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

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

2. Objectives • Overview of VistA Imaging • Current experience with VistA Imaging in Indian Health • Next steps/planning

3. Why VistA Imaging? • RPMS has no image storage capability • Critical implications for the IHS EHR and for diverse Telehealth activities

4. EHR “Image” Needs • Reports • Consults from Outside Specialists • Consents • Advance Directives • Patient Photos • Non-DICOM images • DICOM type images

5. 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

6. 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

7. Tele-Radiology

8. 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

9. 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

10. 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

11. IHS-VHA Project Agreement

12. Support from VHA • For: • Planning and Implementation • Assistance from VistA Imaging Program Office • Training support • VHA Enterprise support • i.e. application help desk

13. 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

14. Hardware Configuratoin • 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

15. 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

16. Possible Models • Different models are possible: • A hardware “cluster” at every site(!) • Regional cluster approach • Option 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: PACS • VI can blend with commercial PACS solns • Or – VI can be used as a PACS system

17. Regional Approaches to Hardware • Pros • Cost-effective • Opportunity for image sharing • Facilitates technical support • Capable of supporting teleradiology • Cons • Relies on Wide Area Network

18. 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

19. 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.

20. Proprietary Licenses • VistA Imaging is free to IHS and Tribal facilities • Some embedded software though must be licensed: • Accusoft Image Gear run-time licens • Other as may be needed: • DICOM query and retrieve • DICOM compression

21. VistA Imaging in the IHS • Extensive work on Distribution and Project Agreements • Phase 1 testing and implementation • Phase 2 planning

22. Possible Deployment Model – circa 2005

23. 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

24. 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

25. EHR Sites as of 6/6/06

26. VistA Imaging as of 011007 Ordered Under Review Installed

27. 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

28. 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

29. How to get more information? • http://vhacollaboration.ihs.gov/VistAImaging/default.aspx • mark.carroll@ihs.gov • janis.sollenbarger@va.gov

30. Thank You