Industry experts report that the picture archiving/communication systems market is 95% saturated. So what's new in the PACS industry?
Well, for starters, the replacement of older systems constitutes at least 80% of new sales. Most hospitals and standalone radiology centers are now purchasing their second-generation PACS systems. In addition, cloud-based imaging that appeared on the scene about three years ago is now a "must-have" feature.
A recent report by KLAS revealed that health care organizations no longer rely on a single vendor and are seeking out companies that can provide an enterprise-wide imaging strategy that can store and archive images.
Depending on the size of a facility and the volume and types of radiological procedures, choosing the right PACS vendor can be an arduous task. What features and tools does the system provide? What about the reputation and stability of the vendor? Does it offer open standards? Does the PACS easily integrate with other hospital systems such as HL7 and the electronic medical records (EMR)? Is it DICOM (Digital Imaging and Communications in Medicine)-compliant?
"In 2012, what I'm looking for in a PAC system is not just a digitization of the film-based workflow, but bringing intelligence into the workflow, making it a lot more about the patient than just a series of images," said Rasu Shrestha, MD, vice president, medical information technology at the University of Pittsburgh Medical Center. "What I really want today is a system that is able to treat the patient as a whole, as opposed to me treating a series of images."
Shrestha said the interoperability and technology radiologists have at their disposal today--particularly systems that can talk to each other--can help clinicians know a lot more about the patient. "It will be beneficial not just for the radiologist, but also for the surgeon and other clinicians," Shrestha said.
What other key features should providers look for when shopping for a PAC system? Industry experts suggest advanced visualization, teleradiology, a customized work list, voice recognition, and cloud-based imaging.
Some experts question whether or not cloud-based imaging is right for everyone. In the current environment, some hospitals are choosing to build their own cloud, while others opt to work with a cloud provider to remotely host cloud-related services. According to Shrestha, cloud-based imaging has been a game changer in many different areas, especially in clinical workflow. He asserted that these days it's very easy for patients to get access to their own images through the cloud if the institution also has capabilities such as personal health records.
What Should CIOs Look For?
What questions are CIOs and IT managers asking when they're getting ready to purchase a new PAC system?
Christine Kao, global marketing manager for PACS vendor Carestream, said that CIO and IT administrators often ask how a PACS will fit into the larger enterprise--and not just from a software perspective. She said that hospitals seek out vendors that have commercial off-the-shelf products that are hardware-agnostic and that offer open-standard integration with what the institution already has in its environment, including its EMR.
For Adam Fuhriman, IT director at Intermountain Medical Imaging in Utah, the number-one issue is interoperability. "With that, we are looking at stuff with a mature application programming interface (API) that we can link into. That's our top item because we have so many different systems in our environment."
Fuhriman added that he's always looking for better ways to link systems together to enable single log-in, or ways to share patient data between systems.
Fuhriman, who oversees five outpatient imaging centers that are associated with Trinity Health, said that voice recognition and reporting are also important components of a PAC system. "Reporting is more important from my perspective than voice recognition--the voice recognition just drives the reporting. We're looking for ways that we can make the reporting part more efficient for the radiologist to get more accurate reports, [and to] deliver that report faster, especially in the case where we have a lot of ERs that we support."
Some industry insiders contend that the best way to think of conventional PAC systems these days is in three parts: visualization, workflow, and the ability to archive images.
"Archiving is being extracted outside of departments because it's the same effort, whether you're doing it for cardiology or radiology or ultrasound in the OR. So those are typically now using vendor-neutral archives," said Keith Dreyer, MD, vice chairman of radiology at Massachusetts General Hospital in Boston.
Dreyer, who is also chairman of the informatics committee at the American College of Radiology, said that when purchasing a new PAC system, it's important to choose a vendor that can demonstrate that it has up-to-date technology so that it can perform things like advanced visualization or cloud visualization.
