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VNA: More Than Just a New ‘A’ in PACS

By Jim Knaub

What would you want a vendor-neutral archive (VNA) to do for your organization? That was a hot question in the VNA-related education sessions and exhibits at HIMSS 2014 in Orlando late last month.

Some view a VNA as the last data migration they’ll ever need for their PACS, but that’s just one possible component of a VNA enterprise strategy. For example, Louis M. Lannum, director of enterprise imaging at the Cleveland Clinic, discussed his institution’s VNA project, which is designed to bring 60 different image-producing services from the clinic’s eight hospitals into one VNA and make those images accessible through its EMR system. Lannum said the organization’s IT team has worked through about one-half of those 60 services, and the project extends far beyond the radiology department. “Imaging decisions are no longer in the silo of radiology,” he said.

“It’s not a storage strategy; it’s an EMR strategy,” Lannum told the audience. To that end, the Cleveland Clinic has elected to place all of its images in so-called DICOM wrappers so they can be seen through one DICOM viewer, eliminating the need to support multiple views on its 35,000 clinical workstations. So a gastroenterologist could view endoscopy images side by side with a CT scan of the abdomen through the EMR. Other reasons for choosing a DICOM VNA are DICOM’s long history as a standard, and that it offers good indexing capabilities.

At the Cleveland Clinic, systems from multiple vendors contribute images to the VNA. Cardiologists use a Siemens product, radiology uses Agfa’s PACS, and women’s health uses a GE Healthcare system, Lannum noted. He said that all three companies provided a DICOM protocol to deliver their images to the VNA so they can easily be read by the clinic’s DICOM viewer in the EMR.

The Cleveland Clinic’s approach is not the only viable one, but it makes sense in terms of what it wants its VNA to do. At this point, there’s no single, agreed-upon way to design a VNA, which makes sense when you think about the need to customize any enterprise IT project to the operation it serves.

For example, some hospitals don’t like the idea of putting every image in a DICOM wrapper. Instead, they prefer keeping images in their native formats and creating a common viewer interface that contains multiple viewers.

A large radiology group serving multiple hospitals would want a different functionality in its VNA. Radiologists would want their VNA to smoothly manage, store, and share images from their various clients. That’s a different job than being a repository for various types of images from a range of clinicians.

As imaging departments and hospitals grow familiar with VNAs, one of the first steps these organizations need to consider is what they want from their VNA.

— Jim Knaub is editor of Radiology Today.