On Tuesday afternoon, Dec. 1, in the middle of the annual RSNA Conference, sponsored by the Oak Brook, Ill.-based Radiological Society of North America, and held at Chicago’s McCormick Place Convention Center, Joe Marion, principal of the Waukesha, Wis.-based Healthcare Integration Strategies, and one of the leading industry experts in the imaging and imaging informatics areas, sat down with HCI Editor-in-Chief Mark Hagland to talk.
Marion, who has participated in more than 30 RSNA conferences, has been observing the vendor industry in imaging and imaging informatics for decades, from the time of the emergence of such technologies as PACS (picture archiving and communications systems) and RIS (radiology information systems), through the emergence and development of newer types of technologies as vendor-neutral archive (VNA) and other newer technologies. He met with Hagland on the edge of the exhibit floor. Below are excerpts from their interview.
What do you think of the exhibit floor this year at RSNA, and of vendors’ pitches this year, compared to in past years?
It still doesn’t strike me that population and meaningful use are big factors yet [in vendors’ marketing strategies]. I do see signs of life, in the sense that some are starting to get it. There’s a lot more emphasis on analytics now—so, GE [Healthcare] and their cloud, and Siemens with “teamplay” (Siemens Healthcare’s new “teamplay” network concept)—there seems to be a lot of emphasis on that arena. Patient and physician portals are getting a lot of attention—and those are probably avenues that will help patient care organizations achieve Stage 3 meaningful use. And the portals really are the answer there.
The other factor that’s really gaining popularity is streaming technology, as opposed to client-server; in essence, you move all the processing horsepower back onto the server. In the current PACS environment, all the images come into the server, and they’re literally sending the images to the workstation. That’s history. The one that’s most known for that is Visage, but they’re winning a lot of business in what they refer to as the deconstruction of PACS. So instead of purchasing a total replacement, buy their capabilities and replace PACS. Sutter Health and Shands Hospital are pursuing that path. Viztek, acquired by Konica, has similar technology. Fuji has a similar product, a new version of Synapse.
For those for whom the concept of streaming technology is new, how would you explain it?
The perfect analogy is Microsoft Office 2016 versus Office 365. Office 365 sits in the cloud. This is similar, in that it’s not a cloud per se, but is interacting with the server that is central, and it is totally web-based.
And that kind of technology will then replace the hardware-based, old PACS architecture?
Right. At the same time, there’s been a push in some organizations to consider eliminating the RIS.
When one looks at the new “Conserus” concept debuted by McKesson, will that kind of technological architecture replace RIS systems?
Yes and no. A lot of what was done in RIS is now being done within the EHR [electronic health record]. So it boils down to workflow management, and there are third-party companies that provide workflow management, like iFellow by McKesson. That seems to be a major trend. But there are exceptions: Fuji has invested heavily in the RIS—there are imaging centers that don’t have an EHR, and there are smaller hospitals that don’t yet have an EHR. And then the whole zero-footprint viewer, everybody is jumping on that bandwagon.
PAC is highly commoditized, as we’ve agreed. Do you see a lot of vendors disappearing in the next few years?
What do you think about IBM’s acquisition of Merge Healthcare, in the context of the strategic approaches on display this year at RSNA?
I have a friend who thinks the endgame of Watson [development on the part of IBM executives] is to replace radiologists. I don’t think that. But this might be radiology’s version of CAD [computer-aided design], in some fashion. Hologic bought a company called CADstream, for mammo [mammography]. There’s potential to augment the radiologist in terms of what radiologists handle at smaller facilities. For example, I might be a community hospital, and I have a hospital radiologist reading regular cases all the time. But maybe with a complex case, I might be able to augment the radiologist by making use of Watson; it’s hard to say.
Frankly, I don’t know what IBM is trying to accomplish. I’ve seen them come into healthcare and leave it, a few times. But they’ve got a lot invested in Watson. And when they first got into speech recognition, they singled out radiology and pathology as two speech-intensive areas but with limited vocabularies. And that sounded good, but was an effective strategy early on, but eventually, it became a commodity. Whether the same thing holds true in the context of Watson, remains to be seen. They look at healthcare as having real potential. Is there more merit to doing this in healthcare versus, say, aerospace? Perhaps yes. But where Merge fits into that, I have no idea, unless it’s just the intellectual property to understand imaging better.
But if I were a Philips or a GE or a Siemens, and IBM came to me and said, I’ve got this great thing called Watson. So why would they want IBM, given that Merge has been a competitor? Unless there’s more to that, if they needed sort of a test-bed play. Then, spending a billion dollars might seem reasonable. The one other thing I can see is that Merge is probably in more PACS-type markets than anyone else. They bought an orthopedic-sphere PACS, and another as well. So perhaps there might be more opportunity there than with other vendor acquisitions.
Can you cite a single most exciting thing you’ve seen on the exhibit floor this year at RSNA?
That’s hard to say. In many ways, it seems like business as usual. I don’t actually see anything really jumping out at me. Analytics is getting a lot of attention. And GE is taking a different approach than Siemens; Siemens is taking this approach of inputting your data into a big database for comparison. GE is focusing on analytics as a service, responding to specific questions their customers might have. Which is better? I don’t know. I think we’ll have to see how some of these trends play out over time.