PACS industry embraces ASPs as key to better market penetration

PACS industry embraces ASPs as key to better market penetration

Partnerships abound as first customers ‘go live'

Some healthcare industry observers are already calling this the year of the application service provider (ASP), and Internet-based image distribution was an overriding theme at this year's SCAR meeting (see related story, p. 2). A number of new ASP relationships were made public at SCAR, and nearly every major modality and PACS vendor now offers some sort of ASP model for image distribution, storage, and backup.

ASPs are not new to the medical field, having been used for financial, patient-record, and other text-based transactions for the past few years. But the concept has captured the imagination of the diagnostic imaging community since the first ASP models were introduced at the RSNA meeting last November (PNN 12/99, 1/00). The result has been a flurry of mergers and alliances and fundamental shifts in marketing strategies.

Siemens Medical Systems' proposed acquisition of Shared Medical Systems, announced last month (HNN 5/17/00), was the beginning of what has already become a trend among PACS vendors: partnering their way into the ASP phenomenon. Philips Medical Systems has since purchased MedQuist to leverage that company's expertise in ASPs and medical transcription (HNN 5/31/00), and Marconi Medical acquired Systems Management Specialists, a $100 million company that specializes in IT outsourcing, with five data centers in the U.S. and healthcare customers that include HBOC, Shared Medical, and IDX.

GE Medical is taking a team approach to its ASP initiative, which was announced just two months ago at the HIMSS meeting. The company has already signed contracts with Cisco Systems for networking, EMC for data storage hardware, Emageon (formerly Imageon Solutions) for the underlying enterprise archive software, and Exodus Communications as its data center provider. (Exodus is also supporting the multimedia TeleConsult application from Global Telemedix.) A similar relationship with a data security firm is pending, according to Milton Silva-Craig, general manager of clinical e-services for GE.

GE has been looking at ASPs as a way to drive PACS into new markets (primarily small- to mid-sized hospitals and imaging centers) since late last year, according to Silva-Craig. One of the first GE ASP sites is the University of Missouri Health Sciences Center, which initially is using the service for the approximately 50,000 CT and MR images it handles annually. The university's radiology department, one of several GE ASP beta sites, will use the off-site image management service in conjunction with Radworks workstations and on-site RAID storage.

Even some of the smaller PACS vendors are joining forces with larger entities to add an ASP to their product offerings. Brit Systems is partnering with Western Geophysics, a data management company that has a strong reputation in the oil and gas industry, and now has three beta ASP sites up and running. Amicas, another small, privately held image-management firm, has engaged IBM to build Amicas.net, a Web portal designed to bring e-commerce to diagnostic image management. The portal is intended to operate under a pay-per-study ASP model to provide Internet-based image access, storage, and distribution to hospitals and imaging centers.

Hybrid models

Despite all of this corporate activity, ASPs are still in the early stages of deployment and adoption, especially when it comes to full-scale image distribution. Some of the first PACS-related ASPs are hybrids of financial and technical models, and it is likely to be another year or two before full ASP models—those in which little capital equipment investment is needed at the customer site and all data are stored and managed offsite by the ASP vendor—are able to meet the technical and security challenges of wide-area image distribution networks.

As with many new technologies, the first imaging ASPs are serving as proving grounds for vendors and customers alike. EMed Technologies, one of the first PACS companies to offer an ASP, has signed a cooperative marketing and service agreement with Axolotl. The agreement calls for eMed's service to be integrated into Axolotl's Web-based clinical messaging products

This deal comes just as eMed's first eMed.net customers are coming online. Summit Radiology, a multi-site radiology practice in Ft. Wayne, IN, already had a PACS but wanted to expand access to its image database. Summit provides radiology services to three tertiary care medical centers, four outlying hospitals, and three imaging centers in Ft. Wayne, and handles about 400,000 images annually, 18,000 of which are MR and CT images.

Summit is initially using eMed.net to make the CT and MR images residing on its PACS (eMed's Framewave product) available to its 400 referring physicians (plans are under way to add nuclear medicine, PET, ultrasound, and CR/DR images). Summit pays eMed a fixed fee per month for management services and a small, incremental toll for each case placed on the Web. EMed assumes responsibility for all equipment requirements, maintenance, and support and hosts Summit's Web site. Summit spends about $15 in film costs alone for each CT and MR study; with eMed.net, the cost is about $13 per study.

"The monthly subscription and transaction fee agreement allows us to offer enhanced services without concerns about equipment obsolescence, software upgrades, and internal support staff," said Jim Bode, administrator for Summit. "If you want to eliminate film and make PACS work at the hospital level, you have to get physicians reading these images on monitors in the OR and other departments, not just the radiologists. It is the referral base that needs to be reading these images online."

Technical barriers remain

Certain key problems in wide-area image distribution remain, however. These include affordable high-bandwidth connections, the effect of compression ratios on image quality, and the ability of offsite data management facilities with multiple applications and customers to handle increased high-volume traffic and ensure that mission-critical images are available to healthcare providers when and where they are needed.

"There are still a lot of limitations on bandwidth, and although there are technical solutions to this, there are still severe economic restrictions on running large-bandwidth applications over WANs," said Rik Primo, director of the IS/PACS division at Siemens Medical Systems. "For high data-volume applications, we are still talking about a lot of money."

Primo notes that a typical radiology department with a PACS generates 2 to 4 gigabytes of image data daily, and this number goes up if access to reports is also required. Thus many imaging facilities are initially considering ASPs not for image management or distibution but as the best way to securely store noncritical data offsite.

"The ASP as a disaster recovery and redundancy solution technically is feasible today—you don't need high speeds for interactivity and you can send the data in batch modes at off hours," he said. "Primary storage and high-end image distribution is today still a challenge, but a year from now this picture will be very different."