Consolidation and integration dominate PACS and RIS at RSNA

"Bigger, faster, cheaper" could have been the overriding theme at this year's RSNA meeting. It is always difficult not to feel overwhelmed when you first enter McCormick Place, but it seemed especially so this year. The center aisle of the North Hall was dwarfed by football-field-sized booths bearing the Philips, Kodak, Siemens, Agfa, and Marconi logos. Even the South Hall was difficult to negotiate at times, especially if you were within earshot of GE's legion of booths or basking in the glow of the Fuji monolith.

But the digitization of diagnostic images has been good to these companies, and it shows. They control about 75% of the PACS market, and that market is expected to continue to expand for at least another three to five years. In addition, the increasing emphasis on enterprise distribution of images has prompted all of the major film and modality vendors to look beyond radiology and cardiology for new business, and they are beginning to find it.

Many of these firms have adopted broader marketing strategies that bridge the gap between the radiology department and everyone else. The message now is less about the technology and more about the process of adopting it. "Workflow" has replaced "image quality" as the watchword of digital imaging in medicine.

As a result, rebranding was all over the place at the RSNA meeting, notably among the old guard. Siemens Medical Systems is now Siemens Medical Solutions, and there are rumors that Philips Medical will soon follow suit. Siemens also took a huge step in the dot-com direction with the introduction of siemensmedical.com, a Web portal designed to revolutionize the medical products marketplace.

Internet-based applications were also central to GE Medical's presence at the meeting. In addition to its traditional PACS offerings, GE emphasized the growth of its Information Technologies division, which includes the company's ASP and e-commerce efforts. And Marconi is adamant that it is well on its way to evolving from a modality company to an IT/IS provider, having spent nearly $6 billion so far in the process.

Marconi is not alone in its investments. Philips' well-publicized acquisitions of ADAC and Agilent Healthcare Solutions just prior to the RSNA show contributed considerably to the exhibit hall buzz. Besides upping the ante in the enterprise market, Philips appears to be looking in even broader directions. Among other potential initiatives, Agilent's established home health and mobile defibrillator businesses have the potential to take Philips' medical offerings directly to the consumer.

Even the film companies would rather be seen as digital technology providers. Kodak's Health Imaging Division, which includes the new PARIS integrated RIS/PACS group (formerly the Cemax-Icon subsidiary), defined the company's presence at the meeting. The Health Imaging group expects to introduce more than 50 new products next year, 75% of which will be digital. Kodak claims that its shift from a provider of film to a provider of digital imaging solutions helped the Health Imaging group achieve a 6% to 9% increase in sales this year.

Similarly, Agfa focused more on its strategic partnerships with Comdisco and Inphact (and the resulting ASP capabilities) than it did on product-specific upgrades. And Fuji continues to tout the advantages of Synapse, its native Web-based PACS, for enterprise distribution and RIS integration. Fuji claims to have 30 U.S. installations of Synapse to date, compared with just three a year ago.

Traditional PACS remains strong

Still, none of these firms have turned their backs on their bread-and-butter businesses or on "traditional" PACS. Each one exhibited enhancements to its existing PACS products, and several showcased improvements in their RIS integration and enterprise distribution capabilities. Voice recognition and integrated 3-D viewing capabilities were also hot topics.

- GE showed enhancements to its PathSpeed PACS that are designed to improve enterprise distribution of images and eventually eliminate the need for film outside of the radiology department. The company has developed its own lossless compression technology, called TruRez, and integrated it into PathSpeed PACS. TruRez combines integer wavelet transforms and lossless compression to help providers across the enterprise view full-resolution images without worrying about bandwidth or workstation constraints. Using a progressive technique, TruRez enables thin Web clients on any end-user computer and optimizes data transmission based on existing bandwidth and workstation viewer capabilities. Compression ratios range from 5:1 to 60:1, depending on the robustness of the viewing workstation. During demonstrations on the RSNA show floor, users were able to access a chest image in two to three seconds over both T1 and POTS lines.

Other PathSpeed improvements include tighter integration with the Cerner RIS, IDX RIS, and speech engines from both Talk Technology and L&H. Three-D and volume rendering are also being integrated into the PathSpeed workstation (these capabilities are still in clinical trials), along with orthopedic templating to enable specialty-specific computer-aided diagnosis.

