VistA Imaging Overview Past & Present  VistA Imaging was conceived in 1987, at first to capture and view video frames of pathology specimens. It quickly expanded into a Multimedia PACS exclusive of Radiology imaging. Wilmington VAMC, an alpha testing site, requested the incorporation of radiology imaging and VistA Rad was born.

VistA Imaging Overview  The VistA Imaging PACS is unique in its tight integration to the VHA VistA HIS and its characteristic multi-media imaging capabilities.  The VHA National rollout began in 1998 and continues to evolve today.

Traditional Proprietary Medical Imaging PACS

VistA Imaging Integrated PACS

VistA Imaging Overview  In August 2001, a VHA Directive mandated the installation of ‘core’ VistA Imaging configurations to support document scanning. All VHA medical centers are in compliance.  Many sites included the VistA Rad application in their core installations.

VistA Imaging Program Design  The VistA Imaging Project is under the umbrella of the VHA Office of Information.  The Project is supported by OI staff from HSD&D, HSITES, and NTEO.  The development office is located at the OIFO in Silver Spring, MD.

VistA Imaging Program Design  Technical support is provided by both VHA staff and an enterprise-wide support contract.  Training is provided both on-site and remotely. The IHS Portland Area Office received on-site VHA training as a pilot.  The Implementation Team assists in planning, design, and implementation.

VistA Imaging Architecture  Defined as a medical device, VistA Imaging’s storage architecture is designed with storage redundancy to protect against the loss of patient data. Image data is stored in 3 places – RAID, tape, and magneto optical discs (JB).  There are plans to re-engineer the storage architecture, but OI funding constraints have stalemated this initiative.

Network Switch Private Network Connection IntelServer System 2 Intel Server System 1 Console Switch Box Monitor Keyboard Mouse 9 GB (slot 3) (slot 4) (slot 5) (slot 6) (slot 7) PSU 9 GB (slot 3) (slot 4) (slot 5) (slot 6) (slot 7) PSU 9 GB Core System Components

Configuration Overview Switch Hospital Information System (HIS ) VistA/Mumps Stores information tables mapping patient to Image information Text Gateway Fuji/ DeJarnette MRI CT Clinician Display Station Capture Station Scanner CR Dicom VA Private Network Connection Intel Server System 2 Intel Server System 1 Radiology Storage Servers (VistA Imaging WIN2K Domain) Radiology Diagnostic Wkstn BDCPDC Video

VistA Imaging Architecture  Some VISNs are consolidating their JB’s.  The trend is to provide approx 7 years of on-line storage w/ the JB being accessed less and less.  Many sites have a ‘hybrid’ PACS environment – Radiology cPACS w/ VistA Imaging PACS.

VistA Imaging Architecture  The VHA has designed its own DICOM text and image interface engines. These presently use MSM databases, but will be migrated to Cache with P. 69.  The VHA and DOD have jointly developed a DICOM conformance statement to assist in the integration of commercial modalities.

VistA Imaging TeleImaging  VistA Imaging P.45, “Remote Image Views”, permits users to view any type of image from any VI database nationally. This requires a Master Patient Index.  Sites use both VistA Rad and commercial products for diagnostic teleradiology.  After hour telerad services are also provided by both venues; contract nighthawk services are commonly used.

VistA Imaging TeleImaging  Using VistA Rad features, images can be ‘auto-routed’ or ‘on-demand routed’ to another facility for interpretation.  Approx. 60 VR sites of which half are using auto-routing for teleradiology transmission.  Most using dedicated T1 lines or shared DS3 lines for teleradiology purposes.  VHA is exploring a national teleradiology solution (Dr.Anderson).

Caveats for Success using VistA Rad for Teleradiology  Determine Who needs What, When and Where.  Ascertain performance expectations  Provide adequate bandwidth  Establish transcription procedures  Ensure workload credit where applicable  QUESTIONS?