Interest Surges in PACS & IT

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Arguably, at no other time in RSNA history has information technology (IT) infiltrated radiology departments - and the whole healthcare enterprise - as it did in 2003. Providers more and more are grappling with the escalating volume of electronic patient data and access to that information from within and outside of the traditional hospital setting.

 With facilities of all sizes still keeping close watch on budget limitations, healthcare providers are looking to IT to make two plus two equal five when it comes to meeting today's challenge of quality patient care.

 A November report from Sheldon I. Dorenfest & Associates Ltd. estimated the healthcare industry's demand for information technology (IT) increased to $23.6 billion in 2003, compared with $21.6 billion in 2002. The study also predicts the healthcare IT market will maintain its 9 percent growth rate for the next three years, with spending reaching $30.5 billion by the end of 2006.




 RIS and PACS

On the exhibit floor at RSNA 2003,  GE Medical Systems Informational Technologies (GEMSIT) introduced a new version of its Centricity RIS-PACS to enhance the management of images and information, including radiology and cardiology images in the single integrated system.

 The updated Centricity RIS-PACS follows version 2.0, which includes image and workflow support for PET-CT and digital mammography images. The system also provides next-generation reporting capabilities for radiologists.

 GEMSIT also unveiled a new version of Centricity Enterprise Web, which allows for the sharing of radiology and cardiology images and report and waveform data among healthcare network providers, remote specialists and referring physicians. With the web technology, Centricity Enterprise can be connected to an electronic medical record system. The new system also integrates with the next-generation CA1000 Centricity Cardiology review workstation.


 BRIT Systems also offers its ASP (application service provider) eRadFiles for off-site support of teleradiology and PACS for disaster recovery for all DICOM PACS installations. Using Brit's DICOM Mini-Server, exams are acquired, compressed and transmitted over secure connections to the eRadFiles center.

 Brit's Scanning Workbench is a film digitization system that allows standard radiographs to be converted into electronic images for transmission to PACS and teleradiology systems. The Scanning Workbench is configurable with either a Kodak laser-based digitizer or a CCD-based digitizer from Vidar Systems.

 Image management firm Brit Systems displayed its Roentgen Files for exam and report storage. It runs on a DICOM server and Web server. The company's Roentgen RIS adds a new scheduling component to its list of features.

 
Eastman Kodak Co.'s DirectView PACS System 5 made its RSNA debut following its August release. As of RSNA 2003, the technology was installed in more than a dozen sites in the United States and Europe.

 Kodak already is planning the release of System 5.1 in the first half of 2004, while features for System 5.2 are in the works. System 5.1's software upgrade will add tissue definition and vessel tracking, single log-in, and fully integrated 3D processing capabilities. System 5.2 is expected to offer volume rendering to the PACS' repertoire, along with support for current works-in-progress digital mammography. Kodak has not announced a release date for System 5.2.

 To complement Kodak's PACS is DirectView Versatile Intelligent Patient Archive (VIParchive), which helps manage a facility's PACS and cardiology storage needs. It also can be used for enterprise-wide management of DICOM and non-DICOM images and information across multiple storage devices and locations. VIParchive is available as an option on DirectView PACS System 5.1.

 Kodak also will launch its RIS 2010 in the United States in the second half of 2004. The radiology information system counts more than 70 installations in Europe and Australia, as of RSNA 2003.

 RIS 2010 can support wireless PDA-based dictation, among other features, and integrate with PACS from Kodak and other vendors. Its open architecture also allows for interface with other information systems.

 
Siemens Medical Solutions touted the depth of its image management portfolio, showcasing RIS-PACS integration with the SIENET Integrated Radiology Suite that unites NOVIUS Radiology RIS and SIENET PACS, as well as the SOARIAN EMR/workflow engine.

 NOVIUS Radiology is a fully featured, scalable radiology information system encompassing scheduling, image integration, paperless workflow management, browser-based results delivery, mammography support, speech recognition and functionality to meet HIPAA requirements.

