How the right image archiving middleware can support better patient care
December 19, 2016
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Medical imaging is often a target in discussions about wasted medical spending, including repeat imaging, but it also plays a critical, often lifesaving role in many areas of health care. The right middleware can link disparate systems and address some of the challenges that lead to wasted spending while ensuring clinicians have the patient records they need to provide optimal care. SmartBrief spoke with OnBase by Hyland's Bob Carson about why such a middleware is needed, how it works and how to choose one for your own organization.

Can you describe the logistical problems that arise when different departments within a single hospital use different Picture Archive and Communication Systems and other medical image archives?

A hospital with different PACS and other medical image archives must first provide governance and assure sustainability around each individual system to include support, security, maintenance and updates.  Since each solution is department-based, there is likely little conformance to any enterprise standards, making all functions more difficult and costly.  Interoperability is also a monumental task because few if any platforms exist to provide a true enterprise view of all of the segmented content.

What are the implications for patient care?

Bob Carson
Bob Carson

The existence of department-based PACS and other medical image archives is the essence of disconnected health care. Usually these systems have been created to support an individual department or function, and the broader needs of the enterprise are not considered.  This means a complete picture of any one patient’s relevant clinical content will not be available when or where it is needed.  These conditions can significantly slow the delivery of care, increase costs for the institution and patient -- who may undergo duplicate exams -- and even cause harm when clinicians are unaware of previous conditions or exam findings.

What do vendor-neutral archive systems do and how do they address these issues?

Health care providers should expect that a well-designed and deployed VNA must behave more like an enterprise content manager and have the ability to ingest all clinical images of any type, DICOM or non-DICOM, and manage them in standard or native file format. 

A VNA is middleware that sits between the storage and the applications that use the storage, and is not provided by the PACS vendor. It supports integrating with virtually any storage system or configuration and any application or system. It is able to archive all unstructured content for the enterprise if desired by the customer.  

The health care provider should expect a VNA to be a single point of access for patient-related unstructured content, which is accessible through secure enterprise single-sign-on services. This would include both DICOM and non-DICOM content. The VNA should be able to store data in its native format. Because of the VNA's mission-critical status, a robust business continuity contingency is imperative. It should image-enable the EHR and possess workflow capabilities separate and apart from the EHR.

How does VNA adoption affect the patient medical record, and in what ways might that influence care?

The optimal clinical experience would have all relevant clinical information available for any patient and presented to any qualifying clinician when and where it is needed.  A VNA is an essential part of the enterprise solution created to address this optimal clinical experience, providing a secure, sustainable enterprise storage for non-DICOM and DICOM clinical content.

What specific features should provider organizations look for in a VNA system?

At a minimum, a VNA should possess the following capabilities in order to support vendor neutrality:

  • Interface with all major PACS via DICOM
  • Interface with major HDO business and clinical systems via HL7
  • Support for IHE-XDS
  • Support for bidirectional tag mapping/morphing
  • Store all images in the native and in a nonproprietary format (for example, DICOM Part 10)
  • Support nonproprietary image compression
  • Support for all major storage vendor platforms
  • A diagnostic quality, web-based universal viewer
  • A means of easily accessing relevant patient information
  • Point-of-care support for ultrasound studies

Other important requirements, not necessarily tied to vendor neutrality, include:

  • Provide for massive scalability
  • Offer a high-availability option
  • Offer centralized system administration
  • Provide a documented set of APIs and web services
  • Provide for advanced archive search capabilities
  • Support for reconciling patient identifiers
  • Support for non-DICOM images
  • Support the pre-fetch of prior studies
  • Provide purge capabilities based on data retention policies
  • Support for mobile devices
  • A single repository in one codebase and architecture for ECM and VNA

Bob Carson is manager of healthcare solutions at Hyland Software, maker of OnBase enterprise content management software, where he has assembled a team of six experts in the field of clinical imaging and clinical content. Their mission is to help health systems provide complete patient records from across their healthcare enterprise, to their healthcare enterprise. Clinicians make more informed decisions when they have immediate access to the complete patient record.