The Guide to VNA (Part 1)

It’s Time to UnPAC Your Archives (Part 1)

Four key market drivers that will make you want to unPAC your archives and (finally) gain control of your imaging data

4 market driversHealthcare analyst firms1 predict double-digit, year-over-year growth of the Vendor Neutral Archive (VNA) market from 2013 – 2018. Some estimates place U.S. VNA market expansion north of a 25% CAGR, growing to more than $1 billion by 2018. Compared to either the growth of the broader Health IT (HIT) market (7.2%), or the growth of the Imaging Informatics sector of HIT (5.2%), the VNA market is set to explode. On its current course, by 2020, VNA market share could eclipse the market size of first-generation image archiving technology, picture archiving, and communication systems (PACS).

This global investment in architecture-neutral enterprise image management technology is further evidence of a C-change in healthcare—a revolutionary shift in how a patient’s complete medical record is managed. Since the launch of the American Recovery and Reinvestment Act in 2009, healthcare regulations, including HITECH and HIPAA, have driven the adoption of electronic medical record (EMR) management technology at a fever-pitch. Now that EMR adoption is mature, Meaningful Use (MU) criteria and EMR adoption metrics will drive the healthcare industry to image-enable the EMR. We’ll discuss this aspect of Enterprise Image Management in a separate executive brief.

Why care about vendor neutrality for image storage and management?
VNAs are poised to help healthcare finally own, access, and share imaging files across the enterprise which impacts costs, patient and provider satisfaction scores, the ability to meet MU, climb the EMR adoption ladder, and ultimately receive reimbursements. All great reasons to learn more about VNA today!

What is Driving VNA Adoption?

Healthcare Imaging Informatics is squarely at the intersection of several key technology and market shifts that are converging to drive significant changes in the way images are captured, stored, accessed, and shared.

Market Driver #1: EMR Adoption Maturity

EMR Adoption MaturityDriven by the HITECH Act, Healthcare CIOs and IT teams are now emerging from mandated EMR deployments. As EMRs continue to evolve technologically and MU stages usher in increasing levels of required patient data management, healthcare organizations will turn their attention to delivering a complete patient medical record. MU stage 2 requires that EMRs include access to imaging data and the HIMSS EMR adoption ladder speaks to both image management and patient access to data. These mandates that call for higher-quality patient data management, greater transparency, and access to patient data are driving rapid adoption of open, standards-based enterprise imaging management solutions.

Define a single comprehensive patient image record with links to your existing EMR. More than two hundred million medical imaging procedures are conducted in the U.S. annually in radiology and cardiology departments alone. A complete patient record with all diagnostic images, pictures, videos, and annotations available at all points on the patient’s care continuum, can be realized with VNAs that consolidate disparate imaging archives, delivering that consolidated view through the EMR. EMRs now have the power to place the patient in the hub of the care circle where clinicians can access all relevant care information, leveraging workflows optimized by clinical specialty. General, primary-care and referring physicians can also leverage this consolidated view of patient care to assess “next step” care protocols, evaluate patient response to care, and even highlight care trends that may impact long-term patient care protocols (e.g. track number and severity of head traumas, track lifetime radiological exam exposure across disciplines). This “partnership” between the EMR and VNA offers a scalable, high-availability, enterprise-wide view of a complete patient care record that is managed seamlessly and is securely and compliantly available to all collaborating care entities across departments, enterprises, and regions.

Imaging beyond radiology
While the lion’s share of archived medical imaging files reside in radiology and cardiology department PACS, MU requires that EMRs have access to all patient studies regardless of originating source (modality), file type, or file size. This radically expands the volume of medical images that need to be managed, accessed, and shared. Are you ready to support DICOM and non-DICOM media? How about support for mobile device image and media capture and viewing?

Key Takeaway: VNAs consolidate imaging files from disparate, siloed PACS delivering normalized imaging data from one neutral, scalable, and highly-available touch-point. This partnership of EMR and VNA technologies makes a single, aggregated view of patient history available exactly where and when it is needed.

