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One CIO Details her Organization’s “Journey from the Basement” to Modernize its IT Strategy

August 21, 2018
by Heather Landi, Associate Editor
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Hybrid IT is increasingly the norm, creating technology, organizational, and management complexity, according a research report
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With the ongoing digitization of healthcare, patient care organizations now generate a significant amount of data, and all that information, from electronic health record (EHR) data to lab tests and imaging exams to research and emails, needs to be efficiently stored and managed.

In today’s evolving IT landscape, CIOs and other healthcare IT leaders are now faced with the challenge of developing a robust data infrastructure strategy to effectively handle all this data, and beyond on-premise data centers, the options now include colocation in an existing data center, hybrid cloud and public cloud solutions.

A research report by The Uptime Institute, a third-party organization focused on data center performance and efficiency, notes that the march towards digital transformation will continue to shape data center approaches across all industries. “Specifically, managers must effectively manage the proliferation of hybrid IT architectures, defined as a mix of on-premises data center capacity and off-premises resources such as colocation, cloud, and hosting. Hybrid IT is now the norm, creating technology, organizational, and management complexity,” the report states.

A survey conducted by KLAS Research published last December found that 70 percent of healthcare organizations have moved at least some applications or IT infrastructure off-premises. While most of those using off-premises computing are doing so through a hosting environment, future plans lean heavily toward the cloud, according to the survey results.

Several years ago, leaders at the Moffitt Cancer Center, a nonprofit cancer treatment and research center based in Tampa, Florida, were faced with the complexity of managing the organization’s steady growth, and the need for an IT infrastructure that keeps pace with that growth.

Established in 1987, Moffitt is a National Cancer Institute-designated cancer center that encompasses a 206-bed hospital, with a large ambulatory practice comprised of three facilities, and a nationally recognized research institute, with more than 220,000 square feet of research lab space. Moffitt has 336 employed physicians and 100 independent physicians, as well as about 200 additional clinicians.

Over time, Moffitt Cancer Center has expanded its facility from 373,000 square feet to 2 million square feet, which has, in turn, increased its system footprint and the amount of data generated, accessed and stored. In 2004, Moffitt opened a new data center in the basement of the hospital to house its growing IT systems. However, by 2011, the on-premise server and storage infrastructure was nearing capacity. In the past seven years, the organization has had to rapidly evolve its technology environment and, as part of this evolution, Moffitt leaders have had to rethink the organization’s existing data center strategy.

Seven years ago, organization leaders considered several options, including expanding the existing data center as well as outsourcing its ongoing IT operations to a third-party provider, according to Jennifer Greenman, Moffitt Cancer Center’s vice president and CIO, who joined Moffitt in 2013. “At that time, the organization’s leaders made the determination that a co-location model was the more sustainable, resilient and scalable model to power our future growth,” she says, noting that Moffitt has a large, growing and diverse data set.

Jennifer Greenman

Moffitt partnered with Charlotte, N.C.-based Flexential, a provider of hybrid IT data center solutions previously known as Peak 10, to move some of the cancer center’s data assets to the company’s East Tampa data center facility.

“During that time, we continued to maintain our on-premise facility, and so we were leveraging the colocation facilities for expansion of new technology infrastructure assets as well as some targeted business continuity needs that we have,” Greenman says. “Our rapid infrastructure growth continued from that time to the present day. In 2016, we had a unique opportunity to transition into a newly constructed, state-of-the-art facility that Flexential had built. We made the decision to move our data center environment into the new data center,” essentially consolidating the organization’s assets to one location.

By migrating to a colocation approach, Moffit leadership contend this enables the organization to focus its internal resources on its core competency—patient care. “From an operating mission, our singular mission is to contribute to the prevention and cure of cancer, and that mission is deeply ingrained into our culture and our practice,” Greenman says. From an IT perspective, uptime is critical as Moffitt physicians,  clinicians and other staff members need immediate access to patient records and research data.

With the transition from an on-premise data center to a colocated model, Moffitt leaders were looking to streamline processes and operations, increase redundancy and high availability, lower costs and improve performance.

“[Flexential’s] physical facilities and operational controls provide us with a high degree of assurance in delivering care to a complex population of patients and enabling cutting edge research,” Greenman says.  

