Robert Cooke

Robert Cooke is vice president, IMPAX Solutions, Global, for Agfa Corporation.

Q:In what year, and for what reasons, did Agfa begin developing its picture archiving and communications system (PACS)?

Cooke: From the beginning, Agfa has always sought to create positive impact through its technologies. In 1990, PACS was a well established concept with few, if any, practical implementations. As we sought to create a positive clinical impact with the emerging digital technologies, we identified the ultrasound department as a logical place to start.

The image and bandwidth requirements were appropriate, given the types and numbers of images involved, so that we could apply off-the-shelf technology. Further, we had a strong base of printers that could be leveraged for image acquisition. At the time, the Digital Imaging and Communications in Medicine standard had not emerged as a concept. We sought to replicate, and were successful in replicating, hard-copy work flow through digital technology. This was appropriate for the time, given the market conditions and attitudes inside radiology. Now, we can create greater impact as we re-engineer the work flow in toto, with technology as our tool.

Q:At that time, did anyone envision PACS as a technology suitable for use outside radiology departments?

Cooke: The notion of electronically managing images tracked with the development of digital means to acquire images. At that time, there were no concepts of PACS as a nonradiology tool.

In addition, technologies were not available to distribute the resulting images broadly outside the department. Of course, as soon as ultrasound departments went filmless, the need to have image access outside the department really hit home. We usually solved the problem with expensive workstations dedicated to radiology’s customers inside the department or with hard-copy film.

Q:When did it become clear that PACS would have enterprise-wide applications?

Cooke: It became apparent after our first enterprise implementation at Beth Israel Medical Center, New York. Together, Agfa and BIMC identified the need for over 30 viewing stations (based on personal computers) in various clinical areas outside the radiology department. This concept has emerged on an industry-wide basis, using web technology to provide access.

The notion of multidisciplinary PACS emerged through our collaboration with Brigham and Women’s Hospital, Boston, which sought to connect any image-generating modality inside the enterprise to our PACS archive. This approach is valuable; building the bridges inside health care that are needed to achieve this goal is even more valuable.

Q:Cardiology is the most natural department for extension of the PACS product. When did Agfa begin developing its cardiology product, and what are the greatest difficulties that the company encountered in doing so?

Cooke: Agfa started about 2 years ago, as the image requirements in radiology approached the size of those in cardiology, and the off-the-shelf technology to manage these data sets became common.

The biggest challenge we face is that it is sometimes difficult to separate a catheterization laboratory PACS from a cardiology PACS. Our approach has been to integrate all aspects of cardiology into our system. Further, the motivations behind implementing a cardiology PACS differ slightly within departments.

Perhaps the biggest challenge is building the bridges between the clinical needs of the two departments and the economies of scale created by integrating storage and image management for both departments. Working with hospital information technology departments has been a good approach to bridging this gap.

Q:What is the economic argument favoring a hospital’s use of one PACS instead of several individual systems? Are there any drawbacks associated with this approach?

Cooke: The economics differ from environment to environment. In general, one must examine the motivations behind implementing PACS in the first place. As you look at the issues-ranging from creating a multisite virtual department capable of contributing to an electronic patient record strategy to solving some specific work flow challenge-the answer comes in many forms.

In general, having many subsystems instead of an enterprise-wide system means higher implementation costs (multiple user interfaces, system management, and loss of economies of scale). This has to be weighed against any clinical or diagnostic benefit of a particular subsystem.

The problem of implementing PACS is best solved by managing the growth of a system in chunks that are economically manageable and have the most clinical impact. In general, managing diversity of technology is expensive, especially when the same problem is to be solved with diverse technology.

Q:What roles have senior-level hospital executives and today’s financial conditions played in promoting the concept of using one PACS to serve an entire hospital?

Cooke: PACS has become a cost-of-doing-business technology. Senior health care executives understand this and are a big partner in driving implementation. This comes from experience in implementing clinical information technology in other areas of the hospital. Their experience has driven them, and us, toward industry-standards-based systems and scalability.

Q:What PACS products does Agfa expect to introduce next?

Cooke: Agfa is working along two axes. The first axis leads into other image-intensive areas of health care and toward developing subsystems (in areas such as ophthalmology) to broaden our base of clinical experience and to use derivatives of our technology in those clinical areas. The second axis leads into the enterprise, bringing these department-level solutions together into enterprise-level storage management solutions and creating impact through medical content (analysis and outcomes).

Agfa will introduce tools to derive more value from the images that we display in the department and to integrate more enterprise content into our images (and vice versa), as well as to allow the whole enterprise to benefit from our technology. Our product strategy will reflect this approach.

For example, our ophthalmology product is a manifestation of our strategy. Ophthalmology is a unique environment in that the technology is digital, there are few players in the field with our experience, and with our investment in MediVision Medical Imaging SystemsLtd/Ophthalmic Imaging Systems, we are uncontested in that space.

Q:How do the data requirements and other needs of ophthalmology compare with those of radiology?

Cooke: Data storage needs for an examination are about the same as for a two-view chest radiograph. The analysis requirements differ substantially, and we will be looking at diagnostic tools to provide more value to users of the displayed images.

Q:How will the recent investment in an ophthalmology company benefit Agfa and its customers?

Cooke: This brings us a whole new set of customers who can benefit from our technology. Further, Agfa will now also be able to bring our existing customers PACS systems across more areas of health care, which will allow them to leverage their existing investment. Of course, the additional volume brought to our business will benefit Agfa, as well as our customers.

Q:Agfa has announced its intention to purchase Mitra; how will this action fit into the company’s plans?

Cooke: Agfa and Mitra Imaging Systems have enjoyed a long and successful relationship based on complementary capabilities. This is the next step of our relationship, and it will ensure that the mission we have pursued in the past is continued, enhanced, and expanded now to include larger and more integrated clinical solutions.

Mitra provides a powerful core of software expertise and technological innovation. This acquisition assures all IMPAX® customers that Agfa will continue to offer a fully integrated software product that will protect and extend their current investment. Further, through this acquisition, we can ensure, for our customers, that  future development and support will be tightly integrated and highly efficient.

Throughout the long, successful relationship between the IMPAX organization and Mitra, we have been able to offer our customers a consistent growth and upgrade path. The acquisition of Mitra is a logical extension of that affiliation, given the tremendous growth that both organizations have enjoyed over the course of the relationship.

Further, the impact of the original equipment manufacturer (OEM) business on Agfa is important. It will allow Agfa, Mitra, and our other acquisitions that enjoy OEM relationships to broaden and harmonize the range of technologies that OEMs can source. The OEM business remains a critical piece of our business, and now, through this acquisition, it is more important than ever.

The range of domain expertise and technical capability brought to bear by Talk Technology, Inc, Quadrat, and Mitra, as well as through our own efforts, is unmatched in the industry. Our profile in the market is greatly enhanced.

Q:What might you predict as the form that the Agfa PACS will have assumed by 2012?

Cooke: In a 1971 meeting, the noted futurist Alan Kay, PhD, said, “The best way to predict the future is to invent it.” This is balanced by Einstein, who once stated that he never thought of the future because it came soon enough. Perhaps our future will be forged by a balance of these attitudes.I would like add this: If you invent it fast enough, you win.

If the tremendous evolution of technology in general is thought of in terms of the network and computers being everywhere, the whole delivery of health care, and radiology services, will be radically affected. One thing is certain: if there are images and information to be brought together to create positive customer impact, we’ll be there too. n

This article may include works-in-progress that are not yet commercially available in the US or Canada.

Kris Kyes is technical editor of Decisions in Axis Imaging News.