A Framework to Aid VNA Implementation

The axes form a shape (pentagon), and the area within the shape can be used to visually represent and contrast VNA scenarios. For example, applications can be differentiated by how much of each axis is shaded. Colors can represent such parameters as internally developed versus sourced applications.

Figure 2. Two different VNA applications are contrasted by the different area under the shape. Key: Green is internal content.

The first example in Figure 2 is a replacement archive in a single clinical service, for strictly DICOM data. It doesn’t need to address life cycle management, and it can span the full range of infrastructure. It is most likely is cost per study or subscription based pricing. If used for disaster recovery, no incremental display is necessary.

The second example represents an enterprise archive spanning multiple service areas. Support for cross-enterprise sharing might be important and rely on XDS content. Because it may span multiple entities and services, replicated or cloud infrastructure is preferred, separate EMR and/or portal viewing are important, and pricing is most likely a per-study or subscription basis.

Figure 3. The framework could be used to represent different VNA vendor segments. Key: Yellow is sourced content and green is internal content.

The first example in Figure 3 emphasizes a vendor who outsources services and display technology, and leverages its own infrastructure. The second example shows a vendor focused on providing the core VNA application as a software-only solution applied to a client’s infrastructure. Note the use of different colors to represent sourced versus internal content.

Real World Feedback

A theoretical model is one thing, but industry feedback improves the likelihood of acceptance and utilization. Initial contact with a number of VNA vendors provided them the opportunity to critique the framework. Figure 4 summarizes companies generous enough to provide feedback on the framework. The following summarizes vendor observations:

• Vendor discussions revealed no opposition to the framework, and vendors encouraged it as a means for improving market consistency of definition.
• Vendors confused “accessibility” to include areas such as user rights. This was clarified in the context of adding a “services” category for workflow, preserving the accessibility axis for visual access to stored content.
• Initial categories for infrastructure did not address virtualization. Changes were made to reflect either physical or virtual and replicated or redundant hardware configurations.
• Discussions were instrumental in adding work flow, and system monitoring to the services axis. A further segmentation was suggested between “system” services such as data integrity, and “clinical” services such as work flow.
• Pricing originally reflected only a capital versus a fee-for service model. Discussions differentiated fee-for-service model and subscription models. Vendors suggested adding a “professional services” category to reflect implementation expenses incurred for both capital and operational models.
• Portal viewers were seen differently from an EMR API, reflecting patient-based portals not directly associated with an EMR.

How did vendors feel about the value of the framework? Lenny Resnik, director of Enterprise Imaging and Information Systems, Agfa Healthcare, stated “The framework…will help providers carefully examine their needs and establish an overreaching strategy while accomplishing their individual goals in a way that will result in meeting their ultimate needs in the shortest timeframe and the lowest cost.” Jim Prekop, CEO of TeraMedica said, “The terminology usage of ‘VN A’…has grown significantly among healthcare providers and technology vendors. We applaud…the… real-world approach to objectively aligning specific customer needs (both today and tomorrow) with the optimal solution.” Bob Mack, director, US&C Business Management at Carestream, points out that “customers are still singularly based on individual components of a VNA…and not focused on the big picture. The framework helps focus on the big picture.” Shannon Werb, chief technology officer for Acuo Technologies feels “[the framework] provides bigger buckets/areas that people should be looking at when making VNA decisions.”