"I would want to make sure that I can see a migration path off that system--so that the data is removed in a way that I can migrate to other visualization tools," Dreyer said. He noted that in the past, purchasers would buy one visualization tool, one workflow engine, and one archive, all from the same company. Today, however, there are a dozen visualization tools, a dozen workflow tools, and a dozen archives. "So if I didn't want to purchase those three [tools], I'd want at least a prime contractor that could outsource those other solutions. But when I buy now, I look for those components, [and] structured architecture so I can replace components that don't work."
Finally, Dreyer said that he would look for layered architecture and a layered system. "I think that's the big thing. The days are gone where you would buy everything from one vendor."
Take a look at the following PACS vendors and see which ones best match your current needs.
The way John Conklin, director of cardiology programs for San Diego-based DR Systems, sees it, the ability to accept, promote, and utilize open standards is a key factor for any PACS vendor. According to Conklin, DR's Unity-SC PAC system offers flexibility in the way images and reporting are presented to each individual user. DR System's Unity platform also offers custom templates for specific procedures and the ability to use speech recognition in combination with a structured report format. It also provides integrated advanced visualization and cloud-based imaging. The system is optimized for imaging centers and small hospitals that conduct up to 25,000 exams per year and is able to connect to other DR Systems PACS, allowing access to other radiology and physician resources.
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CIOs and IT executives might appreciate the ability of Carestream Health's Vue PACS to combine an efficient workflow with advanced visualization and reporting tools and technologies. Images and reports are accessible from on-site or remote PC-based workstations, eliminating the need for costly dedicated workstations or teleradiology platforms. The architecture allows a healthcare system to save both time and money by creating a global patient work list and efficient radiology workflow among all its locations.
Cristine Kao, marketing manager for Carestream, says that the company offers a vendor-neutral archiving at the back end, a cardiology tool, and a workflow integration tool. Kao said that last year the company also launched an embedded, or native, voice-recognition solution. Vue PACS is available as a pay-per-use cloud service that includes an uptime guarantee, technology upgrades, data security, and duplicate data storage that addresses business continuity/disaster recovery.
Siemen's Syngo PACS provides customers with integrated advanced visualization (IAV), teleradiology, and voice recognition, as well as comprehensive administration and monitoring tools. Siemens also offers PACS platforms for radiology and cardiology. Henri Rik Primo, director of strategic relationships, says that Siemens has published application interfaces that allow third-party companies to integrate their products into Siemens'. Siemens also provides a connectivity competence center that offers technical support for integrating products into the PACS.
Siemens has experience in multi-modality imaging and has developed a cloud-based application server called Syngo.via for advanced visualization. Syngo.via is a medical device that acts as a platform for a growing library of additional Syngo.via applications. The applications are specialized for different imaging modalities and clinical uses. Once installed, licensed users can run the apps virtually anywhere. Because the rendering happens on the server, the apps can run even on iPads or iPhones. Advanced visualization software like Syngo.via is becoming an enterprise asset.
Siemens' health care computing center handles more than 300 million procedures per day, and the company has implemented remote archives. When a hospital stores an image to the local PACS archive, a long-term copy is also saved in the company's Malvern, Penn. data center as well as Dell's data center, offering customers a triple level of redundant data storage.
AGFA's Impax PACS offers customers a fully integrated radiology information system (RIS)/PACS/reporting workflow system for data management and reporting. Improved productivity is achieved through the complete imaging chain, from order management to results distribution. The PACS also leverages automated task management by presenting relevant clinical information designed to synchronize with related studies and support informed healthcare delivery.
Impax Business Intelligence is part of AGFA HealthCare's advanced RIS and PACS offering. It provides historical, current, and predictive views of radiology operations in the form of real-time dashboards and management reports. AGFA executives say that Impax Business Intelligence helps demonstrate Meaningful Use of clinical data through its ability to actively monitor the thresholds outlined in Stage 1.
Other Impax platforms include Impax for Breast Imaging and Impax for HeartStation. In June, AGFA HealthCare selected Dell to host its cloud clinical archive portfolio, including the Imaging Clinical Information System (ICIS) platform. AGFA officials said that by delivering a cloud-based solution for the core components of the Impax Data Center, AGFA will be able to provide anytime access to, and fast viewing of, securely stored patient medical images.
