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Enterprise integration enlivens PACS market


The Integrating the Healthcare Enterprise initiative has raised the ante in the radiology casino. Enterprise integration is the new table stakes in radiology informatics, as vendors respond to their customers' need to integrate digital data traditionally

The Integrating the Healthcare Enterprise initiative has raised the ante in the radiology casino. Enterprise integration is the new table stakes in radiology informatics, as vendors respond to their customers' need to integrate digital data traditionally housed in independent systems. The shift presents opportunities and challenges for equipment and systems suppliers, many of whom are playing their integration hole cards at the RSNA meeting.

Merely interfacing systems is no longer a sure bet. The industry has recognized that this is not simply a matter of two products from the same company talking to each other, but rather a reformed environment where a radiology information system, PACS, and possibly a practice management and dictation system - all perhaps purchased from different suppliers - share a common database and architecture. Such an environment assures improved productivity, a reduced report turnaround, and seamless support, thus enhancing patient care.

"The trend is fusion of images and information into a single value-added solution," said Tim Kulbago, vice president and CTO of RIS Logic. "In our opinion, individual RIS and PACS products are going to start going away."

At the RSNA meeting, RIS Logic is exhibiting a RIS-driven PACS that is actually an image-enabled RIS with an integrated dictation solution attached.

"It's the radiologist station of the future: one machine when you are doing medicine," he said.

Medical Manager Health Systems is introducing DIMDX, a fully integrated advanced diagnostic imaging and PACS solution, along with the new version 3.2 of its RIS solution and an e-mail distribution system that electronically delivers encrypted reports to referring physicians.

DIMDX operates hand in hand with the company's physician practice management software, said Jerry Walke, technical marketing manager at Medical Manager Health Systems. DIMDX allows the user to manage diagnostic-quality images with image storage and transmission, modality and interpretive work list management, query/retrieve, and print services, he said.

"Our integrated practice management RIS and PACS solutions eliminate the need to interface databases or reenter information," Walke said. "All patient and practice data are available from any workstation in real-time."

Led by solutions that blend PACS and RIS, systems integration is proving to be such a winning hand that the trend is shifting toward desktop integration throughout the enterprise. Enterprise integration points inevitably to medicine's Holy Grail, the electronic medical record (EMR).

A current trend is taking PACS beyond the radiology department, and even beyond those clinicians outside of radiology who need access, said Renee Stacey, Agfa's director of marketing communications.

"Today we see basic underlying image and information technology bringing together disparate images and information in a single desktop for other clinical departments outside of radiology, such as cardiology, orthopedics, and ophthalmology," Stacey said.

In the future, clear benefits will be found from bringing these data together in one image-enabled electronic medical record.

"The next frontier will be the integration of image management with informatics systems to create the enterprise electronic patient record," said Kelly Pickard, vice president of business development and marketing at UltraVisual Medical Systems.

UltraVisual is showcasing VisualPACS, an enterprise image management solution that includes voice clips and IHE-based key images, presentation states, and structured report distribution, as well as paper report scanning, JPEG image import, clipboard copy, image printing, and enhanced hanging protocols.

For referring physicians, the integration challenge involves putting the right data and tools in front of the right user at the right time and place. Clinicians want to see images, but they aren't going to pay for workstations, said Steve Sandy, marketing vice president at TeraRecon. The company will announce Aquarius Blue, a low-end workstation that can be wired to Aquarius Net, its new network rendering server.

Using patented hardware boards, Aquarius Net strings 2D, 3D, and 4D images from the central server, enabling any thin-client PC across the enterprise to become a postprocessing workstation.

The consistent and key trend is customer demand for a solution that creates real efficiency for all users: radiologists, referring physicians, technologists, support staff, CFO, and CEO, said Scott Neargarder, sales and marketing coordinator at DR Systems.

"You can't provide a truly efficient radiology department, imaging center, or integrated healthcare system unless your PACS is automated with regard to both the radiologist and the referring physician," he said.

DR's RSNA plans include the presentation of its PACS, which includes the reading station, dictation, voice recognition, report viewing, and 3D all in one system.

A.L.I. Technologies, which was absorbed by McKesson this year, is previewing its concept of "closed loop medical image management," an integrated enterprise system.

"We were the small-niche, high-quality PACS company, but our ability to compete on a larger scale in the long term was difficult and limited," said Bing Teng, A.L.I./McKesson sales vice president. "That's why the A.L.I. acquisition made sense. Now we have a parent with a presence beyond radiology, with infrastructure in place ranging from hospital information system to lab, pharmacy, and medication management."


TeraMedica is exhibiting a technology that allows institutions to plug and play disparate PACS, modalities, and clinical and diagnostic review stations.

"People are reluctant to go with just one vendor these days," said Bill Burns, TeraMedica's vice president of marketing and sales.

One emerging trend finds hospitals adopting Web-based EMRs; physicians are offered a branded Web portal for access to patient results. Fuji's Web-integrated Synapse PACS, for instance, associates a URL with every study, which means PACS can be launched from anywhere a local area or wide area network PC connection exists.

Amicas is debuting a new set of products and product extensions. Its Light Beam workstation allows radiologists, clinicians, technologists, and referring physicians to use a single viewing platform, regardless of clinical responsibility or location.

Enterprise-wide CD burning offers a robotic system capable of automatically creating patient and referring-physician CDs of current and prior patient studies and reports. The company positions this product as a high-volume production environment, targeted as a film replacement tool and alternative to its Web-based viewer.


