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Future predictions for PACS

February 20, 2014
by Carol Ko, Staff Writer
As health IT continues to rapidly evolve, certain industry terms are threatening to part company with their intended meaning: For instance, what does the term PACS really mean nowadays? It depends on who you ask.

Radiology’s PACS, once the keeper of image archives, has expanded to include PACS in cardiology, or even pathology. There’s also a growing need to store digital medical images that aren’t DICOM-compliant.

In a podcast recorded on-site in Chicago at the RSNA annual meeting this past year, Ben Brown, vice president of research at KLAS Enterprises, said providers are looking for more efficiency from a storage standpoint, but also looking to improve patient care. “For years and years images have been stored in different silos — oncology, cardiology, radiology — but now providers are looking for an enterprise archive to store all images in one place,” he said.

And the trend is rapidly catching on. A recent survey by CapSite found that one-third of the U.S. hospital market has adopted a vendor neutral archive solution, and that an additional 19 percent plan to introduce one in the next two years.

Furthermore, market researcher InMedica has predicted that nearly one-third of all imaging studies will reside in a VNA by 2016.

“The trend towards interoperability and vendor neutral solutions is a win-win,” says Frank Baker, general manager at CoActiv Medical. “Customers can implement bestof- breed modules to augment workflow and vendors with those offerings have more business opportunities,” he says.

If digital image archiving isn’t yet part of the national conversation around health care and its necessary costs, it soon will be. Medical images are projected to require 30 percent of the world’s storage and could soon represent 10 percent of all of U.S. health care costs — adding up to approximately 1.5 percent of U.S. GDP.

Yet, the definition of what constitutes a VNA is a bit ethereal, making it all the harder to determine exactly what roles PACS will cede. “If a VNA is dropped in the middle of a health care system, it should be able to interact with all the other aspects of the system,” says Yassin Sallam, national sales manager, BRIT Systems. “As long as it has the hooks to address the needs, it can be considered VNA.”

But if PACS is moving away from imaging archiving, ceding that functionality to superior VNAs, then where does the future of PACS lie?

The market is clearly long in the tooth — a recent report from Frost & Sullivan on the North American market for radiology image and information management systems finds $1.1 billion in sales for 2011, a figure that’s set to increase to only $1.4 billion by 2018.

No spin zone
Although the PACS market is a mature one, maturity doesn’t necessarily correlate with customer satisfaction. Yet, with years of use among health care professionals, PACS customers know what they want and PACS providers are listening closely. At the top of the wish list are improvements to workflow efficiency. Customers are asking to have easier access to prior studies. “You’d think that problem would be solved a long time ago, but the majority of customers still have a problem with that,” says Rik Primo, director of strategic relationships, SYNGO Americas, Siemens Healthcare. “This is especially important when treating, say, a patient with cancer — it’s important for the radiologist to be able to determine how big that tumor was five months ago, and how is that tumor evolving now. That will be used to determine what kind of therapy is needed.”

Customers are also requesting better layouts and display protocols – for example, having a prior study on the left of the screen and the new study on the right of the screen, or multiple views of the same anatomy. “If you have multiple views of the anatomy in an MRI, it’s convenient to have these views next to each other and when you scroll, you want the other views to be automatically scrolling too,” says Primo.

Most of all, radiologists seek to move away from what experts call a “swivel chair workstation,” or a work setup that requires radiologists to pivot from one workstation to another. Many radiologists still recall the days of film, which required that they adjust their eyes to the film to see all the detail. Having to look away from the screen and return to it again requires a similar process of accommodation that can lead to headaches. Accordingly, vendors are moving toward a simplified, integrated workstation model that creates a unified view of all images, 2-D and 3-D, for radiologists.

Float this idea
Cloud-based computing is gaining steam as radiologists expect better image access. A recent study by Transparent Market Research reported that the global cloud computing market in the health care industry was valued at $1.82 billion in 2011 and is expected to reach $6.79 billion by 2018.

