Q&A: RTI's allure for IDX
IDX Systems Corporation last week announced plans to acquire RealTimeImage Ltd. (RTI). The estimated purchase price is $15.5 million and is expected to close within the second quarter 2005.
Shawn Gibbons, product line manager for IDX's Image Management, spoke with Health Imaging News this week about the implications of the acquisition for IDX's overall strategy and the recently unveiled Imagecast for Cardiology, a system built in collaboration with RTI that integrates cardiology information and image data across various modalities and locations.

Q: You began collaborating with RTI back in 2004 on your ImageCast for Cardiology. Describe the evolution IDX's move towards cardiology, and the development of the relationship with RTI and the integration of their technology.

We've been in the radiology domain, offering the imaging as well as the informatics, which is really our core business. And we've been moving forward with what we're terming as our Infrastructure for Procedural Medicine, and that's moving outside of radiology into a lot of the procedures that are more episodic-based. We had been building products out to accommodate that. One aspect is the cardiovascular IS system (CVIS) and the other is the imaging project. With our current imaging partner Stentor, we had a technical area for which we were unable to achieve a diagnostic quality or diagnostic tool set, for a workstation specifically. And like other vendors, we had gone out to create a specialty viewer for cardiology diagnostic images. In doing that, acquiring all of the associated requirements, we had engaged in conversations with RTI. That's literally been over the last 2 _ years, and formally 12 to 18 months. They've been assisting us in building that project out. We've been moving along with that viewing technology and we've shown it at RSNA (Radiological Society of North America) and ACC (American College of Cardiology) and to several of our customers. It's actually going to launch at the beginning of Q3 with actual installations.
Related to the integration, what we term as our version 10.4 of our IT portion, it is still maintaining a single database for the imaging. When we say 'single database' it's just that we have a single patient identifier at all the libraries associated. From a user experience, they literally log in to our Imagecast product and its role-based, so depending on who you are, say you're a cardiologist, you'll have the tools associated with your login… and the system will automatically launch the viewer (RTI's technology) for that specialty. At the back end, all the images are stored in our enterprise archive as they are today. And from a clinician standpoint, they also view the images in the web distribution client viewing tool in the same manner throughout the enterprise.

Q: You've used the term "viewing technology" or viewer in the context of Imagecast for Cardiology, could you define it?

There is a viewing technology which is the actual client, the PC or the workstation. And there's an application used in doing that with tool sets [such as] windows, levels, measurements etc.

Q: What do you see as the market conditions that drove the decision to buy RTI? How will the acquisition of RTI better position IDX?

We've identified as a company that we want to move into the cardiology space. To do that, you really need specialty tools. And we approach that in both aspects, one from clinical information aspect as well as imaging. As we built out our business plan, as well as our long term roadmap for Imagecast, [RTI] was just a natural fit and extension of our current product line. We've had a very good relationship working with RealTime and developing their technology in the viewer. They also have some additional tools that we are evaluating as well. The relationship has been very fruitful, the companies have a lot of synergies, and it just makes good business sense to continue that relationship.

Q: RTI's customers have typically been imaging center-size facilities? Is it part of IDX's plan to develop products for this smaller procedure volume market?

From IDX's perspective, our other operating units Carecast, Groupcast, Flowcast do have products that go into that market space. We've been looking at it. At this stage we don't have formal plans to move in that direction. Part of the business decision with RTI is to keep all of that part of their business in tact.

Q: What about RTI's existing customers, how will IDX maintain these relationships?

Yes, absolutely. They have a development office in Isreal, as well as California. They'll maintain within that structure. They have a current organization. Zohar Elhanani, who is executive of sales & operations, will be moving forward with the acquisition as will Zvi Eintracht, CEO. Zohar will be responsible for maintaining his distributors as he currently is. We're actually having conversations with those relationships as well to reassure them that we're not looking at disrupting that model at this stage.

Q: How do you think Imagecast for Cardiology and products similar to it will help cardiologists now and in the future?

If I look at it from a cardiology standpoint, it fills the gap in several areas. Moving forward in the digital world, to term it just loosely, we have a lot of disparate modalities: data points, inventory systems, IT systems, and imaging systems. The solution we're moving forward with is virtually taking all of those pieces in consideration. So, we've done modality integrations, ECG (electrocardiogram) integrations, inventory integration, as well as IT. For a user they're virtually logging in to a single system. They have a roles-based work list that can navigate them from the beginning of the procedure, order entry scheduling, all of the general IT components, as well as nursing notes. Then once the cardiologist logs on, [the system] compiles all of that information for them to be able to view the images as well as all the clinical historical information, and information that was created during the procedure. This enables them [the cardiologists] to generate a report and distribute and sign off on the reports as well, all from one location and one login. In a cardiology realm this is a significant undertaking. It's getting there, it's just not as defined yet.
From there, consider the power of having that information accessible from the database from an administration standpoint or research standpoints etc. Then from an enterprise and imaging point of view, we're also now creating an enterprise image archive from the backend. So you not only have all of the radiology-centric images that we've grown to love, but you also have access to all of the cardiology images as well. They're all housed, archived, backed up, and in a recovery state in the same fashion. So from an overhead, administration viewpoint, there are a lot of benefits there.

Q: This is all possible using your current archive capability?

Yes. It's our current DICOM archive. It's the archive we have had installed in all of our PACS and moving forward as well.

Q: What future RTI products were of particular interest to IDX in considering this acquisition?

One of the pieces is an orthopedic templating product. It's very intriguing. We're evaluating it from a clinical acceptance standpoint right now. It's a thin client, web-based application that fits our [IDX's] model extremely well. That's one aspect we're looking at.