- Philips introduced release 7 of its Inturis PACS, which has been rebranded "myPACS." The company has developed a whole series of "my" products and services that emphasize customization and personalization.

myView allows users to see images on demand with myPACS and features customizable workstations, personal dynamic worklists, and user-specific configurations. myBlanket includes multilevel security features (including audit trails and biometrics), high-availability servers, and built-in redundancy. myTeam is Philips' professional services group, which offers workflow analysis, project management, and network implementation. Philips has also signed agreements with StorageTek and EMC to integrate their data archiving and storage technologies into Inturis/myPACS.

- Siemens showcased its ASP offerings and its new siemensmedical.com Web site, which is designed to enable the company to approach customers, patients, and providers from a disease-specific perspective and better provide them with the clinical information they need to make decisions regarding care and related purchases. The portal is initially intended as an e-commerce entry-point, but the company says it will eventually include communities that will link radiologists and referring physicians and make patient data available whenever and wherever it is needed.

Siemens is already moving in this direction with the SMS Physicians Dashboard, a browser-based product that resides on the user's PC and gives intranet and Internet access to clinical information, patient records, images, and any other applications relevant to the user's day-to-day workflow. Siemens also highlighted the role of its syngo software in systems integration, data workflow, and user training and its participation in the IHE.

- Marconi emphasized enterprise workflow, flexibility, customization, multiRIS integration, and flat-panel displays. The company is now integrating voice recognition capabilities from Talk Technology and L&H into its PACS workstations, and offers the Talk Technology miniRIS with its PACS for smaller sites. Marconi also demonstrated the Xyloc proximity security card, which automatically logs a user on (and loads his or her preset protocols) when he or she approaches a workstation, then logs that user off when he or she walks away. Starting in spring 2001, the Marconi JPACS will also feature embedded security mechanisms provided through its relationship with Xcert. In addition, the company expects to offer new compression and progressive streaming capabilities with its PACS as well.

sigma Kodak's PARIS division showcased the company's plans to integrate its PACS and RIS technologies more tightly and better facilitate enterprise access to images and information from either a PACS or a RIS workstation. The company is focusing on four major growth areas: stand-alone PACS functionality, integrated PACS with digital capture devices (such as its CR and DR products), multiRIS PACS integration, and new distribution models such as ASPs. PARIS is in the process of adding the RealTimeImage progressive streaming technology to its workstations to speed image access over dial-up networks and the division expects to make this capability commercially available early next year.

sigma Agfa demonstrated the Web-based enterprise-distribution capabilities of its Impax PACS, which gives clinical and administrative staff access to images, reports, and RIS scheduling. Impax features embedded RIS and voice recognition, which are also available on the Toshiba simPACS, a department-centric PACS built using Impax technology licensed by Toshiba from Agfa. Other extensions to Impax and the Impax R4 workstations include advanced diagnostic tools for radiology specialties, with 3-D visualization; workstations for clinical subspecialists with unique workflow issues, such as orthopedics and cardiology (Impax for Cardiology, shown as a work-in-progress at the RSNA meeting, is currently in beta testing at Brigham and Women's Hospital in Boston); and the ability to access results via e-mail and images on CD-ROM. Agfa also rolled out a new system monitoring and reliability product called PACS Watch 2.

- Fuji introduced version 2.0 of Synapse, which is designed to bring the full power of PACS to all users outside the radiology department, regardless of the network backbone or number of sites on the network. New features include multifacility, multiRIS, and multireading-group capabilities. Multiple databases in an enterprise can be accommodated with secured log-ins that control the user's ability to see different facilities within an enterprise. In addition, a network of facilities can share information despite having different HIS/RIS systems and reading groups.

Fuji also showcased version 2 of its AON (access over networks) compression and distribution technology suite, introduced at the 1999 RSNA meeting. The AON toolset includes AON Subscription, which allows remote users to access selected sets of information through a secure Internet or intranet connection; AON Engine, an embedded wavelet compression technique that enables on-demand access to full or partial images over lower-bandwidth networks; and AON Factor, which assigns a relative value of compression to an image.

© 2000 Miller Freeman Inc.
12/13/00, Issue # 118, page 1.