PACS, RIS & Teleradiology

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The expansion of the PACS market was apparent in the Windy City as vendors touted a host of new image management solutions. At this year's Radiological Society of North America meeting, the industry's attention to both enterprise and niche needs was clear. There are more cardio PACS options and new solutions geared to the ortho market. Vendors are making it easier for radiology departments and imaging centers (lots of focus and interest on imaging centers!) to cross the last hurdles to filmlessness by providing new solutions for sharing digital images everywhere-including the OR and referring physician office. Non-DICOM modalities like endoscopy and pathology are nudging their way onto PACS, thanks to new innovations. Imaging centers and small hospitals will benefit from new solutions geared for their needs (and budgets).
   
Other highlights included tools to simplify data migration and provide proactive monitoring. Integrated orthopedic templating and 3D capabilities were hot as well. Radiology dashboards that provide a bird's eye view of the department and data analysis functions were on full display at several booths.
   
RIS vendors touted new tools like simplified scheduling and new billing modules. Finally, teleradiology providers shared their business models and hinted at future expansions.

Companies are listed alphabetically with most RIS/PACS offerings in the PACS section, dedicated RIS solutions in the next section and teleradiology follows.    


PACS


First-time exhibitor Acuo Technologies showcased AcuoMed Image Manager, AcuoStore and A.D.A.M.
   
AcuoMed Image Manager is a secure, open-system software solution for transporting, storing, tracking and retrieving digital images across an entire storage system network. It is a DICOM 3.0 Level 2 compliant solution that uses Microsoft Windows 2000, 2003 Server or Microsoft Windows XP Professional on a recommended Intel platform.
   
AcuoStore digital asset manager serves as a digital vault, communicating the instructions of AcuoMed with the diverse DICOM storage devices that contain digital DICOM image and patient information.

Each Acuo system works in concert with other DICOM devices to create local intelligent workflow using its dynamic router, enabling a single view of the entire DICOM network through its peer-aware collaboration feature. Acuo's Next Generation technology offers local caching of image data, seamless integration of legacy data and interoperability with the available information systems for real-time image reconciliation and RIS/PACS synchronization.
   
A.D.A.M., Acuo's DICOM Assisted Migration software, automates the process of data migration from aging DICOM archives to more efficient and cost-effective storage devices. It provides a variety of options for data migration that makes the process invisible while efficiently cleaning patient records with "dirty data" requiring reconciliation, the company says.


Advanced Data Systems (ADS) at RSNA launched its ADS RIS/PACS, highlighted EDI functionality and MedicsDocAssistant Electronic Medical Records system.
   
ADS RIS/PACS offers multi-modality scheduling, electronic document and imaging management, DICOM modality work list, voice recognition, bar coding, electronic signature, DICOM and HL7 connectivity and full integration with ADS PACS. 
   
EDI provides claim submission, verification, reconciliation and reports functions. 
   
MedicsDocAssistant incorporates comprehensive EMR capabilities to simplify clinical work, eliminate paperwork and improve patient care. It records patient encounters, organizes examination forms and offers tools such as dictionary and template builder. Other features include an HL7 interface capability for open connectivity to others systems and programs. 


Agfa Healthcare launched IMPAX 6.0 and IMPAX Enterprise - and highlighted new features of IMPAX SMMS.
   
IMPAX 6.0 features a unique persona-based design to meet the specific workflow requirements of multiple users. The web-deployable application can improve the planning, capture, interpretation, distribution and archiving of diagnostic images throughout the hospital enterprise. Its inherent smart-client design means that the power and functionality of a thick client are available with the simplicity and manageability of a thin client. Integrated with IMPAX RIS and Reporting solutions, IMPAX 6.0 enables healthcare facilities to optimize clinical and IT efficiencies, using a single workflow-based system to service users inside and outside the walls of a facility, providing consolidated management of patient image and information data. 
   
