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VNA: A Whole Hospital Opportunity

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041019-N-5821P-019Now that VNA (vendor neutral archive) based clinical content systems are becoming more and more mainstream in UK hospitals, it’s worth reviewing what it is we’re looking for out of them – and how far we may need to go to get there.

A lot of hospital CIOs have been taking the VNA route in the short term as a way to reduce the costs of running PACS and other image systems side-by-side. But more than a few of them have a longer term view in mind; using the VNA as a standards-based way of creating a single method for working with all sorts of data, not just images – as a back-door, but very pragmatic, way of getting to the electronic patient record promised by the National Programme but which hasn’t happened.

Making that latter aim a practicality and taking the next step beyond DICOM is where a lot of Trusts are paused right now. There’s interest in putting data in the VNA, as hospitals look to the Paperless NHS target of 2018-20 and want to make better use of patient data, keyed to the central NHS Patient Number.

We have been working with a number of Trusts that got that far, and have also been able to go further. We’d like to share some hints and tips about their learning about what to do next.

VNAs are ways to create platforms for the long-term archiving of DICOM format image data, typically as produced at volume in a hospital’s Radiology department. What’s been driving interest in them recently, as a by-product of the winding down of the National Programme for IT, is that there’s been a lot of ‘repatriation’ of DICOM imagery, but repatriation to this newer technology rather than to a standard PACS system. That’s partly due to an interest in collating all sorts of image files, so cardiology and echocardiogram and so on, into one place for clinician access, as a way to improve access but also better store and archive all this content.

So much dead data

So when making this move to a VNA, what we do know for certain? We know that you’re going to end up with a lot of data. For a start, it’s a question of volume. Few people – maybe only you and your team in IT? – will realise how much data has been accumulated.

So an important first step is cleaning that data up. Some of it can be summarised, some will be corrupt and can be deleted. There is clearly a project around data protection and retention and your policies around those issues. This is a great opportunity to get rid of dead data you don’t need any more, saving disk and tape cost at a stroke.

What you need to try and end up with is a purged set of data you know is important and needs to be accessible. Obviously, that has practical implications for both storage and access. The first storage element is IT’s job, but the second part is going to be about talking with internal stakeholders to identify just what departments want to put into the VNA and what they will want to pull out of it. You can start with Radiology as they will need access. But who else?

That’s where a VNA can start to add value. This is where other sorts of content, like stored photographs, videos, endoscopy files, patient medical records needs to be fed in. Getting that DICOM and non-DICOM content in one place is the objective, but it’s also a cross-enterprise, cross-departmental task that will need proper planning and co-operation around the Trust.

I’m going to put my neck out a bit and say that that’s where a lot of wheels are spinning right now. You have to have a strategy and it’s got to be one that all the stakeholders not just understand but buy in to. And to be honest, you can’t buy a strategy off the shelf from a vendor. To get the most out of a VNA, you are going to have to sit down and plan, with department heads, starting with Radiology but radiating out from there, about the best ways of handling all your data.

Next time we speak, let’s discuss what our Trust VNA customers are telling us is the best way to address that issue. The good news is that they have – and the interest in using a VNA as far more than a DICOM repatriation platform is spreading across the whole NHS.

Jason Scholes
Co-Founder
SynApps Solutions

A Commitment To Quality And Standards: How New SynApps Is Going To Work

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161015You’ve not heard much from me on this blog. I’ve been kept pretty occupied these past few years running the customer service and support side of the SynApps Solutions business.

There have been some pretty profound back stage changes in the past few months that have required everyone’s attention here. Those changes are what I want to briefly talk about today, as I think they are both interesting but also important to understand in terms of the direction of travel we’re taking.

In July we announced that we’re re-organising the management part of the company in the wake of Jim’s decision to retire at the end of the year : myself and Mark Winstone are combining forces to become joint CEOs of the company.

Small to medium, in one smooth jump

Now, there are various reasons behind this move, and Mark will have told you more about that in our last blog. But I think it is useful to know that bringing his perspective as the sales and marketing manager and mine as the customer services manager together is about bringing two sides of the company together – so that they are working in unison.

