Why the path to the NHS 10 Year Plan runs through a true VNA and pixel EPR

Imaging lives where the equipment put it – radiology in the PACS archive, cardiology in another system, endoscopy, dermatology, and pathology in whatever their departmental software shipped with. Each comes with its own workflows, data structures, and limits on wider integration. The result is familiar: clinicians without a full view of the patient, multidisciplinary teams building patient care plans with only partial understandings, and patients sent for scans that already exist somewhere. And when the patient’s journey crosses multiple providers and sites for care, these gaps only get worse.

What’s missing is a pixel EPR: a single imaging record of truth that the Trust owns outright, held outside any one vendor’s PACS, that every viewer, PACS, departmental system, and national service reads from, and eliminating the silos that inhibit providers and Trusts from having a holistic view of the patient’s record. Removing these silos not only reduces the burden on the patient to get unnecessary repeat scans, it also allows sites to reclaim valuable scanner slots and reporting hours all without adding extra headcount or investing in additional equipment. By freeing up capacity that is currently lost to duplication and manual workarounds, organisations can deliver more care with the resources they already have.

That is what a vendor neutral archive is; that is what Merge VNA provides; and that is what is required to make the NHS 10 Year Plan a success.

The NHS has announced a national initiative, the National Imaging Registry (NIR), to combat this problem. Expected to launch nationwide in 2026 or 2027, the NIR is designed as a central, standardised catalogue of imaging studies across the NHS. Unlike a PACS, the NIR is not intended to store images, but rather a registry meant to record which patient imaging exists, where it is stored, and how it can be accessed.

Once launched, it will help doctors across the UK reduce duplication and unnecessary tests, glean insights from national population health analytics, and move closer to having that view of a single patient record.

“The Single Patient Record will be a digital record that joins patient data together in one secure, easy-to-access place… Healthcare professionals will access the patient information they need from one single place too, supporting safer, quicker and more accurate care.”

--NHS England, Single Patient Record – your health at your fingertips

But what the NIR will not do is store images. It is not a PACS, it is not an archive, and it will not replace local imaging storage systems. The NIR is strictly a pointer registry that tells a clinician in one Trust that a study exists in another. While that will help make patient studies more easily discoverable, it still not does the crack the fundamental issue of fragmented healthcare records. Different systems across trusts will still produce different records, made from different formats, stored in different archives.

Without a unified enterprise imaging architecture, the NHS and doctors across the country will continue to face barriers to delivering truly cross-organisational care.

Historically, PACS have been purchased as a stacked approach – in large part because that’s how it has been made available to providers in the UK. But PACS vendor lock-in keeps options limited and flexibility a moot point. And without flexibility, imaging integration and interoperability become even harder to achieve.

How do we move forward? The solution is threefold.

1. Connect the patchwork of PACS systems nationwide. Every vendor’s PACS comes with its own workflows, data structures, and limitations for wider integration. This fragmentation continues to be the state of play under the NIR, and will only continue to make it extremely difficult to deliver seamless, reliable imaging access and coordinated patient care journeys across different doctors and trusts.
2. Protect PACS freedom. Any effort to build cross-organisational interoperability has to empower each site’s ability for PACS freedom – that is, the freedom to choose the PACS or departmental EMR that best meets their clinical and operational needs. Standardisation can’t mean vendor lock-in, and can’t come at the cost of innovation and local optimisation.
3. Strong, implicit trust in data security. An interoperable enterprise imaging ecosystem needs to be built on a bedrock of robust and reliable cybersecurity and data quality protocols. Clean, consistent, and trustworthy data is essential – it’s essential to the doctors looking for safe and reliable imaging access across the NHS, it’s essential to the technologists looking to derive insightful analytics about patient imaging, and it’s essential to the patient’s right to a sense of privacy and security over their health data. The ambition for a Single Patient Record that spans the NHS cannot succeed without an implicit sense of trustworthy and reliable security.

