Off the back of a few conversations at various health tech conferences, Adam Coombes, HealthStore® Product Owner, unravels some of the three letter acronyms often used to describe what BridgeHead’s HealthStore solution is and what it does, and aims to dispel some of the myths and incorrect associations in an attempt to provide some clarity.
Alphabet soup anybody?
I’ve been to a couple of trade shows recently representing BridgeHead and, inevitably, have been talking to various people about what we do and why. Often the conversation goes something like this…
Visitor: “Oh, you’re a VNA?”
Me: “No, we’re far more than that, we’re a CDR.”
Visitor: “Is that like an HIE, or SCR?”
Me: “Well, no, not really. HIE is an aspect of what we support. SCRs too. But we’re definitely not an EMR, or an EMPI.”
And so it continues, interspersed with an ‘alphabet soup’ of TLAs (Three Letter Acronyms), many of which have more than one definition. I thought it might be useful, or at least cathartic, to expand on some of them.
“So, BridgeHead’s HealthStore® is a VNA, right?”
Sort of. You see, VNA (Vendor Neutral Archive) is part of our solution. We’ve been ‘doing VNA’ for years but have grown way beyond it now.
The key word here is ‘archive’. It’s the digital equivalent of the microfiche you might find in your local library. It can store a lot of images in a small space, but it’s quite specialised in its scope. Probably the most generally understood definition is that a VNA focuses on storing and managing medical images, particularly DICOM studies, such as radiology and cardiology. That definition has been challenged over the years as too limiting – many feel it should also include non-DICOM images and associated data (such as radiologists reports). But, for many, a VNA is still regarded as:
- A way to move images out of frontline systems onto long term, cheaper storage. E.g. as a store for imaging data that might otherwise be deleted, but can’t be (for a whole host of reasons that I won’t go into today).
- An emergency business continuity solution for patient care where images can still be accessed and viewed should one or more primary systems be unavailable (e.g. cyber-attack).
- A way to retire old imaging systems that have since been replaced or are no longer used, removing the security risks and support costs of ageing applications (something a number of our customers have successfully done).
BridgeHead has certainly showed its ongoing support for a widening of the VNA scope by including images from a variety of other departments, clinical disciplines, and sources, such as endoscopy, digital pathology, and more, but it’s still fundamentally about images. Recently, this has started to get quite interesting as the amount of data in imaging grows quadratically (as a result of the resolution increasing as a squared ratio). The sheer size of images generated from newer technologies, such as tomosynthesis, is presenting serious challenges to the conventional thinking around what a VNA is and can/should do.
“Did your VNA lose its flavour in the datacentre overnight?”
Many purveyors of radiology and imaging suites also offer a ‘VNA’ as part of the deal, so they don’t have to pollute their shiny new PACS (OK, sorry that’s Picture Archiving and Communications System) and can ease the sale. Be careful here! They’re often ‘vendor neutral’ inbound, but not so when you want to replace them in a few years, when you suddenly find you have to pay to get that data back out again AND transform it into the next (not so neutral) vendor’s archive solution AND you’ve lost a bunch of context meta-data along the way.
“So, HealthStore® provides HIE services?”
Carrying on the library analogy, a health information exchange (or HIE) is the ‘post room’. An HIE is a system that allows different healthcare organizations, and their patients, to appropriately access and securely share patient data electronically. For example, if a patient is transferred from their local acute hospital to a specialist unit in another area, it means the clinicians don’t have to spend hours collating all the required clinical data into a document or DVD and then micropore it to the patient as they leave. This can help to improve the speed, quality, safety, and cost of patient care, and is far less painful to access at the other end.
Bridgehead’s HealthStore provides a lot of the foundations required, and in fact can act as the primary data source for an HIE, but doesn’t provide the ‘patient portal’ element. That said, if you have a patient portal, then HealthStore aggregates data from other systems into a single patient record so it could save a lot of interoperability headaches.
The same is true for both flavours of SCR. If you mean ‘Shared Care Record’, then we can bring together a view of data for a patient from across your clinical systems. If, on the other hand, you mean ‘Summary Care Record’, that is similar to the HIE in that we don’t provide the patient access element. Of course, you may mean ‘Silicon Controlled Rectifier’, in which case you’re probably reading the wrong blog, sorry.
“Does that mean you do the job of an EMPI then, and match up patient records?”
No, but we can certainly subscribe to one, and also hold all the different identifiers that other systems provide to us for a patient. Let me explain.
It’s fairly normal for people to go to a number of healthcare providers and have patient records in each setting. This is where the Enterprise Master Patient Index (EMPI), a specialist identity cross reference, normally gets involved. But that is a whole other subject I’ll try to write about in a future blog. Suffice to say, knowing that two patients in different organizations are (or aren’t) really the same person is surprisingly difficult, especially with familial or other related groups. I mean, what sort of idiot who works in healthcare would create a scenario where three people live at the same address, two of whom share a birthday, and all have the same initials and surname eh? Yeah, that was me. I can hear the software testers out there gasping at my faith in them.
“BridgeHead’s HealthStore® is a Clinical Data Repository then?”
In short, yes. But what does that mean? Well, if a VNA is the library’s microfiche for medical images, then a clinical data repository (or CDR for short), is more like the main library and newsroom combined, making all kinds of healthcare data, way beyond just medical images, available to other systems and users.
CDRs can be used to provide a real-time, single patient view for clinicians and multi-disciplinary teams (instead of having to use several different systems), as well as tracking patient care over time and identifying trends. The best ones (yes, like ours) store and index clinical data from almost any source, such as laboratory test results, patient demographics, radiology reports and images, pathology reports, hospital admission, discharge and transfer dates, discharge summaries, progress notes, and much more.
A CDR can also be used to perform the same retirement and protection functions as a VNA, but serves a wider range of systems and data types. BridgeHead’s CDR can bring together imaging, diagnostic reports, and lab results from many different systems and, because we store much of it in a FHIR (Fast HealthCare Integration Resources) repository, it can revitalize data from old, retired systems, reducing your exposure to cyber-attack, getting rid of legacy costs, and making that data available using modern APIs (Application Programming Interfaces). It’s like sticking a Babel fish in the ears of your old systems.
“And where do EHRs fit in?”
Most front line clinical systems, Electronic Health Records (EHR) included, only last about 7 years, and new ones very rarely take on more than a couple of years of data from the old one. HealthStore supports ‘in context’ links. This means your EHR users can jump straight in to HealthStore, in their current patient context, and access all the rich history and up-to-date information about that patient that we bring together.
There are also a few other, related acronyms flying around, such as CIR (Clinical Information Repository), CDA (Clinical Data Archive (not Clinical Document Architecture)), and more. However, these are generally flavours of the three primary use cases I’ve outlined above.
Closing comments…
Please note, this is not intended as a sales pitch, or anything related. Those that know me know I don’t ‘do sales’. It’s purely an attempt to disambiguate a few things. That said, if I have piqued your interest, or indeed if you think this is a load of sulphurous bat guano, feel free to message me (adam.coombes@bridgeheadsoftware.com).
Adam Coombes is Product Owner for BridgeHead’s HealthStore® Clinical Data Repository. His goal is to enhance care delivery by enabling healthcare providers to create a safe, available, and complete clinical history for patients and make it easy to move data in and out of HealthStore, as and where needed.
Adam is an established Business Analyst, Product Owner, and self-confessed ‘physics geek’. For the last 15 years, he has worked with clinical and technical teams to develop solutions that improve patient outcomes.
If you would like to learn more about BridgeHead’s FHIR-enabled Clinical Data Repository…
