There is a paperless target for NHS Trusts. If VNAs are properly specified they can help achieve the paperless NHS objective. Life Cycle management must be considered when digitisation is considered.
VNA must have the following standards based components: 1. VNA must have a DICOM Archive must store DICOM images in DICOM part 10 format 2. VNA must support WADO (Web Access to DICOM Object) to allow for web access to DICOM images without having to do a DICOM query retrieve for display. 3. VNA must support IOCM (Image Object Change Management) Profile of IHE to allow for synchronization between PACS & VNA when images are culled. 4. VNA must contain an XDS Registry—for indexing medical images and documents from various XDS sources 5. VNA must contain an XDS Repository—for storage of standard formats of documents (PDF and CDA), DICOM manifest, JPEG etc from multiple XDS sources. VNA’s XDS Registry-Repository must allow any vendors XDS consumer to connect to display the VNA content 6. VNA must contain a Document Administrator to allow for metadata update or deletion of document set. 7. VNA must have a PIX Manager (or PDQ supplier)—PIX Manager must receive regular demographics ADT updates via HL7 messaging—A-04, A-08 and A-40 (new patient registration, demographics update and patient merge messages). PIX Manager must support standards based demographics query (PDQ query) by any vendors XDS consumers for their patient banner display. 8. VNA must have a ATNA (Audit Trail Node Authentication) based Audit Repository—for storage of audit trail data from multiple XDS consumers 9.XCA Gateway (Cross Community Access)—Would allow VNA to transform the local ID to the NHS no or CHI no and sends to the query to the neighbouring Trust’s XCA gateway. XCA gateway would allow clinical networks to share images and documents between Trusts using standards based federated query. 10. XDR—Cross Enterprise Document Reliable Exchange—to allow for sending medical documents to another institution or to a GP surgery. It could also be used for end of contract migration of data to another vendors XDS Registry and Repository 11. VNA database must support SQL so that it allows standardised migration of clinical metadata within the VNA database.