HIS vendors look to add PACS to their portfolios

HIS vendors look to add PACS to their portfolios

PACS vendors believe radiology expertise will be key to success

Healthcare information system vendors, driven by favorable market dynamics, increases in PC processing power, and the adoption of standards, are looking to integrate PACS technology with their own IS products to develop enterprise-wide image and information management systems. Last month, we chronicled PACS efforts under way at Cerner, Data General, Dynamic Healthcare Technologies, and HBO & Company (PNN 10/97). In part two of our two-part series on the developments of healthcare information systems vendors targeting the PACS market, we examine the plans of IDX, Imnet Systems, and Shared Medical Systems, and discuss how PACS vendors view the impending arrival of what could be a major threat to their business.

IDX Systems

Although it is not building a large-scale PACS itself, information systems developer IDX is developing Enterprise Medical Image Management System (EMIMS), a software package that will facilitate enterprise-wide availability of images and radiology reports. EMIMS does not have certain key PACS components, such as an archive or diagnostic workstations, which the company plans to add to the system through relationships with PACS software developers.

When completed, EMIMS will integrate the capabilities of the company's IDXview referring-physician workstation and IDXrad RIS with EPMS, the company's master patient index, in order to lay the groundwork for an enterprise-wide system, to which PACS components from other companies can be added. To achieve this capability, IDX, of Burlington, VT, is developing additional software modules to facilitate two-way communication between IDXrad and third-party archives and workstations. EMIMS will also use Web protocols to allow users on third-party workstations to access IDXrad.

The vendor will demonstrate its archive worklist and work-flow management modules for both referring physicians and radiologists at next month's Radiological Society of North America meeting. While product development is being conducted internally at IDX, the company is evaluating whether to include some drivers from Canadian PACS software developer Mitra Imaging. In any event, shipments to alpha sites are expected to take place by the end of 1997, said Debra Stenner, director of development for radiology information and imaging.

This is not the development project Olicon and IDX announced at the 1996 RSNA meeting, however. IDX continues to work with third-party PACS vendors, including Olicon, to link the company's work-flow tools within EMIMS to other PACS networks.

IDX is not planning to partner with any specific PACS company for sales of integrated PACS and information systems, however. Instead, IDX will work with any company its customers have decided on for PACS, Stenner said.

"There isn't a way that we can choose a preferred provider of imaging components, because we can't force our customers to make a decision like that," she said. "And so what we need are modules and components that facilitate their freedom of choice."

Imnet Systems

Another prominent IS company, Imnet Systems, arrived on the PACS scene at the 1996 RSNA meeting, where it touted its MedVision PACS product as an "infoPACS" solution. MedVision is part of Atlanta-based Imnet's enterprise-wide information concept, called Electronic Information Warehouse (EIW). The integration of PACS into an enterprise-wide information system is attractive to hospitals looking for one-stop IS shopping, according to Kevin Stultz, marketing manager.

"That is a lot stronger sell, especially now that hospitals don't want to spend millions on a departmental solution," Stultz said. "They want something that's enterprise-wide, and they're much more apt to spend the larger dollars on a system that will benefit the larger healthcare enterprise, not just the radiology department."

Since last year's RSNA meeting, Imnet has beefed up the diagnostic capabilities of MedVision workstations through a value-added reseller agreement with Canadian PACS software developer ISG Technologies of Mississauga, Ontario. Imnet integrates the ISG viewing software to access Imnet's Electronic Patient Record (EPR) system. Previously, MedVision workstations had employed display software from Evergreen Technologies, which Imnet purchased in late 1995. Imnet found that the Evergreen software lacked the features needed for large-scale PACS implementation, however, so the company sought a new partner for soft-copy workstations and settled on ISG. Basic teleradiology software for MedVision is also provided by ISG, although Imnet has augmented that package through a deal with Access Radiology to access the wavelet compression technique and other components of the Natick, MA-based company's Framewave teleradiology offerings (PNN 9/97).

Imnet has installed the teleradiology portion of MedVision with wavelet compression at four sites and five more are being installed or are slated for installation. The PACS portion is scheduled to be installed at beta sites in February, with a general release date targeted for June 1998, said Ron Gesell, product manager for medical imaging.

When available, the PACS portion of MedVision will utilize Windows NT-based servers, and will use local RAID arrays for short-term archiving. Long-term archiving will be provided by magneto-optical disks, although a magnetic tape option is planned for the second half of 1998.

In addition to the Access Framewave wavelet compression products, Imnet will display four workstations equipped with ISG software at the upcoming RSNA meeting. Designed for primary diagnostic applications where high-end MR and CT image processing is required, MedVision 8000 features hanging protocol capabilities and can support resolutions ranging from super VGA up to 2560 x 3300. MedVision 8000 is available in configurations ranging from one to four monitors.

MedVision 6000 is designed for primary diagnosis of plain-film studies and does not include the MR and CT processing algorithms available on the MedVision 8000. MedVision 6000 can support up to four monitors with resolutions ranging from super VGA up to 2560 x 3300.

