PACS: Lost in translation?
February 11, 2011
by Olga Deshchenko, DOTmed News Reporter
This report originally appeared in the February 2011 issue of DOTmed Business News
It’s a late January afternoon and Dr. Sam Friedman, a radiologist with Pitts Radiology, is sitting in front of four separate computers and 10 different monitors in his reading room. Even in a relatively small town like Columbia, S.C., where Friedman practices, patients tend to bounce between imaging providers, requiring radiologists to use a number of systems to compare studies from different facilities.
To look at two studies a patient received through two separate providers, Friedman has to bring up the studies one by one. The process can be problematic. “At best, it slows you down,” he says. “At worst, because I’m looking at one study on one computer and another study on another computer, you miss things — I know I have and my partners have. It’s not optimal for patient care.”
Since radiology’s transition from paper to digital, picture archiving and communication systems have been considered both a blessing and a curse. PACS have proven their ability to cut costs, save time and enhance efficiency, but the lack of interoperability between different systems poses a challenge, especially as health information exchange moves to center stage.
The latest PACS and add-ons enable radiologists to customize workflows, and some vendors have already introduced solutions to iron out some communication and integration issues. And yet, the radiology community is still looking for all PACS to get along. “It would be nice if the machines did talk, if the architecture of the machinery and the political climate would allow for transmission back and forth of everybody’s studies,” Friedman says.
Sharing images
With more than a million studies performed on an annual basis across its health system, radiologists at the Detroit, Mich. Henry Ford Hospital have their work cut out for them.
The hospital has been using Philips Healthcare’s iSite Radiology since 2003, with several upgrades along the way. “Our radiologists like iSite’s simplistic interface — there aren’t too many buttons, it delivers images very well and it’s easy to navigate,” says Dr. Safwan Halabi, director of imaging informatics with the hospital. “We also enjoy the ability to add plug-ins, either third-party software like Poiesis [Informatics] or things that we create internally with our IT group in radiology.”
Henry Ford’s radiology department assigns certain studies to radiologists with the help of specific filters and has evolved to triaging cases. In addition to inpatient studies that require fast turnaround times, radiologists also triage studies in the emergency department. For instance, a scan of a trauma patient takes precedence over someone with a less serious problem, says Halabi.
Reading the studies is one thing but sharing them is another. Halabi says it’s often difficult to share images even within the hospital’s own health system. “A lot of redundant imaging has to be performed because we don’t have those images for the patients at the time that we need them. That’s a huge challenge right now,” he says.
If patients are transferred out of Henry Ford, the patient’s provider is responsible for sending off a patient with a copy of the study on a CD. “We have a very limited ability to send images to other health systems,” Halabi says.
There’s also the question of what to do with studies done outside the health system, in places like independent imaging centers. Should radiologists at Henry Ford read them off CDs or store them on their systems? And viewing video clips from modalities like ultrasound presents a challenge in itself (the hospital has a separate PACS just for ultrasound viewing).
A potential solution in the clouds
To overcome the problem of image sharing, Henry Ford is in the process of reviewing cloud-based solutions, which would enable its referring physicians to easily access or send study images.
“Cloud-based solutions are a great fit for some customers,” Dave Smarro, CEO of Infinitt North America, wrote in an e-mail to DOTmed News. Smarro said it can be an ideal solution for facilities with limited space or IT resources or, “where reading is done off-site and the location of the central archive doesn’t matter.”
Cloud-based solutions can potentially solve the issues of image sharing between institutions and providers and enable facilities to get a hold of critical study results exactly when they need them. Dr. Murray Reicher, co-founder and chairman of DR Systems Inc., said cloud-based solutions are stimulating interest in the area of information exchange, as well as eligibility and authorization and patient reminders and education.
But the long-term reliability of cloud-based solutions is murky. “With a cloud-based solution, you use what you need when you need it, and only pay for what you use,” Reicher wrote in an e-mail to DOTmed News. “The main disadvantage in theory is the risk your cloud-based solutions provider goes ‘poof’ like a cloud.”
Since it’s a Web-based service, providers must also depend on Internet connectivity to use it. And storing the images can add up. “The longer you keep images on the cloud, the more expensive it is,” says Daniel Giesberg, president and CEO of AMD Technologies Inc.