 The Siemens SIENET PACS - with one workstation, one keyboard, one mouse controlling all functions - is now a scalable three-tier solution portfolio:
  •  SIENET Magic is the integrated radiology suite for highest demands and extensive data volume of large practices, large hospitals and academic medical centers. The system is scalable to almost unlimited data volume, offering support of many workflow models and extensive post processing software.

  •  SIENET Cosmos is designed to be the integrated radiology suite for large radiology practices and radiology departments in community hospitals where the reading is driven by a global worklist. Post-processing and 3D are included, while the system is scalable up to 100,000 procedures per year.

  •  SIENET Sky is the integrated radiology suite for private practices, scalable to up 50,000 examinations per year.
 Siemens also offers common viewing and archiving between cardiology and radiology PACS.

 Benefits of the SIENET Integrated Radiology Suite include the ability to view current and prior images for any workstation in the enterprise, as well as speech recognition, the ability to monitor workflow, departmental activity, resource utilization, supply inventory and quality assurance.

 For Soarian, Siemens featured Soarian Scheduling, a new enterprise patient scheduling and resource management solution. It synchronizes resources, processes and information to establish the framework for high quality and efficient service delivery throughout the enterprise.

 
Agfa Healthcare touted version 5.3 of its Impax RIS-PACS configuration, which is installed outside of the United States, primarily in Europe. Version 5.4 is slated to come to the United States with several installations planned for the first quarter of 2004.

 Agfa also unveiled its works-in-progress Impax WEB1000 ES, an IHE-compatible application designed for remote, rapid, secure, clinical review from virtually any location. Impax WEB 1000 ES will be built to extend web-based results distribution to cardiology, with MPEG support for viewing and displaying cardiology multi-frame data for cath labs and echocardiograms.

 Impax WEB1000 ES also will feature an electronic patient record (EPR) integration module for image viewing capabilities to any EPR product. Users from radiology, cardiology or any other department or location would gain access to the EPR via the web relevant images and data from one single point of access.

 Agfa also launched its initia DDM, an entry-level, modular data management technology for imaging centers and small hospitals to expand the capability of their imaging systems to gather data and create a single radiology patient file that can be transmitted or archived.

 Initia DDM features patient scheduling through initia RIS, reporting and archiving through initia Off-line Archive, diagnosis through initia DS1 and PACS through initia BASIX. Agfa is targeting imaging centers and small hospitals with modest budgets or limited personnel for the technology.

 At the show, Agfa also showcased several agreements, including a distribution agreement with Voxar under which Agfa will sell Voxar's flagship 3D software, Voxar 3D, as part of an integrated Agfa IMPAX solution. Agfa also is the first channel partner for the healthcare industry for Dimension Data Holdings' Stratus ftServer system. Lastly, Agfa is collaborating with Heartlab, Inc. on Agfa's next-generation of Impax for Cardiology, with a commercial ready system expected early this year.

 
Amicas Inc. unveiled enhancements to The Vision Series Web-based platform for maximized workflow for radiologists. Amicas' RealTime Worklist now offers personalized workflow, powered by instant messaging for real-time study status.

 Amicas introduced RealTime Worklist Multi-Study Caching in Chicago, designed to automatically retrieve studies in relative priority for greater productivity regardless of bandwidth and location. RealTime Worklist determines the next prioritized unread study, while a radiologist is evaluating his or her current study. The technology also will load the next study on a local workstation with additional radiologist prompting.

 
Cerner Corp. at RSNA highlighted the strength of integrated RIS/PACS. Our Lady of the Lake Regional Medical Center in Baton Rouge, La., is the first Cerner unified RIS/PACS site to transition to a 100-percent filmless environment. The medical center, which cares for 600,000 people in Louisiana, estimates the system saves radiologists one hour each workday. It also provides referring physicians instant access to images through PowerChart Electronic Medical Record System.

