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RSNA PACS Roundtable

other HIT solutions. It’s not an end in itself, but it is certainly the future of healthcare.

One of the biggest roadblocks we’re seeing with implementing a new solution is the change required. We often build into the implementation process the time to meet with practice leaders to discuss the changes and what they should expect prior to actual implementation. Once physicians and practice staff understand they will be doing things differently, we see success and satisfaction achieved more quickly than if we are unable to build this planning phase into implementation. For the system implementation to be fully success- ful, change management can be pivotal and is fully worth the time and effort required. It’s vitally impor- tant that practices dedicate suffi cient time to ensure a successful implementation. The challenge of installing a new solution is daunting and necessary planning, coordination and execution is often overlooked. Implementing software solutions isn’t as simple as

fl ipping a switch; rather it’s an investment in educa- tion. We encourage practice leaders to develop a vision for success; we encourage the vision of success with peers in the practice; and we reinforce how this vision is necessary for realizing success.

David Smarro, president and CEO, INFINITT North America With the emphasis on image and data sharing across multiple depart- ments, multiple ologies and multiple facilities, PACS need to evolve more toward enterprise imaging (EI), sup- porting interoperability by implement- ing industry standards for easy integration with other vendors’ products and with an EHR that hosts all images generated by the facility. Hospitals will have to maintain vendor-neutral archives that receive, store and distribute data in accordance with DICOM, HL7 and IHE standards, and allow images to be retrieved and viewed by any DICOM-conformant system. In addition, EHR integration will require a fast and secure Web-based viewer that can be launched from the EHR for more advanced viewing tools. The biggest obstacle to this kind of interoperability is that hospitals still have many non-DICOM legacy devices. Although radiology and cardiology departments may be mostly DICOM, enterprise imaging has to encom- pass images that are not conformant with any of the latest standards. In ophthamology, for example, many devices can only output to a printer.



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Hospitals are not going to go out and replace all non-standard devices overnight, so the PACS vendor

10 November 2010

has to be capable of converting that data into DICOM. We don’t have a problem with that because we develop our own gateways and have the resources to develop a gateway for almost anything. We also have the ability to consolidate images from multiple PACS for reading on a single viewer.

Chris Hafey, chief architect, Vital Images PACS is evolving and in the process of being deconstructed into three lay- ers: archive, viewer and work flow. The archive layer is being established rapidly through the deployment of vendor-neutral archives (VNAs). The next evolution for VNAs will be to support the real- time demand of the viewers. Viewers will evolve to focus completely on the presentation and manipulation of specifi c types of data, procedures and modalities. The work-fl ow layer will weave together the viewers and archive with other healthcare informatics systems to ensure the right data is presented in the right way, to the right user, at the right time. To achieve this, an extendable model of the domain will be established with well-defi ned standard application programming interfaces (APIs) between each layer. Systems will have to adopt this domain model and integrate through standardized APIs to remain relevant.

The demand for this transition is increasing pri- marily due to the need to stabilize the increasingly complex enterprise imaging system. Once the system has stabilized, the data can be mined and used for analytical purposes to drive cost savings and improve- ments in patient outcomes. The biggest roadblocks to successfully integrating disparate systems include: the establishment of the domain model and APIs by the standards bodies, support for the domain model and APIs by vendors, and establishing imaging informatics as a strategic asset from both a resourcing and talent perspective.

Mitchell Goldburgh, senior vice president, marketing and business development, InSite One

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Standardization for hospital informa- tion systems provided needed compo- nents to not only imaging informatics but other areas surrounding the work fl ow of


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patient care delivery. The combination of standards and an evolution of physicians’ needs driving the quality of healthcare delivery led to the IHE. IHE defi nes actors and integration profi les for the exchange of information


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