Considerations

for a Vendor
Neutral Archive VNA

(VNA)

A Corvette is a great car for a single person. It’s fun to drive, has the ability to
go zero to 60 mph in under 3 seconds, and turns a lot of heads. But what
happens once you get married, have kids and a dog and coach Little
League? You need something slightly bigger and a tad more flexible- like a
minivan. The fact that the minivan takes two to three times as long to get to
60 mph and doesn’t turn a single head is balanced out by the extra capacity,
built in DVD players, spill resistant cloth seats and so much more. That is the
basic premise behind a Vendor Neutral Archive (VNA) versus leveraging
stand-alone PACS-centric archive(s). While an on-site PACS was great for
archiving and disseminating radiology images, the evolution of PACS from a
singular department solution to a global Enterprise Imaging Solution (EIS)
dictates a storage mechanism that can share data between multiple
departments.

Medical imaging systems have evolved from standalone systems to true

enterprise imaging systems by including viewers that support a variety of
platforms, workflow engines and quality control functionality. As such, a
standalone VNA is no longer enough anymore. The VNA must be an
integrated part of the whole system. Integrating components from
disparate vendors can create integration difficulties, vendor finger-pointing
and ongoing support and training issues due to different user interfaces.
That is why it is important to use a common integration platform that can be
leveraged to add new modules and functionality.

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 Benefits of VNAs

VNAs liberate data from being stored within various

departmental silos. This significantly reduces
operating and support costs as well as data
migration costs. Having to only support one archive
vs. several can save 75% or more of the day–today
operating costs associated with maintaining
individual silos. It also makes backup and recovery
much easier by aggregating the data into one
system. All the data in a VNA becomes homogenous
and simply becomes easier to integrate into other
hospital information systems. Departments no
longer have to worry about getting individual
vendor support for backup, integration and other
complex IT tasks.

In addition to the cost savings related to having a

VNA in place, a VNA also helps meet the Health
Insurance Portability and Accountability Act (HIPAA)
Security Rule. This rule requires a backup copy to be
in place to protect the patient data to be HIPAA
compliant. Often facilities store images on a single
server. Having them in a VNA adds a much higher
level of security for the patient data and allows the
organization to meet the HIPAA security rule.

Ownership cost
- Data Migration
- Maintentace Cost
VNAs also protect the financial interest of a facility.
- Operation cost Not only does a VNA provide an extra layer of
protection for Protected Health Information (PHI)
but it also ensures that a facility is compliant with
Ben
Security e Centers for Medicare and Medicaid Services (CMS)
regulations relating to Medicare and Medicaid
- HIPAA compliant
fit

- Disaster recovery payments. The CMS Final Rule effective 11/17/2017

s Of

- Business continuity details emergency response and business continuity

regulations for healthcare. While it doesn't
VNA

specifically focus on disaster recovery (DR), it does

Lifecycle management
- Image deletion rules
include business continuity which incorporates a
- Legal rules for patient Disaster Recovery plan among others.
information
Non-compliance could result in the loss of Medicare
Unified support
- Single vendor
and Medicaid benefits.
Data integrity Support
- All data formats
- Single database

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 Required VNA Functionality

Today’s VNAs provide functionality that many of the earlier versions were lacking. This includes dynamic tag
morphing which allows two different systems to change the values in one or more attributes (usually DICOM data
elements in this context) so that both systems can understand each other. The ability to import/export images and
CD support is also a major plus, even though many facilities are trying to get away from CD usage and using
web-based image sharing instead. The ability to natively handle non-DICOM data and convert it to DICOM is key, yet
many of the older systems could not perform this task. The use of industry standard image transfer protocols like
DICOM, WADO (Web Access to DICOM persistent Objects) and XDS (cross-document image sharing) are crucial to
the success of today’s VNA. The ability to accept non-DICOM objects as found with pathology, genomics and other
systems is also important. Image related objects like presentation states, annotation, regions of interest, and
measurements, key image and object selection as well as various reports all play a role in making a VNA as
functional as possible.