 Cerner systems are built on Cerner Millennium architecture, Cerner that analyze clinical and operational outcomes in real-time and streamline information delivery throughout the medical center. For example, a "wet read" capability for Cerner ProVision PACS enables real-time communication between the emergency and radiology departments. Emergency department (ED) physicians now document their preliminary findings prior to the radiologist's final interpretation. The radiologist can then electronically view the image and agree or disagree with the ED physician's findings and ensure the appropriate follow-up care occurs.

 
IDX Systems Corp. announced the establishment of an IDX Imagecast National Service Center as part of a multi-year operational plan designed to enhance customer success and satisfaction.

 The plan is designed to accommodate IDX's anticipated expansion in 2004 in the imaging marketplace by adding additional services for customers that complement the enhanced feature and functionality of Imagecast software.

 A key objective of the National Service Center is to integrate support services for workflow applications (RIS), integration services (Imaging Suite) and image management (PACS) using best-known methods, continuous improvement techniques to enhance the National Service Center's efficiency and effectiveness to improve customer satisfaction. IDX Imagecast will also establish Regional Account Centers that will focus on delivering services that allow nearly 300 Imagecast customers to achieve their value proposition.

 IDX systems are installed at 380 integrated delivery networks (IDNs) representing more than 500 hospitals; 175 large group practices with more than 200 physicians; 665 mid-size group practices with less than 200 physicians

 
McKesson Information Solutions made a big bang at RSNA, rolling out its new Horizon Radiology and Horizon Cardiology image-enabled workflow solutions.

 Horizon Radiology is the first suite in McKesson's portfolio of new solutions to manage medical images in all diagnostic specialties across the hospital enterprise. In addition to Horizon Medical Imaging, the Horizon Radiology suite includes Horizon Radiology Manager, a Web-based workflow system for managing the full range of radiological functions, including management of patients, films, clinical history, electronic signatures, claims preparation and management reporting. Workflow is further streamlined with an optional module, Horizon Radiology Reporting, for diagnostic report generation, transcription, digital dictation, and voice recognition. Integrated with HorizonWP Physician Portal, Horizon Radiology provides seamless "anytime, anywhere" access to patient information and clinical images and reports. Presbyterian Healthcare Services (PHS) in Albuquerque, N.M., has purchased Horizon Radiology and will be implementing it next year.

 Using Horizon Cardiology, healthcare organizations will be able to include integrated, digital cardiology information and images as part of the electronic health record, enabling simultaneous access and more informed clinical decision-making.

 Horizon Cardiology is offered through an agreement with Camtronics Medical Systems, Ltd., a subsidiary of Analogic Corp. Under the agreement, McKesson will offer two new applications for cardiology as part of the Horizon Medical Imaging enterprise solution. These are Horizon Cardiology Imaging for specialized image visualization for cardiology applications, and Horizon Cardiology Manager to manage departmental workflow (including hemodynamics) and diagnostic reporting functions. Both modules are powered by Camtronics' VERICIS Cardiovascular Information System, which enables single-point access to the complete cardiovascular patient record, including both inpatient and outpatient data. Horizon Cardiology will be integrated with McKesson's enterprisewide scheduling application to form a complete solution for cardiology image and information workflow.

 
Dynamic Imaging unveiled its next-generation IntegradWeb PACS, adding advanced 3D processing to its Web-driven primary reading environment. New at RSNA 2003 was an advanced selection of 3D toolsets accessible directly from within the IntegradWeb viewing software. The features include multi-planar reformatting, maximum intensity projection and 3D rendering.

 Dynamic Imaging also debuted its new SmartLoading architecture, designed to hasten display of 3D and other images in large datasets. The proprietary technology offers enhances level of image information in areas being viewed, while an entire study loads in the background.

 The company also exhibited its SecureServer technology, which includes a toolset to facilitate HIPAA (Health Insurance Portability and Accountability Act) compliance.

