RIS/PACS marks first wave of integrated systems

November 2004 - Integration, interoperability, interconnectedness: "In" is in for PACS and informatics. The RSNA meeting promises to reveal a new world of integrated healthcare systems, PACS, and radiology information systems, all aiming to provide a single solution for data and imaging information management.

While the promise of integrating all hospital information systems under one electronic umbrella is still just a promise, the integration of smaller systems has already begun. This trend will be demonstrated in numerous RIS/PACS products that will be featured on the RSNA exhibit floor.

"Eventually, systems will emerge that are actually capable of managing the overall radiology delivery challenge from end to end in a consistent fashion," said Bob Cooke, executive director of marketing network systems at Fujifilm USA. "Today's systems offer a glimpse of what is possible by tightly integrating two separate systems; e.g., a RIS and a PACS. In the future, these will actually be a single system."

Fujifilm will demonstrate the latest commercially available version of its Synapse software at the company's RSNA booth.

Offerings that continue the move toward RIS/PACS integration include new versions of Kodak's RIS and PACS platforms and new features for its RIS 2010 platform, a RIS/PACS now being marketed in the U.S.

"Our customers are strongly in favor of continued momentum in adoption of the Integrating the Healthcare Enterprise technical framework to simplify integration of RIS/PACS with imaging modalities and electronic health record systems," said L. Jeffrey Markin, general manager of healthcare information systems and vice president, Kodak Health Imaging Group.

Integrating RIS/PACS across the enterprise will enable more collaboration and faster sharing of information among clinicians, ultimately resulting in better patient care and more efficient resource utilization, said Gail McBride, director of marketing programs at McKesson Medical Imaging. Horizon Radiology, McKesson's Web-based integrated RIS/PACS, which will be shown at the RSNA meeting, is available as an integrated RIS/PACS or stand-alone RIS or PACS that can work with offerings from other companies.

Despite the trend toward RIS/PACS integration, some disagreement as to whether a need really exists for a single RIS/PACS product persists.

"RIS/PACS integration by itself is still an important issue, but few believe these will become the 'omnipotent' radiology IT systems, as some thought in previous years," said Staffan Bergstrom, vice president of marketing at Sectra Imtec.

Other products being unveiled with an eye toward integration include Philips Medical Systems' new RIS (powered by Epic) for the U.S. market and its latest EasyAccess radiology PACS release. Both are incorporated into the radiologist's desktop.

Merge eFilm offers the Fusion RIS/PACS integrated single-desktop system that automates and integrates RIS (RIS Logic), PACS, dictation, and billing, among other capabilities, and distributes images through a combination of image streaming and RIS- and PACS-driven routing methods. The RIS and PACS can be purchased separately.

Siemens will show the Sienet Cosmos system, its offering in the RIS/PACS strategies arena, said Rik Primo, director of strategic relationships, image management at Siemens Medical Solutions. The Web-enabled integrated radiology suite, introduced last year as a work-in-progress, features digital dictation and voice functions.

Misys Healthcare Systems will conduct demonstrations of its RIS/PACS integrated workflow product. It includes a RIS, PACS integration module, and image management system.

"The benefit of validating synchronized RIS and image data is that it ensures the accuracy of data when radiologists are viewing images. RIS/PACS integration is among the most pressing topics for our clients," said Angela Jenkins, public relations manager, acute/hospital market at Misys.

But not everyone believes that a one-box RIS/PACS is going to be available any time soon.

"If you'd asked this question a year ago, I would have said you'll see more and more RIS/PACS types of offerings. But I'm not sure that that trend is really as strong today," said Wayne DeJarnette, president and CEO of DeJarnette Research Systems. "It's a dollars issue in the end. There are older, existing RIS that work reasonably well with new PACS. It certainly may be easier to begin with a completely clean slate, but it's going to cost you more. The jury is still out on that issue."

DATA SETS KEEP GROWING

Handling large-volume data sets continues to be a major issue with PACS vendors and users alike. Development of ways to represent complex 3D data sets is a move toward solving the dilemma.

"Since the explosion of images, including those from multimodality fusion, shows no sign of stopping, radiologists may need to change the way they handle interpretation and reporting. This will likely include a widespread adoption of volumetric navigation and decision support tools," Markin said.

Kodak has embedded 3D technology in its diagnostic workstation and is actively developing decision support tools.

Key clinical areas driving the need for large data handling capabilities include digital mammography and multislice CT. Both produce increasingly complex data sets that require software technology tools to help render a diagnosis.

"Growing procedure volumes and staff shortages are driving the market toward IT solutions. Data sets are larger and more complex than ever," said Eric Pearce, U.S. marketing manager for RIS/PACS products at GE Healthcare. "PACS must allow users to efficiently deal with large and complex data sets."

Philips Medical Systems is also jumping into the data set fray, introducing a new version of its EasyAccess product that addresses the high volumes of CT and MR data. Similarly, Intelerad will unveil the InteleViewer from its latest IntelePACS release (version 2-6-3). And DeJarnette, which debuted its dyseCT product last year, will introduce an MR work-in-progress version at this year's meeting. DeJarnette's CT product rationalizes automatically and segments a CT study into appropriate RIS component studies.

