By Tim Kaschinske

A common discussion with regard to a PACS VNA

is whether the archive should participate in the clinical workflow.  The view among most VNA vendors appears to be that the VNA can help correct problems with the clinical workflow, making the clinical workflow more efficient.

However, we take a different view and for good reasons: what we see is that clinical workflows are different from department to department. Trying to accommodate each department in a common VNA has a tendency to pull the VNA into the realm of departmental solutions rather than being a common archive, as it is extremely inefficient and complex to try to participate in the workflows for all departments from a central point. In short, we believe that attempting to fit a central approach to each department is inherently flawed, compromises all departments, and drives up the cost of IT.

For example, in radiology the workflow requires that an electronic order be present for each radiology study. This enables the order identifier, or accession number, to be associated with the radiology images and to tie it back to the order, the radiology report, and the billing for the study.  As a result, radiology PACS now require an accession number for each study in order to avoid orphaned studies that are not tied to their orders.

In cardiology, however, an electronic order is not always present.  In a diagnostic cardiac cath procedure, if a blockage is discovered that can be corrected by angioplasty the procedure becomes an interventional procedure. There is generally not an electronic order for this procedure as the interventional procedure is based upon a verbal order by the cardiologist in the cath lab.

This example is the root of the problem: radiology PACS applications that require accession numbers would have difficulty supporting cardiac cath workflow.

In another scenario, consider pathology. Pathology departments acquire images, but these images are tied to a physical specimen.  The workflow in pathology requires tracking the chain of custody of the physical specimen.  How should an archive tie the images to the physical specimen, and how much of the chain of custody workflow should it be involved in?

As you can see, these differences in workflow contribute to the complexity of the systems that help manage these departments.

To be practical, health IT systems must be structured to enable rich diversity of workflow required within different hospital departments while also balancing the need for centralized, cost-efficient and easy-to-manage systems for health IT. So, where to draw the line in the systems?

There is an easy and obvious place to draw this line, which enables each part of the IT systems environment to function according to its core mission while also covering the requirements and constraints which are unique to hospitals: BridgeHead’s view is to leave the PACS application untouched and in charge of workflow, while establishing a central archive optimized for data management.

The advantages of this approach for clinicians, is to leave each department completely free to obtain the best-fit workflow solution for their particular discipline. The clinical teams are further benefitted by the fact that a centralized approach to data management then supports them, without distracting them with the need to alter their procedures and with assured image availability when they need it. Also, a centralized approach improves the ability of images and, indeed, all types of hospital data to be shared easily among hospital departments as the need arises.

The advantages of this approach for IT professionals, is to obtain a solution for image management which assures availability through all types of failures. This establishes a true hospital archive approach that can work not only for image data, but for all types of hospital data which the IT team must manage.