Health Management Technology asked select experts the following question: What are the most significant challenges today in picture archiving communications systems (PACS)/radiology information systems (RIS), and how might these challenges best be overcome?

H05_PACS RU_Merge_tolleIt’s all about integration

By Steven Tolle, senior VP, solutions management, Merge Healthcare

The most significant challenges in the PACS/RIS market center around the competing requirements to unify these applications at the radiologist reading station, while also integrating each one separately with broader imaging and information solutions.  

Ideally, radiologists need all the appropriate information for diagnosis on screen, automatically linked together as easily and quickly as possible in a unified workflow.  Unfortunately, the tyranny of non-integrated workstation applications and desktops forces many radiologists to read with many windows open on multiple PCs. This gets exacerbated in dispersed reading workflows where the radiologists are spread across multiple locations.

At Merge Healthcare, we believe this challenge can be alleviated by integrating the various viewing functions into a single workstation where all of the studies are presented in proper context. This context requires tight PACS/RIS integration that must move beyond relevant priors and dictation system integration to include read state, ED discrepancy workflow, critical results notification workflow, broader patient health information and the display of related documents.

This unification, however, competes with priorities for broader image and information integrations. Hospital users want RIS/EMR integration for consistent information workflow, as well as broader imaging priorities for standard archiving with VNA, and true enterprise image distribution. In the ambulatory market, RIS must bring in EHR capabilities or integrations to provide certified technology for meaningful use, stay current with payers, connect with referrers and engage patients. Enterprise imaging and information competencies built through natively integrated applications are required to achieve these broader integrations.

Proper prioritization of these competing requirements involves a deep understanding of the longer-term vision defined by the various healthcare legislative changes, along with clinical and technical advancements. Having a broader perspective allows for innovation that maximizes image and information workflow both at the point of the read and throughout the healthcare enterprise. Merge believes this is best gained by tapping into a user community that spans all aspects of the workflow, participation in legislative discourse and key relationships with technology vendors that can be leveraged for PACS and RIS innovation.

For more on Merge Healthcare, click here.



H05_PACS RU_Siemens_rik_primoPACS should be Web-access enabled

By Henri “Rik” Primo, director, strategic relationships, Siemens Healthcare


Radiology information systems and picture archiving and communications systems have been adopted by an overwhelming majority in the healthcare community. Information technology is instrumental to increase the ability for radiologists to grow the types and number of services they provide, to include advanced visualization in routine practice and to increase efficiency and quality of reporting and patient care workflow.

Radiology has already embraced new, disruptive architectural paradigms in IT, such as virtualization and cloud-based storage. These technologies are required to address the evolving requirements that come with increasing data volumes generated by imaging modalities, and to enable the use of a range of mobile devices in a secure fashion.

The Office of the National Coordinator for Health IT recently issued a Notice of Proposed Rule Making for Stage 2 Meaningful Use of an Electronic Health Record. These proposed guidelines now include image access and sharing. IT will be essential to enable this functionality across hospitals, IDNs and health information exchanges. Storing all the imaging information in an EHR is not a practical proposal. As such, PACS and RIS will have to be Web-access enabled, and the imaging studies ideally could be archived with private, or hybrid, cloud-based technologies.

This architecture will benefit the total cost of ownership, because a stringent requirement in today’s healthcare paradigm is to increase quality while reducing cost. The recent popularity of cloud-based, PACS-neutral archives is an example of this concept in action.

With “vendor-neutral” archiving (VNA), PACS will truly become an “enterprise” solution. Different front-end viewing applications will be able to share the common back-end archiving cloud. Cardiology, pathology, dermatology, ophthalmology, surgery, oncology and many other disciplines that have needs for imaging informatics applications today could be able to roll out these applications in a cost-effective way by eschewing the need to manage a department-specific archive.

The traditional PACS paradigm is changing. The future of PACS is here.

For more on Siemens Healthcare, click here.



H05_PACS RU_Novarad_TylerHarrisUnified standards are key

By Tyler Harris, VP, clinical solutions, Novarad


One of the most challenging issues in the PACS/RIS world today is the lack of unified standardization and archiving for the storage and retrieval of medical data.  

Providers have a lot of inefficiencies to contend with as they work to access the patient data that is housed in multiple and siloed sources. These sources include document scans, master patient indexes and other information repositories that exist in disparate products. Often these inefficiencies can be overcome by interfacing. However, developing custom interfaces costs both money and time, and as the healthcare industry continues to see reimbursements cut, the increasing pressures to deliver enhanced patient care more efficiently will only increase.

Additionally, because of the lack of standardization, even creating interfaces is not a total solution as not all of the information can be shared. What this means for providers is that, by default, they are required to use multiple solutions. With a unified standardization, this challenge can be overcome. Novarad, in partnership with Dell, offers the Unified Clinical Archive (UCA), a complete cloud-based storage solution for all medical image data storage and retrieval. Standardizing all patient demographic and clinical history and making it available through a unified archive eliminates wasted time and costs for provides and for patients, removes frustration and delivers an enhanced and consistent level of patient care.

For more on Novarad, click here.



H05_PACS RU_Fujifilm_JMfinaPACS and RIS components should act in unison


By Jim Morgan, vice president, medical informatics, FUJIFILM Medical Systems

The traditional definitions for PACS and RIS no longer apply. Image management, diagnostic reading, image/report distribution and quality-control functions are still needed. To reach the next generation of capability, PACS and RIS must work together as a fine-tuned engine.

Traditional and mobile platforms, referring physician portal, peer review, critical result notifications, business analytics/reporting, communication tools, images embedded in reports and meaningful-use capability are the starting point for functionality required. Patients and referring physicians are the customers requesting relevant information (not data overload) in a timely fashion delivered on the platform of convenience (handheld, tablet, PC, etc.).

Healthcare is moving beyond filmless and paperless. Effective communication across all stakeholders via voice, chat and text is needed. Radiology departments are also being challenged to increase volume of exams, increase equipment utilization, produce more-accurate billing processes and decrease staffing costs. Business analytics are used to refine processes and allocation of resources to produce an optimum result.

PACS and RIS must also have state-of-the-art platforms that utilize virtualization and enterprise-class databases. This lowers operational costs and provides superior, scalable performance.

Having a well-run department will provide the tools and opportunity for radiologists and clinical staff to focus on the most important thing: patients.

For more on FUJIFILM Medical Systems, click here.

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