The 2014 Guide to VNA (Part 1): It's Time to UnPAC Your Archives

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THE 2014 GUIDE TO VNA:
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
WHITE PAPER
Healthcare 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 signals
a revolutionary shift for healthcare, 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!
EMR Adoption
Maturity
Industry Regulations
and Reimbursements
“Big Data” Growth
and Management
Industry Consolidation
and Mergers
VNA
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
Driven 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. n
MARKET DRIVER #2:
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. n
MARKET DRIVER #3:
“Big Data” Growth and
Management
If 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. n
MARKET DRIVER #4:
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. n

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
First 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
PACS 1.0 PACS 2.0 VNA
1990s 2000s 2010s
• Clinician-driven
• Storage silos
• DICOM only
• Storage silos
• DICOM only
• Thin clients
• Enhanced
workflows
• Migrations prove
challenging
• Consolidated storage
• Workflow engines
• Simplified EMR enablement
• Improved image distribution
• DICOM and non-DICOM
• Simplified migrations
• Best-of-breed visualization
support
VIEWER

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.
The story continues…..
If you enjoyed reading “Part 1” of this 2014 Guide to VNA, visit the resources section of our website to read:
The 2014 Guide to VNA – It’s Time to UnPAC Your Archives – Part 2
A Four-Step Guide to UnPACing Your Archives and Finally Controlling Your Imaging Data
Citations
1 MarketsandMarkets, IHS, Research and Markets, KLAS
2 http://www.informationweek.com/healthcare/leadership/himss14-
healthcare-cios-wrestle-with-economic-and-regulatory-pressures/d/d-id/
1113957
3 http://www.inc.com/ss/best-industries-2012/jj-mccorvey/big-data-5-
companies-capitalizing-on-this-business-opportunity#5
4 http://www.globaldots.com/last-week-in-performance-industry-march-
4-edition/
5 2011 International Healthcare Data Management Survey. Survey
allowed respondents to choose more than one.
About Mach7
Technologies®
Mach7 Technologies is a global
provider of enterprise image
management solutions that
allow healthcare enterprises
to easily identify, connect, and share diagnostic image and patient
care intelligence where and when it is needed. Mach7’s innovative
communication and workflow technology delivers complete image
management including rapid record identification, integration,
synchronization and routing, advanced clinical viewing, and optimized
vendor-neutral archiving across the enterprise. Healthcare institutions
around the world use Mach7 solutions for archiving, clinical productivity
improvement, IT cost savings, health information exchange, meaningful
use compliance, and improved patient data communication.

The 2014 Guide to VNA (Part 1): It's Time to UnPAC Your Archives

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The 2014 Guide to VNA (Part 1): It's Time to UnPAC Your Archives