How do you create an enterprise imaging strategy to manage data in 20 different centers across the country? How about 115 locations? While the challenge may seem more daunting with a more expansive network, the Center for Diagnostic Imaging (CDI) found that a single vendor neutral archive (VNA) solution could not only work for both scenarios, but actually enable the growth in the first place.

CDI, a national provider network for imaging services, implemented the Perceptive Acuo VNA more than 12 years ago, and has since grown to operate in 40 states. Today, CDI performs 1.2 million exams each year and has more than two billion images stored in the VNA.

Adopting the technology at such an early stage, CDI became something of a trailblazer on the VNA frontier, but Linda Bagley, Senior Vice President of Business Process & Technology at CDI, says the organization never considered a PACS-based solution because of their unique workflow.

“Our workflow, because we have multiple partnerships, is that we have a need for different viewers, so to purchase multiple PACS solutions was not an option for us,” says Bagley. “We were really looking for an archiving solution that would give us the capability to fit the needs of our business.”

Initially used to route images for cross-market reads, CDI is now offering storage space in the VNA to outside partners at a low cost. Being RIS-driven, Bagley says CDI wanted to keep that focus on workflow as they expanded, with physicians at partner locations being able to use familiar viewers while CDI radiologists can have a single worklist for requests coming from multiple locations.

Flexibility is key, and the sophisticated routing capabilities of the Perceptive Acuo VNA allowed CDI to move images from each partnership to the correct location. CDI has over 200 VPN connections with hospital and medical group image exchange partners, each with different requirements. Some images don’t need to be stored in the long-term archive, such as data from an orthopedic group that is having CDI read cases, for example. Other images do need long-term storage, so CDI needed rules-based archiving that was smart enough to know where to send images depending on where they were coming from.

“Having that capability was extremely important to us and I didn’t want to keep adding devices to manage each one of these,” says Bagley. “I need to do it on a single device and be able to send images wherever I want them.”

While most people think of a VNA as a deep drive to hold images, with data traveling to regions all across the U.S., where the data are stored is also important.

“We found out that we needed a Google-like capability to aggregate and federate image data to where it’s most likely going to be recalled because of [CDI’s] highly distributed nature in their network,” says Jeff Timbrook, vice president of healthcare at Perceptive Software. This aggregation federation engine allows data to more quickly be recalled.

Bagley also notes that CDI has transformed their archiving strategy from a cost center to a revenue generator by offering out low-cost storage to smaller groups that don’t know storage and can’t afford most solutions.  

And of course, having such a large connected enterprise has clinical benefits as well. Bagley says an early implementation at a hospital in rural Northern Minnesota took the hospital filmless, but also brought the community together. Local general practices starting using the routing capabilities to take the whole community filmless.

“We were able then, if they had to helicopter a patient down to the cities, we could have the images down before the patient arrived,” says Bagley. “We weren’t sending CDs, we were sending the images through the network.”

When asked what advice she has for other providers as they look for an archiving solution, Bagley notes that while vendors are starting to better understand needs, she still sees organizations looking at traditional PACS solutions and running into the same challenges CDI faced years ago. Those looking at a VNA need to look at the system’s functionality when PACS is separated and also examine the VNA’s routing capabilities.

“Looking at some of the VNAs out there, a lot of vendors say they have all the functionality to do all the routing that you want to do or to accept images from other PACS, but you still run into issues with images coming in and not being able to send them where you want to send them.”