Don’t Let Terminology Fool You: Get the Archive System You Need

TonyCotterillBy Tony Cotterill, Chairman, Board of Directors; Executive Vice President and Chief Products Officer, BridgeHead Software
Twitter: @BridgeHeadHDM
Twitter: @TonyCotterill

We love our acronyms in healthcare, don’t we?

Even departments within the hospital often have their own names. Consider the differences between acronyms used in the billing department and those used by clinicians. But even clinicians in different specialties may not “speak” the same acronym language. Just for fun, here are the acronyms that the Centers for Medicare and Medicaid Services (CMS) commonly uses for the letter “A.” The website cautions against performing an “all letter” search, due to the length of time that might take. And this is the same the world over. The UK’s Health and Social Care Information Centre, recently renamed Digital Health, has a similar glossary.

One acronym you’ll be hearing more often in hospital technology parlance is ICA, or Independent Clinical Archive. ICAs often are lumped together with vendor-neutral archives (VNA), which sit underneath radiology information systems (RIS), picture archiving and communication system (PACS), electronic medical records (EMR) and other clinical systems as a way to bring interoperability to mainly images stored across hospital IT systems. A related system is image exchange (IE), which facilitates sharing of images and documents between providers. If you’re thinking health information exchange (HIE), you’re not far off the mark, because IE can form a central part of HIE infrastructure.

VNAs and IE make up what research firm IHS Technology calls the medical enterprise data storage market, estimated to be worth $339 million worldwide in 2014. In an October 2015 report on the Medical Enterprise Data Storage market, the firm estimated that the market will more than double by 2020. The research firm doesn’t track ICAs, although it should.

What Are You Really Looking For?
In the same report, some products are listed as “independent VNAs,” to differentiate third-party vendors from makers of PACS/RIS systems that have also, somehow, entered the VNA market. But I like to draw a sharp line between a VNA, which has limited utility to leverage data sitting in disparate (but mostly image-based) hospital systems, and an ICA, a vendor-neutral repository that can aggregate all data types throughout the hospital system.

VNAs and similar systems use application programming interfaces (APIs) to bring data from disparate systems to a common place. Think about an API as a tether, if you will, that links one system to another. But that tether must remain there for the data to be accessed. How many legacy systems does your hospital keep around (and pay to maintain) because you still need to access that data? 100? 200? More? While a VNA may help you access that data, it will do nothing to alleviate your need to maintain outmoded technology.

But an ICA can. Think about moving the data from that legacy system to a new platform where it can interact with other data using a common language that is not vendor dependent. Once the data has been moved to the vendor-neutral platform, there is no more need for that legacy system, which can save hospitals considerable money on maintenance contracts. Multiply one maintenance contract for one legacy system by the number of legacy systems your hospital has, and you begin to see the economies of scale.

The North American market is the largest for VNAs and IEs overall, according to IHS Technology, but installations in Europe tend to be larger because of the preponderance of single-payer healthcare. Finland, for example, is in the market for a common, interoperable data repository to serve the entire country except for Helsinki. Canada also has embraced an interoperable technology framework among its provinces to facilitate the flow of data among providers. The UK, with the recent ending of the National Programme for IT (NPfIT) has also had a surge of activity as they replace or renegotiate their PACS and RIS contracts – many implementing VNAs to facilitate their plans for inter-departmental image sharing as well as between regional healthcare providers.

In today’s U.S. healthcare environment, with federal and private payers pushing alternative care and reimbursement models that reward quality outcomes over volume, providers must understand their patients better. That understanding starts with the data on each patient, each test or image, each diagnostic code and each facility.

It’s a mind-numbing amount of raw data that means nothing if can’t be related to similar data across many different hospital systems. Analytics is an industry buzzword, as software vendors strive to help hospitals and providers hear what the data is saying among all the noise. Tying systems together with APIs is just an interim step to what hospitals and other providers truly need – an independent clinical archive that stores and standardizes the data, enabling data sharing through a common language to give hospitals the analytics they need while allowing facilities to sunset outdated technology.

ICA – it’s the only acronym you need to remember when thinking about how to make sense of your data.