To illustrate one of the benefits of using colocation services, Greenman notes that when Hurricane Irma was aiming for Florida in early September 2017, the hurricane was projected to be severe and was tracking at certain points for a path over Tampa Bay. “As we prepared for the event, my team had sincere confidence in the power and structural resiliency of our colocation facility. This confidence was reinforced by the proactive measures that Flexential took in preparing and communicating in the days and hours leading up to landfall,” she says.

The Tampa Bay area was spared a direct hit from Hurricane Irma and Moffitt experienced relatively minor issues across its infrastructure, mainly due to power outages, she says. “Our confidence is so high that we are now moving our disaster recovery services to the collocated environment as well,” Greenman says.

Greenman notes another significant benefit as a result of migrating to a hybrid IT provider: “Our ability to efficiently manage and administer services within this environment is improved, particularly due to the high level of service provided by the colocation partner.” She adds that special power requests are accommodated within days as opposed to weeks or longer, as Moffitt experienced in the past. 

“These processes have had a positive effect on our discipline in managing the data center environment. Also, this model delivers a higher degree of transparency into power consumption, which informs our expense management and financial forecasting abilities. And, the access and audit controls provided are robust and streamlined, which is important for demonstrating compliance with stringent regulatory requirements,” she says.

By migrating its IT operations to Flexential, Moffitt consolidated its infrastructure to a single location during a period of significant growth all while simplifying processes and operations, Greenman notes. As a result, she says, Moffitt has realized improved redundancy, availability and performance.

Flexential’s East Tampa facility is a Tier 3 data center, per The Uptime Institute’s four-tier ranking system. The Uptime Institute has established data center criteria for power, cooling, maintenance, and capability to withstand a fault, across four tiers. A Tier 3 data center features 99.982 percent uptime and a high degree of redundancy and better fault tolerance. “Those standards can be challenging for any institution to construct and maintain on its own,” Greenman notes.

She adds, “This partnership provides us with assurance and resiliency, two of the most important benefits as a healthcare provider.”

Challenges in the Transition to Colocation Services

It is important for healthcare organizations to understand the factors to consider when evaluating a colocation or hybrid IT model and what challenges to plan for in the transition to colocation services.

For Moffitt Cancer Center, the transition  from an internal IT strategy to a colocation approach, or the “journey from the basement,” as Greenman refers to it, required very careful planning.

“Planning becomes a critical success factor, and when working with a third-party company, planning is even more essential. A tremendous amount of detail and coordination also is required to be successful,” she says. “In the healthcare environment, there is little tolerance for operational disruption. Ensuring the transition from one data center environment to another, and ensuring that it’s executed in a seamless way, it’s a very delicate but critical aspect for success.”

The steps involved include coordinating with vendors regarding connectivity and moving technology assets in a way that was not disruptive to operations. In addition to working with Flexential, Moffitt tapped a third-party advisory firm to help with strategic planning. “There is no such thing as too much planning for these types of transitions,” she says, adding, “Another important lesson is to give thought to long-term space and power needs, as much, or maybe even more so, as if you were planning an on-site environment.”

A key principle of any major technology initiative is ensuring that the IT teams and impacted business units are engaged in planning and execution, Greenman says and this holds true when migrating to colocation services. “You need to reinforce the principle that this is an enterprise project; the data center is not just infrastructure and operations,” Greenman says.

When rethinking the organization’s approach to IT infrastructure and data centers, organization leaders also should account for future growth and expanding data needs.

Moving forward, Greenman says a key benefit of the colocation approach is the inherent capacity for expansion, both in terms of physical assets and network connectivity, including to hyperscale providers, which will be a key enabler for future business-driven innovation. 

“We’ll have the ability to very seamlessly, and in a low latency way, connect our data center environment and migrate workloads from our data center environment to a public cloud resource and back as it makes sense for our business needs,” she says.

 


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Research: AI, Automation Reshaping Healthcare Technology Support

December 6, 2018
by Heather Landi, Associate Editor
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Supporting an evolving, complex technology stack along with the needs of both internal and external customers is not easy for IT vendors. Moving forward, emerging technologies, such as automation and artificial intelligence (AI) will redesign the way in which tech support firms function, according to a Black Book Research survey.

