VistA Imaging:An Update on IHS Activity and Directions Mark Carroll, MD; Janis Sollenbarger

Objectives

Overview of VistA Imaging

Current experience with VistA Imaging in Indian Health

Next steps/planning

Why VistA Imaging?

RPMS has no image storage capability Critical implications for the IHS EHR and for diverse Telehealth activities

EHR “Image” Needs

Reports Consults from Outside Specialists

Consents Advance Directives Patient Photos Non-DICOM images DICOM type images

VistA Imaging Functionality

Multi-faceted software program developed in federal sector for image capture, display, and storage of: Scanned documents Non-DICOM images DICOM images

DICOM

VistA Imaging can serve as a PACS Fully integrated

solution Can interface to

existing PACS Able to capture,

display, route, and store DICOM image files

Tele-Radiology

Strategic Direction

VistA Imaging is the multimedia component of the Veteran’s Administration Electronic Health Record

VI is being offered as the multimedia component of IHS Electronic Health Record

Is VI a mandate?

VistA Imaging is not a mandate Aside from project oversight and VHA support, it is not a funded agency activity

But Imaging is a necessary part of a comprehensive EHR, and - No other solution is available or being supported at present by OIT

It is part of OIT, ISAC, and ISC strategic planning

VistA Imaging in Indian Health

Permission to use VI

Configurations and Models

Proprietary license review

IT/IHS EHR integration issues

Early implementations

Planning and roll-out

IHS-VHA Project Agreement

Support from VHA

For: Planning and Implementation Assistance from VistA Imaging Program Office

Training support VHA Enterprise support

i.e. application help desk

IHS-VHA Distribution Agreement

VHA is manufacturer of FDA regulated device

IHS cannot modify VistA Imaging code Software is free (except for some embedded proprietary software)

IHS must install VistA Imaging on hardware configuration certified by VHA Hardware configuration is “robust” HP is only vendor currently certified by the VHA for full configuration – on-line storage and permanent storage

Hardware Configuration

Storage redundancy and security

Image data is stored in 3 places – RAID

Tape

Magneto optical discs (Jukebox)

Note: Any database IT configuration should have similar redundancy and hence similar costs

VistA Imaging is not CPRS

VistA Imaging is a separate application to CPRS (the VA EHR)

It runs on separate hardware

Some proprietary software embedded within application

Possible Models

Different models are possible: A hardware “cluster” at every site(!)

Regional cluster approachOption 1: Regional solution to both on-line and permanent storage (i.e. “jukebox”)

Option 2: Local on-line cluster with regional permanent storage

Note re: PACSVI can blend with commercial PACS solns

Or – VI can be used as a PACS system

Regional Approaches to Hardware

Pros Cost-effective

Opportunity for image sharing

Facilitates technical support

Capable of supporting teleradiology

Cons Relies on Wide Area Network

Regional Hardware in the VHA?

Some VISNs are consolidating their Jukebox/permanent storage The current trend is to provide approx 7 years of on-line storage so that the JB is accessed less and less

Some VISNs have consolidated or are consolidating VistA databases Many VA Community-Based Outpatient Clinics (CBOCs) use VI via WAN access

VI – EHR Integration

VI Launches from EHR Maintains patient context

Presently requires a separate enduser log-on

Other customization work under review

Annotation tool

Patient photo addition, etc.

Proprietary Licenses

VistA Imaging is free to IHS and Tribal facilities

Some embedded software though must be licensed: Accusoft Image Gear run-time license

Other as may be needed:

DICOM query and retrieve

DICOM compression

VistA Imaging in the IHS

Extensive work on Distribution and Project Agreements

Phase 1 testing and implementation

Phase 2 planning

Possible Deployment Model – circa 2005

FY05 FY06 FY07 FY08 FY09 FY10

Proof of Concept Sites4

FY05 EHR Sites24

FY06 EHR Sites40

FY07 EHR Sites40

FY08 EHR Sites40

FY09 EHR Sites37

Phase 1: Proof-of-Concept/Pilots

Wind River as initial local facility installation in 2004/05 Earlier software version of VI

Portland Area regional installation in 2005 To support all Portland Area sites

Warm Springs as initial site accessing VI via the IHS WAN

“Live” in January, 2006

Phase 2 Implementations

Nashville Area October 2006 Installation

Navajo Area Underway for 6 NAIHS Service Units

Most other IHS Areas in planning

Some individual facilities also in planning Cherokee, NC.

2-3 Tribal facilities in Oklahoma Area

EHR Sites as of 6/6/06EHR Sites as of 6/6/06

Federal Hospital 15

Federal Health Ctr/Stn 20

Tribal Hospital 5

Tribal Health Ctr/Stn 13

VistA Imaging as of 011007

VistA Imaging as of 011007

Ordered

Under Review

Installed

VistA Imaging in the VHA

First version developed in 1987

National rollout began in 1998

“Core Imaging” mandated in 2001 VistA Rad (PACS) is optional Copies of all Rad images from commercial PACS systems mandated to be sent to VI as of 2006

VistA Imaging in Indian Health

First facility pilot in 2004/5

First regional installation in 2006

Additional implementations in process

Roll-out as guided by IHS Areas and IHS/Tribal facilities in 2007-09 To be determined by local and regional Area needs, funding, and priorities

How to get more information?

http://vhacollaboration.ihs.gov/VistAImaging/default.aspx

mark.carroll@ihs.gov

janis.sollenbarger@va.gov

Thank You