Herding cats: Implementing a VNA for a regional radiology group

As many PACS administrators tackle implementation of a VNA, PARCA eNews asked Nikki Fennell, Imaging Informatics Manager for Southwest Diagnostic Imaging, in Arizona, to share her experience in implementing a VNA. Southwest Diagnostic Imaging, is a partnership made up of Scottsdale Medical Imaging (SMIL), Valley Radiologists (VRL), and EVDI Medical Imaging. Together SDI is one of the top 25 radiology groups in the US with over 100 board certified radiologists reading 2 million inpatient and outpatient exams each year. Their radiologists provide specialty imaging in neuroradiology, nuclear radiology, pediatric radiology, vascular and interventional radiology at 32 locations throughout the Phoenix, Scottsdale metropolitan areas, as well as providing diagnostic
and interventional radiology in several area hospitals for Banner Health, HonorHealth, and Iasis Healthcare. Nikki leads a five-member IT team that oversees the VNA, all of the PACS applications, and the third-party applications that fall under the PACS umbrella. She started working for Scottsdale Medical Imaging in 2008 before it and Valley Radiologists decided to merge their IT departments under SDI. The VNA project started over a year ago and implementation began last November.

Q. Tell me a little bit about Southwest Diagnostic Imaging?

Initially SDI was formed by Scottsdale Medical Imaging and Valley Radiologists  to pool together billing resources and leverage the buying power of a larger organization. EVDI joined in the last year. All three companies  maintain separate operational entities with their own boards, with a separate board for SDI. The three companies are part of the SDI management and billing services. SDI IT services currently supports SMIL and Valley  Radiologists. EVDI has not yet decided to be a part of the IT services, and is therefore the VNA project at this time.

Q. What prompted SDI to implement a vendor neutral archive?

We pride ourselves on being a technology driven company and we want to stay ahead of where things are. Ultimately it was the desire to have ownership of our patients’ images so that we would have the ability to be more agile, and be able to implement new systems. We didn't want to be tied to specific vendors.

Q. What were some of the major goals?

When we initially looked into implementing the VNA the goal was based solely on what the radiologists determined to be best for our companies, but we also discussed the future extension of service into our referring community. We have a plan to get to a point where we will be able to offer one place to store and view all of the studies across all of our sites.

Q. Did the partners have different modalities and vendors that made a VNA more challenging?

Yes it is a challenge, and another reason to have the VNA so that we ultimately have the ability to collectively store and access all of those exams from all (32) locations.

Q. How many PACS systems do you have?

There's one primary PACS for SMIL and one for VRL. We have GE Centricity PACs and Philips IntelliSpace PACS. I'm not sure any PACS vendor will embrace you with open arms when you tell them that you're going to take the storage piece away from them, but they have both been cooperative within the scope of the contract requirements , however  it has been a bit of a challenge.

Q. How did you develop the plans for implementing the VNA?

SDI has an IT steering committee made up of physicians from the three companies along with the CIO. VNA vendors were reviewed by the committee based on recommendations from IT leadership, including CIO Travis Haskins  and myself. It's a radiologist owned company so ultimately the radiologists had the final say on the vendor we selected.

Q. Can I ask which vendor you selected?

We went with Mach 7  

Q. What were the main things looking for in a VNA?

Having a system like MACH 7 that does more for us than just being an archive was very important. 

Q. We’re you looking only at "true" VNAs or did you consider vendor-branded solutions?

Vendor neutrality  was important in our final decision, but we did look at vendor-branded solutions including the vendors we had and what they offered, because every PACS vendor is now a vendor neutral archive vendor. We looked at many options, but the key thing for us was functionality and flexibility. We wanted something that would fit our environment and allow us to tweak things the way we wanted to . We had a prior relationship with MACH 7 in a much smaller capacity so we knew they were a great company, we knew their customer support was excellent, and we knew that their star in the vendor neutral archive field was rising. As we evaluated the capabilities more and more we realized it (MACH 7) was the right fit for us.

Q. What are you looking for in terms of using the vendor neutral archive for your referring physicians?

Ultimately, the endgame is to have one portal where our referring physicians can access the images for all of our systems. We're not there yet, but that is where we want to be. We want to be able to be flexible with that. We do a lot of EMR integration with our referring physician community, so we need to look at options for zero footprint viewers and how we can integrate those into other environments as well. Mach 7 offers us a lot of flexibility in that as well. It plays very nicely with other viewers, so we can start at a point where we just initially log into the PACS systems as they are to view images, but then down the line we want to have one viewer for all images. That is the goal.

Q. How long do you expect it to take to implement the VNA?

In terms of scheduling, we weren't sure how long implementation would take when assessing the different phases. Initially it was challenging to fully gain a deep understanding of the architecture of the VNA  but once we understood it, it was a matter of evaluating how best to fit it into our existing environment and get it to do the things that we wanted it to do. There wasn't necessarily a drop-dead timeline on implementation, but there were outside factors that we had to take into consideration such as the existing storage for one of our systems. It was aging and we knew we were getting where we needed to replace it or refresh it. We didn't say we had just three months to implement the VNA because we wanted to make sure we did it right.

We started the implementation with our vendor in November, and we are in the primary phase of our initial go-live this month and it looks like we're going to be another month or two to be fully up and running in the  environment we built.

Q. What are the main objectives for each phase?

We are interacting with two different operational entities, so the first phase of the rollout that we've gotten past is ensuring that current exams from our GE PACS environment are now archiving to the Mach 7 VNA. The second phase will be starting the migration of our prior studies from GE PACS to the Mach 7 archive, and that is coming together over the next few weeks. Once those two pieces are successfully running, then we will do the same thing for the  Philips PACS environment. We wanted to be sure we didn't pull the trigger on everything all at once and then not be able to sort out where there were issues if we were doing this for both companies at one time.

Q. What is one of the biggest obstacles that you've run up against?

One of the most persistent obstacles that we've had has been coordinating and testing all of the integration pieces with our multiple PACS vendors. PACS vendors don't really want you to do this, which can make things difficult. It has been a prolonged implementation. We started this in November, and our implementation is ongoing, we're rolling it out in three phases because of the multiple systems that the VNA touches and the things that we want it to do, but it's still under way and a lot of that is due to wrangling all of the kittens to get everybody on the same page. 

Q. What has been one of the biggest challenges?

I think one of the biggest challenges has been fully understanding the complexity of the vendor neutral archive we chose. It is not just a storage system. It's a very complex application with a robust engine for developing workflows. Learning how to best  use this technology so that we bring more efficiency into our system as well as giving us a place to store everything all in one location was time consuming. Developing use cases, reviewing workflows, and determining where it (the VNA) fit into our environment to give us the most bang for our buck was key.

Q. Have there been any unexpected challenges?

Not yet, so far we've done a pretty good job of anticipating what is coming next, but then again, we're in the first phase of a phased rollout so if you ask me again in three months I might have a different answer. I would like to believe we prepared really well for this.