Best of breed RIS proponents challenge integrated RIS/PACS

February 7, 2005

Only a few years ago, PACS vendors saw little opportunity in the select area of IT defined by radiology information systems. RIS entrepreneurs had beaten them to the punch, installing packages in radiology departments across the U.S. While many larger IT vendors offered RIS, they did so only overseas, mostly in Europe.

Only a few years ago, PACS vendors saw little opportunity in the select area of IT defined by radiology information systems. RIS entrepreneurs had beaten them to the punch, installing packages in radiology departments across the U.S. While many larger IT vendors offered RIS, they did so only overseas, mostly in Europe.

This situation is beginning to change, as vendors see RIS as the engine for powering their PACS. They have begun promoting integrated RIS/PACS as the only way customers can be assured of good performance. But that argument, while prevalent at the 2004 RSNA meeting, is far from being embraced universally.

Randall Swearingen, the founder of Swearingen Software, is fighting back. And his customers are standing by him.

Sharon Fasl, administrative director of the Medical Diagnostic Center in Independence, MO, brought Swearingen Software along when her radiology group tapped her to set up a new imaging center. Deer Creek Imaging opened in Overland Park, KS, on Nov. 29.

"I chose Swearingen because it has worked well at MDC," she said.

The software has been operating at MDC since summer 1995, Fasl said. The RIS today works with PACS at both centers.

Lakeview Hospital in Stillwater, MN, also plans to stay with its Swearingen RIS next year, when the 90-bed community hospital adds a PACS. The hospital could go with an integrated RIS/PACS, but the Swearingen RIS has been doing the job for nearly eight years and there is no reason to switch, said Diana Moberg, operations coordinator for radiology at Lakeview.

"I don't think my RIS is going to let me down," she said.

Sticking with Swearingen Software is in character for Lakeview, which Moberg describes as a best of breed hospital. Administrators have installed information systems to fit specific circumstances, whether it's radiology, pharmacy, or surgery. This runs counter to what most PACS vendors are now preaching.

The larger and more complex the enterprise, the more vehemently vendors at the RSNA meeting pressed their message of integration. Siemens' RIS/PACS, for example, was exhibited as part of a comprehensive clinical information system. The company's Soarian is designed to stretch across multiple hospital departments.

"The total gain in productivity comes only when the system is integrated," said Henri "Rik" Primo, Siemens national director of marketing and strategic relationships. "If you have systems from multiple vendors, you have to be very careful about how you integrate them."

Swearingen takes issue with the term "integrated," however, at least as it is being used by large IT vendors. He contends that the beauty of many sprawling information systems is only skin deep.

"When you look at single-source systems and peel back the first layer, you find individual modules just sitting there," he said. "They are interfaced, not integrated. But what they're touting is integration."

For Swearingen loyalists, the battle is largely semantic. They put as much stock in people as in technology. The commitment of a product's technical staff to making systems work is the determining factor in their success, according to Moberg.

"We talk about all the technical reasons we buy systems, but relationships are huge," she said. "I know that if Randall says he will do something, Randall does it."

Similarly, Fasl based her decision to port Swearingen's RIS to Deer Creek on nearly a decade of experience at MDC with the software and its developer. Fear of the unknown was also a motivating factor for Moberg, who worried that some features she has come to depend on might not be available in a new RIS.

"With a new product, you don't know what doesn't work," she said. "These are the surprises that come later, the functions that you thought would be there but aren't. You don't find out until it's too late."

There are some places, however, that Swearingen Software cannot go. Departments outside radiology are, by definition, beyond the reach of a RIS. Here is where the large IT companies excel. McKesson deploys a wide range of specialty-driven ITs. None is more comprehensive than its Horizon Physician Portal, which accesses information from across the healthcare enterprise.

"The portal knits together the entire information system addressing the patient," said Joe Biegel, vice president of product management at McKesson.

PACS data can be routinely accessed through this portal, as well as through other, less expansive McKesson systems. This practice of culling information from multiple sources will grow more common, Biegel said. And McKesson is intent on capitalizing upon it.

"Our goal is to be the most connectable diagnostic imaging PACS company in the business," he said. "We do that today by using open standards when they are there. When they are not, we solve clinical problems with advanced IT methods."