By Laurence Yudkovitch, Product Manager – Synapse VNA, TeraMedica Division of Fujifilm

It has been hard to watch TV recently without seeing an ad from a leading technology company describing how a top health institution used its video conferencing software for patient care during the COVID-19 pandemic. A featured doctor mentions being able to share a screen with a patient to show X-ray images, and then the camera cuts to the patient looking at a computer screen nodding their head and smiling. There is no doubt that the frequency and value of telehealth visits has increased substantially during the pandemic, but the TeraMedica Division of Fujifilm has been exalting the benefits of virtual collaboration through Synapse® Mobility for years. Given the renewed interest, I thought it would be valuable to describe some of the differences between standard video conferencing and Mobility’s collaboration feature.

Synapse Mobility is an enterprise viewer that any authorized clinician can access directly or from a link in the EHR to view patient images. Mobility displays standard radiology and cardiology images, along with most specialty department images such as dermatology, physical therapy, GI endoscopes, dental images, etc. One of Mobility’s more innovative features allows a clinician to set up a real-time collaboration session with other specialists, physicians, or family members. Examples include:

• An internist conferring with a radiologist, oncologist, and/or neurologist about a patient’s recent exam
• That same internist adding the patient into the discussion or collaborating directly with the patient
• A physical therapist conferring with the school board to demonstrate that a child is able to return to their regular Phys Ed class
• A gastroenterologist reviewing colonoscopy images with a radiologist to identify the source of abnormal anatomy from a recent abdomen CT

An example I frequently share from personal experience comes from my daughter, who has ongoing problems with her knee. A few years ago, my wife took her to the orthopedic surgeon to review her MRI, but I was working, so they conferenced me in by phone, and I wasn’t able to see the MRI. If they were using Synapse Mobility, they could have sent me a link in real time, and I could have been more engaged in my daughter’s care plan by not only hearing the discussion, but also participating in the review of the MRI.

A few weeks ago, we had a follow-up visit with the same orthopedic surgeon, who ordered another MRI for my daughter and said we could have the follow-up by video visit. He mentioned doing it on his iPad so that he could aim the camera at the screen so we could see the images. (When I asked, he said he could also do it from his computer, but found the iPad more convenient).

While standard video conferencing software is now ubiquitous in healthcare, Synapse Mobility offers a few key differentiators for reviewing images:

1. 1. Automatic anonymization: As soon as the clinician initiates collaboration mode, Synapse Mobility removes all PHI from the screen. If a remote user takes a screenshot, they have no way to identify the patient. And because Synapse Mobility runs on the server, there’s no concern about information being left on the remote system.
2. 2. True collaboration: The host can grant each guest the ability to point to the images and/or use the tools. Each guest has a different-color pointer, so it’s clear what each person is pointing to, and they can each scroll through the images while sharing the same view. Measurement and annotation tools are also available to anyone, and markups can be saved as a secondary capture so there’s a record of what was found. Only the host has access to the archive, which is needed to bring other images into the collaboration space and prevents access to images by the guests.
3. 3. Diagnostic-quality images from any device: Synapse Mobility is the leading mobile-viewing platform for unrestricted access to diagnostic-quality content. It’s globally accredited to support diagnosis via desktop, laptop, tablet, and mobile devices, as well as specifically on Windows, Mac, iOS/iPadOS, and Android devices.
4. 4. Full audiovisual collaboration: Synapse Mobility uses the device’s webcam and superimposes the video on top of the images, so users can see each other while viewing the images. Additionally, users can grant access to the device microphones to enable real-time verbal communication during the session.
5. 5. Inherent tool: Synapse Mobility’s collaboration features can be accessed from all platforms, including the HTML 5 browser or through the tools within the iOS app.