Agfa identified six target user groups, or personas, and built IMPAX 6.0 around common work behaviors. The six target user groups include administrators, radiologists, PACS administrators, technologists, clinicians and IT specialists. IMPAX 6.0's features, navigation tools and display modes are designed in a flexible and intuitive way so that they can be tailored to individual preferences and ideal work habits.
   
The system also provides improved user-friendliness through an intuitive interface, which helps reduce training time and increase usage. It is centrally managed to make it easier to deploy solutions, manage users, provide support and configure permissions and roles. 
   
IMPAX Enterprise addresses the intricate and often complex enterprise-wide issues for hospitals and healthcare facilities. It solves the two key success factors: marriage of imaging and information and technology adoption, Agfa says. IMPAX Enterprise provides an integrated image and information management approach to those issues, helping to lower the cost of healthcare delivery by enabling efficient departmental and enterprise workflow. IMPAX Enterprise increases efficiency by providing the right tools at the most critical point - the point of care. IMPAX Enterprise helps users to control information overload and eases the challenges of consolidation of healthcare sites and the varied software solutions they use, while at the same time protecting patient privacy.
   
The architecture of Agfa's IMPAX Enterprise encompasses individual IMPAX building blocks, including radiology information system (RIS), reporting, auditing and Integration Services and Solution Monitoring and Management Services (SMMS), all anchored by the newly introduced IMPAX 6.0 Picture Archiving and Communications System (PACS) solution. The modularity of the system allows users the flexibility of integrating at a rate in line with their requirements and resources.
   
Agfa's integrated workflow approach gives enterprise onsite and remote users the ability to:
  • Securely access patient images, past studies, key RIS information and procedure reports with a single log-on
  • Access image processing tools and features to help automate workflow, reduce the number of mouse clicks and boost throughput
  • Maximize uptime and facilitate regulatory compliance, while easing deployment and daily system maintenance
  • Reduce training time and increase usage with an intuitive user interface
  • Integrate legacy investments and new acquisitions
IMPAX Enterprise is focused on four key areas where it can deliver the greatest benefits: hospital administration, radiology staff, clinician staff and IT department. For administration, IMPAX Enterprise reduces training, storage and system maintenance costs, as it preserves IT investments and more efficiently utilizes previous PACS investments by all users. For the radiologist, it optimizes workflow and improves report turnaround time with fully integrated RIS/PACS/Reporting at a single desktop with improved integration with TalkStation 3.1. Clinicians are provided with secure remote access to the precise information they need, facilitating faster and more efficient diagnosis and treatment. The hospital's IT department benefits from high up-time, adherence to all regulatory requirements and ease of maintenance and support.
   
IMPAX SMMS, commercially released in the summer of 2005, is a 24/7 proactive monitoring service that assures hospital administrators and medical staff that their Agfa diagnostic and archiving hardware, applications  and databases are being continually analyzed and supervised to detect potential technical issues. The system has been designed to help identify ways of resolving specific issues and even catching potential new ones that may not have yet materialized, through a connection to Agfa's global network of support centers. IMPAX SMMS adds confidence for busy IT and radiology departments. IMPAX SMMS provides a virtual roadmap to signal, to track down and to resolve all problems as soon as they appear and often before they appear, according to Agfa.
   
The monitoring service provided by IMPAX SMMS is linked to Agfa's technical call centers via a SRSS (Secure Remote Service System).

The new system provides remote service in several ways, including point-to-point VPN and router-to-router connections. Technical alerts are sent to Agfa's call center specialists, in addition to system administrators at each hospital, so that repairs can be initiated before system performance is compromised.   
   

AMICAS, Inc. at RSNA debuted its new Vision Reach software system and referring physician portal, highlighted the Vision Series PACS and PACS applications and launched AMICAS Office Solutions.
   
