Storage: Native or Standardized, That is the Question

RupinderColby-200By Rupinder Colby, Consultant and Project Manager, Ascendian Healthcare Consulting
Twitter: @RupinderColby
Twitter: @ascendian150

Healthcare organizations are facing an increasingly important task when it comes to choosing the most effective methods for storing patient data across the enterprise. Before a single image can be effectively archived, however, there are a host of critical questions to be answered – will the data be stored in its native format or in a standard viewing format? Which departments will need to access and share these images? Will images need to be segregated for clinical and research purposes?

When faced with these questions, most healthcare organizations think first about a vendor-neutral archive (VNA). Indeed, the versatility of a VNA solution can be leveraged as the cornerstone of an overall enterprise imaging strategy. Most imaging modalities conform to the digital imaging and communications in medicine (DICOM) standard, an industry norm especially in radiology and cardiology environments. However, as organizations look at an overall enterprise imaging strategy, other image-producing service lines such as ophthalmology, pathology, wound care, oncology and dermatology almost exclusively produce image objects outside the DICOM format.

The ability of a VNA to ingest non-DICOM elements and store them in a native format is a significant contributing factor to the scalability and enterprise applicability of the technology. By incorporating all image objects in a patient record, the VNA dramatically expands the ability to access information by allowing the source modality, application or device to retrieve the original image object with all metadata preserved. This is not necessarily the case with DICOM wrapping or encapsulation.

At first glance, it seems preserving the native format of a variety of non-DICOM image objects adds a tremendous amount of complexity to the management of enterprise image data. When storing images in their native formats, a countless number of additional data standards must be supported and managed. While, DICOM is therefore an attractive option due to its existing structured approach, the benefits of maintaining native image formats to the enterprise may be a more pressing concern.

While acknowledging the beauty of native data retention, it’s also important to recognize that healthcare organizations’ growing attention to analytics has emphasized the need to standardize the data elements acquired with each image in a uniform manner. Therefore, healthcare CIOs must carefully weigh all available options and discuss with their selected vendor partners how they will consistently and uniformly acquire data today so they will be able to support predictive and prescriptive analytics – an idea gaining significant traction in the healthcare community – in the future.

For an application that does not speak DICOM, retrieving DICOM-wrapped image objects requires the objects to be unwrapped. This can create unnecessary latency and loss of important metadata and original image quality. Radiology, which favors the DICOM standard, may be one of nearly 40 image-producing service lines within an enterprise. As a result, DICOM wrapping forces a radiology workflow on all the other -ologies whereas maintaining native data formats would allow the flexibility for each -ology to optimize the technology to fit its own unique clinical workflow needs.

It’s also important to recognize that enterprise image acquisition is increasingly happening in non-DICOM file formats even within service lines such as radiology and cardiology which have been traditionally DICOM friendly. The reason? There is an expectation by providers and the referring community that images may be retrieved easily and within standard formats (JPEG, TIFF, PDF, etc.) by the originating data source or on a mobile device. Viewers on the market today allow clinical and reference viewing independent of a picture archive and communication system (PACS) workstation and fully accommodate most non-DICOM images. Thus, the availability of lightweight viewers eliminates the need for DICOM wrapping. Technology has advanced to a point where a multitude of image formats can be much more easily supported.

Cross-Departmental Sharing
Vendor-neutral archives satisfy the need for cross-departmental data sharing and access. By serving as the imaging library for the enterprise, a VNA is able to offer federation or a pre-fetching functionality to legacy systems or disparate data silos across multiple image-producing departments; in doing so, the VNA can provide a single storage management strategy regardless of the number of clinical systems (PACS or otherwise) an organization employs. This provides the best solution for long-term longitudinal patient jacket image availability while establishing a short-term bridge strategy for immediate image consolidation.

A VNA can provide a single outbound point of integration to an electronic health record (EHR) thereby eliminating management and support integration issues from multiple PACS environments. Performance is often improved this way, especially in larger organizations where PACS can struggle to keep up with demand. The VNA manages images and can scale much larger than a PACS. Additionally, a VNA can also be leveraged as a single point of integration into a health information exchange (HIE), a plus for enterprise analytics as opposed to having every disparate clinical system integrate to provide data to bridging solutions.

Important Considerations:

  • Decide early about native format storage: As images are generated, a decision must be made about whether or not they will be stored in their native formats or archived in a more standardized format like DICOM. There are advantages to each, something which IT and those needing access to the images must discuss and resolve early in the process.
  • Explore VNA advantages in sharing data: The need for cross-departmental sharing and access can be satisfied by a VNA which can tie together disparate data silos operated individually by the various –ologies in a healthcare environment with the added advantage of offering a single outbound point of integration into both EHR and HIE systems.
  • Understand segregation issues well: With the number of mergers and affiliations taking place in the healthcare field today, it’s important to understand if images will need to be segregated; this is becoming a hot topic in healthcare IT, particularly for those providing an enterprise imaging platform for an affiliate organization.

About the Author: Rupinder Colby, MPH, a Consultant and Project Manager with Ascendian Healthcare Consulting, is a thought leader on the topics of medical imaging and healthcare information technology (HIT). 

To assist healthcare organizations as they plan their imaging strategies, Ascendian Healthcare Consulting, an industry-leading consultancy specializing in medical imaging, has formed a strategic partnership with Logicalis Healthcare Solutions, the healthcare-focused arm of Logicalis US, an international IT solutions and managed services provider.  Together, the two companies are combining their talents and resources to help healthcare IT pros tackle medical imaging obstacles, something each company believes is going to be one of the fastest emerging market spaces in healthcare IT.  Attending RSNA? Schedule a meeting here.