As a result of new and emerging technologies, support operations will look significantly changed from what exists in 2018, according to the research report.

“IT support will become much more customer-facing, but also much more robotic,” Doug Brown, Black Book Research managing partner, said in a statement. “The power of automation and the rise of the patient experience are disrupting an idling tech support sector as vendors restate relevance in the client services space.”

AI, chatbots and other forms of automation are now grabbing attention within most of the systems targeted at the healthcare IT support industry, but there's not a lot of companies employing them, according to Black Book’s research. Only 3 percent of healthcare providers and 5 percent of payers responding to the Black Book survey have launched automated client service strategies. 

“Healthcare tech support is on the cusp of change and as healthcare technologies evolve and improve, they are likely to reshape the very nature of what is client services and tech support,” Brown stated.

With innovations like AI-powered conversation platforms, tackling challenges in natural language understanding and context resolution, healthcare tech support firms will be able to create advanced virtual agents that retain deep knowledge about supported products.

“Clients will be able to provide end users with a new way of interacting with support services beyond the help desk,” Brown said.

There also is a shift from an exclusively internal focus to an external focus, as delivering and support a superb customer experience is becoming the primary driver of competitive advantage for healthcare organizations.

"As technology becomes more profoundly entrenched into every turn of the healthcare consumer journey, vendors are also beginning to realize that the traditional internally-focused support organization may be best suited to help their provider clients successfully shift their focus to consumers,” Brown said.

Eighty-eight percent of CIO respondents reveal they are beginning to re-imagine the role of the support organization as they recognize technology is now critical to the patient experience and that their existing support teams are not well positioned to provide the best support, the survey findings indicate.

Blockchain, which offers a shared, distributed, and decentralized ledger that serves as a foundation for trusted collaboration among multiple parties throughout the tech support processes, also will play a role in this area. The next wave of innovations will be focusing on standardizing blockchain solutions that can be seamlessly integrated with organizations' IT systems to jointly drive the tech support ecosystem, according to Black Book Research.

The increasing role of Big Data and the Internet of Medical Things also will fundamentally change the technology support functions. Healthcare organizations are growing increasingly dependent on big data direct their initiatives. This tsunami of data requires more computing power, more hardware, more network capacity and more devices, both traditional and mobile, along with the need for ongoing maintenance of cloud infrastructure, servers, desktops, laptops and storage and network devices, according to the report. This will require IT vendors and managed services providers to have a deep pool of skilled subject matter experts available to proficiently service clients and also maintain the certifications to support multiple manufacturers' hardware, storage devices, operating systems, and networks.

With regard to IoT devices, as this technology expands to meet the needs of the industry, service desk teams are given the opportunity to specialize and research better ways to manage these devices and ensure they are under their control, and return value, and not risk to any environment.

More sophisticated tech support also will be necessary to support enhance patient care, according to the research. Eighty-eight percent of clinicians responding to the survey assert their delivery of patient care services are continually impeded by subpar user tech support, increasing nearly ten percent from last year's survey. Ninety percent of hospital chief medical officers surveyed asserted multi-level tech support from their health records vendor ranging from help desk through engineering interventions will be a leading competitive inpatient electronic health record (EHR) differentiator in 2019.

Of the 92 percent of hospital respondents that view high quality user support as a make or break feature in a vendor relationship, 60 percent say their tech support (both EHR firm provided and from EHR tech support outsourcing partners) are currently falling short in their responsibilities to ultimately allow patient care improvements through well trained delivery personnel.

Eighty-three percent of hospital tech managers prefer that their EHR deliver direct, comprehensive tech support, not push the responsibility to third parties or on the hospital system itself as the only options. Eighty-one percent of those clients employing third party outsourcing tech support are significantly dissatisfied with the level of response and the quality of their services in the twelve months following go-live. Clients could potentially be leveraging one vendor for their help desk services and another for their upgrade services and so on which can lead to an overall disparate support strategy, according to the report.

“The increasing complexity of healthcare technology has made it even harder for an in-house help desk team, especially in small and medium sized communities to have sufficient expertise to meet all of an organizations' tech support needs,” Brown said.