A module of Vision Series PACS, Vision Reach is designed to eliminate the challenge of radiology information delivery. While PACS adoption has been tremendous, technological barriers such as system downloads, plug-ins and challenging security issues have hampered the widespread adoption of PACS by referring physicians, according to Amicas. The company says their research indicates that a PACS is generally used by less than 10 percent of a facility's referring physicians. When access is desired, HIPAA and challenging technology and security issues have created significant barriers to adoption.
   
Vision Reach was designed to fit the way referring physicians work. It features a ZERO INSTALL CLIENT FREE web-based application. Vision Reach integrates the radiology report with key images to create a single "multi-media" report. The solution includes an instant messaging system that uses common e-mail and secure messaging to deliver images, reports and information to any e-mail enabled device. Physicians define a messaging and alerting profile and a message destination address. When results and images are available, an instant e-mail is sent to the account of their choice. Information is pushed to the user, eliminating multiple log-ons to search for the needed information.
   
Vision Reach also includes a client-free referring physician portal that supports physician group practices and "on call" schedules for referring physicians. The portal is report-centric and provides a complete visual record of the patients' history, reports and images. With a single click, physicians can launch the Vision Series PACS Web-based workstation with 3D tools and advanced capabilities. Vision Reach can stand alone, run alongside or fully integrate with electronic medical record systems. Vision Reach is targeted for general availability in the first half of 2006.

AMICAS Vision Series PACS version 4.1 extends traditional PACS boundaries, with key additional PACS applications including Imaging Dashboard, RealTime Worklist and Vision Watch.
   
AMICAS Imaging Dashboard is embedded within the Vision Series PACS to provide a fully real time, customizable, digital dashboard for complete visualization of all patients, images and key metrics of an imaging facility's operations. The Imaging Dashboard becomes the RealTime Worklist when combined with the AMICAS Lightbeam workstation.

AMICAS Vision Watch is a 24/7 monitoring tool that provides real-time metrics on system performance and on process performance. It allows users to see, at a glance, staff productivity trends, study bottlenecks and areas of potential improvement; know when system performance is at risk, understand bandwidth usage and storage space and be alerted to exceptional events.
   
Other Vision Series solutions on display included Vision Series RIS, a fully web-based RIS designed specifically for ambulatory imaging centers; Vision Series Financials designed to manage the imaging business revenue cycle and Vision Series Document Management, which provides complete paperless operations for clinical, administrative and billing functions of the complete radiology office.
   
AMICAS Office Solutions is a suite of ambulatory focused, web-based RIS and PACS packages aimed at increasing the efficiency and productivity of outpatient imaging centers and specialty clinics. AMICAS Office Solutions delivers the features and benefits of AMICAS Visions Series PACS and RIS, packaged in a simplified consolidated hardware platform. AMICAS Office Solutions is available as AMICAS Office Solutions Express, a single server solution for complete RIS workflow and filmless interpretation by radiologists utilizing Vision Series PACS or AMICAS Office Solutions Complete, which includes all the functionality of Express and includes a full PACS Archive.
   
The web-based AMICAS Office Solutions simplifies the conversion process from analog workflow and film-based imaging to an automated digital environment, the company says. The system includes scheduling, registration, patient tracking, DICOM modality worklist, DICOM image acquisition, web-based radiologist interpretation with 3D toolset, reporting, DICOM image archive and capacity for image distribution to referring physicians. It is currently available. One early adopter combined the solution with wireless tablets to increase productivity and efficiency, AMICAS says.


AMIRSYS announced integration of STATdx with Sectra PACS.
   
The integration provides diagnostic clinical decision support to radiologists and other physicians at the point-of-care and enables a PACS user to automatically obtain diagnostic clinical decision support information while at the PACS workstation. The integration automatically detects the anatomical region of the study and launches STATdx to the appropriate anatomical region for quick reference to confirm difficult diagnoses.


BRIT Systems exhibited at RSNA its Exam Loop concept and demonstrated enhancements to its BRIT Lite PACS offering.
   
Exam Loop features all the monitoring and tracking tools that assist administrators in determining study and patient flow throughout departments. One screen can provide administrators with all the information they need to determine department workflow efficiency and effectiveness.
   
