By Erik L. Ridley, AuntMinnie staff writer

May 29, 2015 -- NATIONAL HARBOR, MD - Adopting a vendor-neutral archive (VNA) and related technologies has solved a number of important workflow challenges for a North Carolina radiology group, according to a presentation on Friday at the annual Society for Imaging Informatics in Medicine (SIIM) meeting.

By implementing a vendor-neutral image management environment, Wake Radiology was able to realize benefits such as improved workflow, better management of digital breast tomosynthesis (DBT) images, and reduced storage costs, said Mary Lou Lovel. She presented Wake Radiology's experience during a scientific session at SIIM 2015.

A neutral environment

An independent imaging practice, Wake Radiology has 20 locations in North Carolina and provides interpretation services for three hospitals and multiple private physician groups in the area. The practice has 47 subspecialty radiologists who read approximately 190,000 imaging studies a year, one-third of which are mammography exams, Lovel said.

Wake wanted to create a neutral enterprise imaging environment in order to be prepared for future technology advances.

"We wanted to be sure that when the next big thing came along, we would be able to plug that into our environment," she said.

Wake Radiology also needed a consolidated platform for its radiologists, who were reading from three different PACS networks. In addition, the practice wanted to be able to connect to a health information exchange (HIE) when that became available in the area.

"Most importantly, we wanted our radiologists to be aware of patient priors," Lovel said.

Design process

In designing its new model, the group needed a workflow engine to provide routing for mammography images and prefetching of studies from different hospitals. Wake also wanted to create HL7 orders from DICOM and to facilitate normalization of studies.

"[Normalization of studies] was a huge thing for us in bringing in images from different areas," Lovel said.

The VNA would be used for data migration and to serve as an Integrating the Healthcare Enterprise (IHE) XDS repository/registry. Wake also needed a viewer that could support digital breast tomosynthesis images. A workflow manager would provide analytics capability.

In addition, the practice also wanted an electronic medical record (EMR) or RIS to help it meet the U.S. government's meaningful use IT stimulus program requirements.

Wake's informatics challenges were mostly related to mammography, Lovel said.

"We do batch reading for our screening studies, and we use specific mammography workstations," she said. "We were actually sending those [studies] three or four times across the [local area network] just to get them to the different workstations."

Wake also needed to prefetch and route the prior studies to the mammography workstations. DBT images also needed to be stored, as they could not be stored very well on the existing PACS.

"We also had an issue with storage commitment, where you are reading an image on a workstation and you're storing them on PACS; there was always that issue of did they make it to the PACS," Lovel said.

Other archive issues included dealing with proprietary images and an inability to export JPEG images.

"We had that Hotel California syndrome where you could get them in, but you couldn't get them out," she said.

Image object change management capabilities were also a problem, as changes could only be made at a study level. This created issues when studies were moved for CD burning, according to Lovel.

Improvements

With the new workflow engine, Wake was able to implement image routing to the mammography workstations based on the study description, she said. The router also allowed the group to send studies to the advanced visualization workstation, as well as to begin normalizing imaging data received from outside facilities.

Furthermore, Wake was able to start prefetching studies from other hospitals overnight and to support archiving of tomosynthesis studies, she said. The group also purchased a DICOM/HL7 adapter.

Thanks to the new VNA model, the group was able to reduce the number of hours that had been previously required to manually push all of the mammography studies up to three times to make sure they arrived at the appropriate workstation, Lovel said.

In addition, the prefetching capability allowed Wake to lower its bandwidth utilization by moving images at night.

"We're able to lower the storage costs once our new viewer is in place," she said. "Our hope is to be able to use our VNA as the center of our architecture, and our plan is to [connect] everything to that VNA. With that, we don't want any one application to have its claws into our solution that we can't take it apart and put another piece in."

The VNA will also support information life-cycle management for the group's images, she said.


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