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.