Enter the vendor neutral archive, a technology by which images – and any clinical document, in fact – can be standardized, stored, tracked and accessed by other systems, regardless of who makes them.

Market researcher InMedica has predicted that nearly one-third (31 percent) of all imaging studies will reside in a VNA by 2016.

The benefits are easy to see. Beyond DICOM standards, VNAs also use other standards such as XDS and HL7. It offers a single trove of files – they could be radiology images, they could be PDF documents, they could be simple JPEG photographs, that can be accessed by an array of health IT systems.

That makes VNA an ideal technology to bridge the gap among any number of different medical specialties, with their unique ways of documenting care – "some of which are electronic, that can be interfaced, and some of which come off a $100 Canon camera," says Hoyt.

"The downside is that VNA is a very expensive tool," he says. "It will index everything under the sun. But I can't require it for Stage 7 (on the HIMSS Analytics EMR Adoption Model). I'm not going to ask a 100-bed hospital to go out and spend a million bucks to store their ED images."

Whether a hospital uses PACS or VNA, there's no question that the storage requirements for all these images are immense and growing.

"Hospitals are increasingly using outsourced data centers for some of their material," says Hoyt. "The trick is, which material? If you go into the hospital and say, I was here a year ago. Let's see if there was a change in your colonoscopy. And that's now stored in the data center. How long does it take to pull it up?"

Data storage "is an exploding business with no change in sight," he says. "They need more disk space." That means most have to outsource the task. "The only trick is, when do you draw the line? Is it one year (or data), is it two years, is it three years old or older? You have to have a strategy for offline storage of digital images."

Another new wrinkle is the growth of pathology PACS, which is fast becoming "every bit as bit as big or bigger than radiology PACS," says Hoyt.

The really exciting stuff comes when the two work in tandem, he says. "The future I've been reading about is, if I've got radiology PACS and I've got pathology PACS, and we're looking at the same tumor in the same person can we combine the images and improve the diagnosis? That's the real goal of integrative imaging. And our kids will benefit from that – it's cutting-edge right now."

Another trend is 3D imaging, which about one in five hospitals is making use of these days. "It's very data-intensive," says Hoyt. "3D mammography uses eight and a half times more storage than 2D. It just eats up disk space."

Still, despite the challenges posed industry-wide by these acute storage needs, "I think it's solvable," says Hoyt. "The mass storage industry is responding to the demand for storage, because it's everywhere. It's not just medical. Everybody's demanding it. So the mass storage industry is responding, but it's just a matter of affordability."

The real question from here on in is what the market looks like new PACS systems. The technology is changing, for sure, but the hospital marketshare is pretty much saturated, and has been for some time.

But Hoyt predicts there will be some ripping and replacing going on as the healthcare industry continues to consolidate.

"Integrated delivery systems are growing – they're adding more and more hospitals," says Hoyt. "Two years ago, there were about 5.9 or 6 hospitals per integrated delivery system." Now that number is up to 7.24.

In those situations, "you're going to inevitably have multiple brands of PACS systems," he says. "And you're going to want to inevitably eliminate all but one. So there should be and there will be replacements of PACS systems, simply to standardize them."

As HIMSS Analytics Senior Director of Research Jennifer Horowitz points out, another "consequence of the push toward value-based purchasing and accountable care is that as organizations look to solidify their market penetration, it goes beyond hospitals and into the ambulatory facilities that are likewise providing PACS services and standardizing across those environments."

True, says Hoyt. "As hospitals buy practices that have imaging – neurology, cardiology, orthopaedics – then they're getting multiple PACS systems, and they're going to want to standardize."