The Vendor Neutral Archive & PACS market could be worth 3.48 billion by 2018!

DALLAS, October 8, 2013 /PRNewswire/ --




The "Vendor Neutral Archive Market & PACS Market - VNA [On-premise Software, Hybrid & Cloud, Multi-Department & Multi-Site VNA] & Picture Archiving and Communication System [Enterprise, Cardiology & Radiology] - Global Forecast to 2018" analyzes and studies the major market drivers, restraints, and opportunities in North America, Europe, Asia-Pacific, and Rest of the World.

At present, the Vendor Neutral Archive (VNA) And Picture Archiving and Communication System (PACS) Markets form indispensable segments of the imaging informatics market. The overall market (VNA and PACS) comprises of VNA software solutions as well as departmental and enterprise PACS. The global VNA Market is estimated at $165.3 million in 2013 and is poised to reach $335.4 million by 2018, at a CAGR of 15.2%. 

Departmental PACS currently dominates the overall Vendor Neutral ArchiveMarket and PACS Market with around 86.5% of the total revenue contribution. However, this market is a considerably mature market generating most of the revenues from PACS replacements. Hence, the market is expected to witness a stable CAGR of 5.2% from 2013 to 2018. Enterprise PACS, on the other hand, is growing faster than departmental PACS and is expected to reach $510 million by 2018, at an almost double CAGR. 



Owing to the growing popularity of VNA solutions, the VNA Market is currently in the growth phase of its product lifecycle. The market is characterized by several inter-firm partnerships to deliver best-of-breed solutions to healthcare providers. In addition, development of products that enable the integration of VNAs with EHRs and their subsequent launch in the market is a growing trend.



The major driving factors of the VNA Market include the need for centralized storage of standard-compliant imaging data, government initiatives that favor the use of advanced imaging information systems, technology and cost-related benefits. On the other hand, lack of an established definition of VNA resulting in confusion and data insecurity (breaches) is an issue that restricts market growth. Cloud-based VNAs, emerging markets, and patient-focused systems promise high-growth opportunities in the global VNA market.

In 2013, North America contributes the maximum share to both VNA and PACS markets, with shares of 64% and 48%, respectively. U.K., Germany, and France contribute largely to the European VNA and PACS Market, whereas the Asia-Pacific region represents the most promising region owing to the nation and state-wide healthcare IT policies in Australia, China, and Japan. Although the penetration of VNAs in the ROW region is low, the PACS technology is now widely adopted in Latin America and the Middle East. 



Key companies in the VNA and PACS Market include Acuo Technologies (U.S.), Agfa HealthCare (Belgium), BridgeHead Software (U.K.), Carestream Health (U.S.), Dell, Inc. (U.S.), GE Healthcare (U.K.), Fujifilm Corporation (Japan), Merge Health (U.S.), McKesson Corporation (U.S.), Philips Healthcare (The Netherlands), Siemens Healthcare (Germany), and TeraMedica (U.S.).

We’re proud to partner with Dell, Inc, GE Healthcare, Fujifilm Corporation, McKesson Corporation, Philips Healthcare and Siemens Healthcare for their PACS and Vendor Neutral Archive Solutions.

Glossary: Medical Imaging & Medical IT Terms

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Confused by all of the  Medical Imaging & Medical IT acronyms, terms and buzzwords? Here's a handy glossary to help translate!

