By Theo Ahadome, AuntMinnie.com contributing writer

December 14, 2012 -- Vendor-neutral archives (VNAs) have finally moved to the forefront of healthcare IT spending, after years of debate on the value of keeping archiving separate from PACS. As demand for VNAs grows, the market is attracting a host of suppliers with a range of product types and strategies.

A challenge for traditional PACS suppliers in the VNA market is to prove their ability to deliver a nonproprietary, standards-based approach to archiving that gives healthcare providers control of their data without being locked into their PACS.

PACS to departmental VNA installed base
Figure 1: From PACS to departmental VNA -- North American installed base by vendor. Size of bubble represents PACS installed base in North America. All images courtesy of InMedica.

Agfa HealthCare, Carestream Health, GE Healthcare, and Merge Healthcare have all developed VNA products, either in-house or through acquisitions. These suppliers were earlier to market with their VNA products, driving market leadership. Of these, GE has the largest share of departmental archives in North America (figure 1), while Merge, Carestream, and Agfa have established a stronger position in cross-departmental, multi-PACS enterprise archives (figure 2).

Other PACS vendors tend to partner with VNA providers: Fujifilm and Philips Healthcare have partnered with Acuo Technologies; Siemens Healthcare has partnered with Dell.

Independent software vendors

Independent software vendors (ISVs) are those who have a proprietary VNA product but not a proprietary PACS. These suppliers have emerged from outside of the PACS market to meet the challenges created by departmentalized data silos.

The leading ISVs in the VNA market are Acuo, Dell, DeJarnette Research Systems, and TeraMedica. These tend to focus on cross-departmental access to data rather than on the storage of specific departmental information.

More than 80% of VNA studies in North America in 2011 were from managing DICOM images in multiple departments or at multiple hospital sites, showing that current demand is driven by the need to consolidate images and reduce image migration costs. However, as VNA penetration increases, so, too, will demand for larger integration of non-DICOM and nonimage data.

By 2016, VNAs based on the Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing (XDS) standard are projected to account for 30% of VNA studies. VNA suppliers who currently provide full document registry and XDS repository features in their VNA are well-positioned to benefit from this shift in demand.

Departmental to enterprise VNA installed base
Figure 2: From departmental to enterprise VNA -- North American installed base by vendor. Size of bubble represents enterprise VNA installed base in North America. Arrow indicates projected direction of growth in installed base.

Future directions

As demand for VNAs grows and healthcare providers seek better control of their data, PACS suppliers are well-positioned to increase their departmental VNA installed base by providing VNAs to their radiology PACS customers. The bigger challenge for them is to meet the needs of healthcare providers across departments.

Agfa's Impax Data Center VNA provides hospital-wide access to images and is combined with its Imaging Clinical Information System (ICIS) to integrate images into a cross-enterprise workflow to support access from the electronic health record (EHR). As such, Agfa is projected to increase its presence both in terms of departmental archives and enterprise VNA installations.

Carestream has the second largest enterprise VNA installed base in North America and also focuses heavily on cross-departmental synchronization of patient data through its Vue Connect offering. Growth in the VNA installed base is projected from Carestream's PACS installed base, from a departmental viewpoint, as well as from non-Carestream PACS customers to consolidate DICOM and non-DICOM data.

GE has the largest departmental archive installed base in North America through its Centricity Enterprise Archive. It has also recently launched Centricity Clinical Archive to provide a wider nondepartmental approach to an XDS-enabled archiving and workflow environment. Centricity Clinical Archive is classed by InMedica as VNA level 3.1 (highest possible VNA architecture) and is projected to drive GE's presence in the enterprise VNA market.

Merge has the largest VNA enterprise installed base in North America. With the introduction of the Merge Honeycomb Archive as a cloud-based platform to further enhance image sharing, Merge seeks to solidify its position as a provider of nonproprietary imaging IT platforms.

Independent VNA vendors have a greater presence in enterprise than departmental VNAs because they focus more on cross-departmental access to images and other forms of data. As VNAs are increasingly used for this purpose, they are projected to increase their presence further.

Acuo is the leading ISV in North America in terms of VNA installed base, a position it has achieved as an early entrant in the VNA market with a focus on PACS interoperability, XDS, and zero-footprint viewing. It has also successfully partnered with the largest number of third-party vendors, including Philips, EMC, and AT&T.

DeJarnette, arguably the earliest provider of interlegacy PACS integration tools, developed systems to enhance data migration and connectivity of PACS systems. Out of these, the VNA concept was formed and it has since continued to provide a standards-based approach to data storage and workflow integration across departments.

Dell, through its acquisition of InSite One, has established its unique position as the only storage provider with a proprietary VNA. Dell primarily provides a cloud-based VNA solution, which, combined with its experience in data storage, addresses the demand for reduced costs and consolidated medical data storage.

TeraMedica is also one of the earliest providers of VNAs, and its Evercore product has been deployed in departmental and enterprise models. It is, however, the cross-departmental approach to PACS data access with analytical tools that is projected to continue to drive its presence in the enterprise VNA market.

For healthcare providers, it's encouraging that VNAs are an increasing priority for PACS vendors; the strong presence of ISVs also increases the options available. As the debate swiftly moves from "whether or not to adopt a VNA" to "which VNA to adopt," it's up to vendors to prove their ability to meet the most important VNA adoption criteria: reduced storage costs, reduced migration costs, enhanced image sharing, synchronized cross-departmental workflow, enhanced business continuity, and enhanced nonimage data sharing.