That’s one facet of a whole slew of changes that one can sum up as saying, We’re changing from being a small company to a medium sized company. So when I mention back stage changes, what’s been happening there is an important part of our metamorphosis – another way we are preparing ourselves for a new phase in our growth.

The past twelve months or so have been dominated by us committing to a more formal, standardised way of doing business. It’s also been about putting in place structures to focus on better quality and superior customer service. I refer to our move to becoming an ISO 27001 information security certified company.

ISO 27001 is the gold standard for working properly and reliably with data. We want all our customers, in the NHS, in the Police, in the commercial sector, to know that we are a guaranteed safe pair of hands.

Getting that certification requires a lot of hard work, which the SynApps team were willing to get done. As a result, our policies and procedures are enterprise-class and very robust and your data and information are now incredibly secure with us.

Becoming the company you need us to be

We’re not done with standards. Our next push is in the operational quality field, with ISO9001 – part of a concerted SynApps drive to become an accredited professional company to partner and do business with.

At the same time, we’ve been doing a lot internally around building our cloud capability. That’s a side of the business that has seen real growth, reflecting the way buyers’ residual concerns about security and control have been receding. Cloud is another core focus for us as we take SynApps to the next stage.

Putting Mark and I together in the driving seat of these changes makes lots of sense; we need to work together to become the company we want to be – and which you, our customers, need us to be.

Thank you for your time and if anyone wants more detail, just drop me a line at James.Paton@10.128.0.8.

James Paton

James Paton, one of the original SynApps Solutions founders in 2003, has been Customer Services Director for the past seven years. He and former SynApps Director of Sales and Marketing Mark Winstone are now joint Chief Executives of the company, following the decision that founder and fomer CEO Jim Whitelaw is to retire at the end of 2015

A Few Small Words On Some Big Changes

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161015Since we last spoke, we’ve been busy making some improvements and changes to the way that we work here.

That’s mainly what I want to talk about today, though I do have a personal message to end with.

So, what’s been happening?

As you will have seen from our announcement in July, we have created a new management structure to help us make the most of changing circumstances and new opportunities.

There are two elements to this. One half is about the organic changes we are experiencing as a company. SynApps has done amazingly well since we were founded in the early ‘Noughts.’ We have secured two important partnerships, with EMC and with Alfresco, who form the bedrock of all we do here. I would also like to shout-out to another tech partner we’ve done some great work with, J4Care.

Working with these partners has helped us enter a lot of markets where we’ve done some great work. But SynApps is growing – and we’re fast-becoming a mid-sized company.

To service customers as a mid-sized company means a lot more process than when you’re an SME. You have to have real core corporate disciplines in place.

That’s why I have stepped up, with the permission of the board, to become co-CEO.

My colleague James Paton shares the responsibility with me. James has great experience in introducing standards and procedures like the ISO 27001 systems and bedding in our new sales automation tool, Salesforce, and will look after this side of the business and the service side. We are putting a lot more science into our budgeting, forecasting and pipeline, in order to be a slicker, more professional partner for bigger organisations. I know James has some discussion on that front that we’ll be publishing here soon.

My main focus is going to be on strategy and seeing where we need to take the company next. James and I see both roles as equally vital, which is why they need to be at the same level.

A special thanks to a certain Mr Whitelaw

It’s an exciting and challenging time, then. We know we have a lot of work to do. But that’s for the best reason – opportunity. We are doing well in interesting markets that are seeing the potential for ECM for the first time. With EMC, Alfresco and J4Care at our side, we are winning excellent business – especially in areas like the NHS.

So – changing circumstances, both inside SynApps and in the market. But, the other half of that change is the decision of Jim Whitelaw to pass the baton to myself and James.

Jim’s done some amazing work and the company wouldn’t be the same without his leadership and contribution. He’s retiring at the end of 2015, and it’s going to be sad to see him go. Many of the systems and structures I have discussed Jim spotted the need for and he spurred us on this path.

So – Jim, can I say, on behalf of both James and the rest of the SynApps team, how grateful we are that you took on the role of leading us from the front for so long. You’ve put us in a great position. Now it’s time – working with our customers – to make all that come to fruition.

