Workflow will be customer watchword at HIMSS conference

January 23, 2002

Integration promises increase in efficienciesIntegration and workflow are staples of PACS and IT marketing. For years, vendors attending the annual Healthcare Information and Management Systems Society shows have hawked the

Integration promises increase in efficiencies

Integration and workflow are staples of PACS and IT marketing. For years, vendors attending the annual Healthcare Information and Management Systems Society shows have hawked the relative value of their products by emphasizing how well they work with installed equipment and how much they increase efficiency. This year, customers may have a reason to listen.

Many in the industry believe customers are finally ready to implement integrated, workflow-based products into live clinical environments. Integrating the Healthcare Enterprise (IHE) has led the pack in shifting industry focus from competition to cooperation, with the goal of using standards to improve the flow of patient data (images and text).

Visitors to the HIMSS booths will have many choices. Cerner will showcase its ProVision enterprise-wide image management system, which was unveiled at the 2001 RSNA meeting. At the HIMSS show, Cerner will highlight the product's ability to deliver any image, regardless of its point of origin (cardiology, radiology, or elsewhere), at any time and any place. Using Cerner's HNA Millenium platform, ProVision integrates images into the clinical information system-a step toward realizing the electronic medical record.

"We will make images part of the electronic medical record," said Hemant Goel, vice president of Cerner's radiology enterprise. "Our theme at HIMSS will be the concept of gathering knowledge and relating it to the content already available to figure out patient treatment."

GE Medical Systems information technologies will expand its Centricity suite, launched at the 2001 RSNA meeting, to encompass a broad range of images and data. The company will introduce modules for several departments: the emergency room, the operating suite, labor and delivery, critical care, and cardiology. The enterprise version of Centricity also provides electronic medical record functionality.

"A core part of our strategy is providing a uniform platform for productivity across the enterprise," said Dr. Vik Kheterpal, vice president for GEMS IT clinical information systems. "Part of that is pushing information to the mobile caregiver using wireless devices; another part is offering customers cost savings through our ASP offering."

GE's ultimate goal is to influence clinical workflow, according to Kheterpal, but not just by bringing referring physicians into the loop. GE is evaluating broader initiatives in areas such as ambulatory care, occupational health, home health, and long-term care.

Siemens Medical Solutions will extend its product offerings in part by bringing other divisions of Siemens under the healthcare umbrella. The 2002 HIMMS conference is the first time Siemens' booth will include not only health services, but also medical systems, information and communications networks, and Siemens One (construction and financial services), according to Bill Grant, senior sales specialist, SMS Health Services.

"We are naturally broadening the scope as Siemens as a whole covers healthcare," Grant said. "Our message is that best practices and improved workflow will revolutionize healthcare. As voice and data merge, there are obvious and natural solutions that Siemens can bring to the table as a single source vendor."

Siemens' crown jewel is Soarian, a clinical repository that provides access to information from all modalities, as well as to patient histories and financial and administrative data. Soarian is based on the syngo operating system and user interface that Siemens has built into its digital imaging equipment. The system is currently in beta testing at four sites and could be generally available by the first quarter of 2003, according to Kheterpal.

While the enterprise-wide solutions may grab the spotlight, several companies will be drawing attention to more modest offerings. These companies are not convinced that customers are ready to purchase such expansive systems. StorComm, for example, will emphasize its ability to meet the needs of individual departments.

"We're restructuring our focus," said Bill Peterson, senior vice president of sales for StorComm. "In the past we've centered our efforts around the clinical image management systems (CIMS) or enterprise market and not really focused on radiology. It was our challenge to accept that the marketplace hasn't matured for enterprise-wide CIMS and our having the product wasn't going to help the marketplace."

StorComm is not breaking down the functionality of its ImageAccess system but rather repackaging the system as solutions for different departments. The company has also developed a line of stand-alone workstations that have all the CIMS features, targeting outpatient clinics and smaller imaging centers with these products. The company will also parlay its new relationship with Diagnostic Imaging, according to Peterson, into an additional distribution channel for ImageAccess.

Vendors are hoping their new products will jumpstart a generally sluggish market, whose potential vastly outstrips its current performance.

"Of the top 100 equipment vendors in healthcare informatics, 60% failed last year to exceed previous year revenues," said Ronald L. Johnson, healthcare IT analyst. "I question how people can talk about revenue and market growth of large proportions when there was no growth last year. I don't see any major burst in sales in 2002."

Sheldon Dorenfest of the consulting firm Dorenfest & Associates has not yet finished crunching the numbers, but he believes the slow growth trend of 2001 is continuing. The company forecasted 5.2% growth for 2001 at last year's HIMSS conference.

"Growth was flat in 1999, very flat in 2000, and only began to pick up in 2001," Dorenfest said. "This year growth will probably be in the single digits."

Both analysts agree that PACS/RIS integration is no longer an optional feature in customers' minds. The two must work together. The integration of PACS and RIS and the move toward filmless radiology will affect other clinical imaging, such as cardiology and laboratory/pathology, according to Johnson. And departments besides radiology are beginning to look seriously at PACS, according to Dorenfest. Vendors large and small are eager to fan that spark into a flame.

But PACS may take different forms, and customers may be wary about choosing the wrong one. Only last year, the application service provider concept was hot. This year, ASPs have cooled considerably.

"Last year, almost every company had an ASP offering that it did not have the year before," Dorenfest said. "While the ASP model is viable for certain products and certain users, which applications and which users depends on the market."

Johnson agrees. Despite the widespread availability of ASP products, sales do not look strong.

"The ASP model favors the vendor, because it provides a long-term revenue stream and enables the vendor to consolidate and share systems," Johnson said. "The revenue generated will also most likely be higher than anticipated, because often the number of actual transactions exceeds projected transactions. The client loses clout on the contract, since instead of paying a single large amount of money and potentially getting a good discount, the client pays month-to-month."

Even though both Johnson and Dorenfest believe customers have been slow to adopt the ASP model, some vendors are making a go of it, and most still have ASP offerings available, even if they're not selling. Imaging and storage company Stentor claims 70% to 80% of its customer base have chosen ASP-type pricing, which includes charges made on a study-by-study basis.

"It seems like every day brings us a new sale," said Oran Muduroglu, Stentor CEO. "We have done more than a hundred installs in a little over a year, and we've got top ratings from our customers."

Stentor will keep the focus at the HIMSS show on its ability to integrate its storage systems with IT systems at live clinical sites. The company will also showcase its relationship with IBM Global Services for onsite support. Stentor is not selling products, but functionality, according to Muduroglu.

"The promise of service-based sales is the key to our growth," he said. "At least half of our installed base is community hospitals. Our customers define their functional requirements, and we deliver according to those specifications. Most PACS have performance specs, while we are committed to image distribution across the enterprise at a specific level of functionality."