I recently had the opportunity to attend my first ever Radiology Society of North America (RSNA) conference in the great city of Chicago, which was my home from 2008 up until our recent relocation to Northern California. I had many impactful meetings with the leading organizations in the medical imaging space, and got to spend quality 1-on-1 time with thought leaders as well. Here are some of my key takeaways.
VNA is dead! Long live VNA!
Vendor Neutral Archive (VNA) has been oft-considered a panacea for bringing data out of siloed Picture Archiving and Communication Systems (PACS). VNAs allowed organizations to not only adopt a consolidated data archive and communication mechanism for the various departmental PACS systems, but to also provide the promise of features such as a Universal Viewer, interoperability, and standards-based data access, communication and sharing.
Conversations at RSNA revealed the ongoing challenges with VNA adoption, such as:
- Bespoke PACS functionality — yes, silos do still exist, and in some cases, they’re good for the organization. For example, specialty PACS viewers may be favored by departments or specialties over, say, a universal viewer, for specific clinical functionality or productivity benefits.
- Battle Royale: PACS vs. VNA — PACS vendors don’t want to let go of their departmental foothold to an organization-wide VNA vendor.
- Lack of standards — not all PACS are created equal (read: not all “imaging” solutions follow the Digital Imaging and Communications in Medicine (DICOM) standard), leading to additional one-off work by the VNA vendor(s) to assimilate this non-standard data.
- Loss of fidelity — in some cases, VNA vendors may sacrifice DICOM metadata fidelity from the source system. Of course, they can’t impinge upon the FDA-regulated portions of the imaging business.
- Cost — the #1 cited reason for non-adoption of a VNA was the high TCO, especially when organizations believed, somewhat rightfully so, that they would still need to retain their existing departmental PACS systems for bespoke specialty functionality.
All that said, there was still quite a bit of enthusiasm around the future of the VNA as it evolves into true enterprise imaging functionality, specifically around the promise of bringing data management to the centralized IT function. There is potential for the VNA to evolve – invigorated with evolving standards like XDS and better use of semantic information, real-time performance for retrieval and interoperability with clinical desktops. The key, however, is in how, where, and when the next generation of VNA is deployed, and somewhat more importantly, what it’s deployed for.
Ergo, VNA is dead! Long live VNA!
The current, and future, PACS-scape
PACS vendors continue to be bullish around their value-add to the specialties — once again, proving that the departmental silos are somewhat here to stay. However, these vendors are getting pretty savvy around updating their architectures to provide a more modern computing and deployment experience. Some highlights include:
- VNA integration — most PACS vendors seem to be somewhat accepting of the VNA value-add for the enterprise, and as such, have continued to provide better integration with the VNA vendors.
- Universal Viewers — most of which offer cross-platform, cache-less, mobility-enabled viewing options for data across the enterprise — are also being provided native integration opportunities by PACS vendors
- Zero-footprint viewers with server-side rendering — in order to leverage more of the compute resources in the back-end (server-side), and minimize the need for full-client deployments in the front-end (client-side), PACS vendors and Universal Viewer vendors alike are moving towards zero-footprint published-application viewers.
ECM? CCM? HCM?
There seems to be a general thrust towards the consolidation of content across the healthcare enterprise. While the majority of content under discussion is still images, providers are also struggling with content from new sources, expanded use of clinical imaging, scanned documents, visible light images, and video from procedures like ultrasounds and sleep laboratories, among others. Vendors see the value in providing content management across the various modalities and data sources, regardless of the origin.
ECM, or Enterprise Content Management, isn’t a new term, per-se. The idea is simple: can we provide a single content repository (nee archive) for the centralized IT function to manage? The data sources for this content typically encompasses the traditional systems within an organization — databases, files, etc.
CCM, or Clinical Content Management, is the new thrust within the healthcare IT space — it’s an extension of ECM, and also includes management of DMS (Document Management System — both clinical or otherwise), as well as imaging (PACS), video, and other relevant clinical media. Amie Teske, director of global healthcare industry and product marketing for Lexmark Healthcare, has a great blog post outlining the CCM concept.
What if we extended CCM further to incorporate all aspects of the clinical realm, including the EMR? What if we called this Healthcare Content Management, or HCM? What if we really gave control of data management for all the data back to the centralized IT organization? This theme resonated very well with several of the thought leaders I spoke with at RSNA, and, in fact, folks such as Commvault are attempting to do just this with their next-generation Clinical Archiving offerings (you can read about their current offerings here).
So, what does the future look like?
Based on these conversations, I believe that the future of content management in healthcare will look something like this:
- HCM will become the new CCM (which, as a reminder, is the new ECM)
- HCM will evolve to include better, smarter, and faster data management techniques, including must-have features such as CDM (Copy Data Management)
- Architecturally, organizations will begin to consume PACS and VNA as packaged solutions (think Converged Infrastructure “appliances” which will contain all of the necessary hardware, software, and applications), all delivered in a small footprint with single-call support. I’ll write more about this delivery mechanism in a future post.
- Finally, HCM will pave the way for a true hybrid-cloud approach (see my original thoughts on The Cloudification of Healthcare IT), with a slight caveat — I’ll write more about my thoughts on next-generation HCM in a future post, too, so stay tuned!
Whew, that was a lot of acronyms!