Collaborating can cover so many clinical use cases. Many of our customers have had a variety of experiences and are always finding different ways to leverage the tool. Scenarios can include things such as tumor boards and teaching opportunities where multiple guests can collaborate at the same time, family members who are remote or may not be in the same location due to pandemic-inspired isolation, or in the pediatric setting where only one parent can be present during the consultation. All communication is encrypted, and since the source files never leave the server, security risks are mitigated. We’re glad to see telehealth enable continuity of care during the pandemic and look forward to helping providers deliver the best possible care to patients with the Synapse family of products.

By Greg Strowig, Vice President – TeraMedica Division of Fujifilm

In today’s multifaceted healthcare environment, providers need to see the whole patient in order to treat the whole patient. Because of this, image capture, storage, access, and management are all crucial components of your enterprise imaging strategy. Healthcare facilities need imaging interoperability, which allows healthcare professionals to exchange information easily, quickly, and securely so that more-informed diagnoses, treatments, and follow-up care can be achieved.

A vendor-neutral archive (VNA) is the solution for enabling imaging access and exchange across the organization and delivers unparalleled advantages to your enterprise imaging strategy.

Why Does Your Healthcare Enterprise Need a VNA?

A VNA allows you to securely capture, store, access, and manage all imaging and related data, regardless of source, file type, format, or image storage system. It also easily integrates with multiple clinical IT environments so that you can see the complete patient picture.

The variety of health information technology (HIT) systems comprising most clinical environments— including electronic health records (EHR), radiology information systems (RIS), and picture archiving and communication systems (PACS)—were originally introduced as departmental or siloed systems. These systems are difficult to integrate and communicate with each other and can slow down clinical workflow, burden IT systems, and even jeopardize care quality as a result.

Healthcare as a whole is evolving to focus on a more holistic approach to patient care. Connecting your enterprise with a VNA can help you achieve this goal, but how will you know which VNA is right for you? The right VNA for your enterprise provides simplified access to comprehensive patient imaging data from a variety of HIT systems to help you make more-informed and impactful clinical decisions.

Consider the essentials of a VNA:

Standards

• DICOM and HL7: Long-enduring standards for image and data interoperability
• DICOM Web and FHIR: The modern evolution of DICOM and HL7
• Native file support
• Image sharing and exchange support
• IHE profiles for cross-enterprise document exchange (XDS and XDS-i)
• Encounters-based workflows
• Application programming interfaces (APIs) that leverage interoperability

Trust

• Data that remains securely in the data center throughout its lifecycle
• Mobile device capture and viewing that leaves no patient data on the device
• Encrypted access to all data
• Sensitive and restricted data segregation
• Leading-edge security protocols
• HIPAA-compliant access to patient data

Storage

• Secure storage of any file type in its native format, in addition to DICOM
• Organized and accessible data
• Lifecycle management
• Dashboards that monitor storage consumption
• Agile adoption of the latest storage technologies

Clinical Connectors

• Multidepartmental solutions
• EHR integration
• Customizable departmental data tagging
• Robust clinical workflows
• Artificial intelligence-ready

Here are the top-four reasons your organization needs a VNA: 

1. Multimedia Storage and Organizational Capabilities throughout Your Enterprise

One of the most notable benefits of a VNA is its storage capabilities and the organization of stored data. A VNA system allows enterprise-wide access to a variety of file types, all from a single location. Regardless of the file type or format, images and patient data can be securely captured, managed, and accessed in a single VNA. With this, physicians can review a complete collection of patient data from a variety of departments and specialties, enabling them to see the full patient picture.

VNAs may offer both digital imaging and communications in medical (DICOM) and non-DICOM image storing, with access and viewing across a range of systems and specialties. This allows for continuous workflows to be achieved and holistic patient care to ensue. Examples of specialty departments and file types include:

