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Radiologists are increasingly adding non-DICOM data objects, such as scanned prescriptions and reports, to the PACS archive. Additionally, the data contributed by other departments may not be in DICOM format. Without an accepted metadata management standard to

help reference this information to a specifi c patient, this data also remains tied to the PACS as well as to the department that created it. With VNA standardization, management becomes far simpler and sites have the freedom for cross-application use.

Departmental specialty systems Whether or not information from the other specialties is managed in a PACS, naturally, it resides somewhere within the hospital IT system. If archived in a separate application with even more department-specifi c formatting, the diffi culties of introducing it into any standardized system or an EMR are even greater. If stored on isolated hard drives or on CDs tossed in desk drawers, it is probably not managed in a preferred man- ner. Again, the VNA provides a powerful way to fi ll in the gap.

The better way to archive A VNA takes advantage of standards developed by the widely

recognized IHE initiative. In addition to DICOM, these include XDS and XDSI, HL7 and others. Using this common data messaging, the VNA provides one comprehensive archive as the single point of information access for all the healthcare IT applications connected to it, even beyond the four walls of the enterprise that originally created the information. Naturally, existing non-standard data must be transitioned to this formatting as part of the VNA migration process. T e process can be handled effi ciently and cost eff ectively by several VNA or third-party migration specialty vendors. Because the VNA contains diagnostic images, image enablement of an EMR and other systems becomes less challenging than with a siloed PACS archive. Providing this patient-centric storage and information sharing will put a facility on the road to meaningful use.

Standardizing DICOM As data is moved to the VNA, it stands ready to help. T rough DICOM tag morphing, advanced systems can neutralize non- standard DICOM data, reconcile and manage patient identifi ers from multiple sites and resolve inherent metadata discrepancies. It is of note that some VNAs will also allow the altered DICOM header data to retain initial tagging so that it can still interact meaningfully with the system that created it or for full legal analysis at some future date.

Standardizing non-imaging DICOM objects, non-DICOM data As noted, in addition to DICOM images, a VNA stores non-imaging DICOM data. T is includes DICOM-structured reports, containing CAD and measurement data, and DICOM

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presentation states with user manipulations, such as shutters and overlays. T e VNA also stores and manages non-DICOM informa-

tion from other specialty systems across the healthcare enterprise – including, for example, JPEG photos from dermatology and wound care, clinical PDF documents, waveforms from cardiol- ogy, video from sleep or gating studies, surgery, GI examina- tions, specialty formatted radiation oncology-treatment plans and more. T ese versatile storage capabilities make the VNA an appropriate repository for data from specialties as diverse as the lab and ophthalmology to speech pathology and dentistry. Whether for DICOM or non-DICOM objects, once the object header is formatted with consistent patient identifi ers as defi ned by the IHE, a simple search in the appropriate fi elds will gather the information necessary to create a comprehensive patient record. To facilitate this, the VNA includes a patient- centric content database that captures information from the object header such as patient name, patient ID, accession numbers and more. Information is recalled against the database using a standard storage query and retrieve protocol.

EMR integration A key goal of the VNA is to provide access of stored data at the point of care, typically through an EMR system. While IT has long struggled to accomplish this, the VNA simplifi es the task. A link to the standardized archive will bring up all these images, imaging-related data and information for each patient. Embed a lightweight DICOM viewer, and the result is an easy and elegant hospital-wide image-viewing solution that also can be used through any physician portal connected to the archive. As a result, a site also has the ability to switch to any new

standards-based PACS or other clinical system without costly data migrations or signifi cant data reconciliation and cleansing. T e VNA ends the era where a medical facility was tied to a particular vendor simply because its data was held captive in a proprietary format.

The VNA: Consolidated, cost-effective and effi cient storage T e growing emphasis on the consolidation and sharing of medical information as a system of comprehensive patient records demands signifi cant changes in most healthcare facili- ties’ IT infrastructure. T e current patchwork of disparate IT systems with proprietary data storage formats creates major barriers to meaningful information organization and exchange, while elevating costs. A VNA, such as TeraMedica’s Evercore, provides an elegant,

cost-eff ective and effi cient way to overcome these problems. By neutralizing data at the archival level, this advanced technology enables sites to leverage their existing IT applications, while facilitating cross-enterprise data sharing and streamlining the integration of medical images into the patient record. HMT

HEALTH MANAGEMENT TECHNOLOGY July 2013 13

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