A Framework to Aid VNA Implementation

Figure 4. Vendors that provided feedback on the framework.

Overall, vendors felt the framework addressed the “bigger picture” of VNAs, which is beneficial to an enterprise-wide viewpoint. Consumers of VNA technology had similar sentiments, and raised implementation concerns. Phil Wasson, president and CEO/CIO, TriRivers Health Partners in Rockford, Ill., feels the “framework…really outlines the benefit of an independent vendor neutral archive very well.” He feels it is important that their VNA vendor “didn’t sell the other PACS components and only function on the archiving of PACS images and helping to manage the storage and workflow behind all of that.” Conversely, Richard Green, Clinical Imaging Enterprise Architect for Hospital Corporation of America (HCA), is “not so much concerned with vendor neutrality as with leveraging existing company relationships, and ensuring that their data is managed by an entity that is financially stable and able to support them.”

Christopher Roth, M.D., vice chair of radiology for information technology and clinical informatics, Duke University Medical Center feels that “it is important [for the VNA] not to be tied to a particular PACS” so the VNA can address the enterprise needs for storage and accessibility. Greg Pilat, system director of imaging services, Division of Clinical Transformation, Advocate Healthcare, raises concern with respect to implementing a VNA—the need for quality checks, metrics, and working definitions. Obviously, there are different facility motivators and factors for selecting a VNA that may present the need for additional framework elements.

Development of the model and securing real world feedback resulted in a realization that VNA vendors can be segmented as follows:

• The most common form of VNA vendor is the application provider. These vendors develop their own VNA service and content management applications. The vendors may offer software-only or complete turnkey solutions. Application provider vendors probably have the greatest degree of knowledge with respect to VNA applications, as they are responsible for the general capability that constitutes the VNA. Real-world examples include Acuo Technologies or TeraMedica.
• Typically an application provider does not have the infrastructure to support remote or cloud-based VNA applications. The infrastructure provider leverages existing infrastructure through partnerships with VNA Application Providers to provide cloud-based VNA applications. Most infrastructure providers leverage their infrastructure for many different applications, and may be attractive to facilities that have multiple applications or are attracted to a cloud-based environment. Real-world examples include DeepWell, Iron Mountain, or Logicalis, to mention a few.
• Integration providers have an infrastructure and a partnering relationship similar to an infrastructure provider, but go one step further to include integration services, or special customization of a VNA application with an HIE. An integration provider can be thought of as going beyond merely exploiting its infrastructure. Integration provider vendors include Dell and GNAX.

In summary, VNA’s are an effective way to address the burgeoning amount of clinical content that continues to grow in importance as EMRs evolve as part of meaningful use. Employing a framework to define the VNA may be a tool to optimize understanding of requirements and assess vendor capabilities. Segmentation can further assist in assuring that clinical requirements are properly met. CIOs may want to consider the proposed framework to further an understanding of VNAs and aide in effectively differentiating vendor VNA offerings. As noted with respect to implementation, the framework should be thought of as a “living” framework capable of being adapted to changing requirements.

Joseph L. Marion is principal, Healthcare Integration Strategies LLC, Waukesha, Wis.