According to the Government Accountability Office, 75 percent of all imaging is performed outside of the hospital setting, where PACS are harder to come by. The National Healthcare Information Network currently requires a PACS to share medical images, which means 75 percent of medical images will not be available to providers without PACS.

A solution to this problem is cloud-based computing in which users are able to pay for software as a service, otherwise known as on-demand software. Because applications are delivered as a service over the Internet, users can pay on a pay-per-use model.

Facilities are able to avoid paying huge upfront costs by using remote image viewing software and information systems, meaning multiple hospitals can share standard software, infrastructure, storage, and processing power. This also simplifies things like maintenance and troubleshooting, further reducing costs. “There are economies of scale in the cloud – with the provisioning of space for accounts — so there are cost efficiencies,” says BRIT Systems’ Sallam.

Amber Casarez, senior marketing specialist with RamSoft, Inc. agrees. “Cloud services for RIS and PACS are ideal for end users looking for a low cost-of-entry for a new radiology workflow solution,” she says. “Cloud services also free up in-house IT staff from daily server maintenance and offer such features as co-location, redundancy and advanced security measures to protect data from security breaches and environmental catastrophes.”

David Smarro, president and CEO of Infinitt, also sees Cloud services as the future, with the company tailoring solutions to meet a variety of requirements. “We have added new data centers to meet Omnibus, HIPAA and SSAE16,” he says.

Additionally, the flexibility of what health IT experts call “anywhere, anytime” access to medical data allows radiologists to report remotely from outside the hospital. And it also provides a consistent viewing platform no matter what PACS is delivering the images. “The cloud is what you want it to be, it is an environment that can be used for storing data or accessing applications and information from virtually anywhere in the world,” says Sallam. “It is a sound option to complement and for some institutions, possibly even replace brick and mortar based solutions."

Me and my iPad
But many radiologists want to take things a step further than integrated workstations or cloud-based computing — they want to be able to bypass the workstation altogether and view patient studies from their iPads and mobile devices, too. Though newer PACS offer mobile access, PACS more than five years old require upgrades and updates to offer the same functionality.

“In a way, radiology PACS systems are variations of what they’ve been for the past 10 years, you need to buy little add-ons to make them do what you want to do,” says Michael Gray, principal of Gray Consulting. “Some PACS systems have no idea that anything else exists other than what they acquired,” Gray says.

For PACS to remain desirable, the need to play well with mobile devices is a must. This sentiment is backed by several surveys over the past year that have indicated an increased use of mobile devices by medical professionals. The Manhattan Research survey, for example, found that 62 percent of physicians use mobile devices in their daily practice, doubling the rate since 2011. According to a recent HIMSS survey, three-fourths of responding organizations said they would use more mobile devices in the future.

The doctor’s doctor
Back in the day, before PACS were a twinkle in anyone’s eye, old-timers recall that the radiology department was often the busiest in the hospital. Referring physicians would come in and talk to radiologists about the images performed the day before, working as a team to discuss the best approach toward treating a tumor, whether it was surgery, radiation therapy, or another treatment.

“There was a lively discussion between radiologists and referring physicians. Radiologist would be the doctor’s to help determine the treatment of the patient,” says Primo.

With the advent of PACS-centered workflow, radiologists rarely have time to talk with referring physicians — a phenomenon which, according to many critics, has inadvertently put the profession under threat by making it virtually invisible to the rest of the hospital. It’s easier to outsource imaging to a remote teleradiology company when radiologists rarely interact with the rest of the hospital face-to-face, they argue.

Accordingly, radiologists such as Paul Chang, chair of radiology informatics at the University of Chicago Medical Center, propose a different approach: what experts are deeming Imaging 3.0.This approach attempts to change the radiology paradigm from volume-based imaging to value-based imaging.

