VistA imaging

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VistA Imaging is an FDA-listed Image Management system used in the Department of Veterans Affairs healthcare facilities nationwide. It is one of the most widely used image management systems in routine healthcare use, and is used to manage many different varieties of images associated with a patient's medical record. The system was started as a research project by Ruth Dayhoff in 1986 and was formally launched in 1991. [1]

Contents

Hardware requirements

The VistA Imaging System uses hardware components to provide short- and long-term storage. It takes advantage of network servers for storage. It uses a DICOM gateway system to communicate with commercial Picture Archiving and Communication Systems (PACS) and modalities such as CT, MR, and Computed Radiography (x-ray) devices for image capture. It utilizes a background processor for moving the images to the proper storage device and for managing storage space.

Types of data managed

The system not only manages radiologic images, but also is able to capture and manage EKGs, pathology images, gastroenterology (endoscopic) images, laparoscopic images, scanned paperwork, or essentially any type of health care image.

Integration with Electronic Health Record systems

VistA Imaging is currently integrated into the VistA EMR (electronic medical record) system used nationwide in Department of Veterans Affairs hospitals. This integration is able to provide increased efficiency of retrieval of images. [2] It has also been used as a separate software package and can be used with EHRs other than VistA.

VistA Imaging now connects to a nationwide backbone that allows clinicians to access the 350 million images stored in the VA system via Remote Image View software. [3]

The VA has developed interfaces for more than 250 medical devices in VistA Imaging, the images from which can be accessed through the desktop VistA Imaging Viewer. The Department of Defense will use the VistA Imaging Viewer to enhance its own EHR. [3]

Usage in a National Network of Healthcare Records

As part of the US national mandate to co-ordinate care between Department of Defense and the VA, VistA Imaging is forming a cornerstone of the effort to exchange medical imagery between the two systems. “When soldiers come back from Iraq and Afghanistan and eventually enter the VA system, images will be able to move from DOD to VA seamlessly." Eventually, DOD and VA should be able to share all image file types from all sites. Additional enhancements to VistA Imaging include development of a central archive for all VA images (whether acquired through VistA or a commercial system) and new indexing and search capabilities. [4]

Availability

The software for VistA Imaging has been made available through the Freedom of Information Act so that it is in the public domain. Due to its designation as a medical device, however, it can not be designated as free open source software and therefore can not be altered or implemented without FDA approval.

Although it can be used in healthcare facilities that are outside the Department of Veterans Affairs, this is possible only if the proprietary modules that have been integrated into it are also licensed and implementation is registered with the FDA. This has effectively limited its use to government institutions who have licensed the proprietary modules.

The source code can be downloaded from the OSEHRA VistA-M.git tree.

Proprietary modules required

VistA Imaging uses proprietary modules not in the public domain. This makes its public domain use limited.

Information retrieval after a natural disaster

The VistA Imaging system was robust enough to be restored after Hurricane Katrina damaged the data facility at the New Orleans VA. [5] This type of backup proved superior to a paper record system.

Related Research Articles

Picture archiving and communication system

A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage and convenient access to images from multiple modalities. Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or transport film jackets, the folders used to store and protect X-ray film. The universal format for PACS image storage and transfer is DICOM. Non-image data, such as scanned documents, may be incorporated using consumer industry standard formats like PDF, once encapsulated in DICOM. A PACS consists of four major components: The imaging modalities such as X-ray plain film (PF), computed tomography (CT) and magnetic resonance imaging (MRI), a secured network for the transmission of patient information, workstations for interpreting and reviewing images, and archives for the storage and retrieval of images and reports. Combined with available and emerging web technology, PACS has the ability to deliver timely and efficient access to images, interpretations, and related data. PACS reduces the physical and time barriers associated with traditional film-based image retrieval, distribution, and display.

Digital Imaging and Communications in Medicine (DICOM) is the standard for the communication and management of medical imaging information and related data. DICOM is most commonly used for storing and transmitting medical images enabling the integration of medical imaging devices such as scanners, servers, workstations, printers, network hardware, and picture archiving and communication systems (PACS) from multiple manufacturers. It has been widely adopted by hospitals and is making inroads into smaller applications like dentists' and doctors' offices.

The VA Kernel is a set of programs, developed by the Department of Veterans Affairs of the United States Government, which provide an operating system and MUMPS implementation independent abstraction to the VistA Hospital Information System. These programs are the only programs which are expected to not be written in ANSI Standard MUMPS.

A hospital information system (HIS) is an element of health informatics that focuses mainly on the administrational needs of hospitals. In many implementations, a HIS is a comprehensive, integrated information system designed to manage all the aspects of a hospital's operation, such as medical, administrative, financial, and legal issues and the corresponding processing of services. Hospital information system is also known as hospital management software (HMS) or hospital management system.

