RSNA 2014: Imaging IT scales to the enterprise

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 - RSNA 2014 technical exhibits

CHICAGO—After a decade of talk about enterprise imaging capabilities, many imaging IT vendors exhibiting at the 100 th annual meeting of the RSNA portrayed themselves as health IT companies that happened to make PACS.

In almost every imaging IT booth and on the tip of nearly every tongue was the omnipresent vendor-neutral archive (VNA)—some with the ability to upload, store and exchange both DICOM and non-DICOM images—and zero-download viewers to support access from anywhere. Several vendors offered applications and workflow for pathology and lung cancer screening.  

One topic that vendors were less forthcoming on was the federal meaningful use program, specifically stage 2. Those who are offering stage 2 CEHRT reported that customers were working harder to attest in the second stage of meaningful use.

VNA ubiquity

FUJIFILM Medical Systems demonstrated a workflow for capturing non-DICOM images and storing them in its Synapse VNA, which accommodates both DICOM and non-DICOM images. Mobility, the company’s mobile application, was enhanced to handle non-DICOM images, so that caregivers can use smartphones and tablets to acquire and upload, for instance, dermatological images.

Using an iPad that stood in for a camera, William Lacy, VP, informatics marketing & enterprise sales, signed into the demonstration server, captured a non-DICOM image with the iPad, saved it locally and then uploaded it to the VNA. “Simple as that,” he said.

Infinitt also demonstrated a next-generation healthcare platform that can handle non-DICOM as well as DICOM images and data, including XML, PDFs, JPEGs and MPEGs, said marketing director Deborah Reed. “This has non-DICOM support, with multi-site and multi-institution applications,” she said. “If you want to keep data in separate silos you can, but it is controlled by the same software—two hospitals together can share, but if they want to store outside images, they can keep those separate.”

More than one vendor also enabled their VNAs for document and image sharing using Integrating the Healthcare Enterprise workflow. McKesson added collaboration functionality to its Enterprise Imaging Repository with a new offering called Clinical Data Exchange, which leverages IHE’s XDS and XDSi profiles for bi-directional data and image exchange.

“We see VNA as the pavement on road,” said George Kovacs, executive director, product marketing, Imaging & Workflows Solutions. “VNAs, in their effort to connect the world, end up abstracting data away from departmental silos. The bigger issue is how useful is the data once it’s in there?”

Zero-download viewers

With VNAs ubiquitous, so were zero-footprint viewers, but most vendors were calling it something else. Viztek VP Steve Deaton explained that the term and the concept of displaying a DICOM image in a web page was patented about a dozen years ago.

Viztek licensed the term and developed a zero-footprint viewer that along with server-side rendering forms the basis of its new web PACS release, exa-PACS, demonstrated at the RSNA. While many of the zero-download viewers on the floor were written in HTML5, Viztek used the newer Node.js—an open source, cross-platform environment for server-side and networking applications that leverages JavaScript and the Google V8 JavaScript engine—to develop its enterprise exa-PACS platform, Deaton said.

“This is not a lite viewer,” he said. “It offers full functionality for the radiologist, anywhere he or she is in the world.”

As institutions like The Cleveland Clinic seek to bring discipline to the acquisition and archiving of all of the images generated by all specialties, an easy-to-deploy and democratic tool for viewing images will grow in importance.

Cheryl Peterslige, MD, described the Cleveland Clinic’s mission to incorporate all medical images into the patient record during a luncheon sponsored by Agfa Healthcare, which merged its clinical repository and IMPAX PACS into a single platform called Healthcare Enterprise Imaging.

“We want to create a comprehensive longitudinal medical record, and the way we are approaching that is by creating a single archive for all of our images,” she said.

In addition to developing a uniform method to acquire images for each specialty, including radiology, cardiology and ophthalmology, the institution is working toward the integration and indexing of all images in its EHR.

“We believe we are going to be the first to archive all of the imaging that goes on in our operating room and have it