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Integrating an EHR and VNA system? Here are the challenges.

Implementing an EHR and VNA system at the same time is a daunting task. A CIO who has experience implementing both systems at the same time discusses the challenges he encountered.

Integrating a vendor neutral archive (VNA) system is difficult enough. Add on top of that the daunting task of implementing an electronic health record (EHR) and that's what James Wellman, CHCIO, CIO at Comanche County Memorial Hospital in Lawton, Okla., had to achieve at his healthcare organization.

Wellman discusses the challenges of integrating a VNA system and an EHR at the same time.

What challenges did you encounter with the integration of your VNA system?

James Wellman: The bigger challenges were getting some of the vendors to work together. You know, the vendor who's providing stuff for your mammography ... in our case, at that time, we were looking at it and we were going to have to expand based on that. So they're trying to sell us the expansion, we're coming in going, "No. We're going to go just opposite. We're pulling out, putting everything remotely." It changed relationships with some of our vendors.

In that case, we ultimately ended up going away from the mammography vendor. So it became almost a long-term vendor who'd done that, and it became so difficult, we finally pitched in the towel and said no. A few vendors, you know, it was very refreshing… [One vendor] jumped in even though they had, technically, their own competing VNA, they never questioned it, never went above or never made it difficult for us and worked with us very well to make the migration. So other vendors weren't as easy to work with. It strained relationships ... that was surprising to me. The hold they felt they had on us with their imaging.

So, technically, in our case, I think some of our challenges ... we let the VNA provider [make] all the technical recommendations on the storage systems and we adhered to that. I think, occasionally, we might have had a few issues around physical connection and, ultimately, we opted in the end to come back and, for the first run of the migration, we kept both systems on site simply because we were moving at a much faster rate than anticipated locally. Remotely, if we'd have had put [the VNA] on our off-site disaster center, we couldn't have kept up with that mirroring because we're talking some pretty large images, terabytes of data. So that was a little design issue in all of this. We had to go back eventually, bring that unit back on site and get it caught up.

What was your experience with integrating your VNA system and EHR?

Wellman: At the time, when we did our [VNA system], we were struggling in that we were kind of landlocked with our vendors, so we needed to make sure that they had a good solution to work with, a hardware solution here that could run a mirrored option at our off-site … location. So a lot of limitations and changes between ... you know, everybody offers a little bit of something … All of them, to a degree, offered a really good viewer.

James Wellman, CHCIO, Comanche County Memorial HospitalJames Wellman

And that stand-alone viewer, we liked that because you could make calls to it for your non-PACS [picture archiving and communication systems]-related applications. So [for] our EMR, we had to pull a link and pull that VNA here with context management, and that way, when a physician's looking at a [patient's medical] record ... it is just as swift as they can pull that up, and it'll pull all of the images for that person without having to go and re-enter everything into a new application.

Prior to that, it was … our PACS application. They, in turn, would have to go and then log in… put in the patient's name and information, pull that up, and it was limited. So, you know, my cardiologists weren't seeing everything. My orthopedics weren't seeing everything. It comes with so many varied vendors, and still does.

Across all those apps, the vendor neutral archive brought them all centrally together. And we wanted them to test it; that knocked out a few people from the first go around. [We had them] come in and show us, and we brought images with us and just started opening things up with different viewers, and one of them could show that. So that was enlightening, because [we had] a clinician sitting there looking at the viewers for how they want to use them, and not IT people; that also made a difference in how we made our selection. 

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