PACS vendors target workflow, integration

November 1999 - The PACS market continues to plug along, even though Y2K worries have bogged down large-scale PACS purchases through the second half of the year. When this matter is finally resolved in coming weeks, most PACS industry watchers believe purchasing will boom again, driven by favorable market dynamics and the evolution of the technology.

As healthcare facilities show interest in taking advantage of the benefits of integrated image and information management systems, vendors are gearing up to match the expected demand. In response to the complex integration requirements needed for this new era, company participation in the joint RSNA and Healthcare Information Management Systems Society initiative, called "Integrating the Healthcare Enterprise," is expected to be strong. IHE will serve as a meeting within a meeting in Chicago, running from Dec.1 to 3.

Most vendors participating in this sector will highlight their products' systems-integration capabilities in their booths. Many firms have reported dramatic increases in requests for proposals for enterprise-wide PACS installations. Previously, enterprise-wide PACS was often viewed as a lofty, long-term vision of the future, rather than a defined goal for PACS purchasers.

In addition, many vendors continue to add workflow improvements to their technology, seeking to mine even more efficiency gains from PACS. Technology trends such as the World Wide Web and Java protocols will be back in force at this year's meeting. Initial use of Web technology in digital image management has focused on providing low-cost dissemination of images and reports to referring physicians, but Web-based PACS architecture has become more prevalent, particularly among smaller firms and newcomers to the market. Several companies have even employed the Web as the foundation for their PACS product, and much of the technology development under way today in the PACS industry revolves around use of the Web.

In a trend that reflects the maturation of PACS, several vendors are devoting R&D resources to improve the scalability of their product lines, hoping to attract more entry-level business and customers from small to medium-size hospitals.

What To Look For

*Acuson. The company will put the spotlight on KinetDx, a new ultrasound miniPACS that offers a number of new features, including support for dynamic images. KinetDx, which will replace Aegis, has entered clinical trials at five sites. It is being tested in cardiology and radiology situations, as well as in adult and pediatric populations.

*Agfa. Agfa will focus on PACS plus RIS functionality with an upgrade to its 4.0 Impax system that adds RIS capabilities to PACS. Other new Impax features include speech dictation, three-dimensional postprocessing, and enterprise-wide, multidepartmental archiving capabilities. Several new specialty-specific display workstations will also be introduced, including an orthopedic viewing station and a critical-care viewing station, both optimized for the diagnostic needs of each specialty. Responding to the growing interest in digital image management among smaller hospitals, Agfa will also introduce a low-cost, entry-level PACS product that features the same capabilities as Impax but is designed to enable customers to start small and scale up to an enterprise-wide PACS as needed. Version 2.0 of Agfa's Web offering will also be highlighted, along with the company's new professional services organization and PACSWatch, a real-time remote network monitoring and notification system.

*Algotec. The Israeli Web-based PACS firm will debut a number of additions and enhancements to its ImagiNet product line, including MediPrime, an integrated radiology reading and reporting station. Algotec will also show D-Route smart agents for its MediFlow suite of data and workflow management tools. The agents will allow Web-based control of data traffic among PACS components and any DICOM device.

*ALI. As part of a concerted effort to expand beyond its ultrasound digital image management past into multimodality PACS, ALI is introducing a multimodality Windows NT workstation geared toward CT and MR that complements its UltraPACS. Other highlights at the show include extended cine-capture capabilities and a 3-D visualization software option for both its gray-scale and color workstations. The option is focused on CT and MR angiography applications and ultrasound color rendering. In addition, ALI will debut DataStore, an enterprise-wide scalable data repository designed to serve all archiving needs for multisite, multimodality images.

*Cemax-Icon/Kodak. Cemax-Icon plans to launch its new AutoRad Windows NT viewing stations, which run on high-speed storage area networks (SANs) and enable enterprise-wide access to and review of clinical images. Cemax will also display its ArchiveManager archival and work-flow management product, which now features a Java-based Web administration tool and a new high-speed jukebox. Reflecting the company's merger last year with Eastman Kodak, Cemax-Icon will be located in the Kodak booth, where its PACS solutions will be integrated with Kodak DryView laser imaging systems, computed radiography systems, and distributed medical imaging servers, images, and viewing software. A live RIS-to-PACS integrated connection will also be displayed.

