Imaging forecast: warmer, chance of cloud computing

November 2, 2009

Advanced computing architectures are necessary to support the demands of wide area radiology.

The phenomenal popularity of Internet sites like Facebook, Twitter, and YouTube has forced developers at those giants to find new ways of handling massive workloads using virtualization, dynamic scaling, and cloud computing.

Healthcare IT and radiology image management are watching these developments, albeit at a safe distance. As healthcare begins to embrace the electronic medical record, hospital IT infrastructures must find ways to manage enormous patient data files. EMRs are not complete without digital imaging; yet digital image files have grown in size exponentially with the rise of high-field MR, multidetector CT, and digital mammography.

Decentralized radiology departments and demands for remote reading also require faster delivery of digital images through the enterprise, across town, and around the world.

“There is a growing need for information systems that have no boundaries,” said Jim Morgan, executive director for Network Systems at Fujifilm Medical Systems.

If radiologists can access imaging studies from just about anywhere, patients are beginning to wonder why their medical records can't likewise be accessed from any clinician's office or any emergency department, no matter where they're located. Demands for EMR integration with regional health information organizations (RHIOs) and continuity of care records (CCRs) are beginning to surface.

“The only way for radiology to meet these growing expectations is to move to cloud computing, and to use web technologies for the support of next-generation radiology tools,” said Shelly Fisher, president of Brit Systems.

Brit and other industry vendors are watching social networking sites like Facebook closely, where open application programming interface (OpenAPI) has become a popular solution to interconnect websites in a seamless, user-friendly manner. This tactic opens a new generation of possibilities for radiology image management.

Brit is implementing browser-based technologies in Roentgen Works, its next-generation PACS, and has developed a suite of radiology workflow solutions that require no installation of a client and no downloads, not even Flash.

“Our next-generation applications also provide CCRs and will communicate to personal health repositories, such as Google Health,” Fisher said.

Agfa HealthCare plans to exhibit a new version of its Impax Data Center at RSNA 2009 with features that, among other things, support sharing of enterprise medical data and images for integrated delivery networks and/or large regional health information exchanges.

Additionally, Agfa is planning to introduce new enterprise-class viewers in 2010, providing faster, simpler, and more flexible viewing for broad types of medical data.

Demand for wide area radiology has inspired Sectra to focus on making decentralized providers more productive. In June, the company launched Sectra PACS release 12.1 with RapidConnect technology, which enables workload sharing across multiple sites.

“We see the need to improve productivity and resource utilization more than ever,” said Martin Håkansson, Sectra's marketing vice president.

Håkansson said providers need ways to enable collaboration and resource sharing across geographic and subspecialty boundaries, demands that have been catalyzed by current economic conditions and proposed healthcare reform measures.

DESKTOP VIRTUALIZATION

Vendors are also seeing a need for desktop virtualization and consolidation of applications and storage systems on a single set of servers. In virtualized environments, applications are hosted on a central server rather than on individual desktop devices. Among other benefits, maintenance and support is streamlined because malware worries vanish, along with antimalware license fees. IT support costs can be drastically reduced.

Fujifilm, for instance, has deployed imaging solutions that exploit storage and server virtualization in an attempt to lower total costs of ownership and facilitate better image distribution across the enterprise.

GE's Centricity Enterprise Archive expands beyond traditional radiology and cardiology departments to provide a centralized, scalable archive for DICOM objects from multiple departments and multivendor applications. The platform is poised to manage images from endoscopy, ophthalmology, dermatology, and oncology.

“The end result is an application-neutral, multidepartmental image repository that enables an enterprise to create a single longitudinal patient jacket for users across a region that includes multiple hospitals and imaging centers,” said Don Woodlock, a GE vice president and the global general manager for healthcare IT.

GEOGRAPHIC DISPERSAL

While IT systems are consolidating, radiology groups are dispersing. The trend in some radiology groups is toward less geographic consolidation. While procedures such as angiography and fluoroscopy require onsite radiologists, onsite reading of conventional studies is not necessary. Vendor-neutral solutions are making it increasingly possible to manage and distribute images across the enterprise and beyond.

“Time is money and technology is eliminating the time it takes to make money,” said Tyler Harris, NovaRad's director of implementation.

NovaRad's NovaPro facilitates the receipt of DICOM images from unlimited unaffiliated imaging practices and ensures images and information remain separate.

Harris said image retrieval is provided without the need to store or maintain the image file. Images are scrubbed from the archive when a predetermined storage limit is reached, although if archiving is required, the system can be configured as a complete PACS.

IT CONSOLIDATION

The Health Information Technology for Economic and Clinical Health Act of 2009 is the driver behind system interoperability, and interoperability is driving IT consolidation. In radiology, this is expressed as rapid, more efficient communication among different PACS platforms to facilitate workflow across multisite institutions.

With economic and quality-of-care pressures, facilities need fast access to all kinds of health data from anywhere in the enterprise and beyond. Vendors are positioning their solutions to meet these demands.

“The top trend we're following is interoperability, or enterprise reading, which has reading groups purchasing their own image management and reporting systems to read from, as opposed to logging on to various hospital or imaging center systems,” said Seth Koeppel, senior vice president of sales for eRAD.

Many teleradiology service providers already do this, but now community-based reading groups are seeing the advantages.

