Siemens seeks to place PACS business within information systems context

Siemens seeks to place PACS business within information systems context

Multimodality vendor shifts PACS division to reflect market trends

Siemens Medical Systems is one of the most experienced companies in the PACS market, and also one of the most successful. With a client list numbering between 400 and 500, Siemens can point to its large installed base as a distinguishing feature in a market full of new companies and vendors just now getting their PACS act together. The vendor also has the added benefit of being able to leverage its leading position in the scanner modality market into leads for PACS sales.

To continue its growth in the future, Siemens is turning its attention to the enterprise-wide healthcare information system. PACS is no longer a technology that is confined to the radiology department, said Ajit Singh, director of strategic business development for Siemens Managed Health Services.

"It is a system that has to go hand-in-glove with the overall enterprise-wide IS platform," he said.

To help meet this challenge, Siemens has made some changes in its organizational structure. The PACS division, which had previously been its own unit within SMS, was shifted in April to SMHS, a new SMS division formed in 1996 to provide healthcare information technology solutions, as well as administrative, clinical consulting, and financial services.

Siemens is also moving to develop technology to address the new IT climate. To go along with the company's basic RIS/PACS interface, Siemens is working to improve the interoperability between the RIS and PACS, and to determine how the patient data repository will be populated, Singh said. The vendor will also address how radiologist- and referring-physician-specific decision-support tools fit into the equation.

"In the next 12 months, you'll see a broadening of the platform to include those elements as well as consulting services in the area of redesigning clinical processes," Singh said.

Siemens also sees much potential in smart cards, which allow patients to be tracked within the system and will improve a hospital's efficiency, Singh said. Also, to help meet the demand of integrating Sienet with hospital information systems, Siemens is actively pursuing alliances with HIS vendors, he said.

Siemens can also call on the expertise of other Siemens divisions to compete in the hotly competitive PACS market. Siemens Nixdorf provides network design and integration services, while Siemens Business Communications offers automated call centers and wireless technology. Siemens Components has developed smart card chips.

PACS history

Siemens has an interesting tale to tell about its history in the PACS market. The roots of the company's PACS effort began in the late 1970s, when Siemens engineers in Germany designed a prototype soft-copy review station. Versions were installed at five sites in Europe and Canada. Based on the success of these prototypes, Siemens decided in 1981 to launch a full-fledged PACS development program, to be based at Siemens Gammasonics in Hoffman Estates, IL, according to David Armour, marketing manager for Siemens Healthcare Services. At the time, Siemens Gammasonics had just been formed to manufacture nuclear medicine equipment.

Early developmental efforts yielded a system based on Digital Equipment's Vax platform. Although the system offered advanced features for its time, such as the ability to move images around multiple screens and to move the cursor over eight different monitors, Siemens Gammasonics decided not to bring the product to market, due to pricing issues, Armour said.

To bring costs down, Siemens Gammasonics decided to shift to the Macintosh platform, and introduced the LiteBox viewing station in 1985. During its lifetime, over 1000 LiteBox units were shipped, Armour said.

The next major milestone in the company's development of PACS was the Military Diagnostic Imaging Support (MDIS) system. Loral, with Siemens Gammasonics as a subcontractor, was awarded the bid in September 1991.

Unfortunately, the MDIS product was not scalable, and to design a system more appropriate for the nongovernment sector, SMS began work on a scalable PACS, called Sienet. Sienet, based initially on Sun and PC-based platforms, was installed at Danube Hospital in Vienna, Austria, in April 1992.

With the development of the lower cost Sienet product, however, SMS was placed in the awkward situation of competing with Siemens Gammasonics for PACS contracts. While Siemens Gammasonics and Loral had traditionally focused on the comprehensive PACS marketplace, those two companies began developing a modular and scalable PACS in early 1994, thrusting the two Siemens divisions in direct competition.

That problem was solved in September 1994, when the Siemens Gammasonics PACS business was acquired by Loral. Loral was later purchased by Lockheed Martin, which sold its medical imaging division to GE Medical Systems in April.