Enterprise tech support is a highly complex and niche area in healthcare, where specialists can make a big difference in client loyalty by catering from Level 1 to Level 4 product support to ensure all the provider's business goals are aligned with technology readiness.

Vendors scoring highest among the four comprehensive levels of technical support are Cerner, Allscripts and MEDITECH.  The majority (84 percent) of tech support for Epic clients were attributed to third party outsourcers, consultants, and independent tech support firms working in Epic Systems client facilities.

 

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RSNA 2018: Imaging’s Resurgence?

November 29, 2018
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Today wraps up the 104th annual Radiological Society of North America (RSNA – www.RSNA.org) meeting.  Mother Nature made it a challenging place to get to early in the week, but from all accounts, attendance was on par with the past few years. 

From an imaging informatics perspective, this year saw a number of things that point to a resurgence in imaging.  It also presented some disappointment with respect to how the imaging vendors are dealing with a changing healthcare environment.

Artificial Intelligence – the obvious

Let’s begin with the 600-pound gorilla in the room, and that would be Artificial Intelligence (AI).  By all accounts, if you were to sum up this year’s meeting, AI everywhere would be how one would describe it!  AI has been a topic of discussion for several years now, initially driven by IBM’s Watson Health initiative. 

In prior years, there was considerable talk about how AI was going to revolutionize Radiology, and potentially replace the radiologist.  This year, the emphasis seemed to really shift from the “pie-in-the-sky” discussion to real-world, commercially available solutions.

A key development conundrum has been how to commercialize AI.  Academic centers represent a first line of research into AI applications, while “boutique” companies have struggled with how to get developments to market.  Large imaging informatics companies have likewise wrestled with how to approach bringing AI applications to market.  The solution prevalent this year seems to be for both large and small companies to offer a “platform” for the implementation of AI.  By supporting such capabilities as software development toolkits (SDK’s), vendors are providing a means for commercialization of academic and third-party applications without themselves reinventing the wheel.

The AI “store” borrows from the way smart-phone applications have evolved by providing the infrastructure for the validation and distribution of AI applications.  What is not yet clear is the liability of providing access to other entity’s applications.  Is the Store vendor responsible for the application, or the developer?  Who files for and secures FDA approval?  Given that the objective is for these external applications to interoperate with the vendor’s imaging informatics system, there is some development risk on the part of the distributing company, and potentially a shared liability as well.  Only time will tell how effective this strategy is.

Depending on who you ask, AI primarily is perceived as clinical tools to improve the radiologist’s interpretation efficiency, not as a replacement to the radiologist from a clinical perspective.  Conversely, there were a number of applications that make use of AI technology to enhance the way information is handled and presented, and the way it impacts the decision process.  Much of this revolves around the way information is collected and made available to the clinician, such as retrieving relevant lab and other study information. 

One interesting example might be Siemens Healthineers’ Proactive Follow-up application (https://usa.healthcare.siemens.com/healthineers-population-health-management/value-based-care/proactive-follow-up-for-incidental-findings).  It uses natural language processing to identify incidents of follow-up, such as “repeat CT exam in six months.”  Incidents requiring follow-up are summarized in a “dashboard” presentation to enhance the ability of imaging services to coordinate with the necessary clinical services to ensure that the follow-up recommendation is followed through.  While not as “sexy” as an AI image processing algorithm, it may have just as much if not more impact on imaging services’ efficiency.

AI will influence imaging in another way by fostering greater use of the cloud.  To maximize availability and accessibility, the cloud appears to be the major means for the deployment of AI applications.  Some vendors are also increasingly moving to the cloud for their entire enterprise imaging informatics applications.  Such non-traditional players as Intel and Google are becoming a greater factor in terms of how imaging is secured and managed, and AI appears to be an influencing factor. 

Clinical Decision Support – the not so obvious

While major emphasis was on AI, less emphasis seems to have been given to Clinical Decision Support, and the associated mandates.  The Protecting Access to Medicare Act of 2014 (PAMA) originally directed CMS (Centers for Medicare and Medicaid Services) to require Appropriate Use Criteria (AUC) consultation for Advanced Diagnostic Imaging procedures beginning Jan 1, 2017.  The mandate has now been delayed to January 1, 2020, which isn’t that far away!