Figuring out the short and long-term storage capabilities of cloud-based solutions will be important over the next five years, says Giesberg. AMD Technologies is currently beta testing its own cloud-computing system with a number of customers.
“In an environment where everybody expects to get something for nothing, you have to develop methodologies where you drive down the cost of the product,” says Giesberg. “It’s not clear whether cloud computing would do this, but it could possibly help eliminate lots of hardware and maintenance costs to the end-users, which would be beneficial and would potentially allow them to see images anywhere, anytime, anyhow.”
VNAs in store
Vendor-neutral archives have also been generating interest among radiologists. As information sharing across the enterprise becomes an essential component of health care, providers are looking for ways to archive and access images coming in from different systems on one platform.
A 2009 report by health care research firm KLAS found that many providers are looking to their PACS vendor as a potential partner in the enterprise imaging endeavor, while others are considering storage and archiving solutions vendors.
Although several companies have already introduced VNA solutions, some providers are still trying to grasp the concept and anticipate seeing the details play out in the next five years or so. “I still think that the jury’s out on what that really means or what that’s going to look like,” says Henry Ford’s Halabi.
VNAs are gaining traction across the pond, according to Mike Battin, COO of PACSHealth, whose company conducts a significant amount of business in the United Kingdom. “It hasn’t really become a requirement in the U.S. people haven’t heard about it yet,” he says.
A look at other trends
The PACS market may be a mature one but providers continue to look for solutions that address workflow and interoperability.
But before digging into specific features, radiologists tend to get a “feel” of any given system. It’s important to have “an easy-to-use interface, something where I can read the study and go on to the next one,” says Pitt Radiology’s Friedman. “Some vendors get that and some don’t.”
A user-friendly platform goes hand-in-hand with the capability to customize workflow and vendors are quick to respond. Poiesis Informatics, a fairly new player in the radiology market and a first time RSNA exhibitor at last year’s meeting, centers its products on the philosophy of workflow orchestration.
Claudine Martin, the company’s president, says radiologists shouldn’t have to navigate between different systems to find the information that they need. “These solutions should interoperate and integrate seamlessly so that the end-user doesn’t have to be the integrating agent,” she says. “They don’t have to be the person that has to launch multiple systems, multiple windows and multiple log-ins.”
An upcoming battle
The adoption of electronic health records across the country is moving along but it’s also stirring a debate about the role of medical imaging in EHRs. “The role of imaging as a meaningful use aspect raises a number of important and interesting questions that I think we will be looking at tackling,” said Dr. David Blumenthal, the national health IT coordinator, speaking at the Health IT Standards Committee Meeting in early January.
One question already surfacing is what the role of PACS and radiology-specific systems shoud be in EHRs. Some providers, like Henry Ford’s Halabi, believe the two should be separate. “A lot of what’s happening in the general medical electronic record doesn’t really pertain to radiology. I think that radiologists really want their own catered electronic health record, where it’s pushing things that are pertinent to them, whether it’s clinical history or pathology or labs — that are being read just in time for interpretation,” he says.
Halabi believes radiologists at major institutions or large radiology departments want to develop their own EHRs that will ensure “you’re not the orphan of the general EHR but actually a vibrant component of the whole medical system.”
It’s yet unclear how radiology will fit into the EHR realm but some predict that PACS might be an antiquated term in the near future. “We’re really looking at radiology management systems, where you’re not only presenting imaging, you’re bringing in HL7 feeds from the rest of the health care system and presenting them to the radiologist,” says Halabi. “I really think those companies able to do that will come out ahead.”
Vendors expect the consolidation trend in the PACS market to continue, as the technology becomes commoditized and features more ubiquitously across systems. PACSHealth’s Battin believes that as the value differentiation between different players lessens, third-party add-ons and other external pieces will serve as the distinguishing aspects of specific systems.
The most desired features are sure to be the ones that not only help improve efficiency and extract relevant data but also enable providers to connect with their patients in new ways. “You have this huge millennial generation that’s coming up that wants everything at their fingertips. I think it’s going to be a challenge for classic medicine to provide it,” says Halabi.