Sienet product line

Siemens offers network design and integration for Sienet, whose MagicView image-review workstations run primarily on Sun Microsystems computers with a Unix operating system. Targeted at soft-copy reporting applications, MagicView 1000 can be configured with one to four monitors supporting resolutions up to 2K x 2.5K. Siemens released an upgrade in July for MagicView 1000 that optimizes the user interface and workflow management features for radiologists (PNN 6/97).

Also Sun-based, MagicView 200 is designed for clinical review, such as in the ICU/CCU or ER. MagicView 200 is typically used in a dual-monitor configuration, supporting resolutions up to 1280 x 1024.

Designed for remote viewing of images, the Windows NT or Windows 95-based MagicView 50 enables image distribution over LANs and WANs. Typically, physicians use a 1K x 1K monitor with MagicView 50, according to Susan Rossnick, product manager.

A workflow engine works with the HIS/RIS interface to facilitate image and information transfer to appropriate locations, Rossnick said. For example, the engine allows for capabilities such as prefetching and accessing reports from a RIS, she said.

Siemens offers a film digitizer system that includes a PC software package from DeJarnette and a Lumisys digitizer. Lumisys, through its Imagraph subsidiary, also contributes a video framegrabber. For archiving, the vendor's scalable MagicStore server provides online storage using redundant array of inexpensive disks (RAID) technology and ranging in storage capacity from 9 to 96 gigabytes. Multiple MagicStore servers can also be supported for larger archiving projects. For off-line, long-term storage, Siemens typically uses CD-ROM, tape, or magneto-optical disks, ranging from 250 GB to multiple terabytes, depending on needs.

All of Sienet's workstations and archives support DICOM verification, storage, and query/retrieve, while the RIS/HIS interface supports DICOM worklist management, Rossnick said.

While Siemens develops its own PACS software at sites in Germany, it has also signed OEM relationships to fill out its product line as needed. The vendor contracted with teleradiology provider CompuRad to develop MagicView 50. Siemens holds a joint marketing agreement with ALI Technologies for its UltraPACS ultrasound image management system. Merge and DeJarnette provide connectivity solutions, while Fuji and Kodak add CR systems. The company also offers Mitra's PACS Broker, the Canadian vendor's HIS/RIS interfacing engine.

Siemens believes its understanding of workflow management has been key in differentiating its products from those of competitors. For example, MagicView workstations can now prefetch and autoroute images for unscheduled patients, said Kevin Flynn, national sales manager.

"When the workstation has a new exam, it will be able to go back and prefetch and, based on rules you establish, bring older exams back for concurrent review with the new images," he said.

The vendor's long and successful history in PACS makes Siemens a mandatory part of any discussion about PACS market leaders. Along with Agfa and a few others, Siemens has been one of the few companies landing filmless hospital contracts. By recognizing and preparing for the shift in customer interest toward integrated, enterprise-wide information systems, Siemens is placing itself in a solid position to continue thriving in tomorrow's healthcare information system environment.

Siemens Medical Systems
186 Wood Avenue South
Iselin, NJ 08830
908/321-4500
fax: 908/494-2250
www.sms.siemens.com

Management:
Ajit Singh, director, strategic business development, Siemens Managed Healthcare Services
Kevin Flynn, national sales manager
Susan Rossnick, product manager
David Armour, marketing manager, Siemens Healthcare

PACS Revenue growth:
1996: 190%

PACS Product lines:
Sienet digital image management system

Filmless hospitals:
Danube Hospital in Vienna, Austria; Viborg Sygehus in Copenhagen, Denmark; Royal Alexandra Hospital for Children in Sydney, Australia; Theresienkrankenhaus Mannheim in Mannheim, Germany; Klinikium Krefeld in Krefeld, Germany; Krankenhaus der Barmherzigen Bruder, Regensberg, Germany; and the Mayo Clinic in Jacksonville, FL (in progress).

Product distribution:

Direct sales

Long-term PACS strategy
Siemens views PACS in the context of the enterprise-wide information system and has targeted its operational structure and product development to maximize its growth opportunities in this market.