Healthcare enterprises are turning to VNAs to help them cut the chains binding them to proprietary PACS offerings from single vendors. VNA technology offers the promise of more independence, flexibility, and better support for images and data outside of radiology.
But the future of VNAs isn't all sunshine and rainbows -- as Motorola discovered when Apple's iPhone hit the market in 2007. In the Thursday session, representatives from five imaging informatics vendors offered advice for facilities considering a VNA:
Saint-Clair of Dicom Systems cautioned SIIM attendees to consider the system's effect on technologies other than imaging, especially electronic medical records (EMRs). Interoperability is key here, through technologies such as DICOMweb and the Fast Healthcare Interoperability Resource (FHIR) electronic healthcare exchange standard that could become a successor to HL7.
"We have to think about the enterprise and not be fascinated just with imaging," Saint-Clair said. "Imaging is super important ... but we are part of a much bigger picture."
Another consideration with a VNA is how data will be managed throughout its life cycle, including its final disposition after it's no longer needed, according to Merge's Hansen.
"You are not managing your content if you are not managing it throughout its life cycle," he said.
Governance is another important issue, according to White of GE. How does information come into the VNA, and who has access?
This can have different implications for different clinical specialties, such as plastic surgery, where it's very important to control data access due to patient privacy issues.
"You don't want just everybody to be able to see that, so you need to think about your rules-based access control," White said. "If I'm the primary care physician, I don't necessarily need access to that."
Even wearable devices -- your Fitbits and the like -- are an evolving technology to think about, White advised. Such data could be useful for physicians, but how are you going to get it into your VNA?
During the question-and-answer session, a debate erupted over the future of DICOM, the image-exchange standard that has served radiology so well over the decades. Other medical specialties don't use DICOM, so should healthcare facilities be looking to move beyond DICOM with their VNAs?
Not necessarily, most panelists said. Nonradiology users of a VNA often want their data stored in its original format, according to White, and not necessarily in a DICOM wrapper that makes it palatable to radiology-based systems. And storing data in its native format makes future data migration easier.
What's more, can you get a DICOM-based workflow to work for nonradiology clinicians? That's something to consider, Hansen said.
Gurgel pointed out that many medical devices outside of radiology generate data that doesn't conform to any standard. He agreed that bringing such data into a VNA in its native format and then attaching metadata to it that provides clinical context is probably the best course and gives users flexibility if they change platforms in the future.
On the other hand, Saint-Clair noted that DICOM "is the language of enterprise imaging."
"It's like saying we need to move beyond English," he said. "Why?"
DICOM should be seen as a building block that can be used to make other standards better, he believes.
Finally, Laitek's Behlen offered several tips for ensuring that you implement your VNA the right way:
- List your use cases for adopting a VNA, and analyze how the VNA will affect the workflow in each of the clinical areas where it will be used.
- Don't leave PACS out of your VNA planning -- and definitely let your existing PACS vendor know what you're doing.
- Figure out how you will handle annotations, especially if they are for non-DICOM images.
- Make sure that diagnostic and clinical displays will display the same data in a consistent manner.
- Be sure your VNA is equipped to handle heavy data inflow, which can be as high as 1 TB a day.
- Make sure you have full-read access to all the data in the VNA; get passwords and the contractual rights to passwords. You will never have more leverage than at the beginning of the VNA adoption process.
In the end, imaging facilities need to keep in mind that VNAs have a longer life cycle than other healthcare IT systems -- for 10 to 20 years -- a life span far longer than that enjoyed by the Motorola Razr.
"Keep an eye on what you need to do today, but make sure that the technology decisions you make are not locking you in, that you are able to have that data stored and managed in your system, and adapt to whatever technologies are down the road in the future," Gurgel said.
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