Merge eFilm to join with software firm as segue to advanced postprocessing

Integration is the catalyst for innovation at Merge eFilm, from both the technological and corporate perspectives. The company, among the first PACS vendors to develop a RIS/PACS hybrid, announced days before the RSNA meeting that it had signed a definitive agreement to acquire AccuImage, a developer of 3D and other advanced visualization tools.

The all-cash transaction valued at about $6 million is expected to close in the first quarter of 2005, pending due diligence. If it goes through, Merge will begin integrating a range of advanced visualization tools into its Fusion RIS/PACS and Fusion PACS products. Tools already available or in development at AccuImage include 3D/4D visualization, calcium scoring, virtual colonoscopy, CT angiography, lung nodule detection, subcutaneous fat measurement, and image stitching. Many of these are expected to be available on Fusion RIS/PACS by the end of next year.

Merge's interest in 3D was reflected by other vendors on the RSNA exhibit floor, a consequence of the widespread adoption of multislice CT. The goal is increased productivity, a theme echoed in the Version 2.6 work-in-progress that Merge is evolving. The company, like many others in this space, is looking for ways to reduce the time radiologists spend setting up to read cases. The problem is pervasive and complex.

"It isn't one major thing," said Beth Frost-Johnson, senior vice president of marketing and strategic planning at Merge eFilm. "It is death by a thousand duck bites."

The solution is to come up with many small improvements that streamline workflow, she said. On the exhibit floor, Merge executives described capabilities being developed as part of its Version 2.6 Fusion RIS/PACS. Most prominent among these is the company's RIS-driven hanging protocol engine, which presents, or "hangs," images according to a radiologist's individual preferences. These protocols take effect when the radiologist logs on.

"We drive it from the RIS, which means we can route all the right priors to the right workstation," said Timothy J. Kulbago, Merge chief technology officer and vice president of product innovation.

A relevancy manager picks the right prior exams to hang based on the procedure, the room in which it was performed, and the radiologist. A particular neuroradiologist reading brain CTs, for example, might like to see all MRs of the patient's head done over the last two years, as well as any brain CTs done during that period.

"We set that up in the RIS/PACS so that all those studies are found, prerouted, prestreamed, and prestaged, so that when the neuroradiologist is ready to read, everything needed is already there," Kulbago said.

For the referring physician, Merge is developing a RIS/PACS Web portal. When completed in late Q1 next year, the portal will provide updates regarding patient and report status. Its use at a beta site has substantially reduced the volume of telephone inquiries from referring doctors, he said.

The company is also optimizing its integrated document management system, which was launched in Version 2.5. The aim is to implement one-button access to documents such as a referring doctor's procedure request. Today, these are typically sent by courier. Merge would like to deliver them digitally using its RIS/PACS.

"Couriers just take time out of the system," Kulbago said.

Merge wants to deliver end-to-end clinical and business workflow solutions that increase productivity. Technological innovation sometimes affects this process, as with multislice CT, which the company is addressing through its acquisition of AccuImage.

But improving productivity requires a comprehensive approach that addresses mundane problems as well as the more complicated ones.

"We've accelerated productivity through the integration of all components, not just RIS and PACS, but billing, dictation, and document management," Frost-Johnson said. "We segment workflow in very tiny ways and then try to improve each one."