Ascendian Healthcare Consulting

Using Vendor Neutral Archives to Change the Landscape

Imaging has all but completed its rush to implement Picture Archival and Communication Systems (PACS). These last 10 years have seen an industry-wide transformation from film-based to digital imaging workflow. A similar transformation is now gaining momentum within cardiovascular services with cardiovascular information systems (CVIS). These information systems can provide significant improvements to clinical workflow, data capture and availability, and ultimately improve patient care and outcomes.

There are, however, new challenges with managing information in the digital age. Disparate systems need to be integrated or interfaced to ensure data is shared across departments and these bring costs associated with the build and management of interoperability. In addition, information systems have a lifecycle and need to be replaced due to technological, functional or business requirement changes. Replacement efforts bring new challenges and costs associated with data migration and the typical payment for service to both the legacy and replacement vendors. These costs can vary widely depending on the quality and extent of the migration.

Vendors have historically used the constraints of cost and effort as a way to hold on to customers. The unspoken strategy is to keep data locked within a system, making it difficult to achieve either interoperability or conduct migration. Too often, customers evaluate the associated costs and effort to complete these initiatives and determine the easiest path is to stay with a legacy vendor in the face of shifting clinical requirements.

There have been significant technical developments and solutions that provide a better way to store, archive and maintain data outside of the vendor-specific solution. One solution that has gained significant traction in the industry is Vendor Neutral Archiving (VNA). VNAs provide the technology and architecture to allow for centralized data archiving and access for multiple systems and vendors.

A VNA, if designed correctly, will accommodate the migration of all patient and exam data (DICOM and beyond) into a central architecture. Previously all system data was archived in a vendor-specific solution that required the migration of that data every time it needed to be available to another environment—whether it be a disparate or replacement system. In this new environment a VNA can be designed to integrate with an interface engine to receive ADTs, orders and reports, which ensures the data remains in synchronization with its environment (HIS, RIS, PACS, CVIS, LIS). With this approach data is migrated one time to the VNA and is maintained with active interfaces so the data remains relevant and synchronized with upstream and downstream systems. This model also provides users the option to replace systems when necessary without the associated effort and costs required with data migration.

When data is archived and managed effectively by a VNA, the responsibility no longer resides with the originating system (RIS,PACS, CVIS), which opens new opportunities and perspective toward how those systems are utilized. This will allow users to build a flexible system using software like modules built onto the VNA not unlike using an app store. For instance, one vendor may have the most user-friendly desktop, another may have the premier 3D application tool set, and another may have a workflow engine. This environment will allow each to be utilized concurrently, providing the best possible solution for clinicians.

The future of PHI management and mobility will require that data be shared across systems, departments, organizations, providers without the need for complex APIs. A Cardiology exam, for example, performed within Radiology can be automatically added to the CVIS when the patient presents. The CVIS can pull and incorporate radiology data simply because it exists in the same VNA. This is the beginning of shared data that allows providers to have complete patient information regardless of the originating system or department. This interoperability lays the groundwork for shared PHI across organizations, caregivers and providers meeting long-term healthcare goals.

It is important to understand that VNA is only one part of the solution and cannot be viewed as a replacement for department specific systems. Active patient data lives in the HIS, RIS, PACS, LIS, etc. and exam status, changes and annotations. A VNA is an archive, not a clinical information system, and must be designed and managed as such. The landscape of our information systems is about to change and the VNAs are laying the ground work. Vendors will need to maintain openness if they wish to capitalize on opportunities and allow best of breed to exist individually. Hospitals must explore these new technologies as their data storage and accessibility needs increase. Departments using disparate systems such as CVIS or PACS must examine paths to interoperability. VNA is the beginning of this evolution and provides a basis for groundwork to develop this infrastructure.