Imaging companies correctly point out that clinical decision support will be more a function of the electronic health record (EHR) system, and they don’t seem to be particularly concerned with how it will impact imaging applications, with a few notable exceptions.  Change Healthcare (https://www.changehealthcare.com/) has been reformulated over the past few years from a “back office” services company to one encompassing imaging through the acquisition of McKesson’s imaging business.  More recently, Change acquired National Decision Support Company (http://nationaldecisionsupport.com/) to address the PAMA mandates by means of synergy between its product lines. 

Similarly, Siemens Healthineers acquired Medicalis, which was also focused on clinical decision support tools.  Collectively, these two vendors seem most aggressive in addressing the intersection of imaging services and the changing landscape of healthcare management.

Value-Based Care – another not so obvious

Healthcare providers are moving away from fee-for-service models to value-based care models of healthcare delivery.  These changes will ultimately impact imaging services, yet there appeared to be little direct emphasis amongst exhibitors. 

Part of this conundrum may be the perception that much of the informatics needed to address value-based care will be encompassed within the EHR.  On the other hand, imaging vendors seem to be more focused on the “mechanics” as opposed to the topic of value-based care.  For example, analytics tools and intelligent worklists are mechanisms that will help enable radiology to support value-based care, but they are not necessarily emphasized as such.

Consolidation and New Players

The industry continues to be a study in competitive dynamics, in that certain segments demonstrate further consolidation, while other segments continue to expand.  The area of workflow orchestration has seen a transition from “incubator” companies such as Clario, Primordial, and Medicalis to complete absorption by large imaging vendors.  Siemens Healthineers previously acquired Medicalis, and Nuance acquired Primordial.  The surprise announcement at this year’s meeting was the acquisition of Clario by Intelerad (https://www.intelerad.com/en/press-releases/intelerad-medical-systems-acquires-clario-medical/).  This now means all three of the key workflow orchestration vendors are part of larger imaging informatics organizations, and can leverage those capabilities as part of their offerings.

On the other side of the spectrum was the dramatic introduction of United Imaging Healthcare (https://usa.united-imaging.com/united-imaging-healthcare-makes-u-s-market-debut-at-rsna-2/) into the U.S. market.  United made their entry with one of the larger exhibits, and a dramatic first-day unveiling.  While operating in other world markets prior to this year, United has made a large investment by establishing a U.S. presence.

For a number of years, the imaging industry has lived in the shadow of the EHR, as providers scrambled to address government mandates for electronic health records.  Now that much of that infrastructure is in place, it appears that imaging informatics may be well-positioned to capitalize on further investment to support the EHR.  AI appears to be the first recipient of that emphasis.  From my vantage point, there will need to be a further shift to emphasize applications and solutions that support consolidation and value-based care trends.  It will be intriguing to see if these areas receive more emphasis at RSNA 2019!

 

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At RSNA, Imaging Informatics Sage Joe Marion Offers Straight Talk on this Moment in Imaging IT

November 28, 2018
by Mark Hagland, Editor-in-Chief
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Industry observer Joe Marion shares his insights on the path forward into the imaging informatics future

Joe Marion, a principal in the Waukesha, Wis.-based Healthcare Integration Strategies LLC, has participated in 42 RSNA Conferences—probably among the most of any current attendee. No one has a broader perspective on the imaging informatics vendor market than Marion, who spent years on the vendor side before shifting over to consulting a number of years ago.

As in recent past years, Marion sat down at this year’s RSNA Annual Conference, being held at Chicago’s vast McCormick Place Convention Center, and sponsored by the Oak Brook, Ill.-based Radiological Society of North America, on Tuesday afternoon, to speak with Healthcare Informatics Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

What’s your overall impression of the exhibit floor at this year’s RSNA?

Well, obviously, the one buzzword that’s everywhere is artificial intelligence. The reality is that I think it means different things to different people. The difference between last year and this year is that some things are coming to fruition; it’s more real. And so some vendors are offering viable solutions. The message I’m hearing from vendors this year is, I have this platform, and if a third party wants to develop an application or I develop an application, or even an academic institution develops a solution, I can run it on my platform. They’re trying to become as vendor-agnostic as possible.


