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The Trouble with Acronyms

February 26, 2010
by Joe Marion
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Over the years there have been a number of acronyms that have been troubling to me. As an early reseller of Speech Recognition applications, I railed every time I heard someone refer to it as “Voice Recognition.” For the record, Speech Recognition (SR) is a subset of Voice Recognition (VR). VR refers to the process of recognizing voice commands. SR is the process of converting speech into text. So, the purist in me wants to use the more accurate terminology, Speech Recognition, as it is more representative of the process of dictation/transcription.

Then there’s “PACS,” or Picture Archiving and Communications System. When it was first used by the late Sam Dwyer at Kansas University Medical Center, it seemed out of place to refer to radiographs as pictures. But, considering today’s broader view of enterprise PACS, it now eerily seems prophetic!

So, now we come to the latest Acronym – one I expect to hear a lot about next week at the HIMSS meeting, VNA’s, or Vendor Neutral Archives. I’m all for the “Vendor Neutral” part – it’s the “Archive” portion that bothers me. In the early days of PACS, no one even considered the need for an enterprise-scale application. Radiology made images and managed them. The only thing IT had to worry about was the report. Consequently, image archives have evolved as part of PAC Systems since their inception. Early adopters have struggled with the evolution of ever-changing media improvements that have resulted in higher capacity, lower cost storage solutions.

As PACS now expands beyond the bounds of radiology into other service areas, facilities are faced with a daunting prospect. If the radiology model is replicated, and service areas make their own decisions about systems, the enterprise could end up with a number of data silos. Prior to the advancement of digital imaging, this may have been acceptable. But now, with increased regulatory and cost pressures on healthcare, the case for improved accessibility to images is much stronger. Hence the case for enterprise-scale solutions is becoming stronger.

The premise of a “VNA” is that the enterprise has a solution that can accommodate images from a number of different vendor systems (and sometimes multiple systems from the same vendor!) into a single enterprise-scale archive strategy. There are the economies of scale and lower cost arguments, but more importantly, there is the prospect for making integration of images into the electronic medical record (EMR) easier.

What is missing from the use of the term “VNA” is the “accessibility” aspect. Perhaps the “A” could represent “accessibility?” Unfortunately, there is another adjunct to “archive,” and that is the “manageability” of data. The notion of a common strategy for archiving the data is important, but of more value is the management of that data. Just as Medical Records can today pull “Mary Smith’s” file and purge it under a set of management guidelines, a centralized image management solution could easily purge all available images from the archive. Similarly, should the facility choose to adopt a new archive technology, it can be done in the background without impact to the end-user applications.

While we’re at it, what is meant by “vendor neutral?” Is it that I acquire the archive from someone other than the PACS vendors? Does it mandate a solution that is standards driven? Or, does it mean that I have a solution that can accommodate information from all of my current and planned PACS? These may not be independent factors. What is most important is that one not get backed into a solution that limits future options. Hence, I am a proponent of a solution that can accommodate future data formats – whether they are standards based or not.

For those wrestling with this issue, a great resource that addresses the key issues is a document entitled “Top Ten Criteria for Evaluating and Selecting an Enterprise Medical Image Repository” from Agfa Healthcare, located at This white paper does a nice job at presenting key issues that IT executives should be sensitive to as they evaluate their options and formulate a strategy for imaging.

So, will another term gain traction in the marketplace? Giving the topic new acronyms has been a favorite means of promulgating the FUD factor. But should VNA stick, I only hope that the underlying meaning is not overlooked – that of image management and accessibility. As always, I welcome your comments.