This is the third annual "Benchmarks" columns to focus on imaging technology. Each one has been timed for November, to coincide with the mammoth RSNA Annual Meeting – it celebrates its 100th anniversary this year, from Nov. 30 to Dec. 5 at McCormick Place in Chicago – and each one has had more or less the same theme: the market is pretty much saturated when it comes to RIS and PACS systems, but change is on the way.
So, at some point it has to be asked: Is that change here?
"I don't think it's here yet," says John Hoyt, executive vice president of HIMSS Analytics. But it's starting to make itself felt. And in many cases that's thanks to larger forces that have little to do with radiology itself.
"I think we of course have a saturated market, and I think the activity, if it's occurring, is driven out of mergers and acquisitions," says Hoyt. Where new system replacements are happening, that's because "two systems merged and they had two different PACS and they eventually consolidated into one."
Another locus of activity in the imaging IT market has to do with the acquisition of physicians practices, says Hoyt.
"We are seeing more decentralized use of these systems, and centralized data capture," he says. "Not a lot of replacements, because not a lot of docs have PACS in their offices. But we're now seeing that it's serving a physical distribution – you may have physicians within 30, 40 or 50 miles of each other reviewing images. Which you could never, of course, do in a film world."
The upshot? "PACS is serving the ability to grow mergers and acquisitions in a decentralized geographic area," he says. "I've been in many organizations on (HIMSS Analytics) Stage 7 visits where I talk to the radiologist and they say, 'Well, our physicians are doing these images all over Columbus,' or anywhere plus or minus 20 miles from where you're standing."
These PACS are "all on the hospital network, images are being captured off modalities and machines and they're putting them out there to be reviewed; anybody who has a minute goes out and gets it," says Hoyt. "That physician could be anywhere within 50 miles." A side benefit? "I'm seeing more and more collaborations where radiologists have a contract with other radiologists as second opinions. PACS is enabling that."
CROSSHED TK
But PACS is no longer the only game in town, as you might have heard.
"There's this thing called VNA," says Hoyt.
As images proliferate – images of all stripes, shapes and sizes – a new approach is needed to store, manage and share them all. Vendor-neutral archives have revealed themselves these past few years to perhaps be just the thing.
A 2012 Frost and Sullivan report predicted that the market for VNA would double in the next six years, reaching $210 million by 2018.
"Although they have been around for about 10 years, VNAs have been expanding only gradually into the marketplace – mostly following top-down expansion," said Frost & Sullivan Principal Analyst Nadim Daher at the time.
The market is ripe as the volume and variety of imaging data grows by leaps and more and more patients make use of those diagnostic tools. Moreover, "in the wake of ongoing IT consolidation of distributed hospital organizations, enterprise medical image archives are making their way into the marketplace, creating a sizable growth segment for imaging informatics,” said Daher.
Earlier this year, Healthcare IT News ran a story asking, "Is VNA the future of image delivery?" Hoyt wouldn't be surprised if it does indeed play out something like that.
"PACS, of course, is all about DICOM images," he says. "Then you have to get this other product to go look at non-DICOM images. But people don't want to have two different vendors for that. I think VNAs are going to pick up and eat into some of the traditional PACS market."
Without naming them, Hoyt notes that he knows of "two vendors getting into this market, neither of whom are PACS vendors, but they're doing it because they have VNA capabilities. They say, 'Give me the DICOM images, I can handle those too.'"
Beyond VNA, there's interesting stuff happening all over the place with regard to image management. The cloud is changing the equation, of course, as "hospitals are running out of physical space," says Hoyt. "It's just too expensive to use good space in a hospital for disk drives, so get out of that business and move it to a rentable data center."
In July, we reported how blue chip providers such as Mayo Clinic, Rush University Medical Center are backing DICOM Grid, which has developed a cloud-based platform for medical image management.
With $6 million in venture funding, Phoenix-based DICOM Grid – founded in 2006, it manages more than 1.2 billion images – announced it was expanding to expand its development of imaging exchange technology and seek out more integration opportunities with EHR and RIS providers.
"Leading healthcare institutions in the U.S. are adopting our technology to improve the lives of patients," said Morris Panner, CEO of DICOM Grid, in a press statement. "There is a huge demand for an easy workflow that moves imaging data between locations and across disparate systems, all under HIPAA compliance."
In April, Burlington, Mass.-based Nuance Communications, thanks to its acquisition of Accelarad, launched its PowerShare Network, a cloud-based platform to enable the sharing of medical images and reports; by August, PowerShare – used by giants such as Intermountain and Kaiser – had shared a whopping 3 billion medical images.
There's some smarts about this: The scheduling system says I know the patients who are coming in tomorrow let me go see their old records– oh, here are some over here in the data center 400 miles away. Bring it in.
That type of technology is easy, it exists, and I presume it would be in use. If I was a CIO dishing images out to a cloud I would certain expect that to be happening: I queue up tomorrow's images into my data center from an archival storage center.
Stage 2 meaningful use is driving some of this activity, but only some. Its core imaging requirements – computerized provider order entry of at least 30 percent of radiology procedures; test results, including radiology reports, made available to patients within 24 hours – are doable, or should be, says Hoyt.
"They sound pretty easy when it comes to imaging. If you're going to have CPOE live, there's no reason you're not hitting 90 percent of images on your orders. That's a piece of cake. The issue is do you have CPOE live? 60 percent of our hospitals do. So I would think that should not be an issue at all."
Given that the DICOM standard is fairly mature, "I just don't get the impression that sharing images is that difficult," he says. "You just have to have a robust network – you might overwhelm the local rural carrier. But the standard and the ability to send and receive is, I don't think it's a big challenge.
"One of the great early advantages to PACS is getting the radiologist out of bed and looking at an exam at home," he adds. "We've been doing that for 20 years. They're in the network, admittedly, but they're at home. That saves radiologists from having to drive in. I don't think moving these DICOM images is much of a problem."
But non-DICOM images ("colonoscopy images, photographs of patients, all kinds of stuff") are a much different story. "Non-DICOM is really the bigger challenge – and so is 3D imaging, because it occupies so much space," says Hoyt.
So, to sum up: "VNAs. Non-DICOM. That's the real future."