“I think there’s a major shift in radiology of making ourselves more pertinent or relevant, to act as another caretaker of the patient, not just somebody behind the curtains who’s taking care of the physician,” he says.
Does your PACS play well with others? Click here to take the survey & find out how you compare to other providers.
DOTmed Registered PACS/RIS/HIS Sales & Service Companies
Names in boldface are Premium Listings.
Domestic
Amber Trotman, Radical Radiology, AL
Mike Battin, PACSHealth, LLC, AR
David Epperson, Irelan Medical, CA
Tony Gevo, ThinAir Data Corp., CA
Daniel Giesberg, American Medical Sales, CA
DOTmed Certified
Ted Huss, Medical Imaging Resources, CA
DOTmed Certified
Klaus Kraemer, Multi Imaging Systems, Inc., CA
Kenn Matayor, Jaken Medical Inc., CA
DOTmed Certified
Marilyn Solano, RamSoft Inc., CA
Shane Yaghmai, Allied Health Products, CA
Edward Heere, CoActiv Medical, CT
Xiaoyi Wang, Thinking Systems Corporation, FL
Brian Thomas, HRX Imaging, IN
Scott Wasson, Radiology Services LLC, IN
DOTmed Certified
Lasha Dalakishvili, Offsite Image Management Inc., MO
Ronny Bachrach, Viztek, NC
Steve Eisner, Konica Minolta, NJ
Deborah Reed, Infinitt North America, NJ
Joseph Jenkins, International Imaging Ltd., NV
Omar Barlas, Peridot Technologies, NY
Anita Bourdeau, Nasiff Associates, Inc., NY
Al Kappel, NCS DataCom, Inc., OH
Eric Neubauer, Daylight Medical, OH
Jeff Root, Merry X-Ray Corporation, OK
Philip Manly, Connect Imaging Inc., PA
Claudine Martin, Poiesis Informatics, PA
Neal Dahya, Physician CashFlow Solutions, TX
Yassin Sallam, BRIT Systems, TX
Tim Martin, Radon Medical Imaging Corp.-WV, WV
International
Debora Smith, McKesson Corporation, BC, Canada
George Hunt, Etiam, France
Thomas Gibson, TP Global Medical Equipment, Mexico
DOTmed Certified
It’s a late January afternoon and Dr. Sam Friedman, a radiologist with Pitts Radiology, is sitting in front of four separate computers and 10 different monitors in his reading room. Even in a relatively small town like Columbia, S.C., where Friedman practices, patients tend to bounce between imaging providers, requiring radiologists to use a number of systems to compare studies from different facilities.
To look at two studies a patient received through two separate providers, Friedman has to bring up the studies one by one. The process can be problematic. “At best, it slows you down,” he says. “At worst, because I’m looking at one study on one computer and another study on another computer, you miss things — I know I have and my partners have. It’s not optimal for patient care.”
Since radiology’s transition from paper to digital, picture archiving and communication systems have been considered both a blessing and a curse. PACS have proven their ability to cut costs, save time and enhance efficiency, but the lack of interoperability between different systems poses a challenge, especially as health information exchange moves to center stage.
The latest PACS and add-ons enable radiologists to customize workflows, and some vendors have already introduced solutions to iron out some communication and integration issues. And yet, the radiology community is still looking for all PACS to get along. “It would be nice if the machines did talk, if the architecture of the machinery and the political climate would allow for transmission back and forth of everybody’s studies,” Friedman says.
Sharing images
With more than a million studies performed on an annual basis across its health system, radiologists at the Detroit, Mich. Henry Ford Hospital have their work cut out for them.
The hospital has been using Philips Healthcare’s iSite Radiology since 2003, with several upgrades along the way. “Our radiologists like iSite’s simplistic interface — there aren’t too many buttons, it delivers images very well and it’s easy to navigate,” says Dr. Safwan Halabi, director of imaging informatics with the hospital. “We also enjoy the ability to add plug-ins, either third-party software like Poiesis [Informatics] or things that we create internally with our IT group in radiology.”
Henry Ford’s radiology department assigns certain studies to radiologists with the help of specific filters and has evolved to triaging cases. In addition to inpatient studies that require fast turnaround times, radiologists also triage studies in the emergency department. For instance, a scan of a trauma patient takes precedence over someone with a less serious problem, says Halabi.
