Run, don’t walk, to the exhibitor booths showcasing products and services that promise complete integration of informatics systems-it is these innovations attendees are most apt to find worth cheering at this year’s Radiological Society of North America (RSNA) annual meeting, November 25-30, in Chicago.

Leading the charge on integration will be PACS vendors whose products now include a complete radiology information system (RIS) in the same package. Neck-and-neck alongside these PACS suppliers will be RIS vendors now offering full PACS as a component of their own products.

“At RSNA, you’ll be able to see in various vendor spaces the market’s first, truly integrated PACS-RIS products-a single informatics solution that does everything from capturing the order for an examination all the way down to generating the end result for the referring physician,” says one source. “These products will offer users a single database in the radiology department that manages all the patient data, and one integrated desktop application for either the technicians, the radiologists, or referring physician to access all the clinical data relevant to that patient. It’s going to do away with the need to deal with multiple systems, multiple log-ins, multiple computers. This will have a huge impact on productivity.”

Vendors certainly seem convinced of that. One major PACS vendor has even gone so far as to announce that it is now a full-service information-technology company by dint of having acquired and integrated RIS technology with its PACS offerings, another source reports.

Experts suggest integration will be particularly in vogue this year because it arrives on the scene at a time when enterprises desperately need a better way to drive work flow and PACS efficiency. The beauty of integration on the level it currently has achieved is that it provides users with the most flexible tools possible to manage work flow and thus avoid having to shoehorn a department’s processes into a vendor’s concept of what those processes should be, an expert opines.

Protocols Take Hold

Integration is being abetted in part by use of protocols and standards that have taken root within the last few years. Two of these are XML and SOAP (simple object access protocol), which permit the easy exchange of services and information across disparate systems without need of redundant storage, according to one market watcher. Meanwhile, although there will not be any dramatic new developments concerning the 3-year-old Integrating the Healthcare Enterprise (IHE) initiative, that effort has matured to the point where the work-flow protocols it embodies will begin turning up in practical applications to be unveiled at the show, vendors say.

Throughout the RSNA conclave, much attention will be paid to the federal Health Insurance Portability and Accountability Act (HIPAA). In particular, show-goers can expect to easily find all the advice and wares they might ever want for helping them ensure the security of patient images and records as required under HIPAA regulations. Among the most intriguing access safeguard products expected to be demonstrated will be those employing biometric identifiers.

“There are several approaches to using biometrics to authorize access to images,” explains one source. “There are retina scans, there is voice recognition, and there is fingerprinting. Of these, systems that verify user identity by checking their fingerprints will probably be the most popular this year because they are the easiest to use and manage.”

Access rights also can be administered and protected by user context-sharing technology, which is being embedded in a number of informatics systems this year. “Context-sharing technology will permit a user to access data across disparate systems but with a single log-on,” a source indicates. “Accordingly, access will be secure but not cumbersome. It will aid productivity.”

Related to security is the matter of disaster recovery. Experts think vendors who specialize in disaster recovery products and services, or who have these bundled with PACS and RIS offerings, will likely find their booths attracting considerable traffic this year. Explains an observer, “The September 11 terrorist attacks on New York and Washington have most everyone thinking about how they will be able to continue their operations in the wake of a catastrophe. They’ll be interested in exploring ways to duplicate their data, possibly with mirrored but off-site data centers.”

Adds a second source, “Disaster recovery will prompt many attendees to be thinking about hierarchical storage management, tape systems, tape libraries, application service provider (ASP) models, and hot backup sites. In my opinion, the amount of money a user invests in disaster recovery will be the determinant as to how long after the disaster they can restart their operations.”

Some show-watchers scoff at concerns about HIPAA. Overblown, they insist. The reason is that HIPAA regulations are in many cases more generalized and less stringent than state regulations governing the same things, but in place for several years already.

One voice asserts that HIPAA’s impact on radiology will turn out to be negligible. “We’ve all been hearing about it for a couple of years and it’s been portrayed as a scourge, not unlike Y2K,” the source contends. “But, when all is said and done, it will probably turn out to be about as easily handled as Y2K was.”

Another critic argues that “HIPAA has been a creation of consultants, special interest groups, and people who are looking to make significant money from it. Certain vested interests are trying to scare radiology departments into thinking that there are a lot of things they need to purchase in order to get into compliance with HIPAA when in fact they don’t. HIPAA is pretty straightforward in terms of what a site needs to do to keep track of users. It needs to encrypt. It needs to authenticate who the user is. And you need policies on how you’re going to manage your data. That’s it, period.

“Anyone who buys the fear-mongered HIPAA solutions will find it much harder to practice medicine, and that need not be. What’s historically been on the market will be more than sufficient to meet the needs of the HIPAA regulations.”


