With the healthcare landscape changing so rapidly along so many dimensions, it should surprise no one that the landscape of the worlds of radiology, diagnostic imaging, and imaging informatics, should also be changing very rapidly, across the policy, operational, clinical, and information technology fronts. And it is. As HCI Editor-in-Chief Mark Hagland reported in his November/December cover story on imaging informatics, healthcare leaders and industry experts are urging hospital and medical group leaders and physicians in practice to develop strategies to manage the changes sweeping the industry these days. Among those he interviewed was Joe Marion, principal of the Waukesha, Wis.-based Healthcare Integration Strategies, and one of the leading industry experts in the imaging and imaging informatics areas. Below are excerpts from Hagland’s interview this autumn with Marion, published here just days before the start of the annual RSNA Conference, to be held Nov. 29-Dec. 4 at Chicago’s vast McCormick Place Convention Center.
Let’s walk through the current landscape around diagnostic imaging and informatics together. What do healthcare IT leaders in particular need to understand about how the rapidly shifting policy landscape is affecting how they should think about technology right now?
It’s a forest-versus-trees situation. Healthcare IT leaders have got to think about what they’ve got now [with regard to technology], and how they’ll tie into ACO [accountable care organizations], bundled-payment contracts, population health, everything, and what they’ll bring to those arrangements. And with hospitals and larger physician groups buying up medical practices and such, that is affecting everything, too. Large vendors are in this mode now where they’re saying, from a sales perspective, how do we structure, how do we address the client? It’s no longer, I go to Hospital A, Hospital B, Hospital C, and sell them each a CT scanner. Instead, imaging and imaging informatics vendors are working towards signing strategic contracts, wherever possible.
So the large vendors are looking to build longer-term contracts with large integrated health systems that will encompass both modality and imaging informatics technology and services?
Yes, absolutely. And it may even go to the point of onsite equipment support, and even to the point of [contracting around technologists and radiologists.
Certainly, Merge/IBM and other mergers and acquisitions, are significant. I spoke with someone at Merge last week, and a person there says they’ll operate as an independent subsidiary with an influx of people to assist with Watson integration, but otherwise will beat their own drum. But I’m wondering what the benefit of that arrangement is. I’m still wrestling with that idea, because, looking at past acquisitions of the sort, how long will IBM allow the Merge folks to act in an independent way? And Dell acquiring EMC could prove significant, too,” in altering the competitive and contracting landscape around vendors in imaging informatics.
There are two ways to look at all this activity. On the one hand, the fact is that there’s been an overabundance of vendors. Somebody once counted at least 100 PACS vendors out there—and that’s still true, there are all kinds of little players that can offer you a PACS solution. But people are looking at it from a larger perspective, and the whole emphasis on the enterprise is starting to spill over. So that’s one factor. The other is the sustainability of people making the investment. Can they afford to make multiple investments? As well as the “decomposition” of PACS [picture archiving and communications systems]—the Visage people use that term.
And what it means is, let’s say I had been using Vendor A as my PACS vendor. Years ago, if I needed an upgrade, most people would have replaced the entire system. But now, people are taking new pieces of functionality, and adding them in. And in fact, if you go to a vendor-neutral archive architecture, and a universal viewer on an enterprise level, what’s left for PACS to do? The acquisition of images, workstation display and workflow. And so if you see it that way, you might only want certain new functionalities—and most importantly, you may no longer want to purchase an entire dedicated radiology PACS. And given that, how do these little guys survive in the market, when people are trying to take a bigger-picture view?
How might what happens in Stage 3 of meaningful use intersect with imaging informatics?