Time to Retire the term “VNA”?

May 4, 2015
Is it time to create a better acronym for clinical image content management than the VNA?

The term “Vendor Neutral Archive” (VNA) was coined several years back to identify the trend toward more sophisticated storage technology for medical imaging.  The thought was that a device that was not tied to a specific vendor application such as a Picture Archiving and Communications System (PACS) would afford users more flexibility in storage options, as well as the ability to apply the technology across multiple service areas such as radiology and cardiology.

As the market and industry continue to evolve, it is apparent that the need is increasingly driven by Electronic Medical Record (EMR) interoperability, and visualization as well as storage.  Current and future stages of the ARRA/MU legislation require the image enablement of the EMR.  These requirements extend the traditional PACS perspective of providing image access to diagnosticians and clinicians for diagnostic and therapeutic reasons.

Everyone knew that by “vendor neutral” one did not mean that the device had to be supplied by someone other than say the PACS vendor – rather, it addressed the operational characteristic that it would work with more than one vendor’s application, thereby being “application neutral.” 

The question of describing it as an “Archive” is also limiting, in that the functionality requirement clearly is broader than just image storage.  The VNA concept embraces middleware applications such as image lifecycle management (ILS) as well as media management.  In addition, these applications are intended to address the ability to modify image data, such as by means of Dynamic Tag Morphing, as well as the ability to accommodate more image formats than just DICOM (Digital Imaging Communications format). 

The net result is that I believe it is time to retire the term VNA in favor of something more descriptive of the need and actual applications.  In a recent article, “Enterprise Imaging: The “New World” of Clinical Imaging & Imaging IT,” (http://www.healthcare-informatics.com/article/enterprise-imaging-new-world-clinical-imaging-imaging-it), a former colleague of mine, Don Pittman does an excellent job of laying out the evolution of enterprise imaging, and its requirements.  Don speaks to the requirements of an “enterprise” vs. “entity or ology-specific” environment, as well as the importance of interoperability.  This article and the points made help substantiate the case for a new definition.

So what should be encompassed in a new definition?  The case can be made that regardless of how many services are addressed, the focus should be on an “enterprise” solution.  Hence, enterprise would be a good descriptor in the definition.

Previously, we have focused on images, but in the context of all the different types of images found across the enterprise, perhaps it may be more appropriate to emphasize “clinical content” as that might embrace images as well as other related content such as video and documents.  Therefore, clinical content is another important descriptor.

The VNA definition focused on “archive” of content, but in reality, it is more about “managing” content, to include storage, access, migration, and disposition, to name a few services.  Therefore “managing” clinical content may be more appropriate in the long term.

When you put them altogether, you end up with something like “Enterprise Clinical Content Management,” or ECCM.  Of course there may be other ways of addressing ECCM, so other acronyms may be helpful as well.  An alternative approach might be to piggyback on the IHE (Integrating the Healthcare Enterprise) profile extension known as XDS, or Cross Document Sharing.  Perhaps one could refer to devices as an extension, such as XDS-Storage, XDS-Access for universal viewer, or XDS –Management of for addressing services.  The point is, any of them would be more descriptive than the term “VNA!” 

I welcome your perspective and suggestions for an acronym.  The key point is it is time to acknowledge the broader functionality addressed by the concept if we are to progress past the notion of simply replacing a PACS archive, and retire the term “VNA”.  Unfortunately, no one ever challenged the term PACS, and it has become synonymous with the technology.  We must act quickly before we are burdened with “VNA” as well!

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