Single vendor lock-in with PACS has kept providers shackled to a vendor-dependent image archive, which hampers integration efforts. To achieve imaging interoperability and integration, imaging organisations need to implement an independent, vendor neutral archive that lives outside of their PACS enterprise.

The benefits of a true VNA

Own your data at every point in its life, not just at rest. Ownership is easy to claim and hard to test. When contractually locked into a single PACS, a Trust owns its imaging in principle but cannot move it in practice. A Trust must be able to own its data at every stage of the image’s life – procurement, ingest, retention, re-procurement, exit. A VNA makes that ownership real.

Eliminate silos. When all imaging data can be archived in the same place – regardless of data type, format, source, or geography – then you effectively eliminate the data silos that have been blocking interoperability all along.

Onboard all ‘ologies into a single source of truth. Radiology and cardiology have a PACS; most other imaging specialties store their images in a departmental or speciality system, network share, or camera. A VNA holds all of these images in one archive, precluding the need to buy a PACS for each speciality and making images viewable and accessible to all relevant care teams. A Single Patient Record should be just as easy for a radiologist to access and interpret as a cardiologist.

Bottom line: Moving your hospital or organisation’s data outside of a single-vendor PACS, and into a vendor neutral archive, means opening a level of imaging independence and PACS freedom, ensuring data is being used by whichever best PACS or RIS best matches your needs – and not your vendor’s.

PACS freedom with a VNA isn’t just about data autonomy; it can also save money. That’s because when your data is stored in a single vendor neutral archive, you skip the costs that come with repeated PACS migrations.

One study found that consolidating dozens of departmental image archives into a single enterprise imaging VNA deployment resulted in 10% cost savings and 30% reduction in storage costs.

Another found a >5% ROI after one year and 10% ROI after three years.

While the initial archive migration can account for a large initial investment, consolidating multiple imaging archives into a single VNA saves costs over time on licenses and uptime contracts across the hospital, and precludes the costs associated with multiple PACS migrations.

Moving to a VNA that sits outside of any one vendor’s PACS creates a unique opportunity for tackling another challenge that hangs over imaging organisations: cleaning and circulating high-quality data.

If continuity of patient care across multiple physicians and sites depends on having a single, comprehensive patient record, then the bedrock of that single patient record is clean and accurate patient data. Inaccurate or poorly formatted data makes for a poor foundation and can potentially affect both diagnostic accuracy and patient care.

A VNA offers a solution for this: data morphing. Data morphing is the process of rewriting or reshaping DICOM metadata – cleaning, standardising, and correctly formatting imaging data as it enters the archive. This ensures that, regardless of the original PACS or modality, all data coming into the archive follows the same rules and is formatted accordingly. This is a key reason why VNAs are more than just about storing images; they actively improve the integrity, consistency, and usability of patient imaging data.

VNAs can automatically detect and correct problems in the imaging metadata, such as:

• Duplicate studies
• Incorrect accession numbers
• Invalid DICOM tags
• Local vendor-specific quirks
• Missing study descriptions
• Non-standard modality names
• Wrong patient IDs

This ensures the data stored in the archive is clean, consistent, and safe to share across the coordinated care system.

This is also what makes a true VNA critical to the success of the NIR and NHS 10 Year Plan. An image pointer registry is only as good as the identifiers underneath it: a duplicated study, a wrong patient ID, or a non-standard modality name is a national record that resolves to the wrong patient or to nothing at all. Standardising imaging data as it enters the archive is not simple housekeeping – it is the difference between a registry entry that a clinician can reliably act on versus one they have to take extra steps to verify, adding more time and frustration to their workflow.

For years and across regions, Merge has been building enterprise imaging ecosystems for organisations of varying sizes and needs, all with a shared mission: unifying fragmented health data systems to deliver more reliable imaging, less complexity, and better care.

In Costa Rica, Merge partnered with one of the government’s primary healthcare system providers, SOIN Soluciones Integrales, to consolidate the imaging environments of 50 hospitals across the country, and bring them into a centralized Enterprise Archive, PACS, RIS, and EMR. Deploying solutions like Merge VNA, SOIN was able to begin integrating the hospitals’ technology stacks, capabilities, and stored imaging data all into one place.

