8 Considerations Before Switching to a VNA

Radiology vendors advised groups at SIIM 2016 on key considerations before deciding to switch to a VNA. Fred Behlen, PhD, a medical physicist and founder of Laitek, Inc. offered eight tips for practices to consider.

1. List all use cases, identify how each one would work in the clinical workflow. Pay attention to the readiness of the systems for VNA. Don't leave PACS out of the planning, that may seem a bit obvious but there are people out there who think you can buy a VNA without telling the PACS company up front. PACS has to work with the VNA, it's just a matter of going through each use case. Think of everything it has to do, make sure you know how it's going to do it. Will it be fast enough? How much storage do you need in the PACS?

2. Consider consistency of presentation between diagnostic and clinical displays, especially annotations. There are varying degrees of how important annotations are, but even in some cases people are using them for laterality corrections, so annotations can become a patient safety issue. You'll have to migrate annotations, a lot of storage systems don't have annotations in DICOM format, you just have to make sure that's covered.[[{"type":"media","view_mode":"media_crop","fid":"49905","attributes":{"alt":"Fred Behlen, PhD","class":"media-image media-image-right","id":"media_crop_2367516329680","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6071","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":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Fred Behlen, PhD","typeof":"foaf:Image"}}]]

3. Clinical photography, non-DICOM imaging, enterprise imaging, the best thing to do is to provide for encapsulation into DICOM and store them in the VNA. There are DICOM web services, and new tools such as IHE web image capture that should make DICOM implementation of those things easier

4. On your VNA, make sure that it's provision to handle data migration inflows, the inflows can be in excess of a terabyte a day, the VNA ought to be able to handle it but sometimes it requires adequate provisioning.

5. Some groups are doing a best of breed or deconstructed PACS as VNA implementation, if you are thinking of doing this make sure you know what you're doing and have the resources to integrate your own PACS. There is a lot that PACS companies have done in providing these integrated solutions, make sure you know how to do all of those things.

6. Consider the alternatives to VNA. One way to approach it is to maybe expand the role of your PACS to cover enterprise imaging.

7. Make sure that you don't get locked in to your new vendor, allow for multiple viewers, even if you are starting with one supposedly universal viewer, you may want to add others in the future. That's an EHR and a VNA architecture question, keep your connections to the VNA pure vanilla DICOM, in other words don't abuse or overuse tag morphing capabilities.

8. Require full read access to the VNA database and storage, even if you don't plan to use it, get the passwords and get contractual rights to passwords, you will never have more negotiating leverage than you have now.