Reading the studies is one thing but sharing them is another. Halabi says it’s often difficult to share images even within the hospital’s own health system. “A lot of redundant imaging has to be performed because we don’t have those images for the patients at the time that we need them. That’s a huge challenge right now,” he says.
If patients are transferred out of Henry Ford, the patient’s provider is responsible for sending off a patient with a copy of the study on a CD. “We have a very limited ability to send images to other health systems,” Halabi says.
There’s also the question of what to do with studies done outside the health system, in places like independent imaging centers. Should radiologists at Henry Ford read them off CDs or store them on their systems? And viewing video clips from modalities like ultrasound presents a challenge in itself (the hospital has a separate PACS just for ultrasound viewing).
A potential solution in the clouds
To overcome the problem of image sharing, Henry Ford is in the process of reviewing cloud-based solutions, which would enable its referring physicians to easily access or send study images.
“Cloud-based solutions are a great fit for some customers,” Dave Smarro, CEO of Infinitt North America, wrote in an e-mail to DOTmed News. Smarro said it can be an ideal solution for facilities with limited space or IT resources or, “where reading is done off-site and the location of the central archive doesn’t matter.”
Cloud-based solutions can potentially solve the issues of image sharing between institutions and providers and enable facilities to get a hold of critical study results exactly when they need them. Dr. Murray Reicher, co-founder and chairman of DR Systems Inc., said cloud-based solutions are stimulating interest in the area of information exchange, as well as eligibility and authorization and patient reminders and education.
But the long-term reliability of cloud-based solutions is murky. “With a cloud-based solution, you use what you need when you need it, and only pay for what you use,” Reicher wrote in an e-mail to DOTmed News. “The main disadvantage in theory is the risk your cloud-based solutions provider goes ‘poof’ like a cloud.”
Since it’s a Web-based service, providers must also depend on Internet connectivity to use it. And storing the images can add up. “The longer you keep images on the cloud, the more expensive it is,” says Daniel Giesberg, president and CEO of AMD Technologies Inc.
Figuring out the short and long-term storage capabilities of cloud-based solutions will be important over the next five years, says Giesberg. AMD Technologies is currently beta testing its own cloud-computing system with a number of customers.
“In an environment where everybody expects to get something for nothing, you have to develop methodologies where you drive down the cost of the product,” says Giesberg. “It’s not clear whether cloud computing would do this, but it could possibly help eliminate lots of hardware and maintenance costs to the end-users, which would be beneficial and would potentially allow them to see images anywhere, anytime, anyhow.”
VNAs in store
Vendor-neutral archives have also been generating interest among radiologists. As information sharing across the enterprise becomes an essential component of health care, providers are looking for ways to archive and access images coming in from different systems on one platform.
A 2009 report by health care research firm KLAS found that many providers are looking to their PACS vendor as a potential partner in the enterprise imaging endeavor, while others are considering storage and archiving solutions vendors.
Although several companies have already introduced VNA solutions, some providers are still trying to grasp the concept and anticipate seeing the details play out in the next five years or so. “I still think that the jury’s out on what that really means or what that’s going to look like,” says Henry Ford’s Halabi.
VNAs are gaining traction across the pond, according to Mike Battin, COO of PACSHealth, whose company conducts a significant amount of business in the United Kingdom. “It hasn’t really become a requirement in the U.S. people haven’t heard about it yet,” he says.
A look at other trends
The PACS market may be a mature one but providers continue to look for solutions that address workflow and interoperability.
But before digging into specific features, radiologists tend to get a “feel” of any given system. It’s important to have “an easy-to-use interface, something where I can read the study and go on to the next one,” says Pitt Radiology’s Friedman. “Some vendors get that and some don’t.”
A user-friendly platform goes hand-in-hand with the capability to customize workflow and vendors are quick to respond. Poiesis Informatics, a fairly new player in the radiology market and a first time RSNA exhibitor at last year’s meeting, centers its products on the philosophy of workflow orchestration.
Claudine Martin, the company’s president, says radiologists shouldn’t have to navigate between different systems to find the information that they need. “These solutions should interoperate and integrate seamlessly so that the end-user doesn’t have to be the integrating agent,” she says. “They don’t have to be the person that has to launch multiple systems, multiple windows and multiple log-ins.”