Electronic health record

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

OsiriX

OsiriX is an image processing application for Mac dedicated to DICOM images produced by equipment. OsiriX is complementary to existing viewers, in particular to nuclear medicine viewers. It can also read many other file formats: TIFF, JPEG, PDF, AVI, MPEG and QuickTime. It is fully compliant with the DICOM standard for image communication and image file formats. OsiriX is able to receive images transferred by DICOM communication protocol from any PACS or medical imaging modality.

BHIE is a series of communications protocols developed by the US Department of Veterans Affairs (VA). It is used to exchange healthcare information between VA healthcare facilities nationwide and between VA facilities and Department of Defense healthcare facilities.

First Databank

First Databank (FDB) is a major provider of drug and medical device databases that help inform healthcare professionals to make decisions. FDB partners with information system developers to deliver useful medication- and medical device-related information to clinicians, business associates, and patients. FDB is part of Hearst and the Hearst Health network.

VistAWeb is a portal accessible through CPRS, the graphical user interface for the Veterans Health Information Systems and Technology Architecture (VistA), the electronic health record used throughout the United States Department of Veterans Affairs (VA) medical system.

VistA

The Veterans Health Information Systems and Technology Architecture (VISTA) is a health information system deployed across all veteran care sites in the United States. VISTA provides clinical, administrative, and financial functions for all of the 1700+ hospitals and clinics of the Veterans Health Administration VISTA consists of 180 clinical, financial, and administrative applications integrated within a single transactional database.

WorldVistA is an not-for profit that provides the WorldVistA EHR, an open source implementation of the Veteran Administration's Electronic Health Record system intended for use in health care facilities outside the VA.

InterSystems Corporation is a privately held vendor of software systems and technology for high-performance database management, rapid application development, integration, and healthcare information systems. The vendor's products include InterSystems IRIS Data Platform, Caché Database Management System, the InterSystems Ensemble integration platform, the HealthShare healthcare informatics platform and TrakCare healthcare information system, which is sold outside the United States.

AHLTA is a global Electronic Health Record (EHR) system used by U.S. Department of Defense (DoD). It was implemented at Army, Navy and Air Force Military Treatment Facilities (MTF) around the world between January 2003 and January 2006. It is a services-wide medical and dental information management system. What made AHLTA unique was its implementation date, its Central Data Repository, its use in operational medicine and its global implementation. There is nothing like it in the private sector.

LEAD Technologies Inc. is a privately held software company headquartered in Charlotte, North Carolina, USA. LEAD develops and supports a line of imaging toolkits called LEADTOOLS.

Medical device connectivity is the establishment and maintenance of a connection through which data is transferred between a medical device, such as a patient monitor, and an information system. The term is used interchangeably with biomedical device connectivity or biomedical device integration. By eliminating the need for manual data entry, potential benefits include faster and more frequent data updates, diminished human error, and improved workflow efficiency.

A Vendor Neutral Archive (VNA) is a medical imaging technology in which images and documents are stored (archived) in a standard format with a standard interface, such that they can be accessed in a vendor-neutral manner by other systems.

Medical image sharing

Medical image sharing is the electronic exchange of medical images between hospitals, physicians and patients. Rather than using traditional media, such as a CD or DVD, and either shipping it out or having patients carry it with them, technology now allows for the sharing of these images using the cloud. The primary format for images is DICOM. Typically, non-image data such as reports may be attached in standard formats like PDF during the sending process. Additionally, there are standards in the industry, such as IHE Cross Enterprise Document Sharing for Imaging (XDS-I), for managing the sharing of documents between healthcare enterprises. A typical architecture involved in setup is a locally installed server, which sits behind the firewall, allowing secure transmissions with outside facilities. In 2009, the Radiological Society of North America launched the "Image Share" project, with the goal of giving patients control of their imaging histories by allowing them to manage these records as they would online banking or shopping.

Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.

References

  1. ↑ "VistA Imaging Acquires its 10 Billionth Medical Image". DigitalVA. Retrieved 26 April 2021.
  2. ↑ "PACS Lessons Learned at the Baltimore VA". Imaging Economics, Skokie, IL (USA). December 2002.
  3. 1 2 "VistA's horizons". Government Health IT (USA). October 9, 2006. Archived from the original on September 26, 2007.
  4. ↑ "VistA Imaging upgrades will enhance exchanges with DOD". November 2008.
  5. ↑ "New Orleans VA medical center restores data lost to Katrina". Diagnostic Imaging:PACSWeb (Feb. 11, 2006).
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