Joe Marion

Meanwhile, outside of one vendor, I’m not really seeing a whole lot of emphasis this year on value-based care; that’s disappointing. I don’t know whether people don’t get it or not about value-based care, but the vendors are clearly more focused on AI right now. And that’s surprising to me in terms of some of the mandates, for example, for referring physicians to soon use clinical decision support—that’s important. [Here, Marion referred to the Protecting Access to Medicare Act (PAMA), which requires referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services—CT, MR, nuclear medicine and PET—for Medicare patients. The federal Centers for Medicare and Medicaid Services (CMS) will progress with a phased rollout of the CDS mandate, as the American College of Radiology (ACR) explains on its website, with voluntary reporting of the use of AUC taking place until December 2019, and mandatory reporting beginning in January 2020.] And I don’t think the imaging marketplace is anywhere prepared to manage value-based care yet.

Meanwhile, we’re seeing ongoing consolidation among vendors: for example, Intelerad has just acquired Clario. [As announced on Nov. 25 in a press release published on Business Wire, the Montreal-based “Intelerad Medical Systems™, a leader in enterprise workflow solutions, today announced the acquisition of Clario Medical, a zero footprint worklist company based in Seattle, Washington. The combined product offering will augment Intelerad's robust and highly scalable enterprise imaging solutions with Clario's rich, zero footprint worklist, satisfying the demanding needs of rapidly growing radiology practices and health systems.”] Clario was the last remaining independent worklist management/workflow company. Medicalis and Primordial had been the last two others, before being acquired by Siemens and Nuance, respectively. So all of that independent workflow capability is gone. But people perceive that even though Medicalis is now a part of Siemens and Primordial is a part of Nuance, that they’re available for third-party applications. They’re viewed as vendor-agnostic solutions, even though they’re part of bigger companies.

Is anyone buying PACS [Picture Archiving and Communications Systems] anymore outside of pure replacement needs?

Probably not. The only real reasons now that people are purchasing PACS systems any longer are replacement or upgrade. The one that’s on fire has been Visage [the Richmond, Victoria, Australia-based Visage Imaging]; they picked up Mayo Clinic last year and so everything in all of Mayo is now running off Visage. They’ve replaced their legacy GE and Siemens systems. They’ve just announced Partners in Massachusetts. So they’re on a roll.

Why is that?

I think people like their product, it’s scalable, and they’ve got a great user interface. It’s a viewing environment, not a complete PACS. They rely on third parties for the archive. They don’t address the vendor-neutral archive, they’re just about the front-end viewing. And they use third parties like Primordial or Medicalis for workflow, and just focus on the viewing aspect.

The other one that’s on fire is Sectra [the Linköping, Sweden-based Sectra AB]. Philips used them for PACS over ten years ago, and when they bought Stentor, they dropped that relationship. But only half of the sites that had Sectra went with Philips, half stayed with Sectra. And they’ve picked up HAP [the University of Pennsylvania Health System] in Philadelphia, and City of Hope in California. They never used to get invited to the table for the big deals. And the University Hospitals in Cleveland is their showcase. And now that they’ve got some of those big university hospitals, for PACS, they’re getting other deals.

So we’re seeing changes in the lead [PACS] vendors in some cases. Visage is a clear example because they’ve had so much success; Sectra is up and coming—they’ve always been strong in mammography, and they’re leveraging a lot of that technology now. Change Healthcare had some issues in terms of that transition from McKesson to change. They haven’t kept pace; but I think they can easily recover. They’re moving, interestingly enough from their dedicated relationships, and they have a relationship with Google and are going exclusively with Google Cloud, so over the next few years, their product line will change considerably. The same is true with Intelerad: they’re pushing heavily into cloud structure, which is why they acquired Clario. IBM has gotten more realistic. They do have a couple of pieces out there that are current, release product. Last year, it was a lot of smoke and mirrors and promises; this year, they legitimately have some products out there.

The fact is that tTe AI market today is like what the PACS market was fifteen years ago—very crowded. There are something like 50 players out there; it will shake out over the next several years.

What will make some succeed and some not?

