Flow_sync_webHow the VA Midwest Healthcare Network deconstructed their PACS and gained agility and flexibility for its radiologists.

By Aine Cryts

Mike Ryan at the Veterans Affairs (VA) Midwest Healthcare Network—also known as VISN23—is proud of his team’s work on deploying a “deconstructed PACS” across the network’s 11 facilities. Still, Ryan, who is informatics coordinator of the imaging service line, would rather talk about the honor of working with his fellow VA employees to “serve those who have served.”

Eagan, Minn.-based VISN23’s patients include a substantial geriatric population, though the network sees a large influx of younger veterans and more women veterans than ever before, according to Ryan. And this makes sense, since the United States is largely winding down its presence in both Iraq and Afghanistan, after two hard-fought wars in those countries.

Ryan’s team decided on a deconstructed PACS strategy in 2013 because the network was coming to the end of its contract with its previous PACS vendor. He defines VISN23’s deconstructed PACS as a solution that includes three components:

  • First is the imaging viewer from San Diego, Calif.-based Visage Imaging;
  • Second is the storage component, a vendor-neutral archive (VNA) solution from Lexington, Ky.-based Lexmark
  • Third is the worklist component furnished by San Francisco-based Medicalis.

According to a press release issued by Visage Imaging, VISN23’s enterprise-wide viewing solution will provide access to nearly 500,000 annual diagnostic imaging studies for the hospital network that serves 400,000 enrolled US veterans. The network will be able to provide access to imaging throughout Iowa, Minnesota, Nebraska, North Dakota, South Dakota, and parts of Illinois, Kansas, Missouri, Wisconsin, and Wyoming.

Agility and Flexibility for Radiologists

Mike Ryan, Informatics Coordinator of the Imaging Service Line, VISN23

Mike Ryan, Informatics Coordinator of the Imaging Service Line,

There was no precipitating event that caused the move to a deconstructed PACS, according to Ryan. It really came down to the fact that the network wanted more “agility and flexibility” for radiologists. “As [enterprises] look ahead to the next five to eight years, as they consider their [PACS] replacement cycle…they need to do an evaluation to determine if that solution is fully meeting their expectations. The industry hasn’t changed, but maybe it makes sense if there’s a new leader in one of the key components that’s provided by a PACS,” said Ryan.

He highlights the solution’s worklist capability to enable radiologists to interpret studies. “We’re networked and we have distinct facilities. Prior to now, we were more siloed in our facilities. With our worklist solution, we’re able to bridge facility barriers with an integrated solution,” said Ryan. That means radiologists can do peer review more readily and more fully leverage radiologists across facilities, especially for subspecialty readings.

Ryan also points to the value of a worklist that’s customizable to each radiologist. For example, radiologists can now choose the color appearance of the worklist, and they can also arrange the worklist as they decide; that means, for example, that CTs will appear at the top and general radiology studies will appear at the bottom of the worklist. The effect is more control for radiologists, which can help make them more efficient. He notes that it’s also valuable that radiologists and other clinicians will all have a very similar user interface; still, VISN23 is mindful about which clinical team members have the ability to annotate images and those who have read-only access.

“A strategy of deconstructed PACS is reflective of state-of-the-art technologies working in synchrony: workflow, vendor-neutral archiving, and viewing,” according to a spokesperson for the three vendors providing the deconstructed PACS solution. “With Visage Imaging, Lexmark, and Medicalis providing an enterprise-wide approach for VISN23, imaging is no longer restricted by the location of the patient, the radiologist, or legacy system limitations.

“All images are now rapidly available and care is delivered with high quality as all clinical information is at the fingertips of radiologists and physicians, ensuring the right study is read by the right radiologist at the right time,” according to the vendor spokesperson. “Cross-site diagnostic reading, ready access to prior exams, and regional clinical viewing of images is the reality. Enterprise imaging has enabled VISN23 to create a VISN-wide imaging service line, providing a platform for innovative, veteran-focused services.”

Image Migration, Timeline, and Lessons Learned

The storage component has performed to Ryan’s expectations and he’s also pleased with the ability of Lexmark to help his facility migrate studies for the project. Lexmark has helped Ryan and his team by setting up a path to store images to the network’s long-term archive.

The deconstructed PACS deployment should be complete by August. As of the writing of this article, five of the 11 sites were up and running with the deconstructed PACS. VISN23 will continue to work with Lexmark on a full migration of legacy images, according to Ryan. The migration is “proceeding as well as can be expected and…our processes allow us to comfortably proceed with a go-live as we migrate in the background.”

Ryan advises organizations looking into a deconstructed PACS solution to be strategic, realistic about current resources, and to get buy in from across their organization.

His advice includes:

  • Have a solid understanding of your organization’s needs and goals. “It’s important to note that [a deconstructed PACS] may not be the best for everyone,” said Ryan. “We’ve found it to be working well for us—but I’m not saying it’s the best solution for everyone.”
  • Keep your eyes open. Essentially, you need to make sure you have a firm understanding of what your organization needs and the resources you have to do the job. You also have to make sure you’re aware of what’s available from vendors.
  • Realize that this can represent a large strategic change for your organization, so buy-in is essential. “It’s imperative that you have buy-in from your radiologists, your finance people, your radiology administrators, and your directors of radiology. You don’t want anyone to be surprised by your approach,” he said.



Aine Cryts is a contributing writer for AXIS.