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One-on-One with Healthia Consulting's Jim B-Reay

July 17, 2008
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Jim B-Reay gives advice to CIOs striving to get their imaging architectures in order.

A recent survey found data storage to be one of the more pressing issues weighing on the CIO mind. And when one tries to pinpoint the culprit for most of that data, it’s inevitably imaging. Just think of your inboxes, how easy is it to just delete the photo attachments from messages and shrink your footprint in seconds. For CIOs, multiple PACS and image redundancy are sure ways to exponentially increase storage costs. Recently, HCI Editor-in-Chief Anthony Guerra chatted with Jim B-Reay, vice president, business development at Healthia Consulting (acquired last year by Ingenix), about how CIOs can work to get their imaging houses in order.

AG: Talk about the typical issues you're approached with; for example, is it CIOs that are coming to Healthia? What's a typical example of some problems they might need assistance with?

JB: What we’re seeing right now is that, to an extent, especially in the year 2008, PACS has grown. I would say that in 2002-2003, it was one of those strategic initiatives that CIOs were really putting a lot of their work into, much the same way the hospital CMOs and CEOs were getting involved in whether or not they should upgrade their modalities to digital, and there were a lot of those challenges. By this point, it’s almost a foregone conclusion that if you're going to be doing imaging, you’ve got to have a PACS. And so almost all of the major institutions have got some form going and almost all of the vendors have reached a level of parity.

Where we’re getting engaged is on two levels. The first one is we've been brought in on a number of situations where the hospital is looking to almost start over with a digital hospital solution. They want to know, okay, if we were going to start with a blank piece of paper, how should we be pulling this all together. The other area that we’re being brought in on is what I would call departmental expansions of PACS. What I mean by that is that now cardiology is asking for their own functionality, orthopedics is asking for functionality, obviously mammography has always been in the picture, but they're starting to have greater demands for access to the imagery. So what we’re being asked to do is start to say, ‘Okay, does our current PACS architecture support this; if not, what needs to be our solution?’

Unfortunately, what we’re seeing is that PACS on a radiology level is relatively mature, but on almost every other level, it’s still a bit Wild West, and there is still a lot of replication of data; there are still a lot of interoperability issues, and they're very specialized toolsets. And so, we’re in a position where if somebody is saying, ‘We’re an orthopedic specialty practice, I’ve got 15 terabytes of spine files out here; are you telling me that to work with this new PACS tool, I need to copy that data every time?’ Unfortunately, a lot of the times, the answer is yes on that. Everybody wants to be strategic, but there are a lot of cases where the vendors simply aren’t there yet. Going way back, the blank piece of paper gigs are always the most fun, partially because they remind me of the early days of PACS because you really did get to look at all the options. Right now, it is such a mature market.

AG: I would imagine few organizations can take the ‘blank slate’ approach because most need to leverage their existing investments, correct?

JB: Right. At least two of the organizations we’re working with right now are actually smaller community hospitals who are expanding and acquiring other smaller community hospitals. So they're looking for a solution that will work across their facilities. And in those particular cases, there is opportunity, I think, when it comes to the core PACS. There have been a lot of cases where a solution has been put in place and it works great for a single facility, but it doesn’t scale to a larger facility. And that is a case where we get to come in and make recommendations for more horsepower, better architecture.

The other thing that we've run into has been just in a few cases, it hasn’t really been a groundswell just yet, but we have been asked more than once to evaluate a mainstream PACS solution and find out whether or not a replacement is a good idea. This relates to some of the vendors, which the names are familiar, where either an acquisition is going relatively poorly, or they really haven't lived up to things. There is the major group that was acquired just in the last year, and we've fielded more than a few calls saying, ‘Should we get out of that PACS and start to move our data?”

There was another one I was working with on a purely cardiac level where the vendor had been acquired midway through the implementation and we actually looked at the contract and got out of it. So there are some strategic things along those lines as well that we've been working with.

AG: Are you seeing a lot of issues with hospital systems that have grown through acquisition, winding up with PACS from different vendors? How much do you see that versus CIOs struggling with an imaging strategy that has just gotten away from them?