Term	Description
ADT	HL7 Admit, Discharge, and Transfer message
AES	Advanced Encryption Standard is a block cipher adopted as an encryption standard by the U.S. government and announced by the National Institute of Standards and Technology (NIST) in 2001.
AN/API	DeJarnette’s DICOM toolkit. The xDLTM application is built using AN/API
API	Application Programming Interface – a source code interface used to support requests to be made by another program or application.
CILM	Clinical Information Lifecycle Management – a set of strategies for administering storage systems.
COM	Component Object Model – a platform introduced by Microsoft to enable inter-process communication and object creation in any programming language that supports the platform.
DICOM	Digital Imaging and COmmunications in Medicine - the DICOM Standard facilitates interoperability of medical imaging equipment.
DICOM Part 10	Part 10 of the DICOM Standard specifies Media Storage and a File Format for Media Interchange.
GUI	Graphical User Interface
HIPAA	Hospital Insurance Portability and Accountability Act – enacted by US Congress in 1996 that addresses the security and privacy of health data.
HL7	Health Level 7 - the HL7 standard facilitates the exchange, management, and integration of electronic healthcare information
HTTP	Hyper-Text Transfer Protocol – a method for transferring or conveying information on the Internet.
HTTPS	HTTP over an encrypted Secure Sockets Layer (SSL) or Transport Layer Security (TLS) transport mechanism that ensures reasonable protection from eavesdroppers and attacks.
IHE	Integrating the Healthcare Enterprise – IHE promotes the coordinated use of standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.
IIS	Internet Information Services – a powerful web server from Microsoft that is included with the Windows Server 2003 OS.
ILM	Information Lifecycle Management – a set of strategies for administering storage systems.
LAN	Local Area Network – a computer network covering a local area such as an office or a group of buildings.
MD5	Message-Digest Algorithm 5 – a widely used cryptographic hash function
ORM	HL7 General Order message
ORU	HL7 Unsolicited Observation message
PACS	Picture Archiving and Communication System – a system for the storage, management and dissemination of digital medical images.
PNA	PACS Neutral Archive – see VNA (Vendor Neutral Archive)

RIS	Radiology Information System – a radiology scheduling, patient registration, procedure ordering, results reporting, and billing system.
SCP	Service Class Provider – a provider of a Service (in DICOM lexicon)
SCU	Service Class User – a user of a Service (in DICOM lexicon)
SOP	Service-Object Pair - an SOP class is the union of a Service and an information object. (in DICOM lexicon)
SQL	Structured Query Language – a popular computer language for creating, retrieving, updating and deleting data from relational databases.
TAR	Tape Archive file format, based on the original Unix archive command, used to collate collections of files into one larger file for archiving.
TCP/IP	Transfer Control Protocol/Internet Protocol – a set of communication protocols used by the Internet and most commercial networks.
URL	Uniform Resource Locator – a location or address on the Internet.
VNA	Vendor Neutral Archive – medical image archive software that is agnostic to the PACS manufacturer and storage hardware vendor. See the White Paper “What is a Vendor Neutral Archive?”
xDLTM	Cross-enterprise (x) Document Library – DeJarnette Research Systems VNA which scales to archive projects of all sizes, from a simple modality archive to a regional or national image archive.
XDS-I	Cross-enterprise (X) Document Sharing for Imaging – IHE profile for sharing of documents and images across disparate healthcare enterprises.

Infographic: How America Transitions To Health IT

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In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of the Recovery Act, created the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs to promote the adoption of EHRs in support of the ultimate goals of improving the quality of patient care and reducing health costs. Through this program, eligible hospitals and doctors earn incentives by demonstrating “meaningful use” of certified technology, which means that health care providers use EHRs in ways that improve care and lower costs. Examples of “meaningful use” include electronic prescribing of medications and ensuring patients have access to their digital records.

 The following infographic created by the ONC illustrates the progress made in the nation’s transition to health IT since the passage of the HITECH Act in 2009.

Do you need help in transitioning your practice? Contact sales@dejarnette.com 

Since 1992, when DeJarnette released the first DICOM conformant developers toolkit (AN/API®) andACR-NEMA V2 IBM PC interface board (AT/ANSIF®), the company has been recognized as one of the most innovative developers of DICOM and HL-7 compliant PACS components.

Today we manufacture and distribute: 

1. a full-featured PACS migration toolkit designed to provide a complete set of legacy migration tools.
2. a standards based archive gateway that provides image and report sharing in the absence of XDS-I
3. a configurable, rules-based, advanced routing application
4. a CT workflow engine that offers the only automated solution for breaking up CT studies into constituent orders
5. a PACS-HIS-RIS integration engine with 15 years of technology evolution

PACSWare Solution

PACSware® is DeJarnette's family of software only clinical applications and development tools. All PACSware family members run under Microsoft Windows. A number of PACSware products also support SUN Solaris, Linux and other UNIX operating systems....MORE

OEM Tools

DeJarnette provides a number of tools for application developers and OEMs....MORE

Services

DeJarnette provides a number of services for medical imaging equipment & PACS vendors and PACS end-users... 

