RSNA 2016 is but a distant memory now. The annual Radiological Society of North America meeting took place the last week in November. This was my fortieth consecutive show, and it did not disappoint! It once again highlighted the changes I have seen over the years in terms of IT technology, and their impact on imaging. Forty years ago, there were very few CRT’s that were largely based on video presentations, and lots of film display of images. Needless to say, this year, there were flat panel image displays in every nook and cranny of the exhibit halls!
This year, I took a slightly different tack and focused on several areas of Imaging IT that may be relevant to providers over the coming years, as healthcare policies continue to evolve. I will have more to say on these next year, but the following is a summary of vendor activity that I found interesting and relevant.
AI/Machine Learning/Population Health Management
A major emphasis among a number of vendors was Artificial Intelligence/Machine Learning. This covers a number of developments, but most PACS vendors were showing something in relationship to either the analysis of the image pixel content, or the relationship of related clinical information based on the type of image.
Agfa, through its participation in the IBM Watson Health initiative had a tight integration, demonstrating the ability to identify the type of image study selected and the ability to mine related information related to the image content. Siemens also highlighted its relationship with IBM Watson Health for 3 PHM applications.
McKesson continues to demonstrate their iFellow application as part of their Conserus offering. iFellow is similar to what Agfa is doing with Watson Health, in that it reviews the EMR and presents relevant information based on the image content.
Sectra has formed a joint development with Case Western Reserve to do deep data mining of measurements for current and prior exams to identify issues. GE has formed relationships with UCSF and Boston Children’s Hospital for deep learning initiatives.
Carestream is focused on analytics to assist population health initiatives, including business intelligent worklists, dashboards (in conjunction with Zebra (https://www.zebra.com/us/en/solutions/healthcare-solutions.html), and to drive quality compliance.
NTTData, having acquired Dell’s services business presented a novel approach to data migration by analyzing the pixel content of images to identify aspects that might have been missed in prior readings.
Overall, most vendors did not specifically highlight the topic of Population Health Management, and only indirectly referred to it in the context of offering tools to improve the quality and efficiency of diagnosis in support of value-based care.
Vendors varied and had a difficult time understanding how to respond with respect to services. Most have not changed their approach to the market in terms of services. Agfa has not changed its approach to the market, but does offer extensive consulting services in addition to sales and service. They offer security services that will assess a facility’s compliance and the number of intrusions detected.
McKesson offers a range of services, including the ability to share risk with the customer. GE is similar to Agfa in offering a range of consultative services, including managed services. Fujifilm only referenced normal services, including maintenance updates and upgrades. Merge likewise only addressed normal services, and is looking at ways to deploy IBM services, such as its Guardian service for business analytics.
Most vendors offer some form of teleradiology services, notably LifeIMGE, Nuance, and Ambra. These usually entail some use of the cloud for temporary (or permanent) image storage, as well as viewer technology for accessing images. They also encompass some form of worklist management application that enables them to manage multiple sites. GE is partnering with UPMC on workflow tools to improve multi-facility reading.
The greatest observed trend in PACS is the continued move toward server-side rendering for diagnostic workstations. Virtually every vendor has some form of zero footprint viewer utilizing server-side rendering, but only a handful have moved to it for diagnostic workstations. Visage continues to lead in server-side rendering. They continue to win large accounts, most recently Mayo Clinic. They claim that no one has achieved the scale of operation with server-side rendering that they have.
Fujifilm continues to make progress with their Version 5 Synapse software. Philips jumped on the server-side rendering bandwagon with the introduction of their Illumeo application. Philips also touted their Vendor Neutral Archive (VNA), which they argue offers performance advantages. Carestream was demonstrating server-side rendering for diagnostic workstations as a works-in-progress.
Other novel introductions included Carestream’s media production kiosk. It is intended to automate the production of study media for the patient, including flash drives, film, and paper (for reports), all in a single device that can be managed by the patient. The device can be either leased or acquired depending on a site’s needs, with the site sharing in revenues with Carestream should they lease and decide to charge the patient for media. Merge demonstrated a novel approach to image comparison that they refer to as Image Shuffling. Current and prior images are alternately overlaid, making it easier to spot differences in anatomy. They also showed something called “Marktation” that uses machine learning to analyze image content and identify areas for analysis with automated report language for repetitive findings.
TeraRecon highlighted their 3D printing service, which they claim is unique as the images don’t need to be modified before being sent for 3D printing. They also were demonstrating a machine learning application for diagnostic viewing that analyzes the image study content to intelligently present it to the viewer. Siemens demonstrated an image enhancement algorithm that improves the appearance of advanced visualization, with high-definition display.
Relative to the Internet of Things (IoT), no vendor visited emphasized IoT per se, rather choosing to highlight specific applications of the internet and cloud technology. GE is perhaps the most aggressive in this area, highlighting applications that utilize their corporate cloud network, referred to as GE Health Cloud. GE introduced something called GE Centricity Collaboration Suite for multi-site study collaboration applications. The collaboration suite applications address areas such as tumor boards and 3D applications where multiple sites participate. The next step might be to expand GE’s VNA services into the cloud, and they plan to migrate their DoseWatch application there as well.
Siemens continues to expand its TeamPlay application, with a large number of worldwide live sites. TeamPlay enables Comparison of, performance data to peer institutions, and appears to be unique in this factor.
McKesson plans to extend their cloud activities beyond the VNA, including potentially PACS in the cloud for smaller facilities, and to leverage it for applications where multiple clients want the same thing. Their intent is to also take analytics to the cloud. The acquisition of Karos Health by Vital Images does not represent any significant cloud strategy, as they indicated their intent to focus on expanded applications for their installed base, such as addressing workflow.
Ambra, formally known as DICOM Grid changed their name to get away from strictly DICOM services. They offer a full range of services including PACS in the cloud, in addition to their core study archival services. They indicated that a key area for them is clinical trials through the cloud; an area not addressed by other vendors.
Mach 7 and Lexmark continue with VNA applications, and can also offer cloud-based applications. There is an element of uncertainty around Lexmark, as the Chinese investor takeover has been completed, and as part of the agreement, Lexmark must divest its software businesses due to DoD activities.
To date, IoT does not appear to be a specific priority for vendors, rather specific applications will be integrated within cloud services where there is demand and it makes sense.
The RSNA continues to be a huge meeting, with many different attendees and agendas. It is primarily a meeting for radiologists and supporting staff, so imaging modalities are still a prime focus. However, Imaging IT has grown in importance, and is continuing to grow based on the need to address changing healthcare policies and procedures. The challenge that imaging IT vendors face is to address the emerging needs of Population Health Management and value-based care. It will be interesting to see how this evolves over the next twelve months, given the likely changes in U.S. healthcare policy. I can’t wait for RSNA 2017!