As we are looking to start ingesting a lot more digital content into our VNA, I have been trying to find some best practice guidelines or recommendations on what I would need to consider in a “VNA First” workflow rather than through PACS.
This would give a lot more flexibility for ingesting content and cleansing at the first point, rather than relying on PACS to do this and then archive to the VNA instead.
Despite a good few literature searches and a few internet trawls, I have come up with little tangible and practical guidance- other than “PACS first is easier and VNA first is more flexible but a little more complicated”.
Anybody have any recommendations or experience of this workflow, would be willing to share?
I am running a VNA project at Royal Berks Hospital and are working through the various issues transforming a PACS into a VNA.
There are various items that have to be provided by the PACS supplier for this to be successful.
Starting to add different ‘ologies into the system but we do need certain changes for it to be successful.
Happy to share this and current progress. chris.bull@royalberkshire.nhs.uk
Response from one of our local trusts in Mersey who use a VNA:
we never had a choice in the VNA and would much prefer PACS to be our long term storage…
Everything is manually kept in synch as in we make a correction in PACS it has to be corrected in VNA nothing automatically happens - So a worklist down results in us having to correct in PACS and delete in VNA and resend the study down so not favourable.
We have theatre stackers sending direct to VNA but not sure who responsible for this and sure the data quality is not good. BUT that again is IT staff changing and no current knowledge of how it all works. Cardiology used to send from their system to VNA but now go through PACS
I think IT have asked Philips if they could take the VNA over but nothing come of it yet as we need to be using the same strategy for both trusts now we are merged as one
They are interesting comments from your colleagues.
We had to do extensive testing around IOCM (Image Object Change Management) to ensure that the VNA and PACS are in sync with each other. There were particular challenges with MERGE STUDY where the PACS system doesn’t amend the SUID of the two studies but instead, the Web Viewer has a configuration activated to GROUP the examinations with the same accession number instead- not ideal!
On the VNA side, we have implemented the ability to reconcile to worklists from the EPR/RIS and that is fairly easy to mop up on a daily basis however, where there is no over arching DBMS for a given modality (say Cardiology Echoes), we have had to implement a morpher that undertakes a lookup against the MPI to determine if the patient record exists or if it needs to go to exception and be handled manually.
Some of the workflows we have are working well but others are intermittently challenging when there is a change in rules or a specific DICOM Header tag that throws us!.
We are trying to eventually have images come into our VNA and then be served up for consumption by other solutions OR forward onto downstream systems (e.g. VNA > PACS) so that there is a single solution to receive ALL digital content for photos/movies/DICOM etc.
Any thoughts or questions welcome.
We have IBM VNA, GE Healthcare PACS and Pukka-J NEXUS DICOM/HL7 Toolkit.
It’s interesting that things haven’t really moved on in the last eight years since I retired, with the same problems being discussed back then regarding VNA/PACS communication and how to deal with non-radiology imaging and non-DICOM file types.
Does the National PACS Board still exist? If so, this ought to be being discussed at national level to lead to a unified approach, though I’m aware that the delays that would bring and the local need for action requiring a swifter solution. It’s great that this forum continues, in its new ‘regeneration’ , to offer some hope of a consistent methodology.
Good luck with the integrations from an old codger [but still interested!].
I’m pleased and flattered, Deborah! I wrote it in about 2008 IIRC when the ‘encryption directive’ was issued. Good to hear it’s still going strong.
I still have the source code if anyone else would like it!!!
Yes, we’ve been using it since 2008.