Just before the Radiological Society of North America (RSNA) annual meeting a month ago I speculated on what I expected to see (http://www.healthcare-informatics.com/blogs/joe-marion/rsna-presumptions). Now that the dust has settled, the show is long over, and the holidays are upon us, I thought I would recap some of the results.
RIS and Radiology Workflow
Prior to the show, I speculated that there would be more companies subscribing to the demise of the Radiology Information System, or RIS. While some companies continue to use the term “RIS” there is definitely a trend toward its elimination. In its place, companies are referring to “workflow” as the new norm. Call it semantics, as order entry and scheduling may be the primary differences between a “workflow” product and the classic RIS, but fundamentally there is a changing emphasis on incorporating workflow productivity with PACS (Picture Archiving and Communications Systems).
Another revelation is that vendors are building more productivity enhancements into their products. Both Agfa (http://www.agfahealthcare.com/global/en/main/landing/index.jsp) and McKesson (http://www.mckesson.com/providers/health-systems/department-solutions/radiology-solutions/) emphasized unique aspects of productivity aimed at making the radiologist more productive, through smart profiles and intelligent data mining of the EMR to enhance the diagnostic proficiency.
Analytics is also becoming a significant factor, most likely driven by ARRA/MU and the need to be more proficient. Siemens (http://usa.healthcare.siemens.com/infrastructure-it/) introduced a novel cloud-based application known as TeamPlay aimed at enabling better management of dose utilization by means of sharing data and benchmarking. Dell (http://www.dell.com/learn/us/en/uscorp1/campaigns/search-generic-hsb-us?c=us&l=en&s=corp&cs=&&ST=dell&dgc=ST&cid=282004&lid=5356161&acd=123098073120600) introduced a cloud-based version of PACSHealth’s (http://www.pacshealth.com/) dose management application that should extend the reach and application of dose management by exploiting Dell’s cloud.
The term “PACS Decomposition” is becoming more widespread and relevant as providers look for ways to stretch their investments. Rather than replace an entire system, the premise of “decomposition” is to keep what works and add additional capability as required – without having to replace the entire system.
The most pertinent example of this is in the area of the VNA (vendor neutral archive). Vendors are speaking to the concept of adding a VNA, and potentially an enterprise viewer to an existing PACS. Then, replacement of the PACS becomes a simple replacement with PACS workstations and a radiology workflow engine. Visage Imaging (http://www.visageimaging.com/), in conjunction with Primordial (http://primordialdesign.com/testimonials.html), and Medicalis (http://www.medicalis.com/) strongly promote the notion of a PACS replacement in conjunction with a VNA implementation.
I suspect this trend will continue to gain momentum as more and more PACS reach the age of replacement.
Over the many years I have been associated with PACS, I have seen the pendulum swing multiple times between the all-inclusive workstation and dedicated workstations. Usually, as technology incremented to meet specialized needs, vendors would create new workstations to address them. For example, mammography requires higher resolution displays for FDA-approved reading that were more expensive than routine PACS workstation displays. Consequently, dedicated mammography workstations were the norm. As display technology has improved and prices have dropped, there is now a trend to incorporate mammography reading into a common PACS workstation.
Another prime example – advanced visualization. Initially, specialized graphics processing hardware meant such analysis was done on a high-end PC workstation. As new server/streaming technology has come into the picture, as well as improvements in graphics processing, the opportunity to incorporate advanced visualization applications directly into the PACS workstation has gained popularity. The feeling is that such workstation capability can address 80 percent of a radiologist’s advanced visualization requirements, thus lessoning the need for a dedicated workstation. GE Healthcare (http://www3.gehealthcare.com/en/Products/Categories/Advanced_Visualization) is a good example. Previously, the Advantage Windows Workstation was the primary means for advanced visualization processing. Now GE is porting these applications directly into its primary PACS workstation, the Universal Viewer.
Major strides are being made in terms of addressing enterprise imaging requirements, but it still hasn’t received a high degree of visibility at the RSNA. Of course, this may be because this is primarily a radiology event. The most visible references are with VNA (Vendor Neutral Archive) vendors, and with universal viewer vendors, as these are the initial elements of an enterprise strategy. Also gaining in popularity are image capture applications for non-DICOM images. Radiology vendors are leading in this arena as they understand the necessity of defining patient metrics to be associated with the image as is done in radiology (an exam order).
Another area beginning to be addressed is the universal worklist, and several vendors emphasized this capability, both across facilities as well as imaging service areas. Similarly, unified user interfaces are emerging, such as that demonstrated by Philips (http://www.healthcare.philips.com/main/products/healthcare_informatics/products/enterprise_imaging_informatics/), which presents a common user experience regardless of service area.
Radiology reporting experienced a major change with the advent of speech recognition over a decade ago, and it seems poised for another major change. Structured reporting is rapidly evolving, with considerable effort on the part of the RSNA to implement reporting templates with standardized language (https://www.rsna.org/Reporting_Initiative.aspx). Karos Health (http://www.karoshealth.com/2014/11/20/karos-health-supports-rsna-reporting-initiative-with-open-source-report-template-editor/) has been active in conjunction with the RSNA to develop a template editing tool known as T-Rex. Nuance (http://www.nuance.com/for-healthcare/index.htm) has a huge stake in dictation as the largest vendor for speech recognition applications, and is also active in the RSNA initiative.
These technology initiatives were fitting for the 100th anniversary of the RSNA. The meeting started with a bang and unfurling of commemorative flags. Let’s hope that the 101st meeting will be as exciting.