center in Springfield, Ill. When her facility purchased the Carestream Vue PACS and Vue for Vendor Neutral Archive, not only did vendor representatives offer radiologists advanced training, they were also present when the system launched and returned again for a final advanced training round.

What Issues Drive Upgrade Decisions?
According to Pierre Lemire, president and chief technology officer for Calgary Scientific, a medical technology development company, increased mobility is the number one trend surrounding PACS and VNAs.

“Communication among physicians and between physicians and patients is paramount, and mobility provides the flexibility and freedom to discuss outcomes and diagnoses with other physicians,” he said. “For example, they can take images into a patient’s room for a private discussion. Or, consider an acute scenario dealing with a stroke – with strokes, time is brain. If we can give physicians access to images from a PACS or VNA more quickly, then they can make a faster diagnosis and start the appropriate treatment process.”

With its latest release – ResolutionMD enterprise image viewer – Calgary Scientific added features to shorten time-to-diagnosis and facilitate the connection between the company’s servers and a hospital’s PACS and VNA systems. All patient data is protected behind a firewall and is never permanently transferred from the servers to any mobile device.

“The technology advances rapidly, but adoption has been slower than we would have expected,” Lemire said. “Physicians need to be cautious and be sure the solution they’ve implemented will allow them to continue to deliver high-quality care.”

This demand for access and mobility is particularly strong among radiologists.

“From the radiologist’s and radiology director’s perspective, what we’re seeing is that there’s greater demand for access,” said Steve Deaton, vice president of sales for Viztek, a digital software and hardware imaging solutions vendor. “Referring physicians want to be able to get results quicker or at their leisure. In society, overall, everyone uses a smartphone to check Facebook, Twitter, etc., and doctors have finally started to include this technology in their lifestyle.”

Choosing the Right System
Selecting the right PACS or VNA solution is a complex decision, but the most important step, Strowig said, is to identify whether a product is a true VNA or a re-branded PACS solution.

“Customers have to look closely at the legacy and experience of vendors,” he said. “There are many that will have VNA solutions that will only have worked within their product environments. They may call it a VNA, but their list of where and with what other systems it works is very short.”

If a facility wants a true VNA solution, he said, decision makers must look for products that offer interoperability across vendor product lines.

Hospital decision makers should also keep stakeholders in mind – their information technology (IT) staff, radiologists and other clinicians, Rice said. Any system should ensure data can be entered and retrieved in a standard form from a central storage, and it should offer a standard platform for DICOM and non-DICOM.

In addition, a new or upgraded system should provide flexibility on the viewer and reporting solutions, he said, letting clinicians access and use the system most comfortably for them. It’s also paramount, he said, to make access as simple as possible by using a zero-footprint system that stores images in the cloud.

Planning for the Switch
To ensure smooth migration to a new PACS or VNA, stakeholders must be consulted as soon as possible, said Memorial Medical’s Calvetti. Not only does it give providers an opportunity to express their opinions, but it also lets them learn how to use the new system.

“We had a demo test environment available for residents and referring physicians in the physician learning lab, as well as for the radiologists,” she said. “We did pre-education and pre-training for the technologists and support staff that access the PACS regularly before we even went live.”

All radiologists also completed pre-training.

As with all institutional changes, she said, some providers resisted. To overcome this hurdle, Memorial Medical let referring physicians name the new system.

Ultimately, Calvetti said, the decision of whether to upgrade or replace a PACS or VNA is multi-faceted and individual to the institution. It requires a lot of time, money and buy-in from hospital stakeholders.

“My best recommendation is to keep your physicians educated on the available changes and make a decision for your organization when the funding and the full-time equivalent staff support is there,” she said. “You don’t want to rush it. But you also don’t want to delay too long because, then, the delta of where you are and where you want to go is just too significant.”

It is possible, however, to acquire new PACS or VNA functionality without the high price tag that accompanies an entire system overhaul. Instead of purchasing a new product, facilities can select a piecemeal payment plan, Strowig said. Annual, quarterly, monthly, or per-image licensing methods are effective ways for hospitals that don’t have enough capital on-hand to support a major investment.

One Hospital’s Experience
Memorial Medical Center purchased the Carestream Vue PACS/VNA system in February, making radiology reports and imaging studies available to the facility’s more than 500 providers. This increased accessibility has been the biggest benefit so far, Calvetti said.

“We really like the zero footprint – to be anywhere and be able to access the full PACS system,” she said. “Now with web access, things are very flexible for our physician partners outside the hospital. They can log-in with their phones or iPads, and they appreciate and enjoy that.”

It’s a feature that helps providers improve their communications with patients, she said, and it’s available not only for radiology, but also cardiology, neurology, and radiation oncology.

Radiologists appreciate the system’s speed. Calvetti also said the radiologists use Vue to simultaneously compare multiple MRI, CT and other 3D exams to identify small, nearly imperceptible changes. Although not all radiologists and providers use this feature, it has increased productivity, she said.

Although hospitals have varied reasons for making a PACS or VNA purchase, there’s a clear direction for where these technologies are headed and where they’re taking the industry, said Mach7’s Rice.

“Today, people are buying VNAs with some future in mind. Most purchases are driven by radiology, but they are also driven with the expectation that they need to support cardiology and non-DICOM specialties, as well,” he said. “I think we’ll see that, while radiology is driving the trend, we’ll see propagation beyond radiology relatively soon.”