What a year! Here’s to a very busy Q4 – it’s going to be a real landmark for us.

Speak soon,

Mark Winstone
Joint CEO and Sales & Marketing Director
SynApps Solutions

XDS And Its Huge Potential: Is Europe Being Short-Sighted About It?

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woman-83155_1280One of SynApps Solutions’ most important technology partners is J4Care. Its global Marketing and Sales Director, Marcel Swennenhuis, looks today at XDS and how it’s starting to help institutions safely share data beyond the hospital wall

Healthcare providers want to share information not just between departments but increasingly, across organisations, at all sorts of levels. XDS, Cross-Enterprise Document Sharing, is absolutely the right technology to allow you to do that – as we are starting to witness in Finland, Holland and England, but also other countries around the globe.

XDS allows you to set up a federated structure with different repositories which are linked together. Each hospital can have its own repository and still be able to see the information in the other hospitals easily, thanks to the underlying standardisation.

Plus, with XDS you can connect DICOM VNAs, EMRs, laboratory systems and dermatology systems  – there’s so much you can practically do. XDS is a kind of umbrella, enabling you to retrieve information from all of those types of systems. Indeed, our VNA is just one of those sources, but we also provide this XDS umbrella.

XDS is universal standard defined globally by a worldwide standardisation organisation, IHE, which stands for Integrating the Healthcare Enterprise. This is great as vendors like us can build XDS and deliver software on a truly international scale. Many of us expect that soon IHE standards will also be used in a Pan-European way, too, so that a doctor in Spain can access medication information from a patient who resides in Holland but who is on holiday in Spain.

Great – but how do we get there from here?

One of the starting points is medication. The most important medical information you need to share for a patient is medication. One might think it is imaging, but it’s not! Medication is the most dangerous thing to get wrong because with the wrong combination of medications you could end up dead.

So if the Dutch national visits a pharmacist while holidaying in Spain and requests a certain medication but the pharmacist has no clue about what they are using they run a major risk.

Usually, that pharmacist in this imaginary Spanish location will just refuse to issue anything at all – ‘Sorry, but I am not going to prescribe you this medication unless I get a fax from your pharmacist in Holland that shows me what kind of medication you are taking right now.’ And usually, that just doesn’t happen, at least in a timely way. But this is something that could definitely be solved using IHE-standards like XDS.

So XDS could be used at all levels and internationally.

In the first instance, it’s more likely to be used at the Trust, region and country level. Many hospitals will also use it internally as they have so many different systems but by using XDS and forcing suppliers of the different ‘silos’ we discussed to support the standard, they can generate one view internally without having to move to one big system.

They could still have three or four repositories internally but use an XDS umbrella internally with one viewer that shows the integrated records to the doctor. Using XDS as a way of sharing between departments within a hospital is a trend that we see happening a lot right now, especially in Holland.

However I do have to add that there is a difference in adoption-speed at the European level in terms of XDS right now. XDS in Belgium hardly exists while in Holland, every hospital is talking about it. How can that be? They are such close neighbours. In Germany, XDS is again hardly there, probably coming but almost nothing is in place at the moment. It is really very different for each country, with each looking at the healthcare system from a different point of view.

Finally, I look forward to hearing more about SynApps success with its new Healthcare Practice over the coming months.

Marcel Swennenhuis works at our core tech partner J4Care, an innovative software company that’s helping medical professionals, as well as patients, by enabling easy, safe and fast storage and access to complete medical records

Will Open Source Prove Crucial In The Move To Five Year Forward View?

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Ben_Goldacre_TAM_London_2009_(2)Technology is acknowledged as being crucial to the salvation of the NHS – a fact acknowledged by NHS England’s leadership, most recently in its 2014-15 Annual Report, where it is stated that better use of data and technology has the power to “improve choice and outcomes for patients, allow them to take more control, reduce the burden on front-line staff, increase accountability and support the NHS as an engine of science and economic growth”.

It’s regrettable, then, that we are still hitting NHS technology roadblocks. I refer to the General Practice Extraction Service (GPES), whose cost rose from £14m to over £40m with only NHS England so far able to use it.

However, it’s less useful to criticise this particular project than it is to look for new ways of doing Health IT better.

