One of the most respected consultants in the imaging and imaging informatics industry, Joe Marion, principal in the Waukesha, Wis.-based Healthcare Integration Strategies LLC consulting firm, is participating in his fortieth annual RSNA Conference (his first was in 1976). Marion who blogs and writes regularly for Healthcare Informatics, continues to see waves of change lashing the shores of the radiology and imaging informatics world. On Tuesday, during RSNA 2016 at the McCormick Place Convention Center in Chicago, he sat down with HCI Editor-in-Chief Mark Hagland to reflect on this year’s conference and the trends he’s seeing. Below are excerpts from that interview.
After a little over a day here at RSNA 2016, what are your impressions of the conference so far, and of things you’ve seen and heard?
There were a couple of things I wanted to focus on this year, to find out what the trends are. The first is the whole question of population health and differing viewpoints and perspectives on that. Some vendors in the imaging informatics space are keeping an arm’s length away from the population health concept and saying, ‘That’s the EMR, the EHR.’ Others are more involved. Watson Health, big data aspect. But there are interesting options to Watson health, applications, and such. So that’s going to become more and more of a topic. The second one is the question of anything new in the context of PACS [picture archiving and communications systems] and core solutions. I think what’s happening there is that the movement right now is definitely around the whole basis of the universal view, in the context of server-side rendering—instead of physically moving the data to the workstation—in essence, any browser becomes the workstation. That’s advancing. Visage was essentially the founder, they basically pioneered and promoted that initially. Fujifilm has gone that direction with their Version 5. TerraRecon, Vitals, have been going in that, too—in other words, a number of companies have turned to that strategy.
Is traditional PACS, as we’ve known it, dead now?
The old PACS, I think, is dead, yes.
Now, people, including you, have been discussing “deconstructed PACS” for a while. But people mean different things when they use that term. How do you see it?
The initial definition or approach was, since you’re moving to a VNA [vendor-neutral archive] or universal viewer, that functionality no longer needs to be a part of the PACS, so you could replace the viewing portion of your diagnostic capability without having to buy a completely new PACS. What people have discovered is this: they thought that they could just put in a VNA and hang some diagnostic viewing stations off that, and not need a PACS. But people came to realize that that doesn’t work in terms of the workflow. One client of mine in New England told me recently, “Oh, I don’t need a PACS anymore.” I said, “OK, I have a scenario for you: three radiologists are looking at the same set of images at the same time, and want to analyze it. How do you make that work for them?” You need the workflow.
So, it turns out that you still need the workflow capability and the diagnostic-level workstation in radiology. Companies like Agfa have done a marvelous job of enterprise-wide platform development, for radiology, cardiology, dermatology, pathology, etc. And I think that’s the direction things are going in. Here’s an example: Tomtec is a European vendor that provides image analysis tools for cardiology. And, given that, the folks at Agfa said, why reinvent the wheel? So they just licensed the Tomtec tool set for cardiology; GE did essentially the same thing. So I think you’ll see a lot more of that.
Is anything changing right now in terms of the VNA concept?
I think people have wrestled with it; in fact, there are sort of two perspectives on it. There’s the clinical perspective, which says, I just need more storage space or archive, so I’ll just engage a VNA vendor instead of a PACS vendor. But if IT gets involved, they’re going to be looking at centralized, enterprise-wide platforms, rather than separate silos or platforms. The latter is still evolving; IT is still wrestling with the value of doing that. The next couple of years will be crucial for that.
How will some of the current policy and payment trends be intersecting with these operational and technological trends in the next couple of years?
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