What makes you so special, DICOM?

Steve Rudland
Steve Rudland, EMEA Healthcare Practice Leader, Hyland, creator of OnBase

Back in May 2011 I was talking to a doctor at The Guardian’s sadly short-lived Health Network show in London.  We were talking about what Enterprise Content Management actually meant, and specifically about what sort of content OnBase by Hyland could manage.

“Everything…” I said.  “Any unstructured information.  Whatever doesn’t fit comfortably into the rows and columns and tables of a database.  Your EMR is for your discrete patient data.  Your ECM system is for all of the unstructured information that completes that record: the letters, the photographs, the diagnostic outputs, the scanned paper…”

“So, what about medical images?” he asked.  “What about DICOM?”

Indeed, what about DICOM.  On the one hand, everyone had a PACS, but on the other hand it seemed crazy to me that here I was talking about ECM, a technology that was hardly new, being able to manage pretty much any document format except DICOM.  There were a lot of good arguments for keeping medical images separate: special viewers were needed, displays needed to be of a certain quality, the systems were bandwidth-hungry, and so on.  But even as I was talking about this, none of it really rang true. Why should hospitals be investing hundreds of thousands of pounds in ECM systems to manage their unstructured information, but then be expected to invest millions of dollars on a system dedicated to the handling of one file format?

I told the doctor that I envisaged a point where DICOM content would be just another format handled by ECM.  “You think that you can replace PACS with ECM?  Good luck with that…” was the response.

Fast forward to 2015.  Whilst the England Rugby team hasn’t progressed, the tech industry has.  One by one, the arguments for a dedicated PACS system have fallen: Enterprise medical viewers such as those from Calgary Scientific and TeraRecon provide a single window onto multiple DICOM repositories, display quality has improved radically and continues to improve, bandwidth is cheaper, as is storage.

Meanwhile, the DICOM industry has muddied the waters with the concept of the Vendor Neutral Archive (VNA).  The idea of a VNA is to provide a single archive repository for all DICOM and non-DICOM content.  In practice, most VNAs achieve this by wrapping the non-DICOM content in DICOM, rendering it virtually useless for any purpose other than archiving.  In order to be truly useful, and portable (especially at the end of a contract), content needs to be stored in its native format; like in an enterprise content management system…

There has been a lot of confusion around definitions of a VNA.  One VNA vendor whispered to me that it stood for Virtually Nearly Anything!  In reality though, what is an enterprise content management system if it isn’t at least VNA?  The key word here is “Archive”.  An ECM system is so much more than an archive for old documents.  An ECM will enable processes that are currently dependent on physical documents to be automated and improved by replacing paper forms with electronic forms, capturing clinical content directly to the repository, tracking and measuring processes to ensure service levels are met, and delivering documents wherever they are needed without requiring them to be printed. An archive is where you put stuff when you’re finished with it…

Gartner identified that a number of ECM vendors, including Hyland have determined that the concept of a VNA fits within their definition of ECM[1].  This is a logical conclusion and is consistent with Hyland’s approach of managing all content, in its native format in a single repository.  Taking this approach enables OnBase to incorporate DICOM content into workflows that are driven by the workflow engine as easily as if it were Microsoft Word or a HTML form.  It also means that customers know that they can change their EMR, RIS, and even eliminate their PACS/VNA systems without compromising the availability of their DICOM content.

The only issue left outstanding in this approach is the view that DICOM is special and needs its own dedicated repository. 

It isn’t, and it doesn’t.   


[1] Market Guide For Vendor-Neutral Archives – Gartner Inc, August 2015

DICOM, Digital Imaging and Communications in Medicine, ECM, Enterprise content management, Hyland, PACS, vendor-neutral archive, VNA


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