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Journal of Medical Imaging will launch in 2014

September 17th, 2013 http://dejarnette.com

12 September 2013 – In early 2014, SPIE, the international society for optics and photonics, will launch the Journal of Medical Imaging (JMI), covering fundamental and translational research and applications focused on photonics in medical imaging.

The scope of JMI initially will mirror that of the annual SPIE Medical Imaging symposium. Topics will include imaging physics, tomographic reconstruction algorithms (such as those in CT and MRI), image processing, computer-aided diagnosis, visualization and modeling, image perception and observer performance, technology assessment, ultrasonic imaging, image-guided procedures and digital pathology.

"The new journal gives the field of medical imaging, which continues to be more and more interdisciplinary, a home for scientific presentation, discussion, review and archiving," said Dr. Maryellen Giger, A.N. Pritzker Professor of Radiology/Medical Physics at the University of Chicago, who has been appointed editor-in-chief.

Authors are invited to submit articles beginning 1 October 2013, with publication to begin in early 2014. More information is at http://www.spie.org/JMI.

JMI will be published in print quarterly and online in the SPIE Digital Library as each peer-reviewed article is approved for publication, with the online version freely available to all readers in the first year.

"The medical imaging community has a long association with SPIE through the annual symposium the Society has hosted for more than 40 years," noted SPIE President Bill Arnold. "Applications of these technologies have helped save lives through better diagnosis and less invasive treatments, and the field keeps expanding to meet more needs. Supporting the community with a home journal is a significant step forward."

"SPIE is delighted to be able to respond to the needs expressed by the medical imaging community, in particular authors who currently participate in the Medical Imaging symposium. The new journal will provide them a rigorous, peer-reviewed option for their work and help maintain and foster the already well-established connections within the community," said SPIE Publications Director Eric Pepper.

Because it is open to submissions internationally, JMI will also serve to strengthen connections and facilitate collaboration among researchers in academia, medical institutions, industry, and government labs throughout the larger imaging community, Giger said.

Provided by SPIE—International Society for Optics and Photonics

Medical Image Storing is Driving the Growth of Vendor Neutral Archive Systems

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High growth in medical data storage in vendor-neutral archive (VNA) systems will drive strong demand for VNA solutions over the next five years, according to a report from market analysts IHS.

VNA is a general term for networked storage systems in which images and documents are archived in a standard format so they can be accessed by any computer system.

According to the IHS report entitled Medical Enterprise Data Storage — World — 2013, growth largely will be driven by the migration of picture archiving and communication system (PACS) images to VNA. In addition, other imaging departments are also adopting the concept of VNA interoperability.

The Asia-Pacific has been identified as a high-growth region, with the annual VNA study volume growth estimated at 83.3%. This is predominantly due to legislation and increasing support for interoperable care between departments and healthcare provider sites in Asia during the next five years.

“The migration to VNA has been the biggest trend in the healthcare IT market for the past 18 months,” said Shane Walker, senior manager for consumer and digital health research at IHS. “VNA is set to be at the forefront of how all hospitals manage their patient images during the next decade. The technology is moving beyond its initial goal of simply managing PACS images. Instead, migration of PACS to VNA also is leading to the establishment of solutions for non-PACS departmental information, thereby shaping the future of how all information is shared and stored in healthcare.”

The management of images is becoming more important. The key objective is to share images between physicians in multiple regions, and even countries, irrespective of vendor or location.

Taking Australia as an example, with its six states and multiple territories, vendors seek to provide state-level solutions in order to improve the interoperability of care. A similar approach is being taken in countries such as China at a provincial level, albeit at a slower rate compared to Australia’s VNA adoption.

At a healthcare provider level, all hospital departments using image archives have a growing need for VNA software that accommodates their imaging needs, which include both image sharing and providing business continuity. Although VNAs have served these needs so far, demand for improved interoperability is growing at a departmental level for image sharing.

Radiology and Cardiology are well ahead in this area, with PACS images increasingly migrating into VNAs. Dermatology images, endoscopy videos and sleep and gait analysis studies are touted as the next types of departmental image information suitable for migration.

