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Will Pathology Follow in the Footsteps of Radiology?

March 19, 2012
by Joe Marion
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Integrating Radiology systems was evolutionary - will Pathology be easier?

Several recent enterprise imaging engagements have encompassed Pathology as an opportunity for digital image management, and they have afforded me the opportunity to gain a better appreciation for the state of the Digital Pathology market.  From this experience, I am reminded of the similar experience in the early days of Radiology when the transition was made from film to digital images.  The question is how similar will Pathology be, and can we learn from Radiology’s experience?

Let’s look at what happened in Radiology.  In the very early days of PACS, they tended to be standalone systems.  Development was split between specialty vendors such as AT&T, and imaging equipment vendors such as Philips, GE, and Siemens.  Later on, the film companies (Agfa, Fuji, and Kodak) became engaged when they realized the potential impact to the film business.  What is interesting was the absence of most information systems companies!  Gradually, as radiology information systems (RIS) shifted from a film management emphasis to a workflow emphasis, the notion of a RIS-centric PACS emerged.  Finally, companies such as McKesson and Cerner became players in the PACS arena as well.

If one considers the current market, it is probably fairly evenly split between imaging equipment companies and healthcare IT companies.  There continues to be a dividing line characterized by the generation of images.  Since imaging equipment companies have an unfair advantage in the creation of images, there has always been an advantage when it comes to advanced image processing.  Most of the IT companies rely on third-party companies such as TeraRecon and Vital Imaging (now part of Toshiba) for such technology. 

In the evolution, relationships were formed between such companies as GE and Cerner, lest they compete with one another in the development of RIS-PACS technology.  Most of these relationships dissolved as both sides realized there might be a competitive advantage to offering the combined product.  Hence, Siemens acquired SMS, GE acquired IDX, Philips acquired Xiris, and Fuji acquired Empiric.  However, part of the “magic sauce” of PACS continues to be the knowledge of how images are constructed and manipulated, which in some respects still gives the imaging equipment companies an advantage.

Let’s look at how this might play out for Pathology.  There are several Lab Information System (LIS) vendors including Cerner and Sunquest that have focused on managing the reporting process for pathology studies.  Since Pathology reports are generated by reviewing slides, the LIS vendors have not ventured into the image acquisition arena.  Conversely, it appears that several established (Leica, Olympus, etc.) microscope vendors, and some new vendors (Aperio, Omnyx, Philips, etc.) are vying for the Digital Pathology acquisition and management business.  Their interest is in automating the acquisition, management, and manipulation of digitized slides. 

If one were to compare this to Radiology, the LIS is the equivalent to the RIS, and the Digital Pathology systems are equivalent to a PACS.  At the moment, there is little crossover between the two.  Hence, it is similar to where Radiology was when RIS and PACS were separate systems.  As one vendor put it, the LIS vendors eye the digital pathology system vendors with some uncertainty, as it would be logical for them to evolve backward into the LIS functionality.  This is akin to when the RIS vendors eyed the PACS vendors with some uncertainty as to whether they would develop their own RIS. 

Would it ultimately make sense to have some integration between these digital acquisition systems and LIS functionality?  Most certainly!  Will the LIS vendors decide at some point it makes sense to address the acquisition business?  If they follow the same path as Radiology, there will most likely be some overlap.  On the other hand, will the acquisition technology be the “secret sauce” as it has been in Radiology, and favor the leading acquisition vendors?  Only time will tell.  Pathology vendors can learn a lot from Radiology’s evolution, and potentially avoid some of the pitfalls that slowed the evolution of RIS-PACS integration. 

On the other hand, the healthcare landscape is different today, with a more favorable technology integration standards environment driven by healthcare reform.  Perhaps we have evolved to a more open environment that will allow Pathology a better outcome. 

As always, your comments are encouraged!

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