BRIT Lite expands the scope of the virtual environment, by facilitating the access of images and reports anytime, anywhere, anyplace. The company also added 3D and MPR to its Linux-based Diagnostic Workbench. 


Cerner Corp. highlighted new features on Cerner ProVision PACS, Cerner CV Net and Cardiology PACS - and enhancements to its MultiMedia Foundation and RadNet RIS.
   
New ProVision features include virtual colonoscopy, PET/CT fusion and calcium scoring. ProVision PACS provides a RIS/PACS solution that integrates clinically driven workflow and role-based tools for enhanced productivity in the radiology department and throughout the enterprise. Cerner ProVision PACS Diagnostic Workstation provides advanced visualization tools and a unified Radiologist Desktop (RDT) for efficient navigation through the large volumes of imaging studies acquired in busy radiology departments. RDT reduces user interface clicks and contextually displays reporting tools and relevant clinical information required for efficient diagnostic interpretation. Cerner indicated that it plans to add a teleradiology feature for home interpretation in the near future.
   
Cerner CVNet and Cardiology PACS offers an end-to-end cardiology solution that manages cardiology images and digital media (echo, ECG, nuclear medicine) from a single repository and unifies cardiovascular diagnostic activities, therapeutic interventions and follow up regimens into a single electronic medical record history for improved outcomes. CVNet is fully integrated with the EHR on a common architecture
   
Cerner MultiMedia Foundation (MMF) provides the enterprise framework for integrating all types of multimedia objects into a comprehensive EHR.  MMF supports the inclusion of diagnostic images, ECG waveforms, fetal monitor strips, photographs, video images and other multimedia components into the patient's electronic health record. New features include pathology DICOM imaging with an Olympus partnership.
   
New features on Cerner's unified RadNet RIS and Provision PACS include automated critical results notification that supports JCAHO 2006 patient safety initiatives and workflow improvements that ease navigation and optimize the radiologist's experience. Cerner says it is working to provide more accurate orders to the radiology dept through automated conversations with the requesting clinician via CPOE.


CoActiv Medical Business Solutions released EXAM-PACS-ORTHO, demonstrated bi-directional PET/CT Fusion integration with EXAM-PACS and highlighted its Enhanced Dual-Level Redundant Monitoring Service. CoActiv also announced that CoActiv EXAM-Vault Archive Service was validated by Hologic, Inc. as an approved archiving solution for the Hologic Selenia Digital Mammography System.  
   
EXAM-PACS-ORTHO addresses the requirements of the orthopedic practice and incorporates a fully integrated copy of OrthoView's Orthopaedic Templating application, including the new Pediatric Assessment Tool set. 
   
CoActiv's new PET/CT Fusion capability includes the display, distribution and archiving of integrated PET/CT fused exams from directly within the EXAM-PACS workstation to facilitate the complete image management of fused PET/CT technology. A simple right-click on the mouse key allows a complete exam analysis, where key images can be selected and automatically sent back into the original exam as a new and unique series for distribution to consulting physicians. The CoActiv EXAM-Sender Referring Physician System and the CoActiv EXAM-Filer CD Burning System facilitate the distribution of the exams to physicians, and the resulting new series is archived as part of the complete exam on the CoActiv EXAM-VaultArchive System. The PET/CT Fusion capability is provided through integration with technology from MedImage Inc.
   
CoActiv's Enhanced Dual-Level Redundant Monitoring Service is a proactive monitoring service that provides a double layer of up-time protection, insuring automated monitoring of all essential PACS. All EXAM-PACS key systems and services run their own health-check application every several minutes to analyze all key system performance and safety factors and report to an automated web-based monitoring station. This built-in, health-check capability is also remotely monitored by a pre-emptive system application that "monitors-the-monitor."
   