Another trend apparent in the radiology marketplace is a resurgence of interest in PACS on the part of smaller hospitals and imaging centers, whose needs and budgets differ from large urban hospitals or university medical centers.

SmartPACS, a leading vendor in community hospitals that perform fewer than 150,000 exams a year, believes smaller facilities will be adopting PACS in record numbers in order to compete and improve their efficiency.

"Every healthcare facility can and should have an active PACS project," said David Parker, the president of SmartPACS, which has worked with small hospitals that previously believed they weren't ready for PACS.

SmartPACS offers a solution that includes PACS, project development, project substantiation, RIS, HIS/RIS interface, dictation systems, and workflow management.

"We see manufacturers focusing more on meeting the needs of a full range of customers, in particular placing more emphasis on smaller hospitals and clinics with products at a lower price point," said Gene Rubel, vice president of the medical division at RealTimeImage.

With more than 110 installations in the past year, RealTimeImage has broadened its offerings to include specialized products meeting the needs of all facilities, from large hospitals with multisite operations to small practices without PACS archives. In particular, its Prism product allows some practices with low procedure volume to go digital without using a costly PACS at all.

For smaller organizations, the rationale for a PACS purchase has shifted from can-we-afford-it to can-we-afford-not-to, said Susan Worthy, marketing director for eMed Technologies.

"Most cannot afford a large-scale project and are thus seeking scalable, phased implementations," she said.

At the RSNA meeting, eMed is featuring its solution aimed at the needs of outpatient imaging centers, showcasing its application suite designed specifically for this segment. It includes integrated Web-based tools for scheduling and order entry and applications for reading and balancing workload across multiple sites through a WAN.

BRIT Systems is exhibiting a new miniRIS application, an inexpensive, basic module that attaches to the company's PACS for adding radiology orders and scheduling. It is designed for small clinics and hospitals that either don't have a system or have a basic system for which it would be difficult or expensive to develop an interface.

For higher end markets, BRIT has also unveiled a new IBM T221 monitor providing 3800 x 2400 resolution on a color flat panel.

Workflow continues to be one of the industry's hot topics.

"Our RSNA theme this year is workflow, workflow, workflow," said Henri "Rik" Primo, director of Siemens Medical Solutions.

Siemens is demonstrating workflow examples that benefit from new technologies such as electronic medical records, workflow engines, 64-bit computing, and biometric user ID, Primo said.


Many hospitals easily generate 1 TB or more of digital images per year in the acquisition of radiographs, ultrasound, CT, and MR images. In addition, PET scans and genomic and other research pictures will soon begin to flood image databases. The volume of radiology data has inspired even the largest vendors to react.

"We call it 'image velocity,'" TeraMedica's Burns said. "In any given hospital these days, it's not just more procedures, it's more procedures and more images per procedure, so the velocity of imaging data is growing almost exponentially."

Two of the highlights of the GE Medical Systems exhibit focus on the importance of a scalable PACS solution to manage the increasing size and complexity of imaging data. This includes support of large imaging data sets generated by eight- and 16-slice CT, high-resolution MR, and other advanced imaging technologies.

Philips addresses viewing demands with Vequion, its next-generation family of medical IT solutions. One feature is a universal user interface called ViewForum that makes it easier to work on any modality console or workstation.

"It doesn't make any sense to make a distinction any more between a clinical, PACS, or modality workstation," said Jos Bakker, senior director of strategic marketing. "The customer should have access to exactly the same functionality regardless of where their desktop happens to be."

One unique feature of ViewForum is its ability to personalize viewing. All users can have their own particular preferences as to what combinations of view processes they prefer so they are presented only with what they are interested in and are not be bothered by things they don't care about. Bakker describes it as a solution to manage the data explosion created by MR and multislice CT scanners.

"Integration of traditional separate storage resources such as RAID and departmental archives into the storage fabric of the enterprise is also becoming a reality, driven by the requirements of cost-containment, data security, and the Health Insurance Portability and Accountability Act," Siemens' Primo said.

While PACS is an essential part of the hospital's IT strategy, it is only a part, he said. IT departments are now commonly participating in evaluating storage as an enterprise solution that can be shared by multiple departments. The goal is to handle images from radiology, cardiology, anatomic pathology, and other clinical specialties through a single database.

"Since radiology is the largest single consumer of digital storage, the adoption of PACS has been a catalyst for hospitals to think through these decisions coincidentally with a PACS purchase," said Clay Larsen, Fuji's vice president of marketing and network development.

With systems like Fuji's Synapse, which stores DICOM objects in a standard Windows FS manner, institutions have greater flexibility in taking advantage of cutting-edge storage solutions for the broader computer industry as opposed to just medical imaging, Larsen said.

Networked attached storage (NAS) has emerged as a single-tier archiving architecture that can replace conventional multitier storage schemes.

"We're seeing growing acceptance of a single-tier archiving architecture with NAS, and many sites are looking to implement this initially or replace existing systems that have a conventional multitier scheme (a server for short-term storage with an attached jukebox for long-term storage)," Worthy of eMed said. "The immediate access to data is a big benefit of NAS, but our customers are also drawn to its scalability. They buy only the storage required for their needs today, with the ability to easily add storage in the future without interruption to workflow."

Another storage trend is the application service provider model. As more PACS are sold, archiving is in many cases being removed from the package to be purchased separately, on a price-per-study basis.


MR. PAGE is a freelance writer in Pine Mountain, CA.

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