The rapid shift to VNAs for image storage and sharing will affect purchasing decisions and image management. Here’s what you need to know about the impact.
When it comes to image storing, PACS still rule the industry. But vendor-neutral archives (VNAs) - products that help you store and share studies across manufacturer systems - are gaining market share fast.
While only 5.4 percent of the nearly 1.5 billion worldwide imaging studies were stored by VNAs in 2011, VNAs are expected to archive more than 30 percent by 2016, according to a May 2012 InMedica report. In fact, a 2012 KLAS report found 27 percent of providers already plan to include VNAs in their image-storing strategies.
“As we’re moving into health care reform, sharing data with other hospitals to coordinate care will be tough if we have to do it across 10 different PACS vendors,” said Chris Tomlinson, executive director of Radiology Associates of The Children’s Hospital of Philadelphia. “By purchasing a VNA, we could segment ownership from the viewers we read things in. It was like getting out of PACS jail, and it’s a great way for radiology to take a lead role within an institution.”
The shift toward VNA implementation has been - and, by most estimates, will continue to be - rapid. And, it’s a move that will impact your purchasing decisions, your image management, and how you shuttle images between institutions. The question, however, is what those impacts will look like.
Making a Purchase
Whether you work in a private practice or a hospital, roughly one-third of image CDs sent from one institution to another are unreadable because the PACS systems are different. This problem has long been understood as a patient-care issue, but it’s also a financial one, said Steve Holle, senior vice president for solutions management for Merge Healthcare, vendor for the VNA system iConnect.
“Every image CD sent costs about $15 in addition to staff and physician time,” he said. “A hospital can spend between $60,000 and $70,000 annually on courier costs just shuffling CDs between hospitals. That’s a hard savings that can be had with the enterprise and share functionalities of a VNA.”
But you must be careful when selecting a VNA. Examine potential VNA vendors carefully, Gray said, because some have modified their marketing efforts to sell PACS systems as VNAs. After you’ve narrowed your vendor choices down, request quotes from each. Remember, if the price tag is high, you can implement a VNA in stages, such as only replacing your tape library, to control costs.
“Identify what’s the most important thing for you to do right now. Do you want to move all your data? Do you want to stick it in a data center?” Gray said. “Have vendors show you creative pricing for putting in part of a VNA. Few real VNA vendors are so busy chasing the $4 million deals that they’re too busy to tell you what you can do for a couple hundred thousand.”
Impacting Image Storage and Management
Most hospital departments operate in separate worlds, making it difficult to share images across institutions. However, expected increases in team-based care and bundled payments will likely make this business and care model unsustainable.
“Interoperability is where we’re going in this world. We’re going to have to share images, so we can’t have these silos of data sitting around,” Holle said. “VNAs offer an entire view of a facility’s diagnostic images, and they provide a solution for all specialists - the cardiologists, the radiologists, the pathologists and others.”
Merge’s iConnect brings together images from any PACS in an institution and offers replicated content management, a feature that supplements back-up recovery by making and storing elsewhere automatic copies of images and data. iConnect also uses a standardized DICOM format that all vendor equipment can access, Holle said.
Using a VNA will also impact how you interact with your referring physicians, said Merge’s Kurt Hammond, vice president for interoperability solutions. This tool can help you meet growing patient demands.
“Turnaround time is getting really aggressive as physicians expect faster and faster image reads for their patients,” he said. “With a VNA, you’ll save time because there will only be one place to go for images no matter which department they’re coming from.”
According to Shannon Werb, chief operating and strategy officer for Acuo Technologies, employing a VNA also provides you the autonomy to change how you manage your system or distribute your images without contacting the manufacturer.
Acuo’s VNA product, UCP3, is similar to iConnect. However, in addition to DICOM standards, it supports the global authority on international health information technology interoperability Health Level Seven International (HL7) and Integrating the Healthcare Enterprise (IHE) profiles, including Cross-Enterprise Document Sharing (XDS).
VNAs can also save you the time and money you’d expend when migrating imaging data from an old PACS to a new system. Currently, it’s easier to let your PACS vendor transfer the data because it’s time consuming and can be confusing. Often, vendors change DICOM headers, such as CT of the head to CTHead or HeadCT, making it impossible to find some images if they aren’t categorized correctly in the new PACS. The cost for this service is often between $200,000 and $300,000.
Is it a VNA or the Cloud?
It’s tempting to think of a VNA as just another version of the cloud, which delivers services via a secure network, but there is a distinct difference, said Cristine Kao, marketing manager for Carestream Health’s global healthcare information technology. The concept behind both a VNA and the cloud is identical - a universal storage and archiving system that can be easily accessed by all approved parties - but a VNA requires more infrastructure and can be maintained onsite.
Carestream’s VNA solution comes in two formats: a traditional, customer-managed onsite system known as Vue Archive and a cloud-based service, Vue Cloud Archive, that Carestream manages from a data center. To date, Carestream has 10 data centers that manage more than 80 million images worldwide, Kao said.
The decision to choose an onsite VNA over a cloud-based solution usually lies with your chief information officer, she said. CIOs who invest in building onsite data centers, including electronic health records and clinical systems, will likely opt for a capital purchase and consolidate images via a VNA. Other CIOs focus more on dedicating money to patient-centric services, such as clinical support, and will likely select a subscription-based cloud solution.
Although VNAs make your image storage and archiving more efficient, using the system effectively can be difficult for single radiology groups that serve a large geographic area, Kao said. “There can be a very complex work flow for radiology reporting that a lot of people don’t think about,” she said.
In addition, the front-end cost for a VNA are hefty and can be a deterrent to some facilities, Gray said. It can take several budget cycles to fully implement such a system, but the long-term cost savings associated with no future DICOM migration are substantial. With a VNA, you also have more control over your data, better positioning you for your next PACS upgrade.
However, your PACS could present another hurdle. According to a white paper by PACS consulting firm O Tech, you must prime your PACS to hand-off data to a VNA, including synchronizing and updating patient and study data and coordinating life cycle management between the two tools.
These roadblocks aside, Gray said, the popularity of VNAs has grown quickly and, as the industry’s needs shift, their attractiveness is likely to continue. “The move to VNAs is an absolute paradigm shift like none other I’ve seen in medical imaging.”