Nonradiology users entice PACS and RIS firms to sweeten the integration pot

Thanks in large part to the IHE initiative and other standardization efforts, tighter integration of PACS and RIS has become a primary goal for systems manufacturers and software developers. While technology advances have helped facilitate this process, so has the growing awareness that providing more comprehensive diagnostic information to physicians outside of the radiology department can improve patient care and reduce healthcare costs in the process.

Much of the PACS/RIS integration to date has been driven by PACS vendors, who see it as a logical extension of their efforts to take the radiology department filmless and to help create a fuller electronic patient record in the process. But this year's RSNA meeting demonstrated that many RIS and HIS vendors are recognizing the value of offering embedded image management capabilities to their customers, particularly users outside the radiology department. They believe that a RIS-centric approach to image management offers many advantages over the modality and image-storage focus supported by most PACS suppliers.

Leading the charge is Cerner, one of the few IS firms that has remained financially healthy this year. Following its acquisition of ADAC Health Care Information Systems just prior to the RSNA show, Cerner is racing to offer the most comprehensive PACS/RIS package. Just a few weeks after acquiring ADAC, Cerner completed the first installation of the Envoi system, originally developed by ADAC, at American Radiology Services in Baltimore.

Cerner, which claims 390 customer sites for its RadNet RIS, was attracted to Envoi because its existing systems did not have image workflow capabilities or full DICOM services or validation. In addition, Cerner considers Envoi the first truly RIS-centric RIS/PACS. This means scheduling, ordering, and clinical event data are available to users well before the same information gets to the PACS, according to Bill Waters, vice president and managing director of Cerner's radiology and cardiology businesses.

Cerner is working to integrate the best of RadNet and QuadRIS into Envoi. The company is also working to make ADAC's Physician Desktop product available on both Envoi/RadNet and QuadRis, and to integrate all of these products into its Millenium system. The latter should be available by RSNA 2001, Waters said.

Cerner is not alone in its quest to integrate sophisticated image management capabilities with an existing RIS platform. IDX has been working toward this same goal, joining forces with Stentor (HNN 11/29/00). Although it is widely acknowledged that the IDXRad RIS is top of the line, the system's price tag may be off-putting. Version 10, released earlier this year, is a Web-based version of the original legacy system (making it more practical and affordable for enterprise applications), and the company intends to focus more on return on investment in 2001. IDX maintains, however, that there is still a place for a high-value RIS.

With the addition of the Talk Technology voice engine and Stentor's image-streaming technology, plus joint product development between IDX and Stentor, IDX will continue to give its competitors a run for their money. The agreement with Stentor calls for Stentor's iSite system to be embedded into the IDX Imaging Suite (which includes IDXRad) and ConnectR products, creating a medical image and information management system that can be delivered as an ASP. IDX and Stentor are also codeveloping a diagnostic workstation that will be fully integrated with the Imaging Suite, and efforts are under way to image-enable IDX's Last Word HIS using Stentor technology.

Canon used the RSNA meeting to announce what the company says is the first clinical integration of a RIS and PACS using the IHE framework. The application, which enables real-time bidirectional communication between the PACS and RIS, was installed at Holy Name Hospital in Teaneck, NJ, in October. It combines Canon's PACS with the IDX Imaging Suite and implements specific IHE transactions, such as the DICOM Modality Worklist, Procedure Scheduled, and Patient Update. In addition, a unique Study Content Notification messaging feature keeps the RIS updated on the status of PACS images. In anticipation of future IHE Structured Reporting implementations, radiology dictation reports are automatically forwarded from the RIS to the PACS for storage.

Despite ongoing financial struggles and persistent rumors of an impending takeover, Dynamic Healthcare Technologies came away from the RSNA meeting insisting that its future remains bright. The company will remain competitive for several reasons, said newly appointed president and CEO Chris Assif, including having established products not just in radiology but in pathology and laboratory applications as well.

Dynamic is in the process of shifting to a pure ASP model and Assif feels comfortable that a major portion of its business will be ASP-based. At the RSNA show, the company saw much interest in its RadPlus RIS product and in its Internet-based radiology image and report management product, CoMed. In fact, all of the company's applications were provided from its Florida data center to the booth in Chicago via the Internet to showcase Dynamic's online capabilities.

Dynamic was also promoting its new relationship with DeJarnette, which is designed to facilitate the integration of images into the radiology workflow. The company is developing a solution for long-term image archiving that should be available in the first half of 2001. The goal is to offer customers a single network-attached storage device strategy that meets the needs of both in-house and off-site applications, according to Assif.