To date, non-DICOM files (a standard for radiology images) — such as JPEGs, TIFFs, PDFs, MPEG videos and WAV audio — although falling within the VNA definition by IHS, have had little influence in the VNA market. However, with ever-increasing requirements for interoperable patient care within hospitals, the DICOM world is set to propagate beyond PACS, offering a wealth of new migration opportunities for VNA and healthcare information technology vendors.

Pathology, dermatology and ophthalmology departments are making significant attempts to follow in the footsteps of the PACS world. Changes at a departmental level in these areas to adopt VNA platforms will be a major factor for growth of study volumes in the VNA market.

The major challenges for image sharing between healthcare providers vary by region. In the United States for example, the prospect of a patient’s image being used and followed up on by another healthcare professional in another institution is unlikely, due to the inherent complexity of the US healthcare system and insurance providers.

On the other hand, Western Europe has an opposing view in that interoperable care will drastically improve clinical workflow efficiency, not only between departments, but also between healthcare providers.

Regional and even international sharing of healthcare image data is increasingly likely with wider VNA adoption. This is highlighted by the strong prediction for VNA study growth, with the five-year growth forecast at 990% for the EMEA region, 220% for the Americas and 1,960% the Asia Pacific region.

Context Management and Tag Morphing in the Real World

http://www.dejarnette.com/downloads/get.aspx?i=45048

Context Management and Tag Morphing in the Real World
Wayne T. DeJarnette, Ph.D. President, DeJarnette Research Systems, Inc. January 4, 2010

©DeJarnette Research Systems, Inc., 2013

A debate is currently raging in the medical imaging and DICOM connectivity worlds. This debate has been brought about by the recent interest in Vendor Neutral Archive products. The debate is over the need for what is referred to as “tag morphing” functionality when specifying an image archive. “Tag morphing” is the ability to retrieve an image or study from the archive in a fashion such that one or more of the DICOM elements (metadata fields) are created, deleted or manipulated to provide new value(s) for the DICOM element(s) so as to make the retrieving DICOM equipment function properly.

The History of “Tag Morphing”
The concept of “tag morphing” is more than 25 years old. It predates the existence of the DICOM standard. In the early days of digital medical imaging, it was not uncommon to want to acquire image data from modalities of different manufacturers and provide some useful processing capability for that data. Common early external applications included multi-planar reconstruction, radiation therapy planning, dental implant planning, etc.
In each application case, it was required that the image and demographic data be acquired in the modality’s native image format and converted to some “common format” for input to the processing application. Each vendor of add-on-equipment had their own “common format” for use by their application.
The ACR-NEMA1 V1 and V2 standards were an attempt by the ACR to standardize on an “image transfer format” and electronic transfer protocol so that interface development for these third-party applications would be lessened. While this standardization attempt improved the situation, it did not completely eliminate the need to understand each vendor’s modality “image transfer format”. Modality vendors made use of the ACR-NEMA standard, but, due to limitations and inconsistencies of the standard, programmer error and the desire for competitive advantage among the modality manufacturers, the “ACR-NEMA format” only succeeded in decreasing the magnitude of the problem. It was still necessary that users of these modality data sets account for variances in the implementation of the standard by the various modality manufacturers. The numbers and types of variances were large. This accounting for variances, converting from one vendor’s ACR-NEMA implementation to another vendor’s ACR-NEMA implementation was the beginning of what we today call “tag morphing”.

The release of the DICOM2 standard in September 1993 greatly improved the situation. Many of the limitations, inconsistencies and overly general specifications in the ACR-NEMA V2 standard were eliminated. There was wider vendor acceptance and commitment to the DICOM standard than there had been to the ACR-NEMA standard. All of this helped to further limit the amount of “tag morphing” required to effectively communicate between two equipment manufacturers’ equipment3. With the passage of 17 years since the standard’s release, DICOM implementations have become more consistent across manufacturers. The fact that there are now many more manufacturers making implementations has however compounded the communication problem.

The fact that more is being asked of the standard and its usage in ways never envisioned4 has redoubled the communication problem.