Koeppel said eRAD is positioned well for this development with its uniRAD solution, which is capable of receiving and making accessible images from a single worklist, managing multiple HL7 interfaces, and communicating with an unlimited number of DICOM archives. Also, a separate RIS is unnecessary since the company's uniRAD has dictation/speech recognition functionality built into it.

Carestream Health is responding to the interoperability trend with its SuperPACS, an architecture that streamlines radiology workflow by allowing radiologists in any location, onsite or remote, to read from a global worklist that serves all sites in a healthcare system. This enables cross-site collaborative workflow, allows optimized use of radiologists, and provides efficient subspecialty reading.

In the near term, Carestream Health intends to launch a vendor-neutral archiving solution that allows centralized clinical information control and archiving, including viewing of imaging exams and other types of patient documents from multiple locations and disparate systems.

Clinicians will be able to view laboratory and pathology reports, DICOM imaging studies, video files, and other patient data from a single unified desktop, regardless of where the data are located, Padan said.

Compressus operates on the theory there is no such thing as a standard radiology practice, that workflow, process, and care delivery vary from practice to practice. Rapid and robust workflow customization for each environment is therefore necessary.

“There is no one off-the-shelf solution,” said Janine Broda, Compressus' chief marketing officer.

Broda said Compressus' MEDxConn-ect remains the first and only software solution that indexes, integrates, and routes all relevant patient data in real-time, improving physician efficiency, reducing enterprise costs, and increasing patient safety.

Physician efficiency is also a focus at RamSoft, which plans to unveil PowerServer 4.7 at RSNA. This package enables referring physician online ordering and reporting of critical findings.

“Radiologists can now report a critical finding with the click of a button,” said Marilyn Solano, of RamSoft's marketing and business development department.

In September, Merge announced a new zero-client web platform designed to image-enable EMRs and other health systems. This technology is available for healthcare providers via Merge's new FusionWebT product line.

“Also, with our recent acquisitions of Confirma and etrials, we now have the capability to bring better interoperability to Confirma's CADstream solutions and to imaging in clinical trials,” said Julie Pekarek, Merge's chief marketing officer.

NEW SOLUTIONS

Other new productivity solutions are appearing.

Siemens is developing a system that complements and integrates its advanced imaging offering with PACS. This solution combines 2D, 3D, and 4D reading, which enables fast reading in any dimension, in one place. The system features case-specific reading.

“Based on clinical images, the system automatically knows when to call up 2D, 3D, or 4D applications, it remembers user preferences, and sorts images accordingly. Thus, reading tools and layouts can be adapted to the user's daily requirements,” said Henri “Rik” Primo, strategic relations manager, image and knowledge management for Siemens Healthcare.

Siemens has also made enhancements to its existing syngo Imaging system, including the ability to park patient information in the event workflow is interrupted, and to display image data of different patients side by side.

As a scalable solution, this syngo version can handle up to 750,000 procedures per year, Primo said.

ThinAir Data sees a present need for groups to read more efficiently as well, but it places an emphasis on more intelligent business and contract management solutions so groups can make the best use of their most valuable resource, the radiologist.

“Helping radiology be more efficient and profitable is more than simply hooking systems together,” said Tony Gevo, director of sales and marketing for ThinAir Data. Gevo said the company plans to unveil a new version of its TeleRIS at RSNA 2009 featuring a new set of tools and a new pricing structure that makes this demand for efficient, profitable reading more possible.

McKesson also believes that now more than ever it is important for providers to focus on their core capabilities, on how to improve their IT infrastructure, and how to reengineer their workflow.

“For example, current single-use mammography reading stations fall short of improving radiologist workflow,” said George Kovacs, director of product management in McKesson's medical imaging group.

Kovacs said at RSNA 2009 McKesson will offer solutions that allow for more efficient reading of CT, MR, digital mammography, and nuclear medicine but don't require specialized, dedicated workstations. One example is optimized workflow and productivity in the Breast Center.

Dedicated workstations are also seen to hinder productivity in the area of molecular imaging.

“Radiologists want dedicated tools available on PACS so they don't have to relocate themselves to other systems to interpret these molecular imaging studies,” said Thinking Systems' president Xiaoyi Wang, Ph.D.

Wang said Thinking Systems' ThinkingPACS provides vendor-neutral PET/CT and SPECT/CT fusion, nuclear cardiology processing and quantification, general nuclear medicine processing and review, and structured reporting for nuclear cardiology and echocardiology.

IMAGE PORTABILITY

Meanwhile, as the industry waits for EMRs and CCRs containing digital images to gain traction, there remains the familiar problem of transfer of images between hospitals via DICOM CDs and DVDs.

Until regional or national health networks are in place, most institutions will continue to burn DICOM media for out-of-network portability, a manual process that screams for automation. Vendors have heard the cry.

At RSNA, PACSGear will demonstrate GEARView QC, a set of quality-control tools that import, fix, print, burn, and send DICOM images to PACS.

“GEARView QC's Stacker option automates the manual process of importing DICOM CDs and DVDs and can operate unattended,” said K. Thomas Pickard, PACSGear's vice president of marketing and business development.

Many CDs/DVDs originate in outpatient imaging centers, which are becoming busier than ever.

At Sage, radiology product manager Dave Jones said they are seeing a growth rate of roughly 60% for Medicare outpatient imaging in many areas.

Jones said Sage's Intergy RIS targets those outpatient imaging practices seeing steady growth in imaging volume that require a state-of-the-art scheduling, patient tracking, and reporting solution.