RSNA 2014: Imaging IT scales to the enterprise

CHICAGO—After a decade of talk about enterprise imaging capabilities, many imaging IT vendors exhibiting at the 100th 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 available to patients and physicians,” she said.

More than one workflow

Recognizing that different practices require different—and often multiple—workflows, vendors invested in developing specific workflow tools that support different practice patterns.

To assist practices with complex, multi-site reading environments, Intelerad rolled out its InteleFlex solution, which uses a workflow engine to automate case distribution in real time. “We have customers who are doing this manually—there is a traffic control person,” said Helene Gey, Intelerad marketing VP. “This is a solution to automate that process and allow the organization to set the criteria, either by subspecialty or other parameters.”

Sectra has introduced a Cancer Care Pathway that assists in the enterprise management of the cancer patient.  The solution also includes timesaving reading tools that anatomically link current and prior studies, fuse PET and CT studies and assist the radiologist in producing RECIST measurements.

“We are adding more tools because we see that our customers have huge pain points in oncology workflow,” said Sectra’s Lisa Lindfors. Sectra also showed a pathology reading station deployed at three European sites but not yet FDA-approved in the U.S.

The U.S. Preventive Services Task Force B-rating of lung cancer screening at the end of 2013 helped set in motion the development of a comprehensive lung cancer management solution at Philips Healthcare, including consultative services and marketing support to reach high-risk patients, a patient and data management system and an education portal with course and reference materials, where radiologists can measure and report their performance. “It’s been a wild year,” reported Steve Metz, Philips.

The portfolio also includes radiology workflow tools for CT lung image review that include integrated CAD from the German company MeVis to facilitate the reporting of serial CT lung studies.

Digitizing pathology

The opportunities that lie in digitizing the pathology workflow were not lost on imaging IT vendors. Sectra, Siemens and GE Healthcare showed pathology workflow in their exhibits. “The digitization era is over now in radiology,” said Jan De Witte, president and CEO, healthcare IT, GE Healthcare. “On the imaging side, what we are trying to do is provide higher diagnostic confidence and better productivity.”

While GE Healthcare showed a 6.0 version of its VNA, a universal viewer integrated with advanced visualization and its Microsoft Azure-based Centricity Cloud for image exchange, it also showed a four-slide digital pathology scanner and workflow software that is 510K cleared in the U.S. for secondary reads.

Siemens Healthcare unveiled an ambitious plan to extend imaging beyond the enterprise: It intends to leverage its broad, worldwide equipment installed base to develop a global, cloud-based workflow for extracting key image data that it calls “teamplay,” said Marc Lauterbach, PhD, VP marketing, SYNGO. The network will facilitate communication among radiologists and provide productivity, volume, dose and other image data-related benchmarks from anonymized patient data.

“We are planning on creating the biggest imaging team in the world,” he said. “Because it is cloud-based (Microsoft Azure), we will offer benchmarks on a regional and national level.” Siemens is seeking beta sites to implement the teamplay network in the U.S.

Meaningful use of health IT

With the federal meaningful use program poised to enter its fourth year, the subject of MU 2 was notably absent from vendor talking points. Those that do provide an EHR certified for stage 2—and RamSoft, Infinitt and Merge are among them—reported that customers are struggling to attest.

“Meaningful use stage 2 will happen, but it will be driven more by payment reform and less by the ONC,” predicted Steve Tolle, chief strategy officer, Merge, with bundled payments driving the need for technical standards.

“If the government says, ‘You have to do this to get paid,’ it will happen,” he said. “But we need a standard-setting body. The best thing that came out of stage 2 was direct messaging—the regulation drove that, and now we all do it.”

Stage 2 is much harder than stage 1, Tolle said, and meeting the CPOE requirements is a particular challenge. “There are exemptions for radiologists that they can take advantage of,” he noted. “It’s harder for general practitioners than radiologists.”

Participation will hinge on whether or not a radiology practice has an outpatient presence. “Problem is, there's a religious divide,” Tolle said. “If you are hospital-based,  meaningful use doesn't mean anything. If you are community-based, where you depend on referrals, your ability to support referring physician attestation is a big deal. That's why it's important.”

Merge introduced new versions of its VNA and universal viewer, both with the ability to support native XDS and XDSi. “As hospitals start to take risk and become insurance companies again, they are going to need to have all of their imaging together in one place,” he said.