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RIS Rocks at RSNA

January 31, 2008
by Mark Hagland
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With workflow on everyone's minds, radiology information systems took center stage at imaging's super-conference

Given it's the largest healthcare conference in the world, what happens at the annual RSNA (Radiological Society of North America) Scientific Assembly inevitably causes ripples across the industry. And this year, as always, the Chicago-based event lived up to its reputation for the gargantuan and the new.

Attendees, 61,980 strong, from all over the world (four more than the official 61,976 in 2006) attended RSNA in 2007, while 760 exhibitors took up 536,000 square feet of exhibit space at McCormick Place. And though the number of exhibitors was essentially the same (one more than 2006), vendors took up an additional 16,000 square feet than they had a year earlier.

On the modality front, multi-slice CT was the glamour technology, with vendors exhibiting products that are taking computed tomography to the new frontier of 256 slices, promising faster throughput and more images. Other talked-about technologies included advances in voice recognition (including small-word recognition) software for radiologists, integrated scheduling solutions, ever-sharper display monitors, and portable CT scanners.

But even as technology advances on the modality front and in other areas, physicians and others within hospitals, medical groups and health systems are finding themselves overwhelmed by all the images and data flowing out of modality technology and into ever-expanding PACS (picture archiving and communications systems) and RIS (radiology information systems).

Not surprisingly, two of the key terms floating around this year's RSNA conference were workflow (including anywhere-anytime access and related efforts around productivity) and interoperability. The concept of the evolving physician workstation was also highlighted, with a few vendors — including the San Francisco-based McKesson Corporation with its patent-pending hand-guided workstation — showing off ways radiologists and other physicians might work with images in the future.

Certainly, the expansion of images and data is accelerating to the point at which clinicians are turning to CIOs and other IT managers to help them handle it all. At the same time, the concept of PACS is moving away from its origins as a radiology department tool and becoming an enterprise-wide application for physicians and other clinicians to use, from anywhere and everywhere.

It was also not surprising to hear the pitches on the RSNA exhibit floor mirror the industry struggles of adapting to a new world awash with 3-D and now even 4-D (over time) images, and more terabytes of data to manage than anyone ever imagined.

Long-term veterans of the show said the changes in the air were palpable, and understandably so. “Workflow does seem to be on everyone's mind these days,” says Joe Marion, a senior manager and the leader of the PACS practice at Dallas-based ACS Healthcare Services.

The Milwaukee, Wis.-based Marion, who attended his 31st RSNA in November, says, “If you look at the context of integrating more and more workstation functionality into PACS, there's more and more recognition that a RIS-driven PACS is the answer.” In fact, he says, the very increase in diagnostic images is forcing the realization that RIS, the brains of image management, will be more important than ever.

Experts agree that improving image management is also important in light of the fact that more and more physicians need to read images. Such physicians include: primary care referring physicians, orthopedists and cardiologists.

At the same time, PACS products are becoming commoditized, as vendors crowd into an increasingly mature market, says Scott Grier, a PACS specialist at Nashville-based Abrio Healthcare. The Sarasota-based Grier says that interoperability, optimizing physician workflow, and other issues are falling squarely into the laps of senior IT executives at hospitals and health systems.

“I think the task for hospital CIOs and CTOs is to continue to encourage getting their IT departments involved in the broad base of enterprise imaging, because we still get called in as consultants to a lot of departments where the department still has a lot of control over PACS decisions, and what direction the hospital is going to go in for the next five to 10 years.”

Attendees from hospitals and health systems say the issues are turning in a particular direction, or set of directions. As an industry, “We're reaching a plateau in image management,” says Shawn Wiese, applications development manager for the integrated Nebraska Methodist Health System, Omaha. “The emerging issues are all around workflow, communication, and leveraging communication capabilities to help all the different physicians communicate with each other,” Wiese says, agreeing with the current buzz.

Nebraska Methodist Health System, with two hospitals (one in Omaha and one across the river in Council Bluffs, Iowa, plus 16 physician clinics), has a core EMR system and PACS from Kansas City, Mo.-based Cerner, and Wiese says his organization is largely happy with its performance.

“I think the (PACS) product from Cerner is as integrated as anything I saw this year,” Wiese says. But he adds, “Though a lot of vendors are putting a lot of thought into thinking enterprise-wide, the problem is that Philips, Cerner, GE, all of the large PACS vendors are each coming up with their own solutions, while I'm trying to put them all together. So I think there's more IHE (integrating the healthcare enterprise) work that needs to be done for integration.”

For the present though, Wiese says he thinks, “The vendors are more interested in grabbing market share than in helping us run our business. If you go to a single-source strategy, that might help interoperability-wise.”

There was a great deal of talk, and promotion, around thin-client and Web-based solutions this year at RSNA. The interest in such solutions is inevitable, says Colin Murphy, vice president, sales and marketing, for the Chelmsford, Mass.-based Visage Imaging, a PACS vendor that heavily promoted its thin-client approach this year at McCormick Place.

“Productivity is the biggest issue,” Murphy says. “Sitting in a radiology reading room is OK, but the ability to read a 2-D or 3-D image from anywhere is becoming very important to the radiologists.”

Murphy tells the story of a radiologist affiliated with Charite Hospital in Berlin, who was able to read images at 1:30 a.m. after a medical emergency, able to see the clinical problem correctly and advise surgeons in minutes to change their plans. That is the kind of system performance that radiologists — and other physicians — are looking for from PACS systems now, he says.

He adds that, given the 3-D and 4-D images now available to physicians, as well as the ever-more-powerful and faster modalities, it will become more urgent to allow for faster, “thinner” solutions for image access and sharing.

Nebraska Methodist's Wiese doesn't disagree with Murphy's assessment, but says it may take longer than some anticipate before the industry is able to use Web-enabled, thin-client solutions, with the appropriate repository-based backup for Web enablement.

“The database itself is not difficult to retrieve, but it's those objects that cause pain,” he says. It is the strength of data repositories that will make such systems workable and useful in the future, he says. His organization does make use of Web-based tools for clinical review that are built into the Cerner solution, he reports. Wiese is also looking for solutions in the critical area of image storage.

How quickly will vendor solutions catch up with the burgeoning access, productivity, and storage needs of clinicians and organizations? Clinicians, IT leaders, and other healthcare professionals can assess the industry's progress at next year's RSNA, scheduled for Nov. 30-Dec. 5, as usual to be held at McCormick Place in Chicago.

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