HIS firms see PACS in enterprise-wide context

HIS firms see PACS in enterprise-wide context

Information systems vendors may have inside track on PACS firms

The PACS and teleradiology markets for years have been the domain of radiology-centered companies, such as modality vendors, x-ray film providers, and a handful of other players. Healthcare information systems vendors have mostly watched from the sidelines, but this is beginning to change-and many PACS companies may not be happy with how the market eventually shakes out.

HIS companies have recognized the value of PACS technology, and are aggressively moving ahead with plans to integrate PACS with their own IS products to develop enterprise-wide image and information management systems. While such products will confer obvious benefits on patients and healthcare providers, it's unclear what the role of dedicated PACS vendors will be when the enterprise-wide vision becomes a reality.

The diffusion of PACS technology beyond its historic center in the radiology department is inevitable, due to the widespread need for imaging technology outside radiology, such as among referring physicians. By integrating PACS into an enterprise-wide information system, clinicians can realize the benefits of quickly gaining access to images and radiology reports alongside other patient information, according to Ken Waldbillig, radiology product marketing for Dynamic Healthcare Technologies. In fact, the success of PACS depends in large measure on how much demand there is among referring physicians.

"Radiology really won't get the chance to go filmless until radiology's customers are comfortable in a filmless environment," he said. "That means wide-scale image distribution."

Radiologists will also benefit from an integrated PACS and information system. In this environment, radiologists will be able to view images as well as other patient information to provide a complete perspective on the patient, said Marc Luce, director of professional services and business development for Data General's healthcare division.

It's only natural that HIS vendors would turn their attention to the PACS market. In addition to the clinical value of an integrated HIS/PACS, the PACS market has still not achieved a high level of market penetration, leaving plenty of room for new entrants, said Kevin Stultz, PACS marketing manager for Imnet Systems.

"Everyone sees it as a new area in healthcare information management that is virtually untapped," Stultz said. "Most hospitals have not done anything with medical imaging. They may have a teleradiology system, but that's about it."

A big stumbling block to large-scale PACS implementation has been its stiff price. Hospitals, however, are looking to consolidate costs by turning to one manufacturer for all of their healthcare information system needs, and this is where an integrated enterprise-wide system would have an advantage over one comprising separate PACS and HIS components, Stultz said.

"Hospitals are working today in a catch-22 situation, where they're charged with improving patient care, but reducing costs at the same time," Stultz said. "So what they're looking to do is consolidate all of their healthcare information, so they don't have to have three or four workstations to bring up three or four different types of information."

Although PACS can certainly be classified as a healthcare information system, it is one of the most technically demanding and difficult to implement of its kind, due in large measure to the large size and complexity of image data files. As a result, many HIS vendors have chosen to partner with other PACS vendors for at least a portion of their PACS offering rather than develop a PACS in-house.

Still, the reality of an integrated PACS and information system remains in a fledgling state. A survey of several HIS companies by PACS & Networking News reveals, however, that many HIS players are moving toward the goal of an integrated enterprise-wide system.

While these vendors remain in various stages of development of PACS technology, all believe that the integration of PACS into an enterprise-wide IS represents the future of the market. Most of the HIS vendors surveyed also believe that by offering customers one-stop shopping for all their IS needs, they will have an advantage over dedicated PACS vendors.

Cerner

Cerner is perhaps most familiar to the radiology market due to its RIS product line, but the company also provides information systems in other medical specialties. The company offers ProView, a software package that interfaces with traditional PACS networks and digital imaging modalities to transfer images to standard PCs for clinician review. ProView runs on Windows NT or Windows 95, and is installed at two sites as part of an integrated HIS/RIS/PACS.

A ProView version designed to run on Cerner's HNA Millennium network architecture will be displayed at this year's Radiological Society of North America meeting, said Paul Helmuth, project manager for clinical imaging. Cerner is in the final stages of lining up an alpha testing site for the new version.

Although it has the most experience working with Siemens Medical Systems, Cerner will work with any PACS vendor its customer desires, he said. In fact, Cerner has partnered with three of the five finalists in the Department of Defense's DIN-PACS project (PNN 6/97).

Down the road, Cerner will likely offer its own PACS product, although it's uncertain whether the Kansas City, MO-based vendor will develop its own offering or partner with another company, Helmuth said. One partnering possibility could be Imnet Systems, with which Cerner already has a strategic partnership. In fact, the two companies have had some discussions about future opportunities in this area, he said.