In a perfect world where there are only perfect DICOM implementations and vendors do not have a need to innovate and improve their products5, and where customers do not have new requirements, “tag morphing” would never be necessary for the effective communication of image data sets between systems of different manufacture. We, however, don’t live in such a world and as a result, “tag morphing” is still required in many cases.

21st Century Real World “Tag Morphing” Examples
The end user customer desire to share reading workload and/or patient image data between institutions and facilities with PACS products of different manufacture creates a requirement for “tag morphing”. A few easily understood examples appear below6:

• The Patient ID DICOM element needs to be changed when using one facility’s data at another facility. Without the facility’s correct Patient ID for an existing patient, the ingested image set will not be properly associated to the patient record. In some PACS, it is possible the ingested study will be held in QC until a manual “match” is done.
  
• The Study Description DICOM element may need to be changed so that the study hangs correctly on the PACS workstation of the ingesting institution.
  
• The Accession Number DICOM element may need to be changed to match the format of the ingesting institution’s standard format. Many institutions have coding built into the accession number, so an accession number must be formed to match the institution’s coding and then placed into the DICOM object so correct routing can take place.
  
• Private DICOM elements must be either removed or inserted for those PACS systems that can not handle the private elements or need specific private elements to be able to manage the data set correctly.
  
• The Institution Name DICOM element and the Department Name DICOM element may need to be manipulated when multiple facilities are using a single PACS/VNA7. When pre-fetching studies from the VNA, the PACS will not know which facility to send the study to unless the VNA indicates which destination the pre-fetched study is to be sent.
  

Even after 17 years of DICOM experience throughout the industry, programmers still make mistakes resulting in an incorrect implementation of the standard8. A few examples follow:

• Image level DICOM elements such as Image Laterality, Photometric Interpretation, etc. may need to be manipulated to be properly displayed on a new third-party workstation or PACS. This is a frequently observed problem when migrating legacy PACS data.
  
• Some PACS workstations misinterpret graphic overlay data generated by other systems, making the proper display of the graphic overlay impossible without the manipulation of the data prior to being displayed.
  
• At least one PACS vendor requires that the DICOM element Requested Procedure Description be populated by the modalities with known enumerated values, consistent with a list configured into the PACS, in order to accept the study and display it. Most modalities today have the ability to include this optional DICOM element in their DICOM data sets. A problem occurs when ingesting studies from outside the institution where the Requested Procedure Description element may not be provided or is provided but does not correspond to one of the values in the PACS enumerated list. This DICOM element was never intended to be used in this fashion. “Tag morphing” is the tried and true solution to this problem.
  
• CT images archived by at least one PACS vendor cannot be displayed properly by any other PACS or workstation vendor without changing the Pixel Representation DICOM element in all CT images coming from the PACS.
  Modality and PACS vendors continue to innovate with their products. This will sometimes result in the need to make use of private DICOM elements as no standard element has been defined for the innovated application. If the modality and PACS vendor are the same, there is generally no problem. When the PACS is replaced, frequently it will be observed that functionality pertaining to the modality is lost. Often, DICOM data manipulation can correct the problem.
  Similarly, innovation sometimes leads a manufacturer to make use of a standard DICOM element in an improper fashion8. An example:
  

• A particular modality / PACS vendor in an older revision of software assumed that the DICOM elements, Partial View and Partial View Description in the Digital Mammography IOD could be used as enumerated fields to provide for use in display station hanging protocols. The standard clearly defined these fields as free form text, not enumerated text. As a result, the PACS could properly display mammography studies produced by their Digital Mammography product, but would improperly display the mammography images produced by other Digital Mammography modality manufacturers. A software “tag morphing” solution solved this problem until the DICOM standard caught up9.

As can be seen, there are a number of ways to get into a situation where image data sets which are sufficient for usage by a particular product (PACS or workstation) are much less useful, or in some cases useless, to another DICOM conformant system without some type of “tag morphing” or DICOM header manipulation taking place between the two systems. The more complex the system under consideration, the more likely it is that this data manipulation capability will be required.

“Tag Morphing” is Insufficient – The Need for Context Management
In common usage, “tag morphing” refers only to the manipulation of DICOM elements in a DICOM object. This manipulation can include changing an element’s value, deleting the element altogether or inserting an element which had not previously been included in the DICOM object.

