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LIVE FROM RSNA: Joe Marion on Imaging Informatics Vendors and the Future

December 3, 2013
by Mark Hagland
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On the Tuesday morning of RSNA 2013, Mark Hagland sat down with Joe Marion, a leading light in the imaging informatics space, for his perspectives on vendors—and more

On Tuesday morning, Dec. 3, HCI Editor-in-Chief Mark Hagland sat down with Joseph L. Marion, principal in the Waukesha, Wis.-based Healthcare Integration Strategies, LLC consulting firm. Joe Marion, who regularly blogs for HCI, has been working as a consultant in the imaging informatics field for three decades, and has been an RSNA attendee from the start. He shared his perspectives on what he’s been seeing at this year’s RSNA Conference, being held at Chicago’s McCormick Place Convention Center. Below are excerpts from their interview.

What is different this year about RSNA?

I think what I’m seeing is more attention to meaningful use; it’s finally starting to impact the vendors. Some vendors get it; others don’t yet. What’s dawning on some is the need to get to the universal viewer. So for example, TeraRecon changed the name of their product. They stripped out the back end rendering program, so instead of 3D viewing, now it’s a universal viewer.

People are realizing that the universal or unified viewer is a thing of value, right?

Yes. In the last three years, all the talk had been about VNA [the vendor-neutral archive], and that’s valuable and it’s going to happen. But some of the thinking is still bound to modality and specialty.

So really, the solution is a VNA plus a universal viewer?

Correct. The thinking was, we’ll put in the VNA, and then add a viewer. But with the cross-document sharing (XDS) standard, coming out of the IHE [Integrating the Healthcare Enterprise]—and the purpose is to be able to exchange documents between different organizations—part of that is a registry function. I can register a study in that registry. So everything that is related to that study can be located and identified. So TeraRecon is saying, here’s the viewer, and it has the registry function based on XDS under it. So it knows that if the CT study is in the radiology PACS [picture archiving and communications system], it can go to the radiology PACS. So I don’t necessarily need the VNA immediately to do that. Are there advantages to having a single repository? Yes. But it’s not immediately essential. So people are realizing that this viewing and workflow is the most important element.

And particularly per HIE [health information exchange] in an ACO [accountable care organization] situation, right?

Yes. VNA won’t particularly help you with that. And by going up to this XDS level, you can find these objects in the infrastructure. I think TeraRecon gets that, Calgary Scientific to some extent understands that. So some of these emerging vendors will do well.

Will this be a threat to the companies that have staked their claim on VNAs?

I think that it depends on who can make the most effective pitches to the CIOs.

So is a McKesson, for example, better positioned, ultimately, than a TeraMedica, for example, in this kind of environment?

In this regard, yes. TeraMedica has focused on the storage piece, and have said they don’t want to get into the viewing space to compete with certain companies. But they could still do well, because they’re the VNA under Fuji VNA, for example. Another interesting acquisition is Acuo Technology by Perceptive Software, which is turn owned by Lexmark. Perceptive is in document handling in a lot of different industries, healthcare being one of them. So they perceived that document and image management was a growth area. They had all the pieces to manage the documents, but didn’t know what to do with the images, so they acquired Accuo, a VNA vendor. And they’ve also acquired a video management firm, so now you have documents, images, and video, all in one environment. They’ve also acquired PACSGear, so they now have a front-end capability in, say, feeding CDs into PACS, or if someone needs one.

So is the market opening or becoming more consolidated right now?

I don’t think there’s been much change yet. I think there probably will be some changes or acquisitions.

What would your advice be  for CIOs, CMIOs, and imaging informatics leaders right now, in this vendor and operating environment?

I’m still in this mode where I think that CIOs need to really be thinking about the big picture and consolidation of their own infrastructure in an interoperable way. So don’t let radiology and cardiology run off and do things on their own. Start to think about the big picture, and what the driving forces are on the other end, in terms of usability by end-users. The other problem I see is that not a long of people understand in this industry the whole intent of meaningful use around image use. They think it’s oriented around the physician, and it’s not; it’s oriented around the delivery of information to the patient. The other company that gets it is Carestream. And their portal, ViewPortal, is a patient portal. So you can log into this thing, schedule your appointments, and view a report. And Fuji is moving along those lines. It really is going to be about the patient.


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Just to be clear and not to be taken out of context ... the VNA has an important role to play. A key aspect is image storage, but more importantly, the VNA is also, as a colleague put it, the "harmonizer" of images. So, vendor-specific DICOM objects aren't necessarily directly compatible with a universal viewer, and need to be "neutralized" before they can be displayed.

I think it is important for the VNA vendors to expand their message beyond the clinical requirement, and insure that they also address enterprise requirements.

It is also important to note that the VNA vendors are playing a key role behind many of the universal viewer developments, so they are not inconsequential.