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Hospitals strive for centralized image archives

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The goal: Vendor-neutral archives

Michael J. Cannavo, president of Image Management Consultants, a Winter Springs, Fla.--based PACS consulting firm, has coined the terms "vendor-neutral archive" (VNA) and "vendor enterprise archive" (VEA) to describe the vision of centralized archives for image data, as well as centralized archives that blend not only multiple imaging formats but other types of electronic medical record data in an integrated repository.

"A VNA is a standards-based archive that works independent of the PACS provider and stores all data in non-proprietary interchange formats," Cannavo said. A true VNA, he argues, would provide "context management" (metadata) that allows information to be transferred seamlessly among disparate PACS operations through the Digital Imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7) standards, without requiring data migration and reformatting. Such an archive would cut down on the expense and time required to migrate data as technology advances, improve disaster recovery (DR) and business continuity (BC), and provide a centralized "one-stop shop" for patient data readily accessible by physicians.

"You don't want to have to migrate the entire repositories or have to have multiple architectures with support and service contracts," Cannavo said. "A ton of education needs to go on about using centralized archives."

Standards aren't the only issue

One of the main

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obstacles to achieving VNA and VEA utopia is that the DICOM standard is applied differently by different vendors. "DICOM is not a standard about what to communicate; [it says] 'If you communicate, here's what to do,'" said Michael Valante, global business lead for enterprise imaging informatics at Philips Healthcare. "The number of [metadata] elements mandatory in DICOM is not equal to the amount of metadata that actually needs to be communicated. Different modalities within the same organization may deliver different data elements with different exams."

Healthcare IT managers say there are a multitude of other logistical hurdles to clear as well, including data center space, budgetary restrictions, internal politics, and the difficulty of performing data migrations and forklift upgrades.

NEBH's Botticelli said space is at a premium in his facility, located in one of the more expensive cities for real estate in the country. "Our facility is over 100 years old and there are not a lot of places for us to just continue to put on-site spinning disk," he said.

Internal budget negotiations and territorial politics that have grown up around disparate systems can also be a barrier to centralization. According to BIDMC's Passe, his organization is rolling out EMC Corp.'s Atmos system as a centralized, scalable archive for images. There are two 120 TB "cubes" installed and storing cardiovascular diagnostic data among multiple modalities in the cardiac space, and BIDMC may add another cube for radiology, currently approximately 100 TB stored on an EMC Centera. But Passe said different departments might compete for budget and revenue within hospitals, and sometimes don't want to share systems with other departments or are hesitant to cede control to IT.

This was first published in August 2010

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