* Making Timely and Accurate Patient Care Decisions through Vista Imaging

* VistA is a multimedia extension of RPMS. * It is used to capture scanned documents, clinical images, DICOM images, and other non-textual data files. * VistA Imaging and its accompanying client software is an FDA approved medical device.

* Originally conceived in 1987 by the Veterans Health Administration (VHA). It was first designed to capture and view video frames of pathology specimens. * It quickly developed into a Picture Archiving and communication system (PACS). Used to incorporate radiology imagery. And this was when Vista Imaging was born.

* VistA Imaging is unique in its tight integration with VHA VistA HIS system. Which is the equivalent of IHS’s RPMS system. * The VHA rollout started in * August 2001 a VHA mandated the installation of all core VistA imagining components for all VHA medical centers.

* Why Vista Imaging for IHS? * EHR/RPMS has no image storage capabilities. * Needs: Reports, Advanced Directives, Patient Photos, DICOM images. * Portland Area the first site to go live with Vista Imaging. * National rollout began in

* Clinical * Patient * Cost Savings of VistA

* Immediate availability of patient images and data. * Less time spent locating images. * Increased communication among clinicians. * Enables remote consultation with specialists.

* The VA is one of the largest healthcare providers in the US. * VistA Imaging features remote viewing technology. * Any facility within IHS running VistA imaging can easily consult with other facilities.

* Better care because all patient data is readily available. * Improved continuity of care * Decreased waiting times for patients. * Patients can see their condition and participate in treatment decisions.

* Curtails the cost expansion of medical record storage. * Can store Radiology (DICOM) imagery as well. * Cost of duplication of electronics records is almost non existent compared to paper.

* Digital Storage is cheap. And gets progressively cheaper. * Average cost per Gigabyte today: $0.03 * The entire print collections of the Library of Congress roughly equals to 10 Terabytes of digital storage. * This would cost $300. * Kilobyte = 1 Thousand bytes * Megabyte = 1 Million bytes * Gigabyte = 1 Billion bytes * Terabyte = 1 Trillion bytes

* Median image size: 150 kilobytes. (Non Radiology) * Three federal service units started scanning in Jan 2012 accumulated 10,000 images in 4 months. * At that rate they’ll reach 1 Terabyte in 240 years. * Phoenix Area’s Vista Imaging unit can store. * Kilobyte = 1 Thousand bytes * Megabyte = 1 Million bytes * Gigabyte = 1 Billion bytes * Terabyte = 1 Trillion bytes

* Paper records require a fixed amount of space. * Space saving technologies exist but can only reduce paper’s finger print by so much. * These records will be required to be held for a good number of years. * Paper is susceptible to the elements and will degrade overtime. * Duplication of records may take months or even years * Disk storage has increased in capacity exponentially over the past 30 years. And will continue to do so. * Physical housing for digital storage as also become increasingly dense, smaller in physical size and consume much less power. * Digital data will maintain its quality forever. * Digital data can be duplicated within minutes or hours.

* VistA utilizes Windows Server 2008 high availability clustering for primary storage. * LTO-4 backup media is used for the 1 st level backup. * The Plasmon (Jukebox) is utilized for long-term archival and a 2 nd level backup. * The Jukebox creates two backup cartridges of each set of data. When both are full the second is removed and transported to a secure storage location.

* Tier 1 – Local Site * Tier 2 – Area Level * Tier 3 – VHA Enterprise Solution help desk

* A majority of full scale deployments of VistA Imaging have a high level of redundancy built in. * Downtime has been non-existent to very minimal. * Majority of downtime if any will come from network outages that affect more systems then just VistA Imaging.

Questions?