Vendor-neutral archives still require better definition

2012 06 11 08 53 46 906 Computer And Stethoscope 2 70

Vendor-neutral archives (VNAs) have become central to PACS and the management of medical images, and demand for them is clearly growing, as indicated by the increasing number of installations worldwide. As this market develops, there is a need for clearer guidance and dialogue on the requirements that should lead to a decision to implement VNAs. Identifying the benefits that VNAs may provide over alternative systems also will play a fundamental role in their wider adoption.

For successful implementation of these archives, five key recommendations for suppliers and healthcare providers are listed below:

  1. Define and map the needs of hospitals for VNAs
  2. Define the types of VNA architecture and delivery models
  3. Map the needs of hospitals to specific types of VNAs
  4. Map the needs of hospitals to specific VNA delivery models
  5. Prove the return on investment of VNA with regard to the identified needs

This article focuses on the first recommendation of defining and mapping needs.

As the PACS market has developed over the last decade, so too have the number of procedures and images being captured by PACS. Storage requirements and workflow needs of radiologists and other specialists have evolved, as an increasing number of studies become available in digital form.

This evolution has gradually reached a tipping point as a result of several important developments in the PACS market. First, PACS has reached full penetration in radiology, particularly in developed geographic regions, increasing the volume of digital images available. As a result, healthcare providers need secure and long-term archiving of historical data, including disaster recovery options and access to archives in a manner suitable to clinical workflow.

Second, the PACS market has become a replacement market; the cost and time involved in data migration during PACS replacement is a considerable burden on healthcare resources.

Third, PACS has become increasingly available in cardiology and other departments, creating demand for solutions that enable image sharing between departmental PACS. In addition, the penetration and utilization of electronic health records and other enterprise systems have risen exponentially, improving operational and clinical efficiency by sharing patient data across departments; healthcare providers demand that this success is replicated for image data and enable integration of image and nonimage data.

These factors in the development of PACS have created the following needs:

  • Enhanced business continuity: How can long-term storage and disaster recovery be achieved in a manner that is optimal to clinical workflow? This includes eliminating downtime, in the case of hardware or server failures, by providing an active backup of data that can be immediately accessed.

  • Reduced storage costs: How can the cost of storing new and historical data be reduced in a clinically relevant manner for an extended period of time? The term "clinically relevant manner" is vital for life-cycle management of images and other data. Hospitals should be able to define policies for retention of data based on an assessment of its relevance and with data on the frequency of access. The archiving system -- be it PACS, VNA, or another solution -- should then be adaptable in order to follow these policies on a case-by-case basis.

  • Reduced migration costs: Is the cost of migrating data with each replacement overly costly and cumbersome? Reducing the PACS switching cost is important to enable better freedom of choice, improve competition and innovation in the PACS market, and, importantly, reduce the burden to hospitals of changing their PACS provider. However, a note of caution: If PACS-to-PACS migration cost is removed by VNA deployment, hospitals should ensure that it is not merely replaced with equally high VNA-to-VNA migration costs. So the need to reduce migration costs should apply to both PACS and VNAs.

  • Enabled image sharing: Can imaging departments access images from each other, without compromising the quantity and quality of data? Similarly, can nonimaging department's access images in a secure manner?

  • Enabled nonimage sharing: Can nonimage data and non-DICOM data be integrated with images to create a true enterprise-wide integration? Solutions that improve the availability of actionable patient data to healthcare providers have the potential to enhance decision-making, reduce costs associated with lack of information, and ultimately improve patient outcomes.

Considering these are challenges within the PACS market, it is reasonable to expect that PACS products may themselves solve these needs. Some PACS have been developed that indeed solve some of these challenges. However, the inherent nature of PACS as a tool for image viewing and communication, mainly via DICOM in specific departments, means it cannot easily overcome the needs for data sharing, non-DICOM communication, clinical life-cycle management, long-term storage, and business continuity.

VNA Radar - Mapping hospital needs to imaging IT products. Scale of 1 to 10 (1 being a poor ability to address a need and 10 being a full ability to address a need). VNA is deployed with PACS. Source: InMedica.VNA Radar - Mapping hospital needs to imaging IT products. Scale of 1 to 10 (1 being a poor ability to address a need and 10 being a full ability to address a need). VNA is deployed with PACS. Source: InMedica.
VNA Radar - Mapping hospital needs to imaging IT products. Scale of 1 to 10 (1 being a poor ability to address a need and 10 being a full ability to address a need). VNA is deployed with PACS. Source: InMedica.

The figure provides visualization on the extent to which a generalized departmental PACS, enterprise PACS, and VNA address these needs. The challenge for vendors is to quantify the ability to meet these needs. This is much more difficult; vendors may be able to quantify reduced storage costs, but how do they prove the value of image sharing? The extent to which these needs apply to a hospital should guide their decision on implementing a VNA. Furthermore, hospitals must evaluate each vendor's solution on a case-by-case basis with regard to these requirements.

For healthcare providers, establishing a clear set of needs and understanding if a PACS deployed without a VNA is sufficient to address their requirements is a vital first step. This is particularly important because the presence of one or two of these needs does not form a prerequisite for a VNA. Rather, it is the combination of these requirements and the priorities that a hospital attaches to them that should lead to the decision to implement a VNA.

Theo Ahadome ([email protected]) is senior analyst for healthcare IT at InMedica, a division of IMS Research, recently acquired by IHS Inc. (NYSE: IHS). InMedica provides research and consulting services in the medical electronics industry. For more information on its latest research report, "The World Market for Medical Enterprise Data Storage -- VNA -- 2012," visit

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

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