Federal health services choose VA imaging standard

By Bob Brewin
01:00 AM

Two major federal health services expect to standardize on a medical imaging system that the Department of Veterans Affairs developed and already uses. The Indian Health Service will test the VA's medical imaging system this summer in its Portland, Ore., area office before deploying it nationwide, top IHS officials said.

The Defense Department announced last month that it would adopt the VA's medical imaging system as its standard. Carl Hendricks, chief information officer for the Military Health System, said DOD intends to use the VA's Veterans Health Information Systems and Technology Architecture (VistA) Imaging system in its 70 hospitals and 411 clinics worldwide.

The VA operates 154 hospitals and more than 800 clinics, while IHS runs 33 hospitals and 59 clinics. The number of hospitals operated by IHS and the number of clinics operated by the VA exceed the number of facilities operated by Kaiser Permanente, the largest private health care provider in the United States, which has 30 hospitals and 431 clinics.

It makes financial sense for all three federal health care systems to use the same imaging system, said Robert McFarland, the VA's former CIO who retired in April. He said DOD will save tens of millions of dollars by adopting VistA Imaging instead of developing its own system or buying a commercial one.

McFarland said the expanded use of VistA Imaging is a good-news story for the VA. But he added that the VA and other federal health services would be better off not using the VistARad software for reading diagnostic radiology tests, which is built into the VistA Imaging system. He said VistARad is older software that the VA should replace with a more sophisticated commercial product.

DOD's and IHS' decision to adopt VistA Imaging is an example of making good use of government investment in information technology, said Dr. Stanley Saiki, director of the Honolulu-based Pacific Telehealth and Technology Hui, which is a partnership between the VA and the Army's Telemedicine and Advanced Technology Research Center.

Saiki added that because VistA Imaging was developed in-house, the three federal health care systems will be able to share code and adapt it to their specific needs without needing to contact a vendor for expensive modifications.

VistA Imaging integrates clinical images and scanned documents into a patient's electronic health record (EHR). The system also accepts electrocardiogram waveforms and retinal scans.

Dr. Mark Leavitt, chairman of the nonprofit Certification Commission for Healthcare IT, said the private health care sector is less advanced than the VA in terms of integrating medical images into EHRs.

He said the history of DOD's and IHS' EHR systems makes VistA Imaging a natural choice. DOD's Armed Forces Health Longitudinal Technology Application and IHS' Resource and Patient Management System (RPMS) are based on the VA's EHR system.

Dr. Mark Carroll, telehealth program director for IHS, said the agency decided to adopt VistA Imaging because RPMS did not have the capacity to store images in patient records. In addition to VistA Imaging, IHS will use software developed by the federally funded Alaska Native Tribal Health Consortium to integrate images into RPMS. The software was developed to transmit images between various IHS facilities, said Rich Hall, the consortium's IT director.

The first VistA Imaging feature that IHS plans to implement will be document scanning, which will let the service capture records from outside providers, Carroll said.

Speaking at FCW Events' Government Health IT Conference last month, Hendricks also expressed interest in using the VistA Imaging system to capture information from clinicians who operate without EHR systems. However, some health IT experts caution against using scanned images of written documents except as a stopgap measure because the text cannot be searched.

IHS is already testing VistA Imaging while DOD has not yet reached that stage. But their plans to adopt EHR systems with integrated medical imaging illustrate that federal health care providers are on the cutting edge of health IT, said Dr. Theresa Cullen, CIO of IHS.

VistA Imaging is open to many formatsThe imaging system for the Department of Veterans Affairs' Veterans Health Information Systems and Technology Architecture (VistA) has a variety of features that appeal to the largest federal health services, including the following capabilities.
  • Users can integrate VistA Imaging's medical images and waveforms, including X-rays and electrocardiograms, into the VA's VistA electronic health records system.

  • Users can display thumbnail images and click to enlarge them.

  • The system supports network servers, magnetic and optical-disk storage, and gateways to the VA's picture archiving and communications system for filmless radiology.