Greetings from the Midwest wetlands! I haven’t been able to contribute to my blog lately as I have been preoccupied the past two weeks with water … more water than I care to see again for a while! Although this is the second time in as many years that I have ripped out basement carpeting, I consider myself lucky, and my heart goes out to all those in Iowa and other areas affected much more severely than the Waukesha, WI area! In the thirty-two years I have lived in the area, I have never seen it as bad. I have also learned a lesson – no more basement carpeting!
I appreciate the responses to my last posting on whether achieving Enterprise Image Management and Distribution is a Mount Everest. In terms of response, and recent client interactions, I am now coming to the conclusion – is the world ready for it? My conclusion? The need is there, the technology is capable, but the will, urgency, resources, or competitive spirit of cooperation to do it, that’s another matter. Allow me to share a couple recent experiences.
One of the facilities I am working with is an all-Siemens IT environment – aggressively implementing Soarian. We recently had a presentation from a vendor on the merits of an enterprise image management and distribution solution, in which in addition to other benefits, the ability to easily migrate to another vendor was raised. To that, the CIO replied, “Why do I need that? All my applications are Siemens and I don’t intend to change. If Siemens were to present it and maintain it, that’s a different story.”
At another client contemplating an enterprise solution, various vendors have raised concerns with interfacing a 3rd party solution – even going so far as to raise FDA concerns with whether such a configuration would be “FDA approved.” Or, there are certain DICOM fields that may not be supported that guarantee that the data sent back from the archive is what was sent to it that may impact the accuracy of using a third-party device.
From these experiences, one could certainly come away with a couple impressions. First, a one-vendor solution is preferable. And secondly, unless a facility is multi-vendor, why do I need it? I’d like to make a few points to share my perspective on this, and as before, encourage others to weigh in.
Start with a clear objective: It may sound cliché to think that one could contemplate an enterprise solution without a clear objective. However, my experience suggests that there are usually multiple stakeholders with differing opinions as to what is needed. Therefore, it is essential that IT have a clear idea of what the problem is that is to be solved. Is it economies of scale and simplification of the number of archive applications supported? Or, is there a need across the enterprise to improve results accessibility? Which clinical areas need to be addressed – current and future? Are multiple vendors involved or are all areas represented by a single vendor?
Look beyond the current need: Radiology and/or cardiology may be the driving force behind a current action, but a true enterprise solution should be one that takes all imaging needs into consideration. Many facilities may already be implementing a document imaging application. Is the need such that document imaging and diagnostic imaging can live separately? Or, should the solution be all-encompassing? Will other areas such as Pathology or Ophthalmology require the need to consider other vendors from radiology and cardiology? What may appear to be a straight forward solution today may be complicated by future requirements. If the likelihood is that vendor changes may occur in any of those areas, then a vendor-neutral solution may offer advantages.
Is data migration an important factor? In a multi-vendor, “best of breed” setting, data migration may be a crucial factor. However, if one vendor is strategic, it may be better to plan around that vendor’s strategy as a first step. It may even be to one’s advantage to get a solution supported by that vendor, as it keeps the number of vendor interactions to a minimum, and defines a clean line of responsibility.
Can Vendors really favor their own solution? Years ago, I was involved in a PACS joint development effort between GE and IBM known as the Integrated Diagnostics System, or IDS. GE was responsible for the image elements, while IBM was responsible for the other clinical information elements, namely the Radiology Information System (RIS). To IBM’s way of thinking, the solution would never be sold without the RIS integration, while to GE’s thinking, it was obvious that not every facility would need a RIS that wanted PACS. Therefore, GE prevailed in insisting that the PACS had to support both the IBM as well as competitive RIS. The same lesson may be true for enterprise-scale solutions of today. Vendors may offer their own solution, but if they expect to sell beyond a narrow segment that may have their radiology PACS, they will need to accommodate third party solutions as well.
I would like to end on this last point. The spirit of standards efforts is to preserve individual vendor solutions while enabling them to play in a larger arena. For enterprise image management and distribution solutions to succeed, it will be necessary for vendors to accommodate standards and cooperate in a manner that enable customers to succeed. Microsoft is smart enough to know that even though it may include hooks in its operating systems that favor their solution, accommodating competitive products is good for the market. Microsoft Windows Live OneCare may be their preferred solution for antivirus protection, but the company is not about to walk away from an operating system sale to a corporate client that has standardized on Symantec’s Norton solution. Similarly, any PACS vendor that does not accommodate competitive extensions may be at a disadvantage in the marketplace, even though in certain situations their solution may be better integrated. In an industry that is increasingly characterized by “COTS,” a key differentiator may be the vendor that is willing to provide the services to make their application work in an enterprise environment.