Imnet will also show two MedVision workstations designed for clinician review of images and information. MV 2000 is suitable for an ICU or ER environment, although its most common use is as a low-end diagnostic workstation such as in-home teleradiology. MV 1000 will allow clinicians to access non-diagnostic reference images off standard-resolution monitors, as well as medical records.

The company will also be debuting a DICOM Network Agent (DNA) that will provide DICOM 3.0 storage-class support to MedVision, which is currently employing ISG's DICOM support package. Imnet will release its new DICOM conformance statement prior to the meeting.

Imnet will sell MedVision directly, but will also emphasize OEM relationships with other HIS vendors. The vendor has agreements to supply MedVision, along with other EIW components, to HBOC, HealthVision, and CompuCare.

Shared Medical Systems

Malvern, PA-based SMS offers Image Management System, an IS that provides enterprise-wide access to both medical and document images. In the traditional radiology realm, SMS partners with other vendors to offer filmless department capability.

Developed by SMS, IMS is based on Digital's Alpha 64-bit server and connects into an enterprise-wide IS through an interface with the vendor's RIS offering, Radiology Management System, which in turn can be tightly integrated with other information systems, according to Jack Toner, marketing manager for healthcare imaging solutions. IMS aims to treat medical images like any other kind of hospital data, he said.

IMS also includes clinical review stations, which are based on the Alpha VMS platform. SMS relies on other vendors for teleradiology software and primary diagnostic workstations. Although it has worked most often with Olicon, SMS will use any teleradiology package or workstation its customers choose, Toner said.

SMS is also developing its own diagnostic workstation. Based on Windows NT and using Dome Imaging's DIMPL software and Md cards, the workstation will support resolutions up to 2K x 2.5K. The workstations have completed alpha-site testing and are scheduled for beta testing this month, with general release scheduled for the first quarter of 1998.

Short-term archiving is performed using magnetic disks on the network server, while long-term archiving is undertaken using optical disks. SMS partners with archiving firm U.S. Design for its optical disk offerings.

The Mater Misericordiae Hospital in Dublin, Ireland, serves as the company's flagship PACS site and has been filmless in its intensive-care and emergency-room units for over two years, Toner said. With IMS, CR images from ICU and ER departments are transmitted both to clinical review stations in the ICUs and to a diagnostic workstation in the radiology department. Other modalities will follow soon, he said.

SMS will show a Windows NT version of IMS, release 23.2, at this year's RSNA meeting, as well as work-in-progress modes on its clinical review station, such as Web browser and voice recognition capabilities, Toner said. The company is also working on expanding the multimedia applications of IMS to support ECG waveforms, video, and voice data segments.

The role of PACS vendors

Although market demand for enterprise-wide integrated image and information systems is still in the fledgling stage, it is likely to grow exponentially over the coming years. Eventually the selling of PACS as a separate component could become an obsolete concept. In fact, that time has nearly arrived, said Gary Sadow, vice president of electronic imaging for Sterling Diagnostic Imaging of Greenville, SC.

"We are finding customers that believe in the PACS technology, believe in the business model, and have money to spend," he said. "But I believe the selling of PACS (alone) will be shortlived. I think you have about a two-year window, and certainly by the 1999 RSNA meeting you will be selling integrated information systems, of which PACS will play a part."

When these kinds of integrated systems become more common, it appears likely that a raucous turf battle between HIS vendors and PACS companies could ensue for control of this lucrative market. While HIS vendors have a long record at integrating disparate information systems, a PACS network is undoubtedly one of the most complex types of information systems to successfully implement. It's the technically demanding nature of PACS that lead some PACS vendors to believe they will hold the advantage.

"From our perspective, we're saying we own the image and the report, which is the hard part and the critical part," Sadow said. "The rest of the data is all ASCII strings, and that's a piece of cake. Therefore, we ought to be the integrated information provider."

One potential advantage for PACS vendors is their long experience in understanding the work flow of radiology departments. By continuing to adapt IS solutions that meet the work-flow needs of radiology departments, PACS vendors will continue to thrive, said Anthony Lombardo, global general manager for GE Medical Systems' Integrated Imaging Solutions division.

"Our knowledge base and our ability to do a better job there will carve out that piece for us," he said.

Of course, one possible outcome would be increased partnerships between these two types of vendors. In fact, HIS vendors will need to partner with PACS vendors to gain access to their expertise in the medical imaging marketplace, said Harold Goldberg, healthcare industry manager for Siemens Business Communications in Santa Clara, CA.

"I see various companies partnering with and/or acquiring these types of capabilities, because they can't grow them themselves," Goldberg said. "It's just too complex. That may change in five to 10 years, but it's not going to happen within the next five years."

In any event, the PACS market is likely to fundamentally change over the next decade. The term PACS itself may ultimately be phased out as it morphs into another component in an enterprise-wide integrated image and information management system. Although it's impossible to predict who will win out at this stage, it will surely be an epic struggle.