It’s been a year and a half since Nuance Communications launched the Nuance PowerShare™ Network. It did so by acquiring the cloud-based medical image sharing company Accelarad and expanding its platform into a powerful web-based exchange for combined images and reports.
What a year and a half it’s been. Today, PowerShare Network connects more than 2,700 healthcare provider sites and has facilitated the exchange of medical images to the tune of more than 3 billion. And the count grows every day.
Meanwhile, this past summer, Nuance was identified as the mindshare and market-share leader among all medical image-sharing suppliers by peer60, a software vendor and industry research company, after it surveyed more than 500 healthcare organizations.
The peer60 report called PowerShare Network performance “an impressive feat.” The compliment was made all the more meaningful by the survey’s finding that nearly 90% of providers consider receiving medical images from other sites “the most important problem to solve” through image sharing.
To get a clearer picture of PowerShare Network beginnings and its future direction, Health Imaging spoke with Helmut Domagalski, the Nuance product director who serves as product manager of both PowerShare and PowerScribe® 360, the popular voice-to-text dictation system designed specifically for radiology.
The original guiding vision behind PowerShare Network — which Nuance had been working on for several years prior to the Accelarad acquisition — contains three main components.
First, the network had to allow the movement of images across “disparate islands” while working to cut CDs out of the picture.
“If you think about it, as you look at any region of care, even EMRs, VNAs and PACSs are islands,” Domagalski observes. “How can we cut across those barriers quickly? We had several different regions where we’ve been able to connect rapidly, with a very small IT footprint, through our low-footprint IT design and our outreach services.” These include preferred channels, direct messages and automated tools that allow users to immediately act on incoming information.
Second, PowerShare fosters cross-hospital, physician and patient communications in order to help improve patient care while reducing costs on a broad scale.
The PowerShare Network “is built to resemble a social media app, such that hospitals, patients and providers all have their own accounts,” Domagalski says. “The concept was very disruptive of the market norm of CD islands, as it broke away from the traditional EMR/PACS structure and really enabled cross-site, national level collaboration over imaging via the cloud.”
It also made every image associated with every patient available in a single bank regardless of where — or at how many different sites — the images had been captured.
The third and final key piece was only logical. A diagnostic image without an accompanying report is, after all, rather like a silent movie without subtitles.
“Nuance took that original vision and said, ‘Let’s marry reports to images, and then let’s continue to expand the value of that network beyond images and reports,’” Domagalski recalls. “From there we could bring in components for quality and analytics, and we could look at connecting with ACR and other groups.”
The resulting PowerShare Innovation Program — unveiled at RSNA 2014 and well established today — presents this multi-pronged functionality as a jumping-off point for providers to tap into the power of image-based and/or report-based cloud networking.
“Take surgery for example. We can offer users the choice of working with a surgery vendor or deploying other viewers on our technology so they don’t have to play the ‘viewer game,’” Domagalski explains. “They can choose to put their technology and best diagnostic toolsets on the network.”
The PowerShare Network vision doesn’t call for moving away from image sharing, he stresses. On the contrary, it maintains image sharing “as our core product and expands it outward.”
Not incidentally, the Innovation Program had momentum to build on right from its inception. Massachusetts General Hospital (MGH) signed on to partner with ACR and Nuance, announcing the partnership at the RSNA 2014 unveiling. Since then, MGH has used the program to deliver an initial set of radiology clinical decision-support guidelines to the broader radiology community by integrating the guidelines into the PowerScribe workflow.
Through this integration, radiologists across the PowerShare Network will access evidence-based guidelines at the point of interpretation to improve the consistency and quality of their clinical documentation.
“From the perspective of the PowerScribe expansion into clinical guidance and registries, we have first adopter customers who are already tapping into those network capabilities, marrying the network of PowerShare with the clinical depth and knowledge of PowerScribe,” Domagalski says.
As customers upgrade to PowerScribe 360, they are getting onto the PowerShare Network, to which approximately 50% of the PowerScribe base has connected with an account. “We are working with the rest of them so that they’re all enabled to start using the benefits of the network — beyond even sharing,” he clarifies.
In the present, if there’s one thing about the PowerShare Network that has surprised end-users, it’s the speed with which they’ve be able to connect to, and meaningfully leverage, the network.
Domagalski describes an example where a then-non-customer hospital had a trauma issue: They could not move an urgent patient imaging exam.
“Our team created a PowerShare account for them. We deployed an accelerator to extract, bundle and communicate data from the radiologist’s PowerScribe 360 system,” he recalls. “With that, they were able to move the images and data. Our technology helps save lives.”
Not surprisingly, that hospital soon after became a subscribed user.
A network of possibilities, unbound by the ground
Renee Stacey, a senior marketing manager in the Nuance Diagnostic Solutions division, has lately observed a growing number of PowerShare users being pleasantly surprised — not so much by how well the system does what they chose it for but by how it opens opportunities they hadn’t expected.
“I recently had a couple of conversations with different customers who went down the PowerShare path for one particular reason, usually to solve an issue exchanging images, and they found other uses and benefits,” Stacey comments. “They told me, ‘We now have this new opportunity to start communicating with our referring physicians in a better way.’”
See accompanying article, HCA division realizes big return on PowerShare investment.
The anecdotal evidence points to PowerShare Network users being able to grow their referring physician base through better satisfaction with their radiologists, as well as through a streamlined way to meet meaningful use and other regulatory demands.
Asked what tends to open a provider to the possibilities of the PowerShare Network, Stacey points to the cloud.
“I think hospitals are really beginning to understand the value of cloud-based solutions and how scalable they can be — not only from a ‘Let’s enlarge our network’ perspective but also from a use-case perspective,” she says. “There are no barriers to cloud. It’s really just about how you can use this technology in a way that takes you forward, as opposed to solving only the one problem you were looking at when you first tapped into the network.”
Domagalski adds that if there has been one dominant paradigm shift over the past year and a half, it has been PowerShare’s evolution toward becoming a kind of “pipework” embedded in the EMR and other clinician front-ends.
“We have mobile,” he said. “We have web. I would say the key thing we are doing here, though, is getting behind the desktop and letting the clinicians stay in the EMR,” he says. “We will move the images for you and let your EMR or PowerScribe 360 be the front end. And that has been a real focus, especially this past calendar year, continuing to make this a part of the staple workflow for our customers. We can quickly do this with innovation partners using our library of integration tools we have made available to the market place”
Meanwhile, many customers continue to “express amazement” over how quickly they’ve been able to connect to, and meaningfully leverage, the network.
“People generally tend to think of these things as taking forever,” Domagalski says. “PowerShare Network is very fast because, from a technology perspective, it doesn’t ask a lot of all the connecting facilities. And then again, the outreach services, where we uniquely have almost a cookbook recipe for how you can get others connected. Because of those factors, people are equally surprised by how fast they can use it and how much they get out of it.”