Market Driver #2: Industry Regulations and Reimbursements

Industry Regulations and Reimbursements The stick-and-carrot of government and industry regulations, along with changing reimbursement criteria, have become driving forces behind U.S. healthcare industry reform. Healthcare organizations, from practitioners’ offices and hospital systems to Accountable Care Organizations (ACOs), will march to the drum beat of government-mandated metrics, insurance industry reform, and new guidelines and programs including HIPPA, HITECH, and ACA. These mandates dictate whether, what kind, and how many dollars are paid to healthcare institutions across the patient care continuum. The economic squeeze on hospitals and health systems is only going to get more severe and healthcare CIOs are looking for answers.

Government incentives that impact care reimbursements are elevating the importance of care delivery metrics across the enterprise. Patient satisfaction scores (HCAHPS), patient readmission rates, and patient access to electronic care records are just a few of the touchstones that healthcare organizations will use to measure progress against their business goals and new reform mandates.

Health IT could hold the answer if it can create dramatic improvements in the efficiency of the healthcare system and reclaim lost margins. “The successful health businesses of the future will have to be about fundamentally different care, better care, enabled by information,” said Saum Sutaria, MD and McKinsey Director for Healthcare Systems and Services.2 Leveraged at every point of the care continuum, CIOs are looking to technology to deliver a more consolidated, effective, efficient, and measureable care experience powered by data. More effective patient care coordination is central to addressing care metrics and technology is being leveraged to address information delivery gaps from the exam room to the board room.

How does this impact image management? Patient image data (study data) is the fastest growing sector of patient information management. Measured by number of orders per capita, size of image files in gigabytes or the rate at which archives of image data are growing (exabytes/year), effective management of patient data is critical. The resulting intelligence, business analytics, and ability to leverage this data to meet greater and greater regulation reporting hurdles, puts enterprise imaging data management in the bulls-eye for hospitals looking to meet government mandates for accountable care.

Key Takeaway: VNAs break down the image sharing barriers that have developed between departments and across the enterprises. Today’s advanced imaging management solutions (VNAs) give physicians a clear view of the full patient care record, including imaging, resulting in availability of improved analytics to support diagnostic evaluation. Information flows seamlessly across the enterprise and is available where and when needed to improve care delivery, reduce cost of care, and improve patient satisfaction with care—helping healthcare organizations meet industry regulations and deliver value.

Market Driver #3: “Big Data” Growth and Management

“Big Data” Growth and ManagementIf you think that “big data” is limited to terabytes of financial records and transaction data, think again. Healthcare “big data” is already one of the top 5 big data industries in the U.S.3 and is on a course to outstrip even social media and financial data stores. Healthcare organizations better get ready. According to IBM’s “big data” analytics team, the average U.S. hospital will need to manage 665 terabytes of data by 2015. This staggering number is no longer just an issue of storage costs. The real “gotcha” is the cost of data management, or mismanagement. What are the biggest drivers of hospital “big data”? In a Healthcare Data Management survey, PACS applications were cited as the number-one reason for healthcare data growth (63 percent), followed by files held in the EHR (54 percent), and scanned documents such as proof of insurance (51 percent).4,5

In the U.S., 68% of every diagnosis uses imaging. By 2016, 600 million studies will be ordered in the U.S., each year requiring 1 million terabytes (1 exabyte) of storage. The real news in these statistics is that, due to a lack of imaging management technology and a reliance on first-generation image archiving and retrieval technology, $26M will be wasted on erroneous, redundant, unnecessary imaging.

This unnecessary imaging impacts all areas of the healthcare ecosystem and costs healthcare organizations billions of dollars annually. The financial impacts of erroneous, redundant, and unnecessary imaging are significant, but the impacts on patient care, satisfaction, and outcomes are also staggering. Radiation over-exposure, redundant procedures, and delayed diagnosis all directly impact care outcomes. Hospital systems suffer from lower patient satisfaction scores, lower patient throughput, higher readmission rates, and lower Medicare reimbursements.

