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Enterprise PACS or VNA: Which is best for your organization?

By Don K. Dennison
From the July 2017 issue of DOTmed HealthCare Business News magazine

A lot has been written about the merits of using a vendor neutral archive to provide a shared, consolidated medical imaging record repository that spans multiple facilities and clinical domains.

In today’s consolidated enterprise, having a solution to provide a high-quality, longitudinal patient imaging record to any authorized user or system is a keystone of an effective imaging strategy.

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However, regardless of how well a VNA may be working, if it has many different or underperforming PACS connected to it, the cost savings and business objectives may not be realized.

For some organizations, consolidating the myriad PACS at their various facilities into a shared enterprise PACS is the best solution. They see the benefits of having a single, shared radiology PACS and a shared cardiology PACS in the effort to maintain and support the systems. These shared systems allow them to more easily centralize and standardize support services and knowledge. Collaboration and communication within a system is inherently easier than across systems. And if the PACS has comprehensive security controls, organizational policies can be applied consistently.

Enterprise PACS, VNA or both?
Like many things in imaging informatics, the real world is rarely so binary. There are many reasons that a combination of these approaches is used:
• In enterprises that are geographically dispersed, a single PACS may not be able to provide the necessary performance to users across the extended network. Multiple, regional systems may be required.
• In some cases, the legal business relationship among the facilities may be more of a partnership than ownership, and some level of autonomy is desired.
• Workflow at large academic centers with subspecialty reading often differs from that at community hospitals where more general reading is done. Consolidating on a single enterprise PACS may not be accepted if the solution is not ideal for everyone involved.

If an enterprise viewer is used for non-diagnostic user access, the system or systems to which it is connected will impact the overall integration complexity and cost. It may also result in inconsistent imaging and information display performance, if the source systems vary in their responsiveness.

While it is a generalization, many PACS include imaging exam acquisition and quality control (QC) workflows optimized for their intended clinical domain — radiology or cardiology, for example. VNA often provide general capabilities that are adapted, through configuration, to the acquisition workflow within each domain. The system may also include tools to capture so-called enterprise images, such as dermatology, endoscopy, wound care and others.
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