08 DECEMBER 2016
RSNA Imaging IT: Innovation Under The Surface
Written by Steve Holloway
Holy Smoke IT’s Everywhere
Probably the standout from RSNA is just how big imaging informatics and clinical data management has become at RSNA. Both technical exhibit halls were packed with imaging IT solutions, coming at the market from all angles.
While the big issue impacting almost every conversation was artificial intelligence (see our other RSNA round-up on this), it is becoming increasingly evident how many vendors currently have or want a piece of the imaging informatics pie. To add some structure to the plethora of solutions on show, we’ve categorised our takeaways into the three core functions of imaging informatics: view, manage and store.
Viewing technology has undergone a major change in recent years, most notably in merging with advanced visualisation and expanding its reach out to a larger volume of clinical disciplines. Moreover, as enterprise imaging and EMR systems have rolled out across health systems, a new array of users has emerged with unique needs, demanding more and more from viewing technology.
Therefore, viewing technology has had to evolve, and this was evident on the RSNA technical exhibit show floor;
- Thin-client, mobile-enabled, server-side rendering: is rapidly becoming the standard for viewing technology, allowing almost-instant web and mobile access for large imaging studies in any location within a given authorised network.
- User and application interface morphing: another major play from multiple vendors was the adaptability of viewer interfaces, toolsets and even user-preferences, based on the type of image or information displayed and physician using the viewer. While this capability has been available for a while in some platforms, it is increasingly being pushed as a vital component, especially for high-volume reporting.
- Pre-load of context information: improvements in management and storage of historical prior studies and data into centralised, accessible repositories, has also led to automated, intelligent pre-fetching of related data that may be relevant to the reading or reviewing physician. This enables the diagnostician to quickly access previous patient data that may add context to their diagnosis within the same viewer. While this capability has huge potential for diagnostics reading and clinical review, it remains dependent on the underlying management and workflow capability, an area that needs considerable work to get to true interoperability.
Management of imaging and associated clinical data has remained in flux, with vendors from viewing, archiving and storage, EMR and enterprise content management all vying to disrupt the traditional PACS market. There was also notable presence of a range of middleware specialists in DICOM-routing, migration, worklist and decision support tools. This suggests “D econstructed PACS” is not a marketing fad and is a viable alternative for providers that have the resources and capability to manage a migration to a multi-vendor best-of-breed solution.
However, it was also abundantly clear that enterprise imaging remains the core focus for most vendors and providers, unsurprising perhaps considering many incumbent PACS vendors are taking this route. Expansion of departmental PACS capability to a more enterprise platform approach has short- and mid-term benefits for most providers, allowing ingestion of non-imaging content, a single vendor relationship and avoiding complicated and lengthy PACS migration is clear. That said, many of these solutions do little to enable true interoperability of imaging data, something that over time will be of growing importance with the advent of artificial intelligence and population health management.
One positive from the show was the high profile of the RSNA Image Sharing Validation programme, an accreditation scheme for vendors that pass a set of interoperability criteria for the sharing of images and imaging reports. While this is a great start in highlighting the issue that has plagued PACS for decades, there is clearly more that needs to be done on the issue of interoperability both for imaging content and all health data.
Unsurprisingly, almost every vendor involved with image informatics now offers some form of Vendor Neutral Archive (VNA), though few solutions are capable of true agnosticism to data type, clinical application or interfacing vendor.
Consequently, it’s clear that a two-tier market is emerging:
- VNA: solutions that are essentially storage and archiving solutions to replace the “A” of PACS, with limited capability for non-DICOM content and which are usually deployed as a means of connecting disparate PACS or supporting enterprise imaging platforms.
- Independent Clinical Archives (ICA): Fully content- and vendor-agnostic storage and content management platforms based on rigorous, standards-based repositories that exhibit true interoperability of content and support not only imaging content, but all structured (EMR) and unstructured data across health systems.
This distinction, while not immediately clear from strolling the exhibition hall, will, over time, become increasingly important as the demands of ingesting new clinical specialities stretches the capability of these solutions. Further muddying the issue was the raft of vendors in both categories also offering an array of workflow, management, clinical and viewing modules with their storage solutions, thereby appealing to providers across deconstructed PACS and enterprise imaging models. While disruption of the incumbent PACS market has been vital in driving the market towards improvements in interoperability and removing proprietary data blocking, the scramble of marketing jargon and merging of capability and features has made the proposition for health providers increasingly challenging and confusing.
Evolving Business Models Point to Cloud
Perhaps most notable was the increasing presence of new innovative business models across the imaging informatics sector. While today still a fundamentally capital-heavy IT sector, healthcare is tentatively moving to embrace managed services, a move that will undoubtedly also drive the market towards cloud IT technology.
Many vendors now offer some variation of their traditional capital expenditure model, though uptake to date has been minimal. Yet with major US and international initiatives putting greater emphasis on value-based care and a growing appetite for risk-sharing between providers and vendors, momentum for alternate business models is increasing substantially.
Therefore, expect adoption of hybrid and hosted imaging informatics to become increasingly common, despite the obvious concerns that exist around security and data ownership. Why so bullish?
Because the future direction of radiology, aptly caught in the show theme “Beyond Imaging” will demand a more flexible, interoperable and affordable approach to image and health data management. The constant query and amalgamation of data for artificial intelligence will require another level of processing capability, and the flexibility for image and data exchange to maximise radiologist reading resource will also require it. Finally, the spiralling cost of management and storage for the exponentially growing data is unsupportable without it. Get ready for a whole lot more discussion on the role of cloud IT in imaging informatics.
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