The company also highlighted a modality worklist service option and brokerless HL-7 capability with EXAM-PACS enterprise PACS. CoActiv's Modality Worklist Service Option provides DICOM Modality Worklist services for RIS/HIS/EXAM-PACS integrations where the HIS or RIS cannot provide the service. CoActiv's Broker-less HL-7 Capability allows bidirectional HL-7 interfacing to virtually any HL-7 capable application.
   
CoActiv EXAM-Vault Archive Service and the Hologic digital mammography system provide a complete image management system for hospitals and imaging centers specializing in breast cancer prevention, detection and treatment. EXAM-Vault uses a "Quad-Redundant" storage technique to automatically and securely saves every exam in four locations, three of which are always on-line and immediately accessible. This on-line storage solution expedites the recall of prior digital mammography exams for comparisons and transmission to referring physicians.  


DeJarnette Research Systems displayed its PACS Migration Gateway technology and PACSware Intelligent Router technology. 
   
The PACS Migration Gateway technology addresses the need for sophisticated data cleansing algorithms during PACS migration.     

PACSware Intelligent Router technology provides intelligent routing between dissimilar PACS products, providing real-time routing and pre-fetching of studies to non-vendor supplied workstations. 


DR Systems showcased enhanced cardiology and mammography PACS capabilities, along with improved RIS features to facilitate a complete electronic medical record (EMR) as part of Release 8, the next version of the company's software. The company also showcased single sign-on EMR integration. Finally, DR Systems shared results of a study of integration of digital mammography with Dominator PACS.

Windows XP-based Release 8 uses "Smart Client" technology that combines web-based and client-server functionality. The next release offers full integration of mammography PACS capabilities, including a smooth interface to computer-assisted detection (CAD) systems; enhanced patient management tools for the RIS; an updated user interface that enhances the look and feel of the Windows XP operating system; an enhanced cardiology component; integration of TraumaCad to provide orthopedic surgeons with digital images, tools and templates for preoperative planning; integration of Vital Images' Vitrea 2, allowing facilities to acquire and manage advanced visualization images with diagnostic reports across the entire healthcare system and enhancement of Web Dominator, the internet application that allows online reading of medical imaging exams on remotely located home or office computers.

In addition to integrating mammography capabilities more tightly into Release 8, DR Systems technology features lossless compression for transmitting images. This capability enables multisite PACS users to exchange images using T1 telephone infrastructure. This approach makes it efficient for radiologists to transmit mammography and other image information, via the hospital's PACS, to and from remote facilities that do not have their own radiologists and access to digital broadband services.

DR Systems announces additional, single sign-on EMR integration with third-party hospital information systems via their HorizonWP Physician Portal. Release 8 will be available in the U.S. in 2006.
   
The company also touted results from a study completed by Michael Trambert, MD, outlining benefits of integrating digital mammography with DR Systems PACS. According to Trambert, benefits include 100 percent filmless reading and archiving from day one of integration, expedited patient care, excellent image care with a perceived decrease in call backs, read-ready images without the need for radiologist manipulation, filmless access to exam and voice results and a 2.5 fold increase in mammography room productivity. Radiologist productivity, however, was halved, which Trambert attributed to inefficiencies in the design and functionality of the FFDM user interface. Reading exams directly off DR PACS could eliminate the productivity issue, according to Trambert. DR Systems recently received FDA clearance for adding mammography reading capability to its RIS/PACS.


Dynamic Imaging used RSNA to debut IntegradWeb RIS/PACS and IntegradWeb PACS.
   
IntegradWeb RIS/PACS builds on the web-based architecture of IntegradWeb PACS to fulfill the radiology informatics needs of ambulatory settings: RIS, PACS, billing, document management and digital dictation. IntegradWeb RIS/PACS accommodates the requirements of radiology group practices, multi-specialty group practices, single imaging centers and distributed imaging center chains. The system provides a single, unified radiology desktop powered by an end-to-end, web-based workflow that includes scheduling through billing as well as document management and digital dictation. The billing module shares the same user interface and database to provide comprehensive, roundtrip views of the patient visit without the user having to exit the application. IntegradWeb RIS/PACS is scheduled for wide release in early 2006.
   