 
Ferrenia Imaging Technologies showcased its enterprise-level LifeWeb RIS. 2.0 and its tools to manage workflow through an open architecture in which integration of a brokerless PACS and HIS can occur. Patient images and records are obtained through an intuitive user interface and a DICOM Structured Reporting module, making available both reports and images within the same DICOM hierarchy.

 LifeWeb OnNet 3.0 is the latest release of Ferrenia's DICOM Web server, designed to distribute, display and process medical images to any location. The technology also provides online archiving capabilities, image processing tools, and security and compliance with DICOM standards.

 Ferrenia also highlighted its LifeWeb ImageManager 2.0 scalable archiving technology for a single radiology department or multi-site hospital network, as well as LifeWeb One for the acquisition, display and distribution of images and related reports. While LifeWeb One is designed for smaller providers or facilities transitioning to digital imaging, the technology is scalable for future expansion.

 
Fujifilm Medical Systems  rolled out several extensions to Synapse version 3.0. Integrated document scanning and reading protocol enhancements are part of Module Release 1, a work-in-progress Synapse extension. Module Release 1 assists in the ready analysis, distribution and presentation of information, according to Bob Cooke, executive director of marketing, network systems.

 An auto-filer document scanning capability allows users to scan paper-based documents directly into Fuji's PowerJacket application, with a single button click. Fuji's reading protocols have better automation functionality, allowing radiologists to rapidly and consistently view the necessary information based on the acquired exam type, the company said. Physicians can also save, manage, and share reading protocols, allowing users to tailor an interpretation presentation sequence to their own preferences or select from a standardized library of protocols, Fuji said. Users can share reading protocols with other Synapse sites. Module Release 1 is scheduled to begin shipping in the first quarter of 2004.

 A works-in-progress bulk document scanner will permit multiple forms, spanning multiple patients, to be automatically scanned, analyzed and auto-filed with each appropriate master patient jacket, Cooke said. Fuji also showed a works-in-progress CT image processing feature for Synapse, allowing a bone window and lung window in one view. No release dates have been set.


 eMed Technologies Corp. launched eMed Matrix, its next-generation PACS platform and workstation. eMed Matrix incorporates a new platform based on smart client technologies, a redesigned user interface and peer-to-peer communication and collaboration tools.

 With eMed Matrix, radiologists can perform remote diagnostic reading, while the adaptive software learns a user's viewing protocol preferences while taking into consideration the monitor setup and optimizing the display accordingly. eMed says changes in the system architecture provide a platform designed for easy deployment as a thin client, while maintaining performance benefits of a thick client.

 eMed also is partnering with Dictaphone Corp.'s Healthcare Solutions Group in a joint marketing and development partnership to integrate Dictaphone's PowerScribe speech recognition system with eMed's Ideal image management suite. The companies say the combination will allow a radiologist to use a single desktop workstation from image acquisition to diagnostic reading, through dictation and review of recognized text to final report editing.

 
Merge eFilm brought its Fusion RIS-PACS, after having acquired RIS Logic Inc. in 2003. The company integrated RIS Logic's radiology information system workflow with Merge eFilm's own image visualization, distribution and storage technologies.

 Fusion RIS-PACS is designed to distribute images, information and voice data using image streaming and multiple routing processes. An integrated radiologist worklist also offers the ability to view the availability and location of images for each exam. Interoperability between the RIS and PACS also affords a radiologist the ability to click on the RIS Pending Dictation Worklist to launch associated or prior images in the PACS diagnostic workstation.

 PACSGear introduced its new PacsConnect and PacsScan Enterprise at RSNA 2003. PACSGear technology scans paper documents for storage in a facility's PACS. The company has more than 50 installations of its system since mid-2002.

 PacsConnect is an HL7 and DICOM brokering system that can forward HL7 messages based on routing rules to multiple locations. Technologists at each modality also can select the appropriate scheduled study residing on the RIS without having to manually re-enter patient demographic information.

