Former Toshiba GM spreads his wings

Seven years of turmoil in the picture archiving and communicationsystems market has led to greater emphasis on productivity andcost-effective equipment. But radiology departments often assumethat adding new technology in PACS will automatically increaseproductivity. That is not the case, according to Ronald B. Schilling,president of RBS Consultants and former general manager of ToshibaAmerica Medical Systems.

"Radiology departments require a combination of new technologyand reengineering of the way they operate," Schilling said."Then they can win big with increased productivity."

But radiology departments continue to be reluctant to changetheir existing systems, Schilling said.

"People have been doing things a certain way for a longtime," he said. "But I think they (radiology departments)are coming to realize that, with the health-care situation theway it is, one needs to make significant changes."

Manufacturers have also begun to realize they must build flexibilityinto their imaging systems so customers can adapt them and createimprovements in productivity, Schilling said.

Schilling has retained an active focus on PACS following hisdeparture from TAMS this year (SCAN 1/29/92). Much of his currentconsulting activity involves the strategic positioning of PACSproducts for client companies.

Many mistakes were made in the PACS market over the last sevenyears, and equipment was purchased that didn't live up to expectations,Schilling said.

"Things were changing too fast," he said. "Everyonewas looking for a dream. But now people realize there are fundamentalissues that need to be overcome before it (PACS) can be broughtto fruition."

Connectivity, network speed, and the question of local versuscentral storage are some issues being addressed, Schilling said.

"Progress is being made on the connectivity issue by theACR-NEMA group. We expect there will be a demonstration of thelatest version of the ACR-NEMA specification for connectivityat the RSNA meeting in November," he said. "But we areat least five to seven years from having everything fit togetherwithout question, when one will be able to upgrade componentsand not think about connectivity."

SIGNIFICANT IMPROVEMENTS ARE ALSO EXPECTED in network speed throughthe use of fiber-optic networks, Schilling said.

"Departments planning for the future will put in the latestin fiber-optic technology," he said.

The jury is still out on the best methods for storage, however.

Central storage has the benefit of lower cost per unit of information,but information is confined to one location. If something goeswrong with a file, the flow of information is interrupted.

Distributed storage, while more expensive per information unit,allows immediate access at each departmental location.

A combination of the two methods would probably best suit theneeds of radiology departments, Schilling said.

"Each department would have its own storage media andcould then access certain things from local storage," hesaid. "They might call up other information from the mainstorage and then store it locally."

A common mistake when implementing PACS is to look at thisdigital image technology in isolation from radiology informationsystems, Schilling said.

"Understanding the system concept of PACS and RIS is veryimportant," he said. "In the future, we will have integratedRIS and PACS so that you don't have to duplicate the consolesin every location."

Integration of PACS and RIS should come to fruition in thenext two years, Schilling said.

"We're already seeing companies, for example, Radman,that have an RIS and an image management system," he said."There is a logic that ties the two together. We're goingto see more of that."

Another related trend in radiology is the blending of imagingand treatment, he said.

Schilling foresees the development of compound CT and x-raydevices that would allow an imaging procedure and an interventionalprocedure to be performed simply by changing the positioning ofthe patient on the table.

"It's all coordinated and you have all the film and informationthat's needed right there," he said.

A major goal of his consulting business is to play a role instimulating cost-effective health care, Schilling said.

He would like to work with groups such as the American Collegeof Radiology, the National Electrical Manufacturers Associationand the Radiological Society of North America in developing technologyassessment procedures to help manufacturers supply technologybest suited for particular jobs, Schilling said.

Schilling has combined efforts with Technology Marketing Group,an established medical technology assessment and consulting organizationbased in Des Plaines, IL. He joined TMG as a senior associate.

From a personal perspective, working as a consultant allowshim the time and flexibility to be involved in a variety of medicalimaging issues, Schilling said.

"You can take a much broader view and look at the overallpicture," he said. "The industry is under pressure.Reimbursement is changing and the whole environment is markedby caution. There is an opportunity here to play a role in thesecomplex issues and to help resolve them."