As we are entering the new year, one might wonder what this upcoming year will bring in the healthcare imaging and IT field. After the foundation that was laid in the 1990 of solid and reliable standards such as DICOM and HL7, the first decade of the 21st century was dominated by digital imaging and PACS system installations. There are still a couple of departments in a hospital that are holding on to analogue technologies and non-DICOM encapsulation of their data such as pathology and endoscopy which generates MPEG clips, but that will gradually convert over the next few years. Most US based healthcare institutions are already at their second or even third generation of PACS installations. Migration has become a major issue as unexpected costs have become associated with changing vendors and loosing essential information such as image annotations, key images, and other presentation state information. This is one of the major reasons that people are considering Vendor Neutral Archives or archiving images in the "cloud". However, these VNA cloud solutions have created quite some confusion as there is no true definition about what a true VNA storage solution would encompass.
One of the major components in my definition of a true VNA is the capability to provide image access by a stand-alone viewer or through an Electronic Medical Record in a non-proprietary manner. Each vendor has its own plug-in and/or web access which allows for image access to their own images, but the challenge is to provide this capability to different vendors from different systems. IHE has defined a way to do this using the so-called XDS-I profile, which is based on a Dicomized version of a web protocol, called WADO, or Web Access to DICOM Objects. However, the problem with defining standards is that it always includes a certain level of crystal bowl gazing, i.e. one does not quite know whether this will take off and be widely implemented as there might be more pragmatic and readily available solutions that might become a de-facto standard. Therefore, time will tell whether WADO will become the widely accepted standard, but it is clear that image enabling has to happen, through whatever means. This is where we as health care imaging professionals will have to spend our next time and energy. Most of the problems distributing and managing images in an enterprise have been successfully solved, it is now all about ubiquitous availability if imaging and corresponding access. This is also where I feel that our profession will grow into: supporting the infrastructure and products and services to facilitate this. The only thing missing is to make this a “meaningful use” requirement so that it will get more attention of the people distributing resources and funds. Time will tell.