When it comes to picture archiving and communication systems (PACS), most clinicians in an acute-care setting prefer a system designed by radiologists for radiologists. That's one of the key findings of a report from the Orem, Utah-based KLAS ( www.KLASresearch.com).
The report, “A Read on PACS: Hospital Expectations Rising,” examines a market that is highly mature along a number of dimensions, from the level of saturation to the level of expectations among end-users. KLAS researchers and CIOs alike agree that, given the expectations of hospital healthcare IT leaders and end-users, the competition for market share will only continue to intensify.
It is in that context that the PACS vendor that was most highly ranked by CIOs and others surveyed by KLAS was founded by a radiologist and has become known for valuing the feedback of its customers. According to the report, which was published in November 2010, DR Systems Unity took home the honors for acute-care with an overall performance score of 86.0 out of 100. (Coming in at number two was McKesson Horizon Medical Imaging, with an overall score of 83.2.)
For DR Systems, capturing the number one spot in the acute-care arena indicates that the company has adapted to its rapid growth and has renewed its focus on customer service and support, according to Ben Brown, who is KLAS general manager for medical imaging and medical equipment. The fact that DR Systems was founded by a radiologist also gives the company an edge, Brown believes. “It's really been a radiology-focused company,” he says.
DR Systems solicits input from its customers, as well. User groups are regularly asked to submit lists of upgraded features they would like to see incorporated, and the company prioritizes the items on the wish lists, says Brown, who adds that the vendor has found a niche among hospitals of between 200 and 500 beds.
Among the larger, multi-site hospital organizations, vendors like McKesson, Philips, GE, and FUJIFILM still dominate mindshare for PACS deals. But Brown is quick to point out that this market segment is already 95 percent to 98 percent saturated and is well past the initial go-live stage. As a result, these organizations are now concentrating on upgrading existing PACS or contemplating a future system replacement.
However, given the up-front costs, the economy, and the potential effects of meaningful use on radiology, Brown says he has seen a limited number of these hospitals pull the trigger on placing an order. Replacement activity is increasing, especially at the high end of the PACS market. He also observes that there is a discernible difference between large hospitals and smaller community hospitals when making that leap. “In the large hospital market, technology is the driver. Price is probably a close number two. In the community hospital market, price is number one,” he says.
Product availability also is a factor in market share. “There are only a handful of vendors that compete at the highest end of the market,” Brown says. “There are quite a few vendors that are very successful in the smaller market, but provider confidence in their ability to scale up limits the number of vendors that typically compete in the high end of the PACS market,” he says.
ACHIEVING INTEROPERABILITY
One persistent problem, especially for large hospitals that have tended to purchase best-of-breed systems, is achieving interoperability across disparate platforms. In Brown's view, interoperability issues have even been a challenge for vendors that offer integrated systems, which often come up short in the PACS arena, he says. “Epic doesn't have a PACS, but it has an integrated EMR/RIS. GE Healthcare has a RIS, PACS, and EMR, but they have acquired them from other companies. Philips has a large customer base with its PACS, but it doesn't have an EMR.”
Brown notes that “one of the reasons Epic and Cerner are successful is that they have an integrated platform.” However, he adds that “Cerner has a great integrated system, but a majority of Cerner hospitals have not gone with Cerner PACS.” Rick Schooler, senior vice president and CIO of Orlando Health in Florida, says the problem of interoperability is compounded when different hospital departments and off-site radiology groups use different PACS. “Each specialist has its own preference for a PAC system,” he says. “What they want is the functionality. But you can't find it in one solution.”
To accommodate its departmental needs, Orlando Health's eight-hospital healthcare network uses GE Healthcare Centricity PACS in radiology; Merge Healthcare PACS in pediatric cardiology; and Medcon's C-PACS (now owned by McKesson) in adult cardiology. It has recently purchased ThinkingPACS from Thinking Systems Corp. for use in its nuclear medicine department, Schooler says. Obviously, running this many PACS can create IT challenges. “The more technologies you have, the more interfaces you have,” Schooler says. “But you are still in the business of managing multiple platforms.”
Schooler also points to the additional challenge of storing and retrieving images. Each PACS has its own short-term storage capacity, and in order for the EMR to retrieve archived images, it has been necessary to install a long-term, common-platform storage solution on the back-end. On top of that, Schooler notes that Orlando Health is working with Symantic to ultimately roll out a cloud-based PACS image storage solution. “You're going to see a lot of imaging going to the cloud,” he says.
And while Schooler acknowledges that Orlando Health has been able to build bridges between different PACS platforms, he states: “As people like me find options that are integrated, you'll see us buying that integrated solution.”
NECESSITY: THE MOTHER OF INVENTION
Sometimes, specific needs lead to innovation around integration and interoperability. The University of Pittsburgh Medical Center (UPMC) health system, for example, needed to accommodate multiple, diverse PACS solutions, leading the organization to develop a unique solution. With 20 hospitals, 30 imaging centers and a total of about two million imaging exams per year, UPMC uses PACS from FUJIFILM, Siemens, and GE Healthcare. But it relies mainly on Philips, says Rasu Shrestha, M.D., vice president of medical information technology and a member of the KLAS advisory board. “The PACS solution we have here is different from the vanilla iSite solution.”
As a recognized innovator in healthcare IT, UPMC had already developed its own PACS, called Stentor, which was subsequently acquired by Philips and rolled into its iSite product.
What was still needed was a way to bridge different PACS platforms, to make all images available across the entire enterprise, and eliminate duplicate tests. Two years ago, UPMC developed a solution called SingleView to address that need.
In explaining the philosophy behind SingleView, Shrestha says, “A lot of PACS vendors are still focused on a silo approach. But they're missing the point. It should not be about PACS or RIS. It's not about an application. It's about the clinical workspace. SingleView is our imaging interoperability platform that bridges the silos.” One of the unique features of SingleView is that it provides instantaneous access to a patient's previous imaging studies and reports, regardless of the department or origin, he says.
As a radiologist, Shrestha knows the importance of having access to previous images and reports, but his emphasis on the clinical workspace goes beyond PACS. “What we're trying to achieve is treating the patient as a whole-a more holistic approach. I want relevant, actionable and contextual information at the point-of-care. SingleView creates a more patient-centric view of imaging. It gives us, at the point-of-care, all the imaging history of that patient,” he says.
DECISION-MAKING OPTIONS
The decision to purchase or upgrade a clinical system like PACS requires buy-in from a number of stakeholders, not least the physicians who demand a system that works best for them. “This is not a CIO decision,” says Schooler of Orlando Health. “It's a collaborative process.” For those contemplating purchasing their first PACS, or replacing an existing system, Schooler's advice is simple: “You have to get ready to operate on multiple platforms. But if you can buy an integrated platform, why would you buy multiple platforms?”
Adds Shrestha: First-time or replacement purchasers need to spend a lot of time reviewing PACS solutions in their entirety and speak with other customers of the vendors they are considering. “Look under the sheets,” he said. “How future-proof is the vendor? Look for vendors that aren't afraid to embrace industry standards-not just develop a proprietary system.
“And analyze your workflow,” he says. “Make sure the PACS you choose will fit your workflow.”
Richard R. Rogoski is a freelance writer based in Durham, N.C. Healthcare Informatics 2011 September;28(9):28-30