*DeJarnette. This year's RSNA meeting marks the official introduction of Radiance, the company's first turnkey PACS. Last year DeJarnette demonstrated part of Radiance as a works-in-progress. This year, the company will show it as a complete, ready-to-sell product that includes the VisiShare line of Windows NT-based workstations; MediShare IQ, a database manager and HIS/RIS interface; and NetShare IQ, which connects modalities to DICOM networks. The company also plans to introduce a stand-alone teleradiology solution, a new release of VisiShare, and an integrated PACS component.

*DR Systems. An expanded version of the company's DR Reporter digital dictation system will be featured at this year's RSNA show. The new release handles digital dictation, canned report capability, and speech-recognition capabilities. DR will also unveil a works-in-progress interactive 3-D reconstruction package for its Dominator primary reading station. Web Ambassador, a new version of Ambassador, will provide Web-based access to images for referring physicians, and radiologists at home over an intranet or Internet. DR will also show works-in-progress DVD with archiving capability.

*Dynamic. The company will highlight its PACSPlus and RadPlus RIS offerings, which have been further integrated. The firm's Web-based viewer, WebSight, will be shown fully integrated with RadPlus.

*eMed Technologies. Formerly Access Radiology, eMed is targeting the RSNA meeting as a prime venue for launching its new identity. Emphasizing the growing interest in the Internet as a tool to facilitate the business of radiology, the company will debut a new service called eMed_Web. This product is designed to help radiologists, radiology groups, and radiology departments create their own co-branded Web sites, thereby improving the distribution and quality of their services. This turnkey application service provider runs over the Internet and will be offered on a subscription basis. Modular features include First Impression Audio, an embedded, multimedia speech-recognition file that enables audio files to be attached to and transmitted with radiology reports and images for transcription.

On the product side, eMed continues to work toward integration of its FrameWave products and the PACSPro offerings acquired last year in its acquisition of EMED. The company will also introduce a new on-demand capability that can be added to its existing auto-routing algorithm.

*Fuji. The company will showcase the Synapse PACS, introduced at last year's RSNA exhibit. Fuji plans to announce some additional sites that have purchased Synapse, a new pilot site in Japan, and expansions at several other pilot sites. In addition, Fuji recently received FDA clearance for its new image-compression software and plans to demonstrate this software. Citing its expertise in high-resolution computed radiography, Fuji believes its wavelet-based image-compression algorithm--which includes a JPEG 2000 conversion capability--will satisfy the most stringent image-quality requirements, with compression ratios selectable by modality.

*GE. "Destination digital" will be GE's theme again this year at the RSNA meeting. Leveraging off its acquisition of Applicare Medical Imaging in May, GE plans to demonstrate the latest release of Applicare's RadWorks software (version 5.0), which provides both teleradiology and sophisticated image distribution. GE will also highlight an upgrade to its PathSpeed software for improved enterprise-wide image distribution, with improvements in the user interface and integration capabilities, among other things. GE will also emphasize its integration expertise with a demonstration of an integrated RIS/PathSpeed solution.

In its own booth, new GE subsidiary Applicare will demonstrate a range of new technologies, including a version of RadWorks that runs on Microsoft's Windows NT 2000 operating system. The new operating system will allow RadWorks to drive both a high-resolution monochrome monitor and a color monitor on one PC. Other products include RadStore, Applicare's NT-based archive package. In its first release, RadStore will support tape, magneto-optical disks, and CD/DVD media. Applicare will continue with its OEM distribution partners.

*IDX Systems. The firm will highlight its Imaging Suite product--a set of software modules that provides bidirectional communication between RIS, imaging modalities, and PACS. Imaging Suite is part of IDX's Enterprise Radiology Solution.

*Images-on-Call. This teleradiology vendor will introduce new versions of Images-on-Call that employ Internet connections for communications. IOC will also introduce a Web server that allows clinicians access to radiology images over the Internet.

