VistA Imaging VistA Imaging OverviewOverview

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

VistA Imaging OverviewVistA Imaging Overview

The VistA Imaging PACS is unique in its The VistA Imaging PACS is unique in its tight integration to the VHA VistA HIS tight integration to the VHA VistA HIS and its characteristic multi-media imaging and its characteristic multi-media imaging capabilities.capabilities.

The VHA National rollout began in 1998 The VHA National rollout began in 1998 and continues to evolve today.and continues to evolve today.

CPRS

MedSurg

ADT

PTF

TIU LAB

RADMODALITIES

TOOLS

MODALITIES

TOOLS

MODALITIES

TOOLS

MODALITIES

TOOLS

Traditional Proprietary Medical ImagingTraditional Proprietary Medical ImagingPACSPACS

CPRS

MedSurg

ADT

PTF

TIU LAB

RAD

VistA Imaging Integrated PACSVistA Imaging Integrated PACS

MODALITIES

TOOLS

MODALITIES

TOOLS

MODALITIES

TOOLS

MODALITIES

TOOLS

VistA Imaging ComponentsVistA Imaging Components

3 Functional Components:3 Functional Components: Display ClientDisplay Client for Clinical Viewing of for Clinical Viewing of

Images – non-rad, rad, documents, Images – non-rad, rad, documents, drawing templates.drawing templates.

Capture ClientCapture Client for document scanning, for document scanning, import of files or images.import of files or images.

Radiology Viewer Radiology Viewer for display and for display and interpretation of radiology images.interpretation of radiology images.

VistA Imaging OverviewVistA Imaging Overview

In August 2001, a VHA Directive In August 2001, a VHA Directive mandated the installation of ‘core’ VistA mandated the installation of ‘core’ VistA Imaging configurations to support Imaging configurations to support document scanning. All VHA medical document scanning. All VHA medical centers are in compliance.centers are in compliance.

Many sites included the VistA Rad Many sites included the VistA Rad application in their core installations.application in their core installations.

VistA Imaging Program VistA Imaging Program DesignDesign

The VistA Imaging Project is under the The VistA Imaging Project is under the umbrella of the VHA Office of Information umbrella of the VHA Office of Information and Technology.and Technology.

The Project is supported by OI staff from The Project is supported by OI staff from HSD&D, HSITES, and NTEO.HSD&D, HSITES, and NTEO.

The development office is located at the The development office is located at the OIFO in Silver Spring, MD.OIFO in Silver Spring, MD.

VistA Imaging Program VistA Imaging Program DesignDesign

Technical support is provided by both Technical support is provided by both VHA staff and an enterprise-wide support VHA staff and an enterprise-wide support contract.contract.

Training is provided both on-site and Training is provided both on-site and remotely. The IHS Portland Area Office remotely. The IHS Portland Area Office received on-site VHA training as a pilot.received on-site VHA training as a pilot.

The Implementation Team assists in The Implementation Team assists in planning, design, and implementation.planning, design, and implementation.

VistA Imaging ArchitectureVistA Imaging Architecture

Defined as a medical device, VistA Defined as a medical device, VistA Imaging’s storage architecture is designed Imaging’s storage architecture is designed with storage redundancy to protect against with storage redundancy to protect against the loss of patient data. Image data is stored the loss of patient data. Image data is stored in 3 places – RAID, tape, and magneto in 3 places – RAID, tape, and magneto optical discs (JB).optical discs (JB).

There are plans to re-engineer the storage There are plans to re-engineer the storage architecture, but OI funding constraints have architecture, but OI funding constraints have stalemated this initiative.stalemated this initiative.

Primary DomainController

Backup DomainController

Archive StorageJukebox

Magnetic Storage

Intelligent Subsytem

Tape Library

Network Switch

Private Network Connection

IntelServerSystem 2

Intel ServerSystem 1

Console Switch Box

MonitorKeyboard

Mouse

9 GB

(slot 3)

(slot 4)

(slot 5)

(slot 6)

(slot 7)

PSU

9 GB9 GB

(slot 3)

(slot 4)

(slot 5)

(slot 6)

(slot 7)

PSU

9 GB

Core System ComponentsCore System Components

VistA Imaging ArchitectureVistA Imaging Architecture

Some VISNs are consolidating their JB’s.Some VISNs are consolidating their JB’s. The trend is to provide approx 7 years of The trend is to provide approx 7 years of

on-line storage w/ the JB being accessed on-line storage w/ the JB being accessed less and less.less and less.

Many sites have a ‘hybrid’ PACS Many sites have a ‘hybrid’ PACS environment – Radiology cPACS w/ environment – Radiology cPACS w/ VistA Imaging PACS.VistA Imaging PACS.

VistA Imaging ArchitectureVistA Imaging Architecture

The VHA has designed its own DICOM The VHA has designed its own DICOM text and image interface engines. These text and image interface engines. These presently use MSM databases, but will presently use MSM databases, but will be migrated to Cache with P. 69.be migrated to Cache with P. 69.

The VHA and DOD have jointly The VHA and DOD have jointly developed a DICOM conformance developed a DICOM conformance statement to assist in the integration of statement to assist in the integration of commercial modalities.commercial modalities.

VistA Imaging TeleImagingVistA Imaging TeleImaging

VistA Imaging P.45, “Remote Image Views”, VistA Imaging P.45, “Remote Image Views”, permits users to view any type of image from permits users to view any type of image from any VI database nationally. This requires a any VI database nationally. This requires a Master Patient Index.Master Patient Index.

Sites use both VistA Rad and commercial Sites use both VistA Rad and commercial products for diagnostic teleradiology.products for diagnostic teleradiology.

After hour telerad services are also provided After hour telerad services are also provided by both venues; contract nighthawk services by both venues; contract nighthawk services are commonly used.are commonly used.

VistA Imaging TeleImagingVistA Imaging TeleImaging

Using VistA Rad features, images can be Using VistA Rad features, images can be ‘auto-routed’ or ‘on-demand routed’ to ‘auto-routed’ or ‘on-demand routed’ to another facility for interpretation. another facility for interpretation.

Approx. 60 VR sites of which half are using Approx. 60 VR sites of which half are using auto-routing for teleradiology transmission.auto-routing for teleradiology transmission.

Most using dedicated T1 lines or shared DS3 Most using dedicated T1 lines or shared DS3 lines for teleradiology purposes.lines for teleradiology purposes.

VHA is exploring a national teleradiology VHA is exploring a national teleradiology solution.solution.