Implementation of a vendor-neutral archive (VNA) solves most of the problems associated with PACS, can save money over the long term and can prepare an enterprise to participate in a health information exchange (HIE), according to Michael J. Gray of Gray Consulting who presented during a webinar on Jan. 26 hosted by the Healthcare Information and Management Systems Society (HIMSS) and GNAX Health.

Gray referenced a Health Imaging article published in June 2011 that identified the top 10 problems with PACS, and said a VNA helps alleviate seven of them. Problems solved include integration with other providers’ EHRs, unexpected PACS downtime, non-standardized hanging protocols, interoperability concerns, PACS replacement/data migration challenges and disaster recovery. VNAs also give more control to radiology departments at a time when PACS are becoming enterprise-wide tools.

Among the advantages of a VNA is that it provides an enterprise class disaster recovery and business continuity tool, while accepting both DICOM and non-DICOM image data and related metadata, according to Gray. VNAs eliminate the need for future data migration and can simplify enterprise viewing with one viewer.

Money talks, however, and one of the barriers to VNA implementation is the high costs–“bigger than your biggest PACS,” said Gray. A VNA will probably require multiple years and multiple budgets to implement, he said.

Despite the large upfront costs, there is a long-term economic rationale for VNA implementation. While proactive data migration to a VNA costs more than migrating data during a PACS replacement, migration from one proprietary format to another is a waste, said Gray. VNA infrastructure will offset some infrastructure costs of a replacement PACS and VNA data will be ready to use by the next PACS, meaning no future DICOM migrations. VNAs shift control of study data from the vendor to the provider, giving the provider more leverage in the next PACS upgrade negotiation.

Gray said there a number of VNA precursor products that can solve some PACS problems on their own. These include open storage solutions shared by multiple PACS, data migration engines, DICOM routers and zero-client viewers that provide server-side rendering.

Gray outlined several entry-level VNA strategies. While not full VNAs, these can help with certain PACS issues:

• Level 0: Deploy a local DICOM router to facilitate local and remote PACS-to-PACS data exchange. Rules-based automatic routing based on metadata provides efficient data transfers.
• Level 1: The first step of Level 1 is the migrating the primary copy of data to an open storage solution. Gray advised keeping the most recent three years of data on-site and transferring the balance to the cloud. Choosing an open storage option protects the organization from obsolescence,” said Gray. The second step of Level 1 is transferring a second copy of the data to the cloud for disaster recovery.
• Level 2: Deploy a migration engine, a subset of a VNA, on-site and perform a proactive DICOM migration to the VNA-fronted cloud infrastructure. Any PACS-driven disaster recovery solutions can be retired after this step. This eliminates future DICOM data migrations and transfers control of data away from the PACS vendor.

• Level 3: Activate the viewer in the cloud infrastructure and image-enable the EMR with the viewer and cloud-based secondary copy of data.

To move from Level 3 to a full VNA, the organization must deploy the primary instance of the VNA and the viewer; establish local PACS, EMR and HL7 interfaces; ship primary storage to the primary data center and reduce local PACS storage to 12 to 18 months, said Gray.

Another benefit of heading down the VNA path is with the Level 2 strategy and above, an organization can participate in an HIE, said Gray. This can be done with cross-enterprise document sharing for imaging and a companion enterprise master patient index upgrade option activated in the cloud infrastructure.