An upcoming battle
The adoption of electronic health records across the country is moving along but it’s also stirring a debate about the role of medical imaging in EHRs. “The role of imaging as a meaningful use aspect raises a number of important and interesting questions that I think we will be looking at tackling,” said Dr. David Blumenthal, the national health IT coordinator, speaking at the Health IT Standards Committee Meeting in early January.
One question already surfacing is what the role of PACS and radiology-specific systems shoud be in EHRs. Some providers, like Henry Ford’s Halabi, believe the two should be separate. “A lot of what’s happening in the general medical electronic record doesn’t really pertain to radiology. I think that radiologists really want their own catered electronic health record, where it’s pushing things that are pertinent to them, whether it’s clinical history or pathology or labs — that are being read just in time for interpretation,” he says.
Halabi believes radiologists at major institutions or large radiology departments want to develop their own EHRs that will ensure “you’re not the orphan of the general EHR but actually a vibrant component of the whole medical system.”
It’s yet unclear how radiology will fit into the EHR realm but some predict that PACS might be an antiquated term in the near future. “We’re really looking at radiology management systems, where you’re not only presenting imaging, you’re bringing in HL7 feeds from the rest of the health care system and presenting them to the radiologist,” says Halabi. “I really think those companies able to do that will come out ahead.”
Vendors expect the consolidation trend in the PACS market to continue, as the technology becomes commoditized and features more ubiquitously across systems. PACSHealth’s Battin believes that as the value differentiation between different players lessens, third-party add-ons and other external pieces will serve as the distinguishing aspects of specific systems.
The most desired features are sure to be the ones that not only help improve efficiency and extract relevant data but also enable providers to connect with their patients in new ways. “You have this huge millennial generation that’s coming up that wants everything at their fingertips. I think it’s going to be a challenge for classic medicine to provide it,” says Halabi.
“I think there’s a major shift in radiology of making ourselves more pertinent or relevant, to act as another caretaker of the patient, not just somebody behind the curtains who’s taking care of the physician,” he says.
Does your PACS play well with others? Click here to take the survey & find out how you compare to other providers.
DOTmed Registered PACS/RIS/HIS Sales & Service Companies
Names in boldface are Premium Listings.
Domestic
Amber Trotman, Radical Radiology, AL
Mike Battin, PACSHealth, LLC, AR
David Epperson, Irelan Medical, CA
Tony Gevo, ThinAir Data Corp., CA
Daniel Giesberg, American Medical Sales, CA
DOTmed Certified
Ted Huss, Medical Imaging Resources, CA
DOTmed Certified
Klaus Kraemer, Multi Imaging Systems, Inc., CA
Kenn Matayor, Jaken Medical Inc., CA
DOTmed Certified
Marilyn Solano, RamSoft Inc., CA
Shane Yaghmai, Allied Health Products, CA
Edward Heere, CoActiv Medical, CT
Xiaoyi Wang, Thinking Systems Corporation, FL
Brian Thomas, HRX Imaging, IN
Scott Wasson, Radiology Services LLC, IN
DOTmed Certified
Lasha Dalakishvili, Offsite Image Management Inc., MO
Ronny Bachrach, Viztek, NC
Steve Eisner, Konica Minolta, NJ
Deborah Reed, Infinitt North America, NJ
Joseph Jenkins, International Imaging Ltd., NV
Omar Barlas, Peridot Technologies, NY
Anita Bourdeau, Nasiff Associates, Inc., NY
Al Kappel, NCS DataCom, Inc., OH
Eric Neubauer, Daylight Medical, OH
Jeff Root, Merry X-Ray Corporation, OK
Philip Manly, Connect Imaging Inc., PA
Claudine Martin, Poiesis Informatics, PA
Neal Dahya, Physician CashFlow Solutions, TX
Yassin Sallam, BRIT Systems, TX
Tim Martin, Radon Medical Imaging Corp.-WV, WV
International
Debora Smith, McKesson Corporation, BC, Canada
George Hunt, Etiam, France
Thomas Gibson, TP Global Medical Equipment, Mexico
DOTmed Certified