Over the years, hospitals have seen a substantial increase in PACS rolled out within their environments. With the ongoing mergers and acquisitions in healthcare, the number of medical imaging implementations within the hospital network is increasing significantly. This is because different departments within a health system choose imaging systems that fit their specific needs.
While these systems have historically been stable and provided adequate features to physicians and radiologists, hospitals are turning to imaging software vendors to identify a potential enterprise imaging system that can help them address some of the modern challenges they face with existing imaging solutions. There are a number of options available to hospitals, including hosted radiology information systems (RIS), picture archiving and communication systems (PACS) and vendor neutral archives (VNAs).
Enterprise imaging explained
There are several imaging examinations a patient may undergo during a care episode, such as an X-ray, MRI, CAT scan or echograms. Imaging systems, such as PACS, RIS and VNAs, commonly offer core functionalities centered on image storing and data management. Departments such as dermatology, oncology and neurology use these systems at different levels based on the specialty and role of the users.
Many of the existing imaging systems in hospitals are able to meet traditional picture archiving and data management requirements. However, the need for more data sharing with electronic health records (EHRs), accessibility of data by external entities, interoperability, modernization and mobility is forcing many healthcare executives to reevaluate their enterprise imaging strategy. VNAs continue to rank top of mind as the most regarded enterprise system.
How it works
The objective of a VNA is to centralize medical images from the different "ology" systems. By installing a VNA platform in a hospital environment and making it accessible to other imaging platforms, the VNA can receive common standards such as the Health Level Seven International (HL7), Digital Imaging and Communications in Medicine (DICOM) and Cross-Enterprise Document Sharing (XDS). It can also act as a destination for images from multiple imaging systems. The system then allows the end user to pick a favorite imaging viewer or EHR to access all of a patient's medical images regardless of which system they originated from.
Having the option to use a VNA to create a consolidated image archive can also help a health system meet its disaster recovery needs. The images archive in one location and can be replicated to a secondary site or client. In the past, this was a challenging and costly task, as it required hospitals to maintain multiple imaging systems backups.
While VNAs have been a popular option for many hospitals, using PACS from the same vendor across multiple departments is also a viable option for a hospital’s enterprise imaging strategy. This is because PACS from the same vendor are able to communicate and exchange imaging information without any of the common burdens of system integration and interoperability.
For hospital executives, selecting a new enterprise imaging solution brings several changes to workflows, infrastructure and interactions with medical images. As a result, when upgrading a system or buying a new one, it becomes critical for the selection committee to evaluate several top considerations that should be present in a hospital's enterprise imaging strategy.
Integration with multiple imaging sources. With the intent to consolidate imaging data from different sources, one of the key features that an enterprise imaging system should have is the ability to accept data from imaging solutions by other vendors. This is indicated when the new system supports HL7, DICOM and XDS, which are the common standards used by most medical imaging systems. There are some cases for which a hospital requires non-standard integrations in order to process non-DICOM images, so it is important to ensure that the platform offers additional flexibilities to process nonstandard data formats.
Universal viewer and support for zero footprint. Hospital executives should take into account two trends when it comes to image interaction. The first is where hospitals simply use a VNA's own client for all their imaging consumption. The second is where hospitals use another preferred universal viewer. An enterprise imaging strategy needs to support both methods, as well as offer a zero-footprint viewer, such as a web-based client, in which an end user can interact with imaging data without the need to install tools or be tied to viewing stations.
Viewing with native apps on mobile devices. Physicians and radiologists are increasingly turning to mobile devices to gain access to medical imaging regardless of platform. Hospitals should ensure that clinical archiving systems can support access to images and other parts of the software from a tablet or smartphone. Native apps in iOS or Android platforms typically offer a more enhanced experience in terms of quality of images and end-user experience. While some vendors opt to use a simple, web-based solution as their mobile app, native apps are likely to support more capabilities and richer experience.
Access to migration tools. Hospitals that plan to move toward an enhanced enterprise imaging platform like a VNA require an upfront migration to move existing data from one or multiple PACS into the new consolidated image platform. This step is critical as it allows for the initial seeding of the information. Once completed, the integration with the PACS allows for any new imaging to flow in regularly. Some VNA vendors offer migration services in which they assist the hospital in the migration process, while others simply offer the tools for an IT department to complete that process itself.
Analytics and data insights. A centralized imaging system is able to collect data around the activities performed in the system, such as imaging acquisition, file transfers, order entries and scheduling. This can be mined to deliver new insights around workflows and other measurements. Some imaging system vendors offer analytics capabilities that highlight performance metrics such as imaging volume trends, workflow analysis and turnaround times, system performance, imaging activity trends and resource use. Several of the key performance indicators can be used to display the analysis of archived data and system performance. These dashboards may include a daily or weekly summary of the volume of data activities, system uptime, DICOM exam volumes, service-level agreement data on patients, reporting physicians, locations and other benchmarked information.
DICOM images available to external care facilities. With the recent changes made to incentive programs and the shift away from fee-based payments for Medicare and Medicaid beneficiaries, a new federal law outlines that providers who make standard, searchable DICOM images available to external groups will receive incentives. This aspect becomes a significant feature to have in a system and a key differentiator amongst VNA systems. Hospital decision-makers must ensure these shared services are available to them as they select a new enterprise imaging system.
Support of non-DICOM formats. A VNA must also support non-DICOM media, as there are a number of cases in which other data formats flow out of other imaging systems. It is common for providers to have patient documents scanned and attached as part of their imaging exam; due to that fact, having the ability to support non-DICOM images adds a valuable functionality to an imaging system. Some of the document types in question that may require support include Clinical Document Architecture, XDS.b and XDS-I.b.
Integration of multiple medical record numbers. The ability to support or integrate with existing Patient Identifier Cross-Referencing components and an enterprise master patient index is increasingly critical given healthcare mergers and acquisitions. A single patient can exist in multiple EHR systems and have different identities. To ensure the accuracy of the data within the imaging systems and the mapping of the all images into one unique patient record, support of master patient index solutions is a must.
Convenient access to all medical imaging records. The ability for a primary care physician or other specialist to retrieve all recent imaging related to a patient from one single place or EHR becomes a huge benefit for hospitals. Providers are finding it more effective to simply go to one system for all the patient records. To offer that, a VNA, as well as a PACS, must be able to support sending images of patients to an EHR via URL, web service, web access to DICOM persistent objects or FHIR (Fast Healthcare Interoperability Resources) platform.
The bottom line
Over recent years, the enterprise imaging market has moved beyond the proprietary platforms that stored medical images in silos. VNAs helped reshape the market and made it possible for hospitals to consolidate their images and increasingly move away from grouping images in disparate systems. Now, however, even VNAs have undergone a significant transformation as demand for shared services, mobility, data replication and support for EHR-system integrations has increased.
Despite the modernization of new imaging systems, decision-makers still must plan adequately and evaluate all of the different capabilities offered in these systems to ensure they align with the hospital's enterprise imaging strategy. Once those steps occur, then the organization can begin to address many of the challenges experienced by supporting multiple systems within their facilities.
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