VNAs bring consolidation, structure, and control to “big data” image archives by finally allowing users to own and manage their own data. A complete patient record with all diagnostic images, pictures, videos, and annotations available at all points on the patient’s care continuum can be realized today. Healthcare solutions place the patient in the hub of the care circle where clinicians can access all relevant care information, leveraging workflows optimized by clinical specialty. General, primary-care, and referring physicians can also leverage this consolidated view of patient care to assess “next step” care protocols, evaluate patient response to care, and even highlight care trends that may impact long-term patient care protocols (e.g. track number and severity of head traumas, track lifetime radiological exam exposure across disciplines). This enterprise-wide view of a patient’s care record can be managed seamlessly with a VNA making all care data available across the enterprise and to all collaborating care entities.

Key Takeaway: Growth of the data management challenge for healthcare is staggering. With 68% of an average healthcare organization’s data trapped in sequestered and locked PACS, the question is not whether but when will HIT teams be forced to address unPACing their patient imaging archives. VNAs offer a scalable, high-availability solution for organizations that must optimize image management, access, and sharing across the enterprise.

Market Driver #4: Industry Consolidation and Mergers

Industry Consolidation and Mergers With healthcare M&A on the rise, healthcare IT departments must address the migration, synchronization, and ongoing management of electronic medical records. Aging, proprietary, disparate, and expensive PACS must be reconciled across expanding enterprise footprints. “Rip-and-replace” solutions can be time consuming and costly, and many IT organizations simply cannot afford to undergo a multi-year migration and reconciliation project. Yet, organizations must continue to support the real-time, day-to-day challenges of increasing study orders, intra-enterprise communication, and data sharing, along with the rising demand for anytime-anywhere access to patient data.

IT organizations are looking to VNAs that allow consolidating healthcare systems to rapidly cleanse, synchronize, and standardize image management across the enterprise. Isolated PACS are unlocked and patient data becomes patient care intelligence. Standardization of patient data access and storage across the enterprise enables advanced data mining, streamlined image management, optimized DR, visualization flexibility, and simplified image enablement of the EMR system.

VNAs directly address integration, reconciliation, normalization, and synchronization of patient imaging data to help maximize existing IT investments. The average cost of storing a study without disaster recovery (DR), business continuity, and labor costs is ~$1.15. The sheer ongoing capital expense of storage and network HW management is driving many healthcare CIOs to evaluate virtual storage and cloud solutions for DR. But what about your “real-time” support requirements for department-specific diagnostics, EMR image enablement, and support of patient data portals? Addressing enterprise image management is simplified with VNA solutions that build intelligence into image management by “unPAC”ing silos of data across your enterprise and consolidating, integrating, and synchronizing departmental PACS. VNAs maximize existing storage investments, optimize ILM strategies, and offer an enterprise image management solution that reduces costs, bringing intelligence to study and patient data storage. This helps ensure that the right data is cached and available when and where it is needed.

Consolidation of storage and reduced management of siloed PACS significantly reduces an organization’s capital investment and ongoing management of disparate image archiving systems; a key consideration when consolidating infrastructure across acquired/merged healthcare operations.

Key Takeaway: Successful integration and alignment of merged healthcare organizations requires adoption of scalable IT solutions that can grow along with existing investments. Advanced VNA technology is helping growing healthcare organizations by allowing them to finally unlock vast stores of imaging data and elevate that data to seamlessly reside with and help power EMR solutions creating a comprehensive patient care record.

Significant market drivers are propelling VNA adoption forward but we need to break down the VNA to really understand what is making this next-generation archiving solution so compelling for healthcare organizations.

Breaking down the rEvolution of VNA – The Road to Neutrality

EvolutionFirst generation image archiving tools emerged in the 1980s as a solution for “lost films.” By the 1990s, these picture archiving and communication systems (PACS) were widely adopted in radiology and then cardiology departments for storage and management of digital images. PACS instances were specific to each department, though some departments could share archive space across two PACS installs from the same vendor. Today, PACS continue to deliver proprietary archive and communication solutions with limited data access and sharing.

The proprietary nature of PACS image compression and storage algorithms has become a “locking” mechanism that limits a customer’s ability to manage images once they have been added (ingested) into the proprietary archive. As image captures are routed from their source (modality) to the PACS archive, they are often compressed, at times converted to proprietary non-native DICOM file formats, vendor specific attributes may be added, and wrappers are used to group and further compress images. What remains is a vendor-specific proprietary format. These proprietary storage algorithms often lead to a loss of critical data, including study presentation state and annotations. The removal of annotations literally strips away intelligence that is linked to the image. Once the image is compressed and stored, it is virtually “locked” in the PACS vendor’s storage “vault.” Even when uncompressed, it may not be possible to fully restore to an image’s original format. This is a point of significant frustration for users and can lead to challenges in patient care.