“Merge believed in us on the most challenging project in our region. We received the best and most professional support, at every step, from expert people who helped us both remotely and on site. We managed all of our challenges side by side with Merge. They made this project successful.”

--Adrian Jimenez, Senior Manager, SOIN Costa Rica

Merge also brings proven experience with helping organisations drive large-scale improvements to the patient experience by making it easier for patients to access their own records. In the United States, Presbyterian Healthcare wanted to make patient exam data and imaging data easily available for patients to see alongside physicians’ notes in post-exam summaries; they also wanted to make patient images available to other provider organisations, so that clinicians could more easily access a patient’s imaging history.

To achieve this, Presbyterian leveraged a combined deployment of Merge VNA and Merge Universal Viewer (MUV). The VNA produces a basis study content notification, which goes to the patient’s chart in Epic MyChart. That chart is then linked to the patient portal, with MUV, to make the study visible externally to the patient within the context of the portal. This same setup was also used to facilitate image sharing and viewing between teams across the organization: because Merge VNA consolidates the images in one archive, it enables MUV to generate links to any images, regardless of study type, so that the images are viewable within MyChart.

“We wanted to get away from stovepipe systems for storing images, and go toward a centralized archive. We had different databases for different sets of studies. It was inefficient, driving up costs, and made it more difficult for our clinical side to see a patient’s images and for our IT side to maintain those systems. Merge helped us streamline all of that by consolidating to one system.”

--Karl Seitz, IT Enterprise Imaging, Presbyterian Healthcare Services

Merge also works with the second‑largest teleradiology provider in the UK, supporting over 80 NHS Trusts through a network of more than 400 remote reporters. For this team, security, reliability and speed are absolutely critical. One of the key ways we maximise uptime is through application‑level replication. In practice, this means the VNA runs with two active peers, ensuring that if one goes down, a fully synchronised and secure fallback archive is always available.

Moving your radiology PACS archive into a VNA is more than just a simple technical upgrade. It’s the decision that determines whether imaging is an asset your organisation owns or a dependency it rents.

A pixel EPR underpinned by a true VNA – creating one imaging record of truth that is standards-based and held outside any single vendor’s PACS – is what turns the national ambition into a local reality. It’s what allows a National Imaging Registry pointer to resolve into an image a clinician can use. It’s what lets each Trust keep choosing a PACS and RIS that accommodates clinicians and pathways, rather than forcing the clinician to accommodate the PACS. It’s what puts the pixels, and not only the report, inside the Single Patient Record.

By decoupling your imaging data from PACS vendor lock-in, organisations create a unified, standards-driven foundation that supports the underlying goal of the NHS 10 Year Plan for a Single Patient Record. Ultimately, a VNA‑led strategy of PACS freedom and flexibility lays the groundwork for safer care, faster pathways, and better outcomes across the entire NHS ecosystem.

• Learn more about Merge’s dedicated offerings in the UK and Ireland, and how enterprise imaging solutions like Merge VNA are supporting radiology and imaging teams across the NHS, HSE, and private sector to optimise care delivery and improve patient outcomes.
• Watch a virtual conversation on how Merge VNA helps organisations reduce downtime, improve efficiency, move images quickly and consistently, and ultimately eases the journey toward the NHS 10 Year Plan.
• Explore how Merge VNA helped a world-renowned UK children’s hospital achieve a secure and seamless PACS migration, while maintaining medical imaging integrity and clinical uptime.

Merge empowers healthcare organisations with advanced medical imaging solutions to deliver reliable imaging, less complexity, and better care. Merge’s Imaging Suite, built on a cloud-native foundation, provides capabilities for Vendor-Neutral Archive (VNA), Enterprise Diagnostic Viewing, and Workflow Orchestration. The Merge portfolio also includes PACS and support for Digital Pathology.

Learn more at https://www.merative.com/merge-imaging/uk-ireland