An important clue in the discussion of GPES was there. Listen to well-known, medical sector commentator Ben Goldacre, who posted this statement on the GPES row: “[This is why] we need open APIs, open data, open source, shared mapping ontologies &c to permit innovation AND inter-operability”.

Why are people like Goldacre talking about open data and open APIs? A growing number of NHS Health IT experts – including NHS England itself, as well as commentators like Goldacre – see incredible potential in de-risking IT projects by accessing the power and scope of a wider, supportive Open Source community.

‘All kind of vendor tricks’

Those are important stakeholders to get behind Open Source. Much more important ones are actual practitioners – front-line NHS IT leaders who are using Open Source. We have worked with many, as our Clinical Content Store has an Open Source option.

Take just one example – an Integrated Care Trust in the North of England whose CIO told an audience of NHS health leaders and other HIT (Health IT) stakeholders recently why she was so attracted to the idea: “The entire marketplace that comes through our door is the commercialised EPRs – the big American vendors, trying to get our time and trying to sell us the big Americanised products. They do have a lot of ‘pulling power’ and work very hard to get you to buy their products,” she says.

The problem is, the situation is much more complicated at the coalface – and she needs more flexibility and a wider range of options to deal with the reality she sees than is on offer, basically. “We have got about 300 systems in my organisation alone, because it is made up of several previous Trusts and organisations put together, so I have a whole set of systems to deal with,” she says. “And you see all kinds of tricks from vendors who don’t work in Open Systems who try to make sure you can’t get to the data. We all need in the NHS to abstract data from applications so that we don’t have that situation any more.”

She contrasts this situation with the Open Source alternative, as she sees it: “I can put my clinicians into a product community; we can help steer it – indeed, it is really up to us to make it go somewhere – It is slightly lazy always selecting a safe vendor (but knowing you’re paying over the odds for that ‘safety’) as opposed to contributing to a community where you are steering the product. I also think there are many advantages in the longer term in this kind of shared product development.”

But perhaps the single statement that shows why people from Goldacre to NHS CCIOs are right is summed up by her last remark to the audience about all this: “I just can’t tolerate vendor lock-in any more.”

Is it time to look at Open Source as a way to avoid many of the problems of older style technology delivery? I think it is. Of course, it’s not a silver bullet and won’t solve all your problems overnight – this is real life, after all.

But to get to the kind of NHS Simon Stevens envisages, I suspect Open Source is going to play a much bigger part than any of us can imagine right now. What do you think?

Tony Backhouse

Head, SynApps Healthcare Practice UK Team

Why Are Trusts Interested In Non-DICOM Solutions Right Now? A View From Industry Experts J4Care

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Img_blog49Let’s find out more about one of our most important technology partners here at SynApps Solutions, J4Care, whose global Marketing and Sales Director, Marcel Swennenhuis, shares his views on the non-DICOM aspect to the health IT market

Emerging customer demand around non-DICOM

Patient records are a combination of medication information, documents, reports, patient history – and also typically images, both DICOM images, e.g. radiology, as well as non-DICOM ones, which could be dermatology pictures or other pictures of a patient.

The problem is that all those types of content are spread over different systems and in different formats. For a doctor, that can be very frustrating, because to get a complete view of the patient he often has to go to different systems, to get to what he needs to know about a patient.

That is not ideal. Doctors are starting to say, ‘Just give me one way of looking at an entire patient record, including radiology images, cardiology, dermatology and medication!’ Because that is a lot easier, clearly. I hear from a lot of medics that they only have a few minutes to talk to a patient during a consultation – and if they have to log into three or four different systems, it’s unmanageable and they won’t do it. They have to ask the patient ‘Please tell me what kind of medication you are using,’ and ‘Can you bring me a CD with the back X-ray images’. Information should be simple to access and available, in one place. That is the marketplace demand we are seeing more and more of.

The curse of the silo

The reason we’re at this point: silos. Historically, each and every department in a hospital had their own ‘silo’ of information. They all had their own database with information that had to do with their specialisation.