Cerner SkyVue is a customizable cloud-based viewer platform that enables one cohesive viewer within the enterprise and beyond, regardless of the user's role or venue. Clinicians can use the Cerner SkyVue viewer platform for diagnostic reading or deploy it for broad image distribution, allowing users to view multimedia and non-diagnostic images side-by-side in any Web browser. According to Cerner, this eliminates the need for disparate viewing platforms. The Cerner SkyVue viewer platform also allows clinicians across the enterprise to discuss a patient while sharing the same view of images and EHR information.
GE's Centricity PACS is a single-vendor radiology suite that contains all the components of traditional RIS, PACS, virtual reality (VR), 3D, mammography, real-time analytics, and dose monitoring. It offers customers a Web-based graphical user interface (GUI) for 24/7 diagnosis and native mobile access on Apple or Android for interpretation or collaboration. Real-time workflow alerts help improve uptime and productivity.
Other key attributes include real-time work lists; the ability to dictate macros; single desktop access to advanced 3D, mammo, dictation, EMR or RIS; exam-locking to help prevent duplicate reports; Web-based diagnostic image access for referring specialty physicians and radiologists; and native application to Android and iPhone operating systems.
Centricity's Web-based image access provides access to more than 20 advanced clinical applications, including cardiac, oncology, vascular, and neuro; it also provides diagnostic reporting and advanced speech understanding designed to help reduce training time. The PACS also offers an open application programming interface (API) interface with Epic, Cerner, and McKesson EHRs.
Merge Healthcare, Inc. offers fully integrated PET/CT fusion and mammography tools. The consolidation workstation (3D, mammography, and PET/CT/MR/NM fusion) is designed for faster diagnoses, more advanced image content, and expanded workstation functionality. Workflow acceleration is achieved with real-time work lists on a multitasking workflow dashboard that includes updates of studies, STAT management, critical results notification, and management of emergency department discrepancies. Patient identification information is removed from studies to make it available for research and teaching without violating HIPAA privacy rules. An instant-communications feature and the ability to share links with colleagues helps make for more efficient readings and faster time to treatment.
McKesson offers a complete suite of medical imaging systems, including McKesson Enterprise Image Repository, a new offering independent of PACS that archives and manages image data. The Horizon Medical Imaging PACS includes a medical imaging workflow platform, a mammography system, medical imaging collaboration tools, medical imaging system tools, and architecture and infrastructure.
Designed to improve the administrative and clinical workflow of radiology departments, the Radiology Manager workflow management software tracks and manages patients and exams. Horizon Study Share is a Web-based system that enables radiologists and other medical imaging specialists to organize and share images, teaching files, and reference case information needed during the course of daily practice using PACS. Variable Thickness Regional Intensity Protocol (VTRIP) allows for efficient reading of CT and magnetic resonance (MR) by embedding advanced viewing, image analysis, and reconstruction capabilities directly into the workflow. McKesson officials assert that this feature allows faster case reading times.
In February, FujiFilm Medical Systems unveiled Synapse PACS 4.0, the latest addition to its Synapse line of medical imaging and information management systems. Among the product's key features are image processing for all of Fujifilm's Digital Radiography (DR) and full-field digital mammography (FFDM) systems, advanced integration utilizing DatCard collaborative image access, intelligent archival management, and standards-based interoperability across all imaging environments.
Fujifilm's Synapse allows the archiving and distribution of image information from multiple modalities, and it can be managed via a single system. With its PACS and next-generation Web technology, Synapse utilizes the latest Wavelet compression technology for on-demand compression and access of large files regardless of location. (Wavelets are functions that allow data analysis of signals or images according to scales or resolutions.) Synapse supports image diagnosis with high-quality images and numerous image processing features. The same Synapse code that runs a 30,000 exam/year outpatient imaging center can run a multi-server, multi-site configuration with more than a million exams a year.
Synapse workstation software provides viewing and manipulation of radiological data such as images, reports, patient status, and clinical information. In addition, it also provides for integrations to clinical applications including dictation systems, radiology information systems, and three-dimensional processing applications.