Hospital IT systems have clinical/data silos throughout the enterprise. In the coming age of healthcare delivery, silos must be replaced with interoperability. One key to the delivery of patient data will be an integrated medical records archive. Determining the best archive solution is dependent on the size and scope of your imaging needs across the enterprise.
To address these needs the industry has responded with the creation of a new tern: Vendor Neurtal Archive (VNA). The VNA market is in the emerging stages of combining a multitude of technologies into a single unified platform. This platform typically consists of a hierarchical storage manager, intelligent archive feed by HL7 interfaces, health information exchange (HIE) integration engine with XDS-i conversion, DICOM archive, non-DICOM storage archive, DICOM normalization tools often seen in the picture archiving and communications system (PACS) neutral archive market and an encompassing universal viewer that can display all stored data types. While the tern Vendor Neutral started as a marketing ploy by small players to disrupt large PACS vendors, it was quickly adopted as a term indicating an archive that is standards based and that can stand alone separate from any middle-ware systems such as PACS. The concept is that the archive of data that is held in a VNA is neutral to the requestor or supplier of data.
There are many terms and definitions for levels or types of VNA’s. Suffice it to say, there is no standard. Most vendors and consultants adopt the concept that there are several levels or types dependent upon the types of images stored and the cross application indexing. Vendor selection in this market will have a significant impact on the clinical and technical functionality of your archive. Thus, you must first understand VNA and all of its possible options
VNAs can offer the following abilities:
• Web services for patient record publication
• Certified hardware virtualization
• Hardware-agnostic implementation option
• ILM (image lifecycle management)
• Routing/prefetch rules
• Data normalization tools
• Native DICOM and non-DICOM object archival in native format
• Single patient record across all disciplines
• Single integration point for image enablement for all archiving clinical systems
• Unified fully integrated image viewer for DICOM and non-DICOM objects
• Ability to utilize best-of-breed DICOM viewers from a third party
PACS and cardiovascular information systems (CVIS) are by default architected to archive image data in perpetuity. With many facilities reaching 500+TB, the data center has become a graveyard of images that haven't been accessed in years.
A VNA will provide you with a one-stop shop for all archiving needs and dissemination of all image data to electronic medical record (EMR) and health information exchange (HIE) exchanges by default. They will provide viewer support or access to the data if a third-party viewer is warranted by your analysis. A full VNA will archive all data types.
It is important to understand that many archiving systems use proprietary objects or TIFF formats for image and data storage. This category of VNA vendors recommends these objects be wrapped or encapsulated in a DICOM wrapper. This renders the object unusable by the clinical archiving system. It solves the ability to disseminate the object, but destroys the ability for the archiving system to utilize it, because it lacks the ability to retrieve that object once stored.
Evaluating your enterprise needs is a difficult and sometimes overwhelming endeavor, especially when you venture into the non-DICOM world. For radiology and cardiology, DICOM is a format we are all very familiar with. However, DICOM is not typically the standard outside of these two imaging service lines.
Non-DICOM will bring with it very interesting integration storage methods and different retention and compression rules not typical in the PACS environment. It is wise to bring in an expert who has the ability to look at your enterprise with new eyes and your strategic roadmap, while providing you with a list of requirements your organization needs for a unified storage platform. Once you have your requirements, you will know what options your facility or enterprise will require in a VNA.
Intelligy’s VNA analysis will uncover what future system dataflow and workflow would look like for all clinical imaging departments.
A VNA will and can touch every clinical imaging system and acquisition device in your enterprise. The planning for a VNA must be comprehensive, and you'd better get it right. Your VNA will likely be around longer than any other clinical archiving system you currently have today.
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