In today’s modern healthcare environment, there are a number of devices generating ever increasing amounts of data. These devices do not typically come from the same vendor and even if they do this is not a guarantee that the data will work in concert from a cohesive and easily manageable unit.
The Picture Archiving and Communication System (PACS) was the first predominant solution to this problem of data interoperability. While many providers currently use this system, it is quickly becoming outdated as the growth of the healthcare IT industry has outpaced its flexibility. According to a white paper written back in June by Michael Gray, Principal at Gray Consulting, the PACS system is becoming “increasingly expensive to support, and the rapidly rising volume of medical image data is quickly outpacing (its) limited functionality.”
“Furthermore,” he added,”the strategy of interfacing multiple clinical PACS viewers to the Electronic
Medical Record (EMR) system’s physician portal is misguided and unlikely to encourage meaningful use.”
A solution for this problem that has been gaining traction lately is the adoption of vendor-neutral archives (VNA). VNAs take medical images, photos, and other test data generated from different sources and organizes them on a single platform. Similar to PACS, this keeps medical data from remaining in individual “silos” that must be accessed separately.
One such system was recently unveiled by Dell in the form of its Unified Clinical Archive system. According to the company website, “the Dell Unified Clinical Archive is a flexible, end-to-end solution for hospitals and practices of all sizes,” which “enables easy data retrieval and secure data sharing for the clinician, while simplifying management and maintenance overhead for IT.”
The new Dell archive system is available to be located either on-site or off-site in the cloud depending on the preference of the provider. On-site systems would keep the recorded information close at hand, thereby making it less susceptible to online safety and security concerns. The cloud-based solutions allow for the remote access of information through mobile devices as well as the ability for a provider to keep the data in a remote system, which would prove useful in the case of an on-site IT disaster.
In another VNA development, IT solutions company Logicalis announced last month that it was partnering with TeraMedica Evercore Clinical Enterprise Suite, a leading vendor-neutral archive. This partnership allows TeraMedica to offer a robust cloud-based archiving system to its customers.
According to Mike Martin, Logicalis’ vice president of cloud solutions, Logicalis will be able to provide “cloud infrastructure, managed services and HIPAA compliant data handling” technology.
Ed Brown, TeraMedica’s vice president of business development, said that because medical images are not typically used more than once—“it only makes sense to farm that data off to the cloud.”
For large providers looking to adopt a VNA, one of the biggest challenges could be economic as a comprehensive VNA is often more expensive than a heterogeneous PACS environment. This is why hosting data in the cloud make sense according to Gray. He wrote in his blog that a Hybrid VNA, with both on-site and off-site data hosting”can have a 30% lower TCO than its capitalized, self-managed, on-premise counterpart.”
–>
I am pleased to see interoperability as being the core attribute of the VNA, too often I see positioning that the VNA’s primary responsibility is backup, disaster recovery, reference imaging, or PACS migration. Although I agree all of these are important the core tenant (at least in my opinion) of the VNA is interoperability by and between multiple clinical systems. These could include imaging (DICOM), scheduling (HL7), viewing (PACS and Universal Viewing), data exchange (HIE), non-DICOM (XDS), and of course gluing it all together in the EHR. I agree Mike Gray does a nice job positioning VNA/PNAs (as he once called them).
Both solutions mentioned in this post are cloud offerings, although I do agree that cloud offerings of VNA’s are important I think it is necessary to consider a few possibly different points. I’m pleased to see Dell’s UCA solution being offered in a hybrid approach, both onsite and offsite (cloud), as a supplier to Dell’s UCA solution offering we feel the hybrid approach is key to solving the interoperability issue along with maintaining the right level of performances. After all interoperability happens within the clinical domain, not necessarily within the cloud, thereby requiring a strong onsite offering that can get into the workflow and replace many of the archival and workflow components of the active systems.
I’m not sure I understand the reference to medical images “not typically used more than once”, in our experience VNA deployments of today are far more important than reference imaging and as an active contributor to onsite workflow imaging can be accessed multiple times. A few examples include access within the primary PACS, distribution to 3D reconstruction, possibly Surgical Navigation or 4D (US) technologies. On top of this, although the curve is steep once you get outside of 90-180 days, access to imaging priors is extremely important within that initial window and imaging (DICOM or otherwise) can be recalled multiple times within that initial care window. As such cloud strategies need to take this into account – back to local intelligent workflow enhancements, interoperability, and finally vendor neutral archiving to the cloud.
The term “archive” often makes people think of data at rest but let’s remember that most clinical HIT systems, especially clinical content management systems, are dealing with data that isn’t at rest, especially at the beginning of the care continuum, and requires a high level of interoperability to provide value. The cloud will continue to develop as an extremely important strategy for medical imaging, and all bulk clinical content, but as we make this shift we need to make sure we are achieving the core attributes (interoperability) along with the need to create operational efficiencies that the cloud contends to bring to IT in general.