Reversing for success -- universal viewers and VNAs

By Jef Williams, contributing writer

June 3, 2013 -- For the past several years, medical imaging has evolved based on new demands, sources, technology, and delivery models of care. Much has been written and spoken about vendor-neutral archiving (VNA) and its trailing associated technology, the universal viewer.

Jef Williams
Jef Williams of Ascendian Healthcare Consulting.
During this time, many business cases, return-on-investment (ROI) analyses, road maps, and strategic plans have been developed regarding how to deploy this emerging technology to manage enterprise medical imaging in both the near and long term. Most of these solutions link the universal viewer (also known as a univiewer) to the VNA technology as an add-on value, and the implementation comes after the installation of the VNA. What if these roles were reversed?

In 1984, a young teenager named Michael Dell looked at the business model of selling computers and asked the same question. At that time, the computer market followed most other markets: build the systems and sell the systems -- in that order. He decided to reverse it, and, as we all know, created an entirely new way of approaching the sales transaction: sell first, then build.

This same idea should be considered as you pursue your VNA/univiewer procurement and, ultimately, your implementation. By implementing a good univiewer, there are several early wins that could bolster your business case and also ease VNA implementation, ultimately positioning you for long-term success in managing your enterprise medical imaging.

Referring community satisfaction

This is a no-brainer if you have a large community of providers and referrers who are using viewers from multiple vendors. Very few large organizations are able to bring all of their medical imaging onto a single platform without a univiewer.

Disparate PACS networks, cardiovascular imaging systems (CVIS), and other specialty on-off systems all launch their proprietary viewer by default. This creates a frustrating environment for clinical users who are dealing with compatibility issues with versions and devices.

By replacing the cacophony of viewers with a single federated solution, you will gain user buy-in and satisfaction and, more importantly, an army of advocates for your imaging strategy. This logically should lead to increased revenue from the referring community as their satisfaction is immediately -- and tangibly -- improved.

Early win means buy-in

The VNA project for any larger healthcare enterprise will take eight to 12 months, and the value of the VNA doesn't get felt until the solution is live.

Many organizations are dealing with significant challenges and have sold the VNA as the panacea to the user and stakeholder community. The problem is that in a world of impending deadlines around meaningful use, ICD-10, accountable care organizations (ACOs), and healthcare information exchanges (HIEs), patience and resources are scarce.

As John Kotter writes in his landmark book Leading Change, "Running a transformation effort without serious attention to short-term wins is extremely risky."

Your VNA/univiewer project will take time, a lot of capital, and dedication of resources. This amount of investment deserves a clear strategy that includes early wins. Deploying your univiewer early gives you an early win across the stakeholder groups. IT is happy to reduce complexity in supporting the portfolio of viewers, and users appreciate a simplified way to access image data.

Know your environment

To successfully adopt a univiewer, it is imperative to know your environment both as it currently exists and as it's intended to be in the future. Questions around image caches, clinical systems, and the adoption of a master patient index (MPI) all must be captured and understood in selecting the appropriate vendor.

Several solutions available on the market provide robust feature functionality that allows organizations to mitigate issues of image ingestion from external entities, matching patient demographics when no MPI exists, and even providing diagnostic quality images and toolsets.

Choosing wisely means two things:

  1. Know your environment. Make sure you are aware of the systems, the structure of support, the long-term strategy, and the business (mergers and acquisitions) strategy, as well as the downtime and business continuation strategies.
  2. Know your options. Take the time to learn what each vendor offers in the market. There are as many different flavors as there are vendors. Resist the urge to choose from an existing vendor, and take some time to research options. You will find the process to be beneficial in understanding the market, and you will undoubtedly learn more about the dynamic imaging market.


Many older systems and those that have been leveraged to manage umpteen terabytes of data are starting to sputter with issues around uptime and ongoing performance. Many of the biggest sufferers are the largest and most complex provider networks in the country. Coupled with this frustrating reality is the fact that most downtime solutions really don't satisfy the key users: radiologists.

One option with pursuing a viewer implementation prior to the VNA is to adopt a downtime solution that brings a better environment to the radiologists. With many univiewers now presenting image data in diagnostic-quality and associated toolsets, this solution can be architected to allow departments to stay up and running while the clinical system is remediated and brought back live.

But don't forget the VNA

Keep in mind that the goal is not to adopt a viewer without a VNA. This solution has its limits. Most viewers cannot aggregate all image data, and this solution is still dependent upon departmental clinical systems for its horsepower. Users will experience an exponential improvement in performance once the VNA becomes the horsepower for accessing and viewing image data. But this transition to a live VNA will be largely seamless for your user community.

For some, this approach will not be ideal. But isn't that the beauty of where enterprise medical imaging is headed? One size no longer fits all. We've moved away from single-vendor turnkey solutions to a modular approach. And this includes our methodologies and implementation strategies.

The best advice I can give is to consider your world, your environment, and your options. Then ask: Can I turn this thing a different way (à la Michael Dell) and get to where I want to go faster, at a lower cost, and with a better outcome? Sounds like the mantra of the new landscape all around.

Jef Williams is vice president at Ascendian Healthcare Consulting and a frequent speaker and writer on healthcare technology topics and enterprise imaging solutions. You can contact him

Copyright © 2013

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