In this new model, radiologists act as advisers for referring physicians, steering them away from unnecessary scans. “If a patient comes in with abdominal pain, the referring physicians shouldn’t ask for a CT scan. Here is where the radiologist can suggest an ultrasound scan, which is able to identify potential problems in the gallbladder, a fatty liver, hernia, and so on and then maybe when you have the results, that may lead you to do the next step which could be either a CT scan, or therapy,” says Primo.

PACS with enhanced interoperability plays a big role in strengthening partnerships between referring physicians and radiologists, since a more integrated image archiving system and workstation will enable radiologists to connect with patients and collaborate with other physicians.

Mother tongue
Collaboration is a large part of what’s driving one of the biggest trends in PACS and one of the most buzzed-about terms at RSNA this year: structured reporting.

The ultimate goal for health care is to be able to form a master database of patient data, informatics, and image archives that spans all hospitals in the U.S. Ideally, doctors should be able to pull up a patient’s medical records across multiple facilities, not just one. Whether hospitals will achieve this dream without further government intervention remains to be seen.

Currently, hospitals lack a standard way of recording patient data, meaning some hospitals jot down codes in a non-standardized, and often haphazard, way. This is slated to change in the fall when hospitals will be required to standardize their universal coding and disease classification to ICD-10

“What we’re being driven toward is a much more precise vernacular,” says Steve Hamburg, director of RIS Sales at Advanced Data Systems.

If, say, a patient was admitted into a hospital for a torn knee ligament, the ICD-10 coding would be specific right down to whether the right or left knee ligament was torn.

The coding can be specific almost to the point of being comic. “There are actually ICD-10 codes for accidental injury for paintball guns,” Hamburg says. “There are 14 different guns relating to paintball gun injuries.”

Hamburg predicts this will rock the industry, likening it to a sudden natural disaster rather than a trend. “A trend is gradual. This is like a tsunami,” he says.

The advantage of a universal coding system is clear: doctors will be able to access macro-level data around, for example, a certain kind of slow-healing fracture. “You never had that data before, but now you do,” says Hamburg.

Ultimately, more precise coding leads to better data around the efficacy of treatments. It also ties in with a larger trend around increasing the level of quantitative data in imaging.

“Once you have structured reports, the data can now be available for data mining,” says Primo.

At the New York Imaging and Informatics Symposium last September, Dr. Eliot Siegel, professor of diagnostic radiology at University of Maryland, gave a presentation in which he stressed the importance of mining quantifiable data from images.

He envisioned every patient’s image studies being saved and incorporated by decision-supporting algorithms to help physicians make better choices when treating patients. “Every patient’s medical care would become a clinical trial,” he said.

Click here to check out the DOTmed New Equipment Guide for PACS/RIS solutions.

DOTmed Registered DMBN February 2014 - HIT Companies

Names in boldface are Premium Listings.
Diane Sappah, INFINITT North America, NJ
George Saadi, Intuitive Imaging Informatics, CA
Amber Casarez, Ramsoft, CA
Rob Fabrizio, Fujifilm Medical, CT
Xiaoyi Wang, Thinking Systems, FL
Jennifer Jawor, Merge, IL
Cindy Hilliard, 3M Health Information Systems, MD
Jenae Cahanes, Amcom Software, MN
Nichole Gerszewski, Vital Images, MN
Jill Hamman, Carestream, NY
Katheryn Roberts, Swearinge Software, Inc., TX
Cormac Donovan, TeraRecon, CA
Frank Baker, CoActiv Medical, CT
Debora Smith, McKesson, GA
Philip Manley, Connect Imaging, HI
Scott Wasson, Radiology Services, IN
DOTmed Certified
Mike George, Paxeramed, MA
Steve Deaton, Viztek, NC
Marc Klar, Advanced Data Systems, NJ
Luisa Rosen, Agfa, SC
John Ciccarelli, Avreo, SC
Yassin Sallam, BRIT Systems, TX
Paul Shumway, Novarad, UT

Carlos Rueda, Innovacion Tecnologica, Mexico
Tina Blais, Intelerad, Canada