There’s another IT aspect to this to consider. Hospital IT departments are buying more and more archives/storage from different vendors. They have to go to one particular company for storing their radiology data, then another for storing the cardiology information, then to another for storing the medication information etc.

The problem that results from that is that it is very difficult to keep everything in line. They would like to have just one system where everything is stored about a patient.

The good news is that with more modern systems, especially VNAs, we are getting to a more integrated view of the patient, driven by the doctors, who want everything together.

The 2018 paperless NHS target

In the UK, there has been a drive to create a unified patient record, and there is an NHS paperless target for 2018. What’s interesting is, this ambition is far from being a UK-one only – it’s European wide, although manifesting itself differently in different countries.

Finland has, for instance, said it wants one integral view of the patient, with everything digitised in a centralised way, so it is setting up one central system where all hospitals are required to send important data, then any other hospital or any GP can access it, even the patient. The goal is to get rid of paper and see the end of patients running around with CDs or documents if they visit another hospital.

In The Netherlands, they are also trying to digitise everything – however, here there is a completely non-centralised approach. Each hospital is individually aiming for digitisation, then connecting to all the other hospitals so that, with all kinds of protocols and security, each hospital can look into the data of the other.

Estonia is also following the Finnish centralised route – which we’re helping by implementing one integrated viewer for all images, across the country; we are also doing a project in the region around Johannesburg (South Africa), which is following a centralised approach for 30+ hospitals to share patient-data. In England it’s more of a semi-centralised approach, which is closer to the Dutch model.

Marcel Swennenhuis works at our core tech partner J4Care, an innovative software company that’s helping medical professionals, as well as patients, by enabling easy, safe and fast storage and access to complete medical records

J4Care And What It Brings To The SynApps Healthcare Story

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We are a software company located in Vienna, Austria, with a focus on VNA (Vendor Neutral Archiving) and DICOM viewing and reporting.

We were founded in 2007 by a group of experienced PACS engineers, who wanted to do something that was a) based on open standards and b) used Web technology as its basis. From those beginnings, we delivered our first solutions in 2009, and we now have an install base of around 80 customers – mostly in Northern Europe, some in Africa and the Middle East and so on, but we have had most of our success in the Netherlands, Belgium, England, Austria and Finland.

The two core products we have are a VNA and a viewer, both based on standards and which can also be sold as two independent products. We have customers who have both the VNA and the viewer, but we also have customers that just have the VNA and customers that just have the viewer. In terms of who those customers are, they are hospitals: regional ones that share medical imaging amongst each other; national organisations (for instance, two of our main projects are the national medical imaging archive of Finland and the national viewing of images system for Estonia); and at the other end of the spectrum, diagnostic centres and diagnostic laboratories, which are relatively small but will do a lot of works for GPs, say. In England, of course, we are working with Acute Trusts.

In terms of functionality: we are one of the few VNA suppliers to allow clinicians the chance to do full diagnostic work with our viewer. We are one of the few full Web-based diagnostic workstations. Many suppliers out there have a viewer, but it is not equipped for radiology diagnostic work – clinicians can look at the images, but they cannot take a full diagnosis on what they see and usually need special workstations. With our solution, everything can be done through the web.

Away from proprietary

The key to our success is “Open” standards. We aim to be the most compliant VNA and viewer solution in the market, so we can integrate easily with any other supplier and are furthest along supporting various standards in the field. That’s very important for our customers, as they know those standards are being supported and we are continuously up to date with that.

Standards are also incredibly important in the healthcare marketplace.  That’s because so many healthcare organisations want to exchange information amongst each other and if you have your own proprietary way of doing it, it is often very difficult to connect between hospitals and regions.

Last but not least

And, of course, SynApps Solutions is a big factor in our success. It’s our distribution and implementation partner for the United Kingdom – and anything we deploy in England goes via SynApps. We focus on technology development and work with local partners to do all the marketing, sales, support, and use our software for their businesses.

Marcel Swennenhuis is one of the leaders of core tech partner J4Care, an innovative software company that’s helping medical professionals, as well as patients, by enabling easy, safe and fast storage and access to complete medical records

Next time Marcel will be taking a look into emerging customer demand around non-DICOM, for both Medical Photography and Patient Records-type customers