 The company says its PacsScan Enterprise software product serves as an "electronic folder" whereby all patient documents are scanned, stored, archived and retrievable throughout a healthcare facility.

 
RealTimeImage has upgraded its iPACS technology with primary, enterprise and remote reading capabilities for radiologists and orthopedic surgeons. The additions include streaming-based 3D review capabilities, extended measurements tools, improved overlay presentation and editing, support for DICOM printers and for multi-head display and high-resolution display.

 On the back end of the iPACS, RealTimeImage has added management and administration tools, hierarchical storage management capabilities and broader DICOM support, including full DICOM JPEG 2000 support.

 
InSiteOne Inc. (Wallingford, Conn.) introduced InDex Web for real-time, secure Web-based access to stored images. Using RealTimeImage's advanced iPACS Web-based image streaming, InDex Web enables secure access any time, anywhere to lossless images archived at InSiteOne's permanent data storage centers using an Internet or network connection. Images are accessible in real-time in increasing levels of resolution to speed transfer over any bandwidth.

 Images are sent to InSiteOne's archives for long-term storage from the company's RAID-based archives located within the customer's individual enterprise. Utilizing the iPACS viewer's patented Pixels-On-Demand technology, InDex Web is designed to allow authorized users immediate access to images anywhere in the world, any time, with any PC and an Internet connection.

 
Sectra Imtec AB debuted its Sectra PACS release 10, based on a new web deployment strategy. Release 10 includes zero client administration for automatic workstation upgrades without user intervention, and a roaming desktop that provides users with a personalized desktop environment and consistent set of tools regardless of where the user logs in.

 Addition features include a new web client for image and result distribution and integration with electronic patient record systems, enhanced functionality for multislice CT and MR visualization and an extensive e-learning tool for new users. It includes the Sectra PACS control tower, a workflow monitoring tool for department managers and systems administrators. For image distribution, a CD-DVD production center and email-based teleradiology are now available.

 
Stentor Inc. brought its iSite PACS, which is designed to integrate seamlessly into a healthcare facility's existing infrastructure. iSite is designed for any size provider and features image distribution, online long-term storage and advanced radiology reading stations for integration into a hospital's existing network. All those features become an integral part of a provider's electronic medical record (EMR). As a brokerless PACS, iSite can integrate with any pre-existing HIS/RIS system

 Stentor also showed its iSite Enterprise for the distribution of large medical image datasets using standard desktop PCs, existing Intranets and the Internet, with no new infrastructure is required. Stentor's iVault is an online medical image archive technology designed to eliminate bottlenecks of pre-fetching, routing, forwarding, off-line media management and ad-hoc querying. With integrated RIS workflow, iVault is intended to provide a single view of images and information to all users across an enterprise.

 
MedPACS Displays Inc. launched a new image and report distribution and review system called Vista.

 The system is an Intranet- or Internet-enabled picture archiving and communications system (PACS) designed to allow radiologists and referring physicians to access images and reports from the hospital, imaging center and remote locations.

 Intended for busy radiology departments, remote image review and on-call applications, Vista meets HIPAA requirements since all access to patient data is password-protected and images and reports are encrypted both when transmitted and stored.

 
New in IT

Cedara Software Corp. trekked to RSNA 2003 with its latest acquisition and reading technologies, such as Cedara I-Acquire Video to help extend the lives of legacy modality scanners, including MRI, CT, fluoroscopy, ultrasound, nuclear medicine, angiography and endoscopic devices.

 Cedara's I-ReadMammo is set for release in 2004, as the technology combines an acquisition console application and an image review workstation, utilizing dedicated mammography tools specially designed to enhance ease of use and automate presentation procedures. Cedara also has a new PET-CT fusion plug-in module, designed to expand the features of the company's I-Soft-View line of PACS viewer with new fused 2D and 3D displays of PET and CT data.