The use of an integrated viewer is a plus instead of having to use a third-party viewer that requires integration.
These viewers should address not just diagnostic viewing but also web-based viewing and even zero footprint
viewers that enable referring physicians to access images and reports via the Web from a PC, Mac or tablet without
software installation or plug-ins.

Administrative functionality takes on a more important role as information systems support is stretched thin and
PACS administrators can only do so much. The better VNAs in today’s market are designed to provide a much more
robust product than those of the past and, more importantly, to be able to be managed by the customer, not the
vendor. This includes all types of VNA architectures - on premise, cloud-based or hybrid designed VNAs. End users
can set up user groups and rights as well as creating branches for individual hospitals or departments
Being able to have access to both structured and unstructured data, including text, images, and other related
information allows a facility to analyze this information in various ways. Changing unstructured data to structured
data as many new VNAs offer also allows a facility to sort, sample, model and validate the data as well.

With the advent of larger file sizes as found with 3-D mammography and increased slice counts with various CT
protocols, the ability to perform load balancing (share the data between various servers) is also crucial. This
provides not just increased performance but fault tolerance and high availability as well. Systems also need to be
designed to prevent against unneeded multiple copies of studies, preventing excess on-line and off line storage
costs as well.

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 The Need for Interoperability

So when moving forward with an enterprise imaging strategy, why is implementing a VNA so important? First it
allows for interoperability between various components that make up an Electronic Health Record (EHR). This
includes not just radiology and cardiology images and data but information obtained from all clinical systems in use
including electronic medical records (EMR) systems, laboratory and pharmacy systems, billing, and so much more.
Sharing data between these various clinical systems has always been a challenge requiring either the use of pricey
interface engines or time consuming and difficult to implement customized interfaces known as APIs (application
program interfaces).

The use of an industry standard for exchanging healthcare information electronically called FHIR (Fast Healthcare
Interoperability Resources) has made the integration of these systems much simpler. Even though FHIR has been
defined for nearly a decade, not all vendors support FHIR. Even fewer support the newer version of FHIR called
SMART FHIR which emphasizes web standards like HTML (Hypertext Markup Language), Java, and others and
provides support for terminologies for coded data like SNOMED (Systematized Nomenclature of Medicine - Clinical
Terms). SNOMED is a collection of medical terms providing codes, terms, synonyms and definitions used in clinical
documentation and reporting.

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 Choosing the Right VNA

So what is the difference between the various VNAs being offered out
there? Going back to our earlier analogy, it’s like the kind of car you have.
You define your specific needs, your budget, how long you plan on
having it and your pain threshold and pick a vendor who can best meet
all your needs. Most of the hardware used is virtually identical from
vendor to vendor with only a few upgrades offered like the use of solid
state devices (SSDs) to archive the data on versus hard disk drives or
spinning discs (HDD). SSDs costs more currently than HDD but are
considerably more stable as well as being faster.

The biggest differences price wise deals with the software that is
bundled with the system and vendor support. Interestingly, pricier
systems do not always equate to better systems either so you need to
take a close look at the value you are getting relative to your needs. You
should also recognize the entire process from evaluation to
implementation can easily take a year or more so the sooner and closer
you look at VNAs the better off you will be.

In summary, the key elements in evaluating a VNA should include:

1) Using a common integration platform that can be leveraged to add new modules and functionality.

2) Ensuring that Information Lifecycle Management (ILM) is a part of the software offering.

3) Ensuring the system can perform dynamic tag morphing.

4) Having an integrated image viewer, not a third-party add on.

5) Making sure the system can be managed by the customer and not solely by the vendor.

6) Ensuring that the data is equally distributed between the servers using load balancing so the system servers
can perform optimally.

Author - Paul Dandrow

Chief Technology Officer

300 Washington St.

Newton, MA 02458
www.paxerahealth.com
sales@paxerahealth.com
1 888 430 0005

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