Theo Ahadome is lead market analyst for healthcare IT at InMedica, the medical research division of IMS Research. The information in this article is obtained from InMedica's research on healthcare IT markets, including PACS, RIS, cardiovascular information systems, enterprise management, cloud storage, and vendor-neutral archives. He can be reached at theo.ahadome@in-medica.com.

The comments and observations expressed herein do not necessarily reflect the opinions of AuntMinnie.com, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group.


Copyright © 2012 AuntMinnie.com

Last Updated np 12/13/2012 3:29:14 PM

23 comments so far ...
12/15/2012 1:14:33 PM
imago
This is not a serious VNA market analysis
Department PACS or enterprise PACS are not VNA
Michael Gray and other authors have given perfect definition of what is a VNA ,especially in a lot of auntminnie forum
GE as a leader of the VNA market ????
The single GE VNA is a canadian project developed by dejarnette and a wales network also outsourced
At the last RSNA GE has anounced so called universal viewer with a
VNA in a couple of years
Agfa as no 2 in VNA market ?,agfa data center is not a VNA .At the last RSNA agfa present its VNA solution as the Dell one ,and Dell outsourced to acuo !
Carestream no 3 a superPACS is not a VNA
In fact it is well known that the majority of VNA are outsourced to dedicated software company acuo,teramedica or dejarnette
I wish to know the opinion of a VNA expert as M Gray onthis so called market analysis and to know if this analysis has been sponsored by GE as i have heard the same argument from the GE marketing :we are the leader of the VNA market,but we have already no VNA in the US !!!!

12/17/2012 3:56:46 AM
Theo_Ahadome
Thank you for the feedback – very much appreciated.
The analysis of VNA above does not include departmental PACS or enteprise PACS. VNA has to be defined by certain criteria, not by who the vendor is.
InMedica’s definition of VNA, which is agreed on by both PACS vendors and ISV, is based on the following criteria:
  • DICOM and HL7 communication
  • Support for multiple PACS
  • Non-DICOM data sharing
  • Clinical lifecycle management
    • Security, long-term archive and disaster recovery
A VNA may include these additional components:
  • XDS registry and repository
  • Storage virtualization
    • Web-based access & zero-client viewer
A PACS – enteprise or departmental - will not meet the above criteria; only a true neutral archive would. It is for this reason, that Fuji, McKesson, Siemens and Philips were adjudged not to have VNA products, even though they clearly have high shares in departmental and enterprise PACS (Fig.1).
 
You could make a distinction between an archive, which meets all the above criteria and is supplied by a PACS vendor; and an archive, which is supplied by an ISV. This is legitimate. However, it is classifying vendors NOT products. It is our opinion that the focus should be on the features and components of the product, as well as importantly, the managed services and delivery models (hosted, hybrid, non-hosted) that make up a VNA, rather than the type of vendor. The term "vendor-neutral" archive in itself is unfortunate because it drives this debate around the term rather than the components of a product. 
 
Moreover, there are a number of industry relationships which further complicate the picture - Dell does partner with ISVs, but also has a VNA in UCA (from Insite One). 
 
A departmental VNA meets the above criteria and is employed to store radiology images from a single radiology department only. It is a VNA because it can support multiple PACS from multiple vendors, it just isn’t necessarily being deployed in that manner. Acuo’s VNA (which we can all agree is a VNA) for example, can be deployed in that manner, but that wouldn't make it any less of a VNA. It is simply the case that GE has the largest deployment of such departmental VNA. Agfa is NOT no.2 in overall VNA market, but is in terms of departmental VNA. 
 
The ISV’s deploy their VNA in an enterprise manner, increasingly with XDS, and hence have a larger position in enterprise VNAs (fig.2 X-Axis) and strengths in non-dicom data integration. Many think of enteprise VNA (connecting more than one department – radiology and/or other) as  VNA, and would refer to enterprise VNA shares for positioning in the VNA market (in which case, Merge is no.1; Carestream and then Acuo). Also on that figure you might segment PACS vendors from ISVs, in which case Acuo is the no.1 ISV. However for a full picture of the VNA market, one must consider both departmental and enterprise (Figure 2 X and Y-Axes). 
 
I am glad we can get an open dialogue on VNA going and welcome a further discussion. Please note, this analysis is not sponsored by any vendors.
 
Thanks
Theo
InMedica (IHS). 
 

12/17/2012 9:48:54 AM
imago
semantic confusion !!
i do not understand why you do not use the well established michael Gray's definition of a VNA
in fact you have a proprietary,not vendor neutral,definition of a VNA
you exclude fuji,mac kesson ,siemens and philips and you include GE with bizarre argument !!!!
nobody beleive that a department PACS,even from GE is a VNA
at the last RSNA,even GE and Agfa present their VNA solution as outsourced or as a work in progress ,so please do not name your marketing study a VNA anlysis it is rather a PACS analysis,
the comment of VNA experts will be welcome

12/17/2012 10:31:47 AM
Chris Hafey
Discussing the definition of VNA and what features one may or may not have is far less interesting to me than what fueled the development of these products in the first place.  The fact is, money and responsibility has shifted from the radiology department to the IT department and these VNA vendors were first to listen to IT and deliver solutions that met their needs.  The industry needs to learn what these new buyers want and fast - otherwise the clinical side will suffer heavily.

12/17/2012 12:50:32 PM
imago
Excellent question
Archiving move from radiology to IT department
Fortunately the added value is not in archive but in intelligent business software
This is well described in the RSNA lecture of K Dreyer and P Chang radiologist must exploit IT to,secure their future published in auntminnie
The fuure is not PACS nor VNA but Medical IMaging IT and imaging health record