VistA Imaging Overview Past & Present

1. VistA Imaging OverviewPast & 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.

2. 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.

3. RF MRI CT CR Traditional Proprietary Medical Imaging PACS

4. RF CR MRI CT VistA Imaging Integrated PACS

5. VistA Imaging Components • 3 Functional Components: • Display Client for Clinical Viewing of Images – non-rad, rad, documents, drawing templates. • Capture Client for document scanning, import of files or images. • Radiology Viewer for display and interpretation of radiology images.

6. 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.

7. VistA Imaging Program Design • The VistA Imaging Project is under the umbrella of the VHA Office of Information and Technology. • 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.

8. 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.

9. 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.

10. Archive Storage Jukebox Magnetic Storage Intelligent Subsytem Tape Library Primary Domain Backup Domain Controller Controller Core System Components PSU PSU (slot 7) (slot 7) (slot 6) (slot 6) (slot 5) (slot 5) (slot 4) (slot 4) (slot 3) (slot 3) 9 GB 9 GB 9 GB 9 GB IntelServer Intel Server System 2 System 1 Private Network Connection Network Switch Console Switch Box Keyboard Monitor Mouse

11. 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.

12. 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.

13. 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.

14. 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.