Radiologists on staff at ProMedica, a not-for-profit, 12-hospital healthcare organization serving northwest Ohio and southeast Michigan, may not know how spoiled they are. Working remotely, they can call up real-time diagnostic images from the Emergency Department or archived data from four years ago without logging into several systems to find what they need.
“Our radiologists are doing real-time radiology here,” said Free Beck, Enterprise Imaging PACS Administrator at ProMedica. “If our radiologists had to wait a few seconds, they would see that as an issue.”
Beck, whose system generates 60,000 studies a month, said that slow retrieval of images represents a care issue for patients and doctors, who may need answers quickly. In addition, he said, “Time is money.”
The PACS and VNA approach
Beck added that health information technologists debate the fine points of approaches to image retrieval. A common solution is combining a PACS (picture archiving and communication system) with a separate VNA (vendor neutral archive). The former offers short- and long-term storage, retrieval, management, distribution and presentation of medical images. The latter stores images with standard format and interface, making data accessible via different PACS.
But Beck maintains that this approach is unnecessarily complex and costly.
“When you speak with people who have both a PACS and a VNA as separate systems, the terms expensive and complex are often part of the conversation. It is expensive to manage both systems and complex because you must manage your images and archive in both locations,” he said. “Slowdowns in image viewing via the VNA are another common concern. That’s probably the top complaint that I hear from people who have a VNA.”
He said a VNA typically costs a minimum of $1 million. Such systems were originally promoted to eliminate problems migrating to a new PACS because they store images in a standard format.
“Most people had a hard time justifying that because there was no guarantee that you’re going to migrate. Over the years [the argument] evolved, [stressing that] the VNA could also store non-DICOM images, not just for radiology, but for cardiology, ophthalmology or even visible light images for wound care and such.”
“I could not find any reason to justify our institution buying an entire separate VNA,” Beck said.
A Double Duty PACS
Instead, ProMedica adopted a different approach: an enterprise PACS system from the Swedish firm Sectra doing double duty as a PACS and a VNA.
“Our health system’s Sectra enterprise PACS fills the roles of both PACS and vendor neutral archive. A VNA stores images in a central location in a vendor neutral format, as well as providing a universal viewer to be used anywhere. We have an integrated zero-footprint viewer of our PACS integrated with our EMR system, so those images can be viewed right from the portal,” Beck said.
“Our enterprise PACS sits at the center of orders, image viewing, reading and archiving radiology, mammography, cardiology and ophthalmology images.”
ProMedica will soon add cardiology, maternal-fetal medicine, wound care and pathology images to its PACS.
What about cloud?
Beck said, “I am not a fan of cloud solutions. Cloud solutions give you the advantage to offload certain support responsibilities, but if you have radiologists reading those images, they are likely going to notice significant performance issues.
“Our radiologists don’t like when there is even a few second delay, so pulling data down from the cloud would only increase the time to look at images, as well as the support complexities. Personally, I like total control of our support solutions. I am also more in favor of having as few break points as possible in IT solutions. If you have radiologists finalizing reports in real time, then I do not think a cloud-based image solution is even an option due to performance issues.”
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