Viztek CEO Joe Cermin: PACS is almost a bad word

Viztek is on a roll. In early January, the Garner, N.C.-based radiology vendor won FDA approval for Exa, its web-based, zero-footprint PACS platform. Later that month it reported a 20 percent year-over-year increase in software sales. And during the last week of February, it announced a personal-best sales pace for its new ViZion + Wireless DR panel.

The latter has only been on the market since November yet has already sold more than 300 units—one of the reasons Viztek projects close to $70 million in sales this year. That will be up from $60 million last year, and it will more than double what the company did six years ago.

Seeking to find out what the 100-employee outfit is doing so right, imagingBiz reached out to Josip “Joe” Cermin, native of Croatia, winner of the Ellis Island Medal of Honor and founder of Viztek in 1999. Cermin has helmed Viztek as president ever since. We caught up with him as he was gearing up for HIMSS15, where the company will demonstrate Exa.

You entered 2015 riding a series of successes. What right decisions did you make to get to this point, and how do you plan to build on your momentum?

Cermin: What we do as a company is try to move each division an inch forward. Some by definition move a mile forward, like our software division, where we went from Opal-RAD [PACS] to Exa PACS. In 2012, when we began designing Exa, you couldn’t have envisioned a zero-footprint delivery meshed together with an EHR, plus full delivery of billing, in the same context of workflow.

The challenge for us has been to move away from thinking about PACS in the traditional sense, which we’ve now been doing for 15 years.

In fact, our aim is to eventually not do just PACS at all anymore. PACS is almost a bad word for me. We are in a different world now, in a patient-centric delivery system. How do you get the doctor to automatically share the images and still be HIPAA compliant? It was with long-range ideas like that in mind that we set out to create the Exa system.

It starts from the beginning, with patient registration, and it ends somewhere in billing. In the process of all this, you do have an image-delivery system like PACS, you do have report delivery, which is like a RIS. However, you also have a full-blown EHR, with features that are unheard of in PACS and RIS—and it also complies with Meaningful Use.

The design was very ambitious in 2012.  We just emerged out of the design phase: Exa was developed under our roof. We are, of course, very pleased with the reception it has received. A lot of people claim to have zero footprint, but it’s really not that simple. It’s not about just the delivery of an image. It’s about the whole [radiology] workflow.

What did you have to do to take the full radiology workflow into account during product development?

Cermin: We had to adjust to all of the workflows for every situation based on the FDA’s requirements for image delivery. And we had to come up with every single possible scenario that could happen in a radiology practice’s workflow.

I think we are quite unique in what we have achieved, because everything we did involves a piece of software. Our customers who install Exa will not require upgrades, they will require only updates. There’s a big difference.

It doesn’t really matter what kind of computers they have. What’s important is that everything—the whole workflow, the whole patient management system—is both zero footprint and all delivered at the same time. Scanned documents, patient charts, blood types—everything is delivered within the same package. So, it’s really not a PACS at all.

Now you see why I don’t like the word PACS. PACS is very simplistic. It’s moving something from point A to point B. Full workflow support is the difference with Exa, and I am of the belief that it will carry Viztek very far over the next 10 years. That is a big thing to say, when you build a platform. It’s a big thing to say that you’ll be using that platform for the next 10 years: In the software world, that’s unheard of.

Let’s shift gears from image and data management to imaging itself. A new market research report from Life Science Industry Research projects that the global x-ray 2D market will grow from $5 billion in 2014 to $16.9 billion by 2021. Where do you expect the action to be for Viztek’s product portfolio?

Cermin: We are in a retrofit market. Everybody has digital something, be it DR or CR. Because of the talent level of the people we have in-house on the DR side of the fence, we are actually—believe it or not—scaling up in the whole arena of x-ray.

We have a low-end DR product for retrofit purposes. It has been an important part of our business. But now we are moving into high-end products, and we actually have quite a name in delivering new systems in this country. We started about seven years ago. Before then, we did not have a single DR system. Today we sell more than 250 DR systems a year. We’re approaching market spaces where systems have been too expensive. Our idea is to approach the market space, improve it and upscale it. We offer better technology and offer it at the same price as the competition is offering with less technology. This strategy is paying off, as the numbers of our installations continue to grow.

How is your business split between hospitals and integrated health networks on the one hand and outpatient imaging organizations on the other?

Cermin: It’s tough, because in this country you have the top-tier triangle where basically everything is integrated by one vendor. And that vendor usually has a large service contract, and the hospital cannot peel itself away from that. So we are aligning ourselves with 200- to 300-bed hospitals. That’s our standard range.

You use the term “patient-centric” a lot. It’s clearly an important theme in your leadership of Viztek. How does it manifest itself day-to-day in the company culture?

Cermin: We are always asking ourselves, how will an end-user benefit from this and pass that benefit on to the patient? In an EHR workflow, how long does the patient have to wait before their name is called and their exam is completed? In delivery of reports, how would a patient get access? How can we facilitate a doctor who might just click on a checkbox indicating that he or she agrees to automatic delivery of images to patients, instead of burning a CD or printing out a report? How can we learn from Apple about end-user experience?

Do you expect to be encouraged or disappointed by national levels of EHR adoption/Meaningful Use attestation in the U.S. by the end of this year?

Cermin: I’m not sure what to expect, but I can tell you that Viztek will be Meaningful Use stage 1 and stage 2 certified with the 2014 addendum, and we will be fully Meaningful Use-ready all around. Our customers invested money in our product lines, and we have to keep up. The government dictates what has to be done, and we have to abide.

You are an entrepreneurial IT guy and could have chosen any industry to work in. Why healthcare?

Cermin: In the late 1990s, healthcare was the least IT-forward industry I knew of. Nothing was digital, everything was analog, and my background to this point was pretty advanced in IT. So when I looked at healthcare as compared to banking and insurance and other sectors, healthcare was the least sophisticated. I knew I could apply my talents quickly.

Today, it’s a totally different story. I am more medical than IT, if you will. We are focusing on how to get the country to be more patient-centric—to where, for example, patients don’t have to wait to benefit by technological advances, where they don’t get bounced around within the healthcare system and where everything can get done in a smooth, seamless way.

As the leader of a healthcare company succeeding in a highly competitive arena, can you offer any leadership advice to radiologists?

Cermin: The leadership that I would push for is better IT leadership within radiology. We need to have people who can talk to their peers who are not IT savvy and explain how to deliver a more synergistic process when it comes to devices, software, patients and how to bridge the gaps between all of those points.

The philosophy at work within Viztek is this: We don’t compare ourselves to anybody else. We don’t compete. We walk to the beat of our own drum. We don’t orient ourselves around how we’re going to be, relative to other companies in the market space. We just know what makes us happy as we set out to reach our goals and bring benefits to doctors and patients in the process.