For modality to workstation or modality to PACS communication, “tag morphing” is sufficient to address issues of clinical utility. This is not the case when the communicating systems are larger, such as PACS to disparate PACS for data sharing, or shared archive to multiple disparate PACS, etc. To effectively correct for differences in the clinical utility of a particular data set, you must be able to manage the entire workflow context. This includes having the ability to manipulate DICOM data sets and the ability to manipulate and communicate data passing between the various information systems, such as RIS, PACS, digital dictation, HIS, etc. This requires HL7 communication and HL7 “tag morphing” capability.

A simple example will illustrate this point. Most PACS deployed today will either not accept or will provide highly limited workflow for an image study received for which there is not a pre-existing RIS order (generally provided by means of HL7 communication). Assume that a Vendor Neutral Archive is used to share image data between a number of disparate PACS at a number of different institutions. Assume that an image data set stored by PACS A is to be reviewed by PACS B at a different institution. In order for PACS B to make maximal use of the image data set stored by PACS A, PACS B should receive a RIS order associated with the data set stored by PACS A prior to receipt of the image data set. This can be accomplished by the Vendor Neutral Archive “preparing” PACS B for receipt of the image data set by sending it the appropriate order and report (if PACS B is not doing the primary read). This, of course, requires that the Vendor Neutral Archive sees all of the communication between each PACS and RIS so that it is synchronized and can act as a synchronizing agent.
In the above example, the Vendor Neutral Archive must appropriately manipulate the stored DICOM image data set and provide the appropriate order and patient information to PACS (and perhaps local RIS as well). This is an example of required Context Management capability for a Vendor Neutral Archive. DICOM element manipulation is only a piece of this broader solution.

Conclusion
Whether one needs “tag morphing” or Context Management capability depends on the problem you are trying to solve. If the problem is simply to store DICOM image data from a PACS or modality, and you don’t care about the ability in the future to have these data sets be usable, without migration, by a PACS of a different manufacturer, then you have no need of either “tag morphing” or Context Management in your DICOM archive.
If, however, you want to minimize the need for archive data migration and maximize the usability of the data you are storing in the DICOM archive, then “tag morphing” is required. If you intend to share data between disparate PACS then Context Management (which includes “tag morphing”) is required of the archive. These features are the primary distinction between a DICOM archive and a true Vendor Neutral Archive10.

1 The ACR-NEMA standard is the forerunner of today’s DICOM standard. The DICOM data transfer format is an extension of the ACR-NEMA data transfer format. The ACR-NEMA V3 standard was renamed DICOM so as to gain support for the standard outside of the U.S.2 A historical perspective of the making of the DICOM standard appeared in the article, DICOM – The Making of a Standard, published in Advance for Administrators in Radiology and Radiation Oncology in November, 1998. A copy of this article can be found at www.vendorneutralarchive.com in the White Papers section of the web site.3 In the 7 year period immediately after the publication of the 1993 DICOM standard, “tag-morphing” to facilitate the interconnection of various pieces of DICOM conformant equipment was still very common. The strangest example, a major modality / PACS manufacturer as late as 2000 required a third party protocol converting gateway (another name for a DICOM “tag-morphing” engine) in order to connect DICOM conformant MR systems they manufactured to the DICOM conformant PACS they also manufactured.

4 Today DICOM communication between PACS of different manufacture has replaced modality – PACS communication as the most challenging usage of the standard.5 Innovative new equipment usage frequently results in vendors defining and making use of proprietary, private DICOM elements.
6 The described “tag-morphing” requirements have been found while deploying Vendor Neutral Archive and inter-PACS image data routing applications.7 VNA – Vendor Neutral Archive

8 The author’s company, DeJarnette Research Systems, Inc. is the market and technology leader in legacy PACS data migration. The company has performed more than 250 migrations between more that 40 different vendor’s PACS products. The described problems are frequently observed in legacy PACS data migrations.
9 This situation ultimately led to additional DICOM elements being added to the DICOM Digital Mammography IOD, some years later.
10 A Vendor Neutral Archive is more fully defined in the White Paper, What is a Vendor Neutral Archive? A copy of this paper can be found in the White Papers section at www.vendorneutralarchive.com.