• Radiology: MRIs, CT scans, X-rays, voice dictation files, advanced visualization images
• Oncology: Fluorodeoxyglucose (FDG)-positron emission tomography (PET), CT scans, X- rays, treatment plans
• Cardiology: Echocardiography (echo), catheterization (cath), nuclear, ECG ultrasounds
• Ophthalmology: Ophthalmology laser images, voice dictations, formatted PDF reports
• Surgery: In-department X-rays, endoscopes, arthroscopes, surgery reports
• Dermatology: Photos, dermatology reports
• Sleep lab: Polysomnograms, sleep study videos
• Point-of-care ultrasound (POCUS): Audio-video interleave (AVI), jpegs (JPG), ultrasound reports
• Wound care: Photographs, reports
• Endoscopy: MP4, JPG, endoscopes
• Ear, nose, and throat: MP4, JPG, otoscopes
• Orthopedics: MPR, JPG, gait studies, range of motion videos

A VNA is also critical to optimize your organization’s EHR investment while increasing physician adoption and user satisfaction. Images from the VNA are displayed within the context of the patient’s clinical information presented in the EHR, eliminating the need to switch between applications to access and view them. Consider the following VNA features:

• Interoperability: A robust VNA allows for interoperability across departments and systems, making access to information seamless and efficient for providers, all while remaining secure and Health Insurance Portability and Accountability Act (HIPAA)-compliant.
• Scalability: As your healthcare enterprise evolves, imaging data needs to evolve with it. A VNA provides a framework for fluid scalability and can adapt to include more facilities as your enterprise grows. VNAs should also work at various levels of an enterprise. Small departments, for example, can benefit from the data provided by more-established facilities, while large multi-facility organizations can enjoy the simplicity of compiling images from previously untapped clinical areas.

2. Security and Compliance of Patient Data

Mature VNAs follow industry-standard IT policies and principles when handling enterprise data, so you’ll never have to worry about valuable patient data being compromised.

A VNA is designed with information management at its foundation. A centralized IT system helps to keep your data under centralized control and management instead of being run by several different departments. This can improve security, reduce operational costs, and simplify administrative tasks. It also helps the IT department run more smoothly and have better control over various departmental branches. By operating under this centralized method, you can reduce the risk of data loss, theft, and HIPAA concerns. Another benefit of a centralized IT system is your ability to consolidate hardware storage by reducing the number of data silos needed for the system to run.

Patient data is kept secure by means of the following VNA failsafe’s:

• Zero-footprint: The VNA’s zero-footprint system requires no downloads and is accessible without requiring additional steps. When users need to view images, they are not downloaded in order to display. This means that they also do not require a client-side study cache, helping you to stay HIPAA-compliant while optimizing your bandwidth.
• Secure data: Your patient information never leaves the data center, keeping it secure at all times.
• HIPAA-compliant: Audited access is an important component of HIPAA compliance. A VNA should log user activity and identify what information was accessed when and by whom. Encrypted data capture and transmission are also critically important, particularly when working with mobile data collection.
• Segregated data: A VNA should support configurable access on a need-to-know basis. For example, only those with a hand in a specific patient’s care will be able to view their data. Sensitive data has additional restrictions and controlled access, helping to keep your organization compliant and your patients safe.
• Image lifecycle management (ILM): Data retained longer than legally required can present a legal compliance risk over time. Image lifecycle management is not only critical for managing storage costs, but also an important aspect of a comprehensive enterprise data management strategy for provider organizations and an essential element of a VNA.

One unique feature of a true VNA is its ability to allow you to choose how to store and manage non- DICOM content. With a VNA, you can either store it as a native file or DICOM-wrap the data. With non-DICOM items in their native format, the legal source of the image remains untouched, allowing the data to be returned to its departmental source and/or any consumers of the data in its original format. Private metadata tags also stay intact while reducing complexities for the originating source system.

3. Streamlined Imaging Viewing and Workflows

A VNA can also help to streamline efficiency across your organization. Without the need to cross- reference data or wait for images from another department, providers have more time to focus on patient care. Because of this, intuitive design and user-friendly operations are important elements in any VNA. For example, patient images in the archive can be displayed within an EHR, saving time for providers while reducing ancillary software needs.