At a gathering as consequential as RSNA, there inevitably will be products and services that attract unwarranted attention-much of it manufactured by hype mills. Some show-watchers predict that the Internet ASP model may garner the dubious distinction of being this year’s most overhyped offering.

Skeptics cite the reluctance of health care organizations to locate their data off-site for anything other than disaster recovery.

“No matter how they deny it, hospitals are not and never will be really comfortable with the idea of storing images outside their four walls and entrusting them to an entity that they do not have control over,” says one vendor.

ASP critics make a distinction between the remote-hosted (classic) model and the on-site managed variety (basically a financial model). Proponents of on-site ASP say it is a huge benefit to radiology, in terms of fast implementation, better cost of ownership, and better utilization of IT resources and space.

“It’s a value-added offering to the radiology industry,” an ASP defender points out. “The fact that major vendors are committed to ASP and haven’t abandoned it says a lot right there. It says that, in radiology, ASP makes sense because of the large amounts of data generated.

“The biggest bottleneck in ASP has been the result of departments not being able to get the cost-effective bandwidth necessary between the hospital and the data center. Sending across a traditional WAN (wide area network) is not good enough because you lack the reliability, security, and speed that are needed for deploying a PACS application remotely.”

Nevertheless, some vendors worry that leeriness toward remote ASP will unfairly taint the reception given to wares such as Web-based, thin-client diagnostic read-

ing stations, actually an application foundation, as opposed to something that uses a browser.

Also liable to be misunderstood-and not properly appreciated-is the way that Web-based access is no longer seen in some circles as a nifty extra but fast becoming a fundamental, required feature of informatics systems.

“Whether you’re talking about images or modality work lists or patient-clinical access, a Web-based system allows you access to that information from virtually any device,” according to an observer.

Beware the term Web-based: It is imperative to pin down its precise meaning in the context in which it is being used.

“Many vendors feel that if they attach the words ‘Web-based’ to their product, it will be like a magic charm that causes customers and the press to take notice,” says one vendor. “But what exactly does ‘Web-based’ mean? Does it mean lower cost of implementation? Does it mean better productivity for clinicians? That does not seem to ever be made clear.”


Then there is storage. According to some forecasters, interest in that facet of informatics should be stronger than ever at this year’s RSNA.

“Deep archives are going to be a hit at the show,” says a source. “There’s also going to be curiosity about the strategy of deploying individual archives per imaging station and per modality in order to achieve much faster retrieval speeds.”

Some of that interest will have been piqued by the terrorist attacks. “HIPAA and the tragic events of September 11 are forcing people to take another look at disaster recovery and what they have in place for business continuance models,” believes one vendor. Expect to see data systems that are scalable, with software modules that offer options for backup, disaster recovery, and business continuance.”

One or more vendors plan to introduce new tape-storage systems boasting massively larger archiving capability and an image retrieval speed no less than twice as quick as the fastest tape systems currently on the market.

Of course, no show is complete without its sleepers-innovations that make barely a ripple at first glance, but that astute attendees quickly pick up on as a pivotal or even seminal product or service model. Thought to be fertile ground from which will emerge this year’s RSNA sleepers is the realm of information routing.

“There are many radiology practices that have no real ability to service their existing workload because they lack the professional expertise and cannot move the images around,” a source offers. “For that reason, show-goers will do well to keep an eye peeled for innovation geared to moving images and data within the environment of virtual radiology.”

One potential sleeper this year could be SAN-storage area network. SAN promises to deliver greater connectivity and storage sharing on an open topology at a much faster rate than previously available. It replaces two topologies (LAN [local area network] cables and SCSI [small computer system interface] interfaces) with one-and that single topology is faster than the other two combined, according to experts.

“In layman’s terms, SAN would be akin to giving each resident of the city of Los Angeles his own private, personal dedicated freeway for driving to and from work,” says a source. “SAN allows for more efficient use of storage, data consolidation, centralized management of data resources, and, in some cases, faster access to data. SAN provides a solution that functions regardless of the legacy environment of all the imaging applications that need to be connected. It allows radiologists to connect with the hospital information system and any other brand of imaging application workstation that might be utilized throughout the hospital or clinic.”

Not everyone thinks SAN is all that it is cracked up to be. Says one skeptic, “Yes, SAN gives excellent performance, but the price associated with it is horrible. It’s outrageously expensive-around 10 times as much as conventionally structured systems. And, besides, SAN is not necessary for most sites as long as the system being used is well designed. If you have the interfaces developed properly, you can have all the information downloaded from your slower, less-expensive tape systems before the patient walks in the door. For patients who aren’t scheduled, you can download when they walk in the door, so that by the time a radiologist or doctor is looking for the images, it should be on disk.

“There are sites that run more than? 200,000 examinations without a SAN. I marvel when I see sites doing 60,000 examinations a year and spending $400,000 on SAN. Frankly, I don’t see SAN as being all that relevant