*ISG Technologies. The company will formally change its name to Cedara Software at the meeting. On the product side, the company will feature version 3.5 of its VR viewing and reporting software. The latest release integrates the firm's VR HardStore archive solution.

*Medweb. A low-cost satellite service to link multiple facilities across North America, Mexico, Hawaii, and the Virgin Islands will be featured at this year's RSNA show, according to Medweb. In conjunction with MedwebSat, the company will also showcase SkyPACS, a shared online PACS product open to all MedwebSat users.

*Merge Technologies. Merge has completely rebuilt its CaseWorks digital image management tool following the acquisition of Canadian workflow and information management products developer Interpra Medical Imaging Network in August. Interpra's Web architecture now serves as the infrastructure for CaseWorks. Merge has also redeveloped its information management offerings to support a building block approach for customers. The new infrastructure employs a Java-based healthcare database repository with the distribution power of the Web, according to the company.

*Philips. The Dutch multimodality vendor plans to introduce several workstation upgrades and new service programs. Release 6.1 of its EasyPACS software, which will debut at the meeting, includes several workstation improvements: The user interface has been redesigned for better ergonomics, workflow, and user-efficiency; the display and default-display protocols are more flexible; and digital dictation integration has been added, as have enhanced security features that include the ability to log in using fingerprint recognition. Philips will also show some new wall-mounted flat-panel monitors that are speech-driven, and a new release of its EasyVision modality-cluster workstation and software that supports multiple image-processing applications in various modalities.

In the distributed viewing arena, Philips is releasing version 3.0 of EasyWeb, which uses Web-based technology to distribute images to remote locations. New features include cine-capture capabilities and improved security. In addition, this version of EasyWeb can be used as a Web browser for both cardiology and radiology/PACS applications.

*Picker. The company plans to emphasize its networking and integration capabilities throughout its booth. Enhanced versions of JPACS/Results, which distributes key images merged with clinical reports, and JPACS/Remote, Picker's teleradiology software product, will be on display, along with RadWorks 5.0 (from Applicare). In addition, the company will demonstrate the routing of images to and from its Intelli-Store archive and workflow management product.

*Rogan. Rogan will highlight its DVD-R archive system, which can store seven times more data than CD-R archives, according to the company. Rogan shipped its first DVD-R-based PACS in September.

*Siemens. As part of the IHE demonstration, Siemens plans to highlight the integration of PACS in the healthcare enterprise. Existing products will feature expanded functionality, and several new products for image acquisition, storage, viewing, and communication will be introduced. Many of the new PACS workstations, using industry-standard mechanisms and off-the-shelf components such as PCs running Windows NT, are designed for community hospitals with limited budgets.

The entire booth will be structured like a virtual hospital, with various departments and their respective imaging modalities on display. The emphasis will be on how various modalities can be integrated and how Web-based technologies can be used to access clinical data and images across the enterprise. In addition to displaying PACS/RIS integration on a single desktop workstation, Siemens plans to demonstrate an integrated radiology/cardiology PACS application that enables dynamic images to be viewed on a single workstation, regardless of modality. Siemens will also show how NT workstations loaded with PACS software can be used for accessing electronic patient records, hospital intranets, and the Internet.

*SMS. PaXway, a software package that provides direct communication between DICOM-compatible modalities and the SMS radiology management system, will be highlighted at this year's meeting. Other featured products include SMS Voiceway, an HL7-based voice dictation interface. Enhancements to the company's Novius RIS will also be shown.

*StorComm. Version 4.0 of StorComm's ImageAccess clinical image management system will debut at the RSNA meeting. ImageAccess 4.0 includes a number of new products and features, including MedChat--a technology that allows two or more physicians to remotely consult with each other while viewing the same images and accompanying reports. The company's ImageWeb, a Web-based access product, has also been enhanced to support multiple functionality for the client software, including Java-based systems and wavelet compression capabilities. Remote real-time full motion exam monitoring has also been added for ImageAccess 4.0.