I think it’s going to be the value of the product, and also the extent to which the vendors will make their products flexible in terms of being interfaced with others, so there’s this integration aspect, folding into vendor A, vendor B, vendor C, etc. So for a third party, the more they reach out and create relationships, the more successful they’ll be. A lot of it will come down to clinical value, though. Watson has had problems in that people have said, it’s great, but where’s the clinical value? So the ones that succeed will be the ones that find the most clinical value.

This is your forty-second RSNA. When you look at the trajectory of last ten years and what’s ahead, what do you see happening in the next few years?

I think the first push of AI right now is in the context that some vendors have described it as enabling the radiologists to become more efficient. That’s the primary, initial set of tools. But that’s the clinical set of tools. The next wave will go beyond the clinical to the operational, making the department more efficient, and being supportive of value-based care.

What should healthcare IT leaders be focused on right now, as they look at this market?

Well, the other aspect of this is that more and more of this technology, on the imaging side, is moving to the cloud. And that’s part of the struggle of this: how are they going to manage that, in terms of security and all the other issues they worry about, while maintaining ownership of their data?

Are there any dangers or cautions for IT leaders to consider in the next few years?

I think the challenge lies in asking how much to focus on the EHR [electronic health record], versus how much to focus on other areas.  Some of these cardiology solutions are reporting modules. Cardiology has looked unfavorably on cardiology  PACS systems, because they haven’t proven to be full-fledged cardiovascular information systems. Many providers have tried to make cardiology PACS systems work as full cardiovascular information systems. For example, one major EHR system has a cardiology solution that just collects data, but doesn’t manage the images. So the IT people think they’ve got a solution, but from the standpoint of cardiologists, they don’t; it’s not robust enough to serve all their needs. And cardiology has come out of disparate systems, EKG, vascular, ultrasound, a hodgepodge of systems, and no single environment. And over the last ten years, those have evolved to provide a true cardiovascular IS. GE’s done that, Fuji’s been transitioning to that. Lumedx [the Oakland, Calif.-based Lumedx] really has proven itself to be the gold standard in that area; they started with the databases, and then expanded off that to do the reporting; they do the registries. So they have full-service capability. They acquired a PACS vendor. They have a relationship with a vendor for the hemodynamic data.

On a scale of 1 to 10 in terms of optimism versus pessimism, in terms of imaging informatics moving forward to where it needs to go, where would you say you are right now?

I guess I’d say maybe a “6.” One of the things I’ve done is to create a schematic that I’ve been sharing with vendor executives this year on the exhibit floor. It has to do with the integration of various capabilities. On the one hand, you’ve got one set of capabilities that are fairly well established—the modalities, PACS, RIS [radiology information systems], EHRs, and advanced visualization. Then you’ve got emerging capabilities, including analytics, AI, workflow orchestration, CDS [clinical decision support], and referral management. How will vendors integrate all of those capabilities on behalf of their customers?

Every vendor has a slightly different strategy. But for them to succeed, they’ll have to figure out a strategy to enable them to do all of those things, either by themselves or through others. And even as far back as the modalities, people are starting to build AI into the modality. For example the patient moved [residences]; what do I do. Do I have to repeat images or not?

Ultimately, then, vendors will have to move towards a new level of robustness?

Yes, they’ll have to figure all of this out in terms of a changing customer mix. So Advocate [the Downers Grove, Ill.-based Advocate Health Care] and Aurora [the Milwaukee, Wis.-based Aurora Health Care] are now together, for example [on April 2, the two systems merged into a 27-hospital, $11-billion-in-revenues integrated health system, the tenth-largest in the U.S.] And they’re working off two different Epic EHR systems. Advocate concentrated on GE for PACS; Aurora is focused on McKesson/Change for PACS. So how will they contend with that and move forward? If you think of the workflow, why shouldn’t a radiologist sitting in Milwaukee be able to read a case down in Chicago? So because of consolidation, it’s a different picture than five years ago. So the workflow orchestration element is huge. How do I now divvy up that work between Advocate and Aurora? How do I provide the information from the EHR that accompanies the images, to make that information available? The vendors are wrestling with this. They haven’t yet realized that their customer base has changed.

 

 


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