If any consultant could claim the mantle of “sage of imaging informatics,” it might well be Joe Marion, principal in the Waukesha, Wis.-based Healthcare Integration Strategies. Marion, who has attended and participated in more than 30 RSNA annual conferences, was highly present as usual this year, as RSNA 2012 took place Nov. 25-30. On Wednesday, Nov. 28, Joe sat down with HCI Editor-in-Chief Mark Hagland for a conversation about this year’s conference, and his perspectives on both the conference and on imaging informatics more broadly. Below are excerpts from that interview.

What are your overall impressions of the conference this year?

One thing that strikes me is that, when it comes to healthcare reform and meaningful use, I fundamentally believe that people have been working at cross purposes: the vendor people have been focused on one thing, and the government has been focused on something else. The vendors were focused on clinician exchange of information, while the government was focused on being patient-centric. The vendors didn’t understand the direction this is going. So I think there is very much an opportunity in the whole stage 2 meaningful use situation for vendors.

Joe Marion

There has been buzz about slightly lower attendance this year at RSNA. Do you have any thoughts? And what’s your perspective on the conference more generally?

I don’t know that the lowered attendance has any other implications other than perhaps budgetary constraints [at hospitals and medical groups]. What I do think is that I’m still surprised at the lack of communication or thinking beyond departmental limits. Here’s a prime example: for the last two or three years in the advanced visualization area, the focus has been on helping people to advanced visualization processing. This year, Carestream, McKesson, GE, Agfa, are all starting to work on bringing the advanced visualization back from an open-architecture/client-server environment, back to the radiologist’s workstation. So there’s still a strong radiology department focus to their efforts.

What’s most exciting this year at RSNA?

You’ve heard about BYOD[bring your own device]? I think that that phenomenon is really starting to catch on, but there’s still a dichotomy going on in the context of the concept of zero-footprint viewers. Vendors are grudgingly doing it [expanding viewing capability for physicians], but they’re still thinking, “Oh, this radiologist wants to view images on his iPad,” but without understanding that that device is going to be the gateway into the enterprise. Client Outlook, a Canadian company, has a product called eUnity; and they see this enterprise accessibility as sort of a twofold challenge. Here’s what they’re seeing, and why I think they’re onto something. On the one hand, everyone sort of expected that any expansion of viewing capability might just be tacked onto a VNA [vendor-neutral archive], as an image-viewing entrée. On the other hand, the VNAs are taking so long to implement because of the length of the time it takes to migrate the images and data, that instead of the focal point being the VNA, people are starting to say the VNA is so complex because of the migration challenge from multiple PACS [picture archiving and communication] systems, why don’t I start with the viewing capability, which is so important?

In other words, a recognition is emerging that anywhere-image-viewing will be important in itself?

Correct.

And in addition, companies like Laitek [the Homewood, Ill.-based Laitek], which focus on data migration, are doing well.

Yes,  and so is Vital Images, acquired last year by Toshiba. [The Tokyo-based Toshia Medical Systems Corporation announced in April 2011 that it was acquiring the Minneapolis-based Vital Images. Inc.] They see their position as really bringing imaging to the enterprise. They were a client-server environment for advanced visualization; and they’re still into that, but they’ve taken the front end of that and made it into a vendor-neutral, enterprise-wide viewer.

So the gateway points into and out of the enterprise, will be a focus?

Yes.

So what will happen in the next few years, then?

I think it’s inevitable that because of the EMR integration, that imaging is going to have to expand beyond just radiology; it has to. And particularly so as it becomes more and more of a factor in meaningful use. So we’re moving towards an enterprise focus. As a result, the PACS system is becoming no longer a self-contained unit, but rather a workflow capability within radiology. And some of the vendors get that.

The other big issue is this whole question on dose management. And Bayer Healthcare bought Medtronic several years ago, and now they’ve acquired Radimetrics [the Toronto, Ont.-based Radimetrics], the leading company in the dose tracking and management area, and they’re promoting their capability as total dose management.

There has been a lot of discussion this year about dose tracking and management. I’m wondering where exactly that capability will sit, in relation to other capabilities and tools? Will it be an independently provided tool, or will it be integrated into the RIS [radiology information system] architecture?

I think Siemens [the Malvern, Pa.-based Siemens Healthcare] provides a prime example of how that might work; they bought the toolkit from Radimetrics and put it under the covers as their own tool, just as they did with Nuance with voice recognition. Also, the dose management element interfaces with the modality, and the analytics element interfaces with the RIS.

So will the larger vendors create their own under-the-covers capability in this area, then?

Yes, McKesson [the Alpharetta, Ga.-based McKesson Corporation]and GE [the Chalfont-St. Giles, U.K.-based GE Healthcare] have built their own solutions in that area.