Data General

Systems integrator Data General has participated in the HIS market for the last 10 years, and in the past year and a half has focused on developing a complete enterprise-wide information systems offering. At the 1996 RSNA meeting, Data General announced a partnership with MarkCare Medical Systems to market the Bloomfield, NJ-based company's IntraScan II PACS and teleradiology system.

Data General, of Westboro, MA, uses its AviiON Unix and Windows NT-based servers in conjunction with IntraScan workstations, which are based on the Windows NT operating system. The workstations are available in either 1K or 2K configurations.

A key factor in Data General's PACS concept is its use of clustered servers, said Marc Luce, director of professional services and business development for Data General's healthcare division. Under this approach, two servers are employed to ensure that if one server goes down, network operation would be unaffected, he said.

Work-flow management is handled by the image server, which moves the image to the archive server after the image is transferred to its appropriate location based on work-flow rules. The archive server then stores the image on two different storage media, RAID and optical disks, to maintain redundancy, Luce said. Data General's CLARiiON RAID servers store 30 days of studies for near-term storage, while optical-disk jukeboxes handle long-term archiving.

Data General's first site to implement the vendor's IS concept is Leicester General Hospital in Leicester, U.K. The hospital is in the second phase of installing an integrated PACS and HIS/RIS.

The first phase consisted of bringing computed radiography into the PACS network, which included installing diagnostic workstations in the radiology department and clinical review workstations throughout the hospital to allow for clinician review of images. Servers to support work-flow management and archiving were also added.

Other modalities will be integrated by the end of this year in the second phase of the project, Luce said. A third phase to the project, still in the determination stage, will likely consist of integrating the hospital's satellite facilities into the network.

Data General is now focused on landing similar deals in the U.S. The vendor hopes to announce some U.S. contracts at the 1997 RSNA meeting, Luce said.

Dynamic Healthcare Technologies

Maitland, FL-based Dynamic's PACS offering is called PACsPlus+ and is part of what the company calls its Dynamic Vision virtual multimedia electronic health record package. Although also available as a stand-alone PACS network, PACsPlus+ can tie into Dynamic Vision through the use of a master patient index database, allowing both radiologists and clinicians access to the enterprise-wide information system, said Ken Waldbillig, radiology product marketing.

"In the traditional radiology arena, Dynamic Vision takes those radiology blinders off and allows access to a wide variety of different types of information, such as multimedia information, voice, document images, pathology images, laboratory, and admitting information," Waldbillig said. "We think that PACS that do not have an IS strategy fail."

PACsPlus+ was released for general availability in January and has been installed at several sites as part of an integrated PACS and IS, Waldbillig said. He would not disclose the number of installations.

PACsPlus+ uses Windows NT servers in a client-server architecture and can support a filmless radiology department, Waldbillig said. The workstation software is based on either Windows NT or Windows 95 and supports configurations ranging from 1024 x 768 to a four-monitor 2K x 2.5K setup.

For archiving, PACsPlus+ uses a combination of RAID, magneto-optical disks, and digital linear tape, depending on the archiving needs of the customer, Waldbillig said. PACsPlus+ offers prefetching as well as physician profiles to customize the workstation display for the particular user, he said. PACsPlus+ is DICOM-compliant and achieves HIS/RIS connectivity through HL-7 interfaces. It is also Internet/intranet-ready, he said.

While PACsPlus+ workstations were designed by Dynamic, other elements of the product are provided by partners in the areas of data acquisition and storage. Dynamic would not disclose with whom it is partnering. Beta testing of PACsPlus+ was done at Children's Mercy Hospital in Kansas City, MO.

At the 1997 RSNA meeting, Dynamic will introduce a teleradiology component to PACsPlus+, called WebSight. Based on Web protocols, WebSight will enable both sending and receiving of images and is slated for an early 1998 release, Waldbillig said.

The vendor will also debut release 2.0 of PACsPlus+ at the meeting. The new version will add some elements to the product that are typically found in radiology information systems. For example, bar-coding technology will be added, and radiologists will also be able to electronically approve reports. Voice recognition capability will also be available, Waldbillig said. PACsPlus+ 2.0 is also scheduled for an early 1998 release.

HBO & Company

Atlanta-based HBOC privately labels Imnet's MedVision product for its PACS offering, which rounds out the vendor's enterprise-wide IS offering. HBOC has sold the Imnet solution to five sites, two of which have installed the teleradiology component of MedVision. The other three will be installed when the PACS component of MedVision is ready in 1998.

HBOC chose to partner with Imnet over dedicated PACS companies because of MedVision's ability to be integrated into an enterprise-wide IS, said Harry Gibson, executive director of business partner alliances. MedVision and HBOC's information systems are also based on common architecture, he said.