PACS migration is not a quick or easy road. With PACS silo archived images stored in proprietary formats, IT teams cannot easily or quickly extract their image files for migration to another archiving solution. Generally, the PACS vendor’s service team must be engaged incurring additional costs. PACS migrations are widely considered multi-year time investments for companies who want to change vendors and migration costs are often prohibitive. Critical patient information including priors, image annotations, and demographic changes to studies, are often lost during PACS migrations. These business impacts often make PACS migrations unattainable, even when PACS no longer meet customer’s imaging management requirements effectively.

The proprietary architecture of PACS archives keeps customers linked to their PACS vendor, though most customers feel more shackled than linked—evidenced by a recent industry survey that found nearly 68% of PACS owners reported feeling that they have lost ownership of their imaging data and 27% were actively evaluating next-generation solutions. These market statistics support the rapid growth projections for the VNA market (25% CAGR) compared to the PACS market (5.8% CAGR).

Scalability beyond the departmental boundaries

It is estimated that by 2015, the average hospital will generate 665 terabytes of data; 68% of that is attributed to archived imaging studies. The tremendous growth in study volumes, now estimated at 64% of every patient encounter, is challenging even the most technologically-advanced hospitals to re-exam their enterprise imaging strategies as PACS struggle to keep pace, even at the department level.

In the wake of the market drivers discussed earlier, healthcare image management has moved beyond the department to encompass the enterprise and the region. Consolidation of hospital systems, integration of advanced EMR technology, expanding demands for record access and sharing, regulations driving improved analytics, and the looming shadow of big data growing bigger, have created a gap in imaging management that demanded an evolutionary shift in imaging management solutions.

Vendor-neutral, enterprise imaging management solutions emerge as the next-generation solution. Progressive healthcare IT and radiology teams have begun turning to new archiving technologies. Technologically innovative next-generation image archiving solutions emerged and answered the question that had been plaguing imaging informatics teams. Could the archive be separated from the PACS, built on a standards-based architecture and provide superior access, sharing and management of imaging files? In other words, could PACS archives be “unPAC’d” giving data ownership back to the users. The answer was, yes, and vendor-neutral archives were launched.

Built on a foundation of “architecture neutrality,” these standards-based solutions ushered in the next generation of imaging management; archives without boundaries that could house and manage study information from any department, in any format, across the enterprise.

These vendor-neutral archives, also known as architecture-neutral archives, or super DICOM archives, finally delivered the promise of breaking the ties to proprietary PACS archives, unlocking the data stored in those archives and unleashing the patient history, data, and intelligence that had once been sequestered from healthcare organizations.

Unlock. Unleash. UnPAC.

The ability to finally “unPAC” imaging archives has ushered in the growth of the VNA market, projected to top $1 billion by 2018, possibly eclipsing PACS market share by 2020. Enterprise Image Management solutions are already unlocking disparate PACS archive silos, consolidating patient data and simplifying sharing and access across the healthcare industry. Healthcare IT teams are building comprehensive views of the patient’s electronic care record. They have “plug and play” access to best-of-breed specialty visualization solutions. They can resolve proprietary storage formats enabling standards-based storage and interoperability. All of these advances are making it possible to accelerate care delivery, centralize access, and lower IT costs across the enterprise.

Now that you know what is driving the growth of the VNA market and what can be achieved with a truly neutral enterprise imaging solution, let’s look at four key steps that will help you unPAC your archives and finally take control your imaging data.


  1. MarketsandMarkets, IHS, Research and Markets, KLAS
  5. 2011 International Healthcare Data Management Survey. Survey allowed respondents to choose more than one.

The Guide to VNA: It’s Time to UnPAC Your Archives (Part 1)

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The Guide to VNA: It’s Time to UnPAC Your Archives (Part 2)

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