Some VNAs also offer mobile viewers that allow you to access your images from any HIT platform through a zero-footprint application on any device. This diagnostic viewer allows physicians to access a patient’s imaging record from any location throughout the healthcare enterprise, whether in a patient’s room or even in their own home. Through this powerful visualization solution, the physician can see the same results on their mobile device as they would at a workstation in a hospital without requiring any code to download or caching of local images. This capability is also HIPAA-compliant.

Diagnostic accreditation, which encompasses the treatment decisions made by a provider, is also an important factor to consider in enterprise viewers. Consider an enterprise viewer that has obtained FDA Class II 510(k) clearance—one of the most stringent standards from the FDA that allows providers to make diagnostic decisions using web clients and view images using iOS apps.

Some solutions may incorporate collaborative programs, such as voice and video calls. These can help increase the interoperability of your system to further encourage provider collaboration, but they must be secure and HIPAA-compliant as well. With access to cross-platform data, informatics professionals can also use this information to improve their operations and patient outcomes. Provisions should also be made to allow patients to access their own images and share with other providers.

Another convenient feature of a VNA is the ability to share clinical records across an enterprise, which helps to improve workflow efficiency for providers. Synapse® VNA uses integrating healthcare enterprise (IHE) cross-enterprise document sharing (XDS) to achieve this while providing full referral tracking information to the original provider. Additional documentation can be attached to these systems, with notifications to inform the providers involved.

4. Cost Savings When Choosing a VNA

Successful VNA implementations can reduce overall costs for storage and data management by providing a centralized location for all specialty department data. Having fewer systems to manage, back up, upgrade, and support can result in significant operational savings. With that in mind, you will still want to choose a VNA that offers the most value to your business. Consider the use of DICOM and non-DICOM objects. Is increased availability and security of non-DICOM content something you need? You should also think about the options for workflow improvements. Would your facility benefit from mobile access, capture, and viewing?

VNA implementation requires a governance plan with a strong and strategic outline for the planned uses of the system and the goals you wish to achieve. Consideration should be made to review technical setup and requirements needed to integrate existing systems to a VNA.

While the initial implementation of a VNA initiative can be wide in scope, it can save money in the long run through lower operational costs and increased efficiencies. Consider the following features to further support this concept:

• Flexibility: Data migration is expensive and time-consuming. It may even be one of the highest costs associated with replacing an image management system. Using a VNA requires you to migrate data only once, eliminating the need to incur this cost in the future. VNAs also offer you more flexibility in the products you can use, instead of locking you into the imaging software vendor’s products. You can find cost savings here as well.
• Informatics: A VNA can save you money by expediting your informatics professionals’ workflow through simplified access to imaging data. Not only does this enhance productivity, but it can also inherently bring more-positive results to your facility.
• Lifecycle management: VNAs are designed with the future in mind. They require no data migration after initial setup and offer image lifecycle management (ILM) benefits. ILM is a necessary component of any data system, as it identifies data for purging and optimizes files to lower the storage costs associated with long-term data archiving. It can also apply rules to determine what data will remain on high-speed, high-cost storage tiers and what will be deleted or moved to various lower-cost storage tiers over time. VNAs with robust ILM can also apply higher levels of image compression, freeing up storage space as images age throughout their lifecycle.

Disaster recovery can also be a major cost-saving component of a strong VNA. Ensuring that your facility has the proper strongholds in place can be crucial to your business if data recovery ever becomes necessary.

Choose the Right VNA for Your Organization

In today’s healthcare environment, there is no room for substandard processes. Your patient image and data management system must be efficient and trustworthy. It should offer features that improve workflow, such as flexible file type storing, organizing, and viewing, with secure access from any device. It should also prioritize interoperability, through which clinical data can easily be stored, shared, and accessed by those who need it, with the clinical connectors that support it.

Synapse® VNA from the TeraMedica Division of Fujifilm can improve patient outcomes, increase workflow productivity, and lower costs for your organization. Please contact us for more information on how the industry’s leading image management solution can benefit your business.