VNA's: Let's Make A Deal!

June 24, 2013
I have recently been involved in several client situations involving enterprise imaging, and after listening to all the “hype” I almost feel like I’m on the game show, “Let’s Make a Deal.”
I have recently been involved in several client situations involving enterprise imaging, and after listening to all the “hype” I almost feel like I’m on the game show, “Let’s Make a Deal.” My concern is that there is too much emphasis on solutions and not enough emphasis on understanding the need! The proverbial cart in front of the horse. I understand the motivation of vendors to generate sales, but I sometimes feel that a failure on the part of some to take time to understand the customer’s underlying need could come back to haunt them.

It seems the industry has gravitated to using the term “VNA” or Vendor Neutral Archive. I for one have never been a fan of this as it is too limiting and misleading! What does “neutral” mean? If I have two different image generating system vendors, must I choose a third neutral archive vendor? More importantly, the term misses a key aspect – accessibility. It is about more than just “archiving” the images, it is also about “managing” them. Again, it’s all about understanding the need.

There are many different applications and requirements for image management and accessibility. Is there just one service area involved, or does it need to embrace multiple service areas such as radiology, cardiology, pathology gastroenterology, etc.? Are all the images to be managed in DICOM format, or are there other image types to be managed as well? Is there just one facility involved, or does it need to embrace multiple facilities as part of an IDN (Integrated Delivery Network) or HIE (Health Information Exchange)?

Does the need require a simple archive of the images for disaster recovery purposes, or is the intent to be a local enterprise archive for multiple services? Is the expectation that the application will be responsible for managing the content, such as for life cycle management, or is the expectation that individual services will manage the data? Will individual services be the only access to the images, or will other applications such as an EMR be expected to independently access them?

Without a clear understanding of the need, it can be confusing for facilities to appreciate which capabilities of vendor offerings are essential and hence differentiators. Take the case of Tag Morphing. Within the DICOM (Digital Image Communications) standard, every image contains certain attributes that define the patient, type of study, etc. These attributes are stored in a header file before the image information. There can be both “public” and “private” attributes defined. Patient name would be a public attribute, whereas specific information relating to a vendor’s 3D application might be a private attribute.

In some circumstances it may be desirable to have the ability to change these attributes globally within an enterprise archive device. An example might have to do with differing study identification schemes when migrating from one PACS to another. Another example might be to update a patient’s last name such as with a marital status change. The applications to accomplish this are sometimes referred to as “Dynamic Tag Morphing.”

In this example, Dynamic Tag Morphing would be very important to a DICOM-only archive, and one that potentially interacts with data from more than one facility. On the other hand, if the requirement is for an enterprise-scale image management solution that entails multiple data formats, is predominantly for one health system, and is intended as a central repository for an EMR, then Dynamic Tag Morphing may not be as essential.

Over the coming months I will try to illustrate more examples of matching requirements to capabilities, with the intent to create more informed decision makers, who in the terms of “Let’s Make A Deal” select the correct door for their situation. An informed prospect is one who understand their requirements well enough to know what is important and what is not in terms of picking the right choice for their situation.

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