 Cedara also recently released I-Acquire/FD, a new film scanning console application for hospitals to convert film into digital format; and OrthoWorks, a complete PACS and digital planning technology for orthopedic surgeons.

 
IBM Life Sciences launched an integrated storage management product for hospitals, clinics and other medical facilities to protect, manage and access medical images. The new IBM Medical Archive Solution consists of IMB disk and tape storage, server systems and storage management software that are all preconfigured, tested and customized for PACS applications.

 The technology can be utilized for short-term viewing or long-tern archival with up to 80 terabytes of storage capacity that can be expanded on demand.

 IBM Global Financing also is expanding its IT financing business to include medical technology. The company will offer specialized leasing and financing programs for customers in healthcare, life sciences and pharmaceuticals. The minimum financing amount would be $300,000.

 
Philips Medical Systems touted its new alliance with Epic Systems Corp., as the companies combine their respective imaging technologies with enterprise software across the enterprise, including the point-of-care. Philips sees the clinical benefits starting with a single process for order entry and medication administration to reduce medical errors and continuing with the management of patient diagnosis and treatment. Philips will market its IT products - powered by Epic software - as part of its Vequion family.

 Philips launched its ViewForum in 2003 to control the escalating volume of CT and MR data. ViewForum is designed to give providers access to information at any location and can be integrated with Philips' EasyAccess PACS workstations.

 
DR Systems Inc. highlighted its Dominator radiologist reading station, which added RIS functionality in time for RSNA 2003. Other options include image processing, digital dictation and reporting, and speech recognition.

 The Dominator is designed to automatically displays images based on each radiologist's preferences for display format on multiple high-resolution monitors. The reading station also offers filtering and sorting for quick access to cases and a radiologist can create and apply exam filters by combining a variety of filter parameters, such as modality, priority, and patient location.

 DR Systems also offered its new RIS Administration station, which the company currently has in two beta sites. Plans are for the station to hit the market by mid-2004. Also on exhibit was the company's Catapult technologist workstation to annotate images, and manage patient and exam information. Additional features include advanced 3D image processing and document scanning.

 
Medical image storage firm  Emageon joined forces with medical imaging visualization software company UltraVisual Medical Systems last June and followed with the creation of its Intelligent Visual Medical Record (IVMR). The technology is designed to provide enterprise access to visual medical content using advanced visualization tools and specialized workflow.

 Integrated delivery networks, hospitals and imaging facilities can deploy a standards-based technology that can manage multi-specialty content across the enterprise through Emageon's Intelligent Enterprise Platform. The IVMR provides multi-specialty images, related information and advanced visualization toolsets through a single visual interface.

 
Intelerad Medical Systems Inc. launched a series of additions to its InteleViewer, the company's JPEG 2000 Web-based viewer for diagnostic users. Features include radiologist worklist for reading management; advanced connectivity with digital dictation; lossless and lossy compression levels adjustable by modality to speed communications over all bandwidths; and advanced layout manager.

 The new diagnostic viewer is designed to complement the existing InteleViewer for non-daignostic users to create an intuitive interface for image access for all users.

 Intelerad also showcased its new Tracer Tools for PACS support and analysis. Tools are included to track a study's status.

 
Resonance Technology Inc. showed its audio and visual technology for MRI systems. The virtual reality audio and video headsets can be used to either entertain patients during an MRI procedure or in clinical procedures to stimulate the brain in cases of functional MRI studies.

 The company's newest product - Cinema Vision - is FDA-cleared and due for release in the first quarter of 2004. The next generation of its Serene Sound also is due for launch in the first quarter of 2004. Resonance Technology also offers its VisuaStim with 3D capabilities.

 Approximately 1,000 systems in place around the world -- some 400 of which are in Japan - including the Children's Hospital of Los Angeles under the direction of Stephan Erberich, M.D.