IntegradWeb PACS version 3.5 features extended integration to a host of third-party applications including: 
  • Dictaphone PowerScribe for single-click voice recognition.
  • Dynamic Imaging integrated document management for paperless operations.
  • Dynamic Imaging's OrthoTools powered by Orthocrat TraumaCad for web-based orthopedic templating and planning software.
  • Barco Voxar 3D embedded integration for 3D rendering anywhere, with single-click saving of reconstructions back to the original study.
  • TeraRecon AquariusNET for server-based 3D rendering.
  • Vital Images Vitrea 2 for 3D and advanced visualization.
  • Fusion7D PET/CT, multi-modal image review, co-registration and analysis.
  • Medimage MedView for advanced nuclear medicine applications.


Emageon Inc. touted an agreement with Orthocrat Ltd. to distribute TraumaCad orthopedic surgical planning applications. 
   
The agreement allows Emageon to offer tools to orthopedic specialists in its customer base. TraumaCad is a thin-client DICOM application that integrates with a PACS and network architecture, while delivering a consistent orthopedic work environment over a web-enabled workstation. It streamlines interventions, enhances outcomes and cuts costs by enabling advanced orthopedic surgical planning through precise manipulation of 3D soft-copy images and application of fixation and prosthetic systems. TraumaCad also includes advanced modular deformity correction and pediatric packages.
   
The company strategy is to blend multiple specialties in the visualization experience, Emageon says. In the future, Camtronics solutions will be integrated into Emageon's solutions.


Emdeon Practice Services highlighted its Intergy PACS and Intergy RIS.
   
Intergy web-based PACS provides designated users from both inside and outside a practice with a single, unified view of critical information. Regardless of their location, users have secure access to the same database, archive and toolsets online.
   
The Intergy RIS features integrated Intergy billing, patient flow tracking, appointment scheduling, split billing and other RIS. The Intergy RIS is equipped with HL7 support to allow the exchange of critical information with hospitals or billing services.


eRAD introduced the e3 paradigm of image management and showcased 3D capabilities.
   
According to eRAD, the e3 evolution extends the workplace, produces effective workflow and results in an evolved environment.

The eRAD products associated with e3 provide an offering to meet the broad needs of radiology. eRAD PACS Classic Edition is a scaleable, cost-effective solution for web-based teleradiology and the imaging center environment. Options are provided a la carte, allowing the system to evolve with the customer needs. The eRAD PACS Enterprise Edition is designed for high volume demands and with multi-site operations. These high reliability applications call for equipment redundancy and include disaster recovery failover provisions to provide high uptime. Enterprise is an inclusive solution.
   
The eRAD PACS PAL - PACS Accessory Line includes tools to extend the workplace and the utility of PACS. PAL provides a communication and professional interaction capability. This is a single, uniform, web-based system to address teleradiology, PACS, reporting, dictation, transcription, referring physicians and clinical specialists. PAL applications include: web access for legacy PACS, query of multi-vendor PACS, integration of departmental mini PACS and radiology group access to multiple PACS. PAL preserves existing PACS investments and eases the migration from older PACS architecture to web-centric orientation.
   
eRAD PACS solutions will be offered with a choice of 3D capabilities. In addition to the current web-enabled 3D, eRAD PACS can now be configured with the VOXAR 3D software from Barco. The eRAD 3D module is a plug-in module that provides support for creating and viewing 3D objects. Users can create a shaded volume from a single CT or MRI series, rotate it in three-dimensional space, define cut planes and apply segmentation algorithms. 3D objects can be saved, annotated, archived and attached to a report. Licenses for eRAD 3D allow an unlimited number of users to work from an unlimited number of locations via the internet. VOXAR 3D from Barco includes specular lighting effects that provide radiologists with lifelike views of patient anatomy. Adv