Amicas will exhibit a new 3D study cropping capability for its LightBeam Diagnostic Workstation.

Dynamic Imaging will introduce its configurable slice thickness reformatting engine to meet the increased demand of maximum intensity projection/multiplanar reconstructions and 3D postprocessing performed at the PACS workstation.

"With 64-slice CTs on horizon, the conventional way of managing the data will soon become extremely difficult, if not obsolete," said Alex Jurovitsky, CEO of Dynamic Imaging.

EMERGENCE OF THE EMR

The electronic medical record typifies the continuing move toward interconnectivity of all information systems and immediate availability of data or images produced among departments in a hospital. Not only are PACS slowly being integrated into EMR systems, they are also exhibiting in miniature the move toward one-box solutions.

At the RSNA meeting, Agfa HealthCare will promote the sixth generation of its IMPAX line, intended to move PACS beyond the radiology department. According to the company, the product focuses on distribution of images and data to a wider set of constituents who employ those results in patient care.

"A PACS must be able to provide a wide variety of tools traditionally associated with specialized workstations and deliver them to a wider audience of end users, enabling the user to leverage the image and text information for patient treatment and follow-up," said Renee Stacy, manager of media relations at Agfa HealthCare.

The company is also offering its IMPAX MPI, a departmental master patient index for radiology, and the IMPAX orthopedic planning station, which features a range of biomechanical tools to assist orthopedic surgeons in surgical planning.

The move outside the radiology department includes other "-ologies" such as cardiology, neurology, and gastroenterology, said Douglas Dill, director of marketing at DR Systems. The company will feature the Cardiology PACS and Cardio Cath and Echo products at its RSNA booth.

"There is a trend toward integration of other disciplines into RIS/PACS. Additionally, you'll see more support of the IHE initiative-collaborative sharing of multiple exam notes and audio clips with technologists, radiologists, and ER physicians," Dill said.

The Web is also being used to move radiology images and data through the enterprise, as seen in eMed Technologies' Matrix, which incorporates a new platform based on smart client technology and peer-to-peer communication tools. The architecture combines the capability of the PC with the reach of the Web, enabled by Microsoft .NET technology.

GE Medical Systems will offer the Centricity PACS 2.1, the Centricity Enterprise Web 2.1 with additional feature functionality, and the Centricity RIS/PACS, an integrated system with embedded voice recognition.

Amicas will present the latest version of its Web-based PACS, the Vision series, as well as Meditech and RadConnect RIS integration.

"Long-term, integration is key, but partnerships and a corporate vision are central to PACS purchasing decisions," said Brad Levin, director of strategic marketing at Amicas. "PACS buyers want to purchase solutions that give them-not their vendors-the flexibility to hold the cards."

Interest is growing in integrated departmental management beyond RIS/PACS, including billing, distribution, and reporting, McBride said.

"The ability to access reports, images, and patient information from any clinical department across the enterprise is generating interest in moving RIS/PACS beyond radiology to include other medical specialties," she said.

Sectra will demonstrate workflow solutions that include image distribution and remote reading capabilities. It will also show clinical applications running on the same PACS platform, including an orthopedic imaging module, a cardiology workstation, and a mammography workstation, which come from Sectra or third-party vendors.

"We believe that being able to offer one platform for all image management within the enterprise is increasing in importance," Bergstrom said.

Stentor will demonstrate version 3.3 of iSite Enterprise First PACS at the RSNA meeting. The product, launched commercially in October, provides enterprise-wide Web-based image distribution.

"Imaging as a foundation for the proliferation of the EMR will be key," said Mark Reis, marketing manager at Stentor.

RealTimeImage will introduce iPACS Prism v.5.0, a Web-based PACS complemented by a thin-client PACS architecture, said CEO Zvi Eintracht. The company will also introduce iPACS Cardio for cardiologist reviewing.

Merge eFilm will unveil Unified Single System Strategy, which includes RIS, PACS, clinical applications, and EMR with a RIS-driven single-desktop integration of specialty clinical applications such as 3D and calcium scoring.

Dynamic Imaging will introduce a number of product enhancements for its IntegradWeb PACS at the RSNA exhibit, including OrthoPACS, a template library that includes screws, nails, plates, and prosthetic devices.

ScImage will demonstrate the new features of PICOMEnterprise Version 2.0. This enterprise-level PACS is intended to tie together all the data from one or more departments, using a common database. Version 2.0 includes a new interface engine that provides a single point of entry through any third-party RIS, EMR, or practice management system. ScImage will also introduce PICOM ECG, a Web-enabled ECG management module that augments the cardiology offering.

The number of products that integrate previously disparate applications into one workstation indicate that the information technology needs of the healthcare enterprise are converging. The recent merger and acquisition activity within the RIS/PACS industry is a good indicator of this trend, said Christian J. Carr, manager of business development at ScImage.

Open standards are beginning to play a larger role in the development of this market, allowing a facility to choose the best of breed for its clinical application needs, he said.

"Over the long term, there will be a major emphasis on open architecture to provide comprehensive virtual patient records that extend beyond a single enterprise, as emphasized in (Health and Human Services) Secretary Tommy Thompson's healthcare initiative," Eintracht said.