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The Book of Joe

November 30, 2011
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A conversation with Joe Marion at RSNA

If anyone has a long view on the annual RSNA conference, it’s Joe Marion, the industry thought-leader and consultant who noted Wednesday afternoon that this year’s RSNA was his 35th. That’s right! Thirty-five annual pilgrimages to Chicago’s McCormick Place convention center. In fact, Joe told me, 1976, the first year he attended, was also the first year that the RSNA Conference was held at McCormick; prior to that, the gathering had been held in the ballroom of the Palmer House Hotel downtown (now the Palmer House Hilton). Obviously, RSNA must have been literally a rather lightweight affair in the days when the modality machines could be fitted onto a single hotel ballroom floor without their weight collapsing it!

Indeed, one of the more astonishing elements—when one stops to ponder it—of RSNA every year is the sheer weight of the modality machines and other equipment on the exhibit floors at McCormick Place, not to mention the enormous exhibitor booths that have grown literally to the sizes of multiple city blocks. As Joe also noted, “The first year RSNA was here, it was contained within the basement floor of what is now the Lakeside Center” (the original, eastern building in the massive, 2.76 million-square-foot McCormick Place complex, the nation’s, and one of the world’s, largest convention centers). Over the years, Joe noted, McCormick Place has expanded along with the growth of RSNA, whose exhibit floors now fill three enormous buildings.

A lot of other things have changed, too, of course. Indeed, one of the interesting challenges of covering the RSNA Conference every year (along with the physical challenge of mastering foot travel across McCormick Place’s vast spaces) is getting a good handle on the main trends and buzz each year, particularly nowadays, with several hundred exhibitors in the exhibit halls.

This year, the buzz-term on nearly everyone’s lips has been “VNA—the acronym for “vendor-neutral archive.” Of course, if you were to ask ten people at RSNA how they define “VNA,” you would get ten, potentially very different, answers. I’ve been particularly fascinated this year to speak to different vendor executives from very different types of organizations—on the one hand, the traditional PACS and RIS vendors, and on the other hand, the new wave of vendors coming out of general IT, telecom and other industries, whose execs see tremendous potential in the healthcare industry and are busy invading it right now. I’ve had executives from the two types of vendors express drastically different visions of the VNA future at this year’s RSNA.

Essentially, they simplify down to this: either hospitals, medical groups, and health systems will turn to vendors like Dell or AT&T, and those vendors will loosen them from their tight ties to their historical PACS vendors, unleashing a new era of cloud storage, mobility, and anywhere-access; or, alternately, the traditional healthcare vendors that have been operating in the PACS and/or EHR space will broaden out their offerings and create “multi-ologies”-based vendor-neutral archives that will provide far more granular, healthcare-appropriate, mechanisms for image and data storage and sharing, than the broad vendors coming into healthcare from outside it, could provide, and those historically healthcare-specific vendors will triumph in the image-management marketplace.

Joe’s verdict? “I think I’d pick a door somewhere between door number one and door number three from that set of choices,” he told me. “On the one hand, the PACS/RIS vendors are probably still a bit too proprietary and controlling; on the other hand, the AT&T and Dell people are going to learn quickly themselves. And as organizations move forward and have to make choices such as building out cardiovascular information systems or creating truly enterprise-wide image and data archives, you get into all sorts of questions in terms of who controls what.”

So, as Joe put it, the future of vendor-neutral archiving is like “a teetering tree—one that might blow either way in the wind in the coming years.

But regardless of which type of vendor ultimately triumphs in this context, Joe told me that “My vision of the world is that you have an EMR infrastructure, and sitting below that is an image repository below, but not down to department-level repositories in radiology, pathology, etc. It’s a patient-centric repository. And in reality, what’s the difference between a document and a CT scan?”

Meanwhile, Joe and I agreed that clinical decision support and analytics capabilities, as offered by emerging vendors like MedCurrent and Radimetrics, will become increasingly important going forward. Like Joe, I visited with those vendors, and was impressed by the value that they and others like them could potentially bring to the industry in the coming decade.

In the end, after touring the exhibit halls at RSNA each year, it falls to any thoughtful visitor to reflect on what he or she has seen and heard, and to try to sort out the substance from the hype. That has always been true at this conference, and will always be true. Fortunately for us at HCI, we have real thought-leaders like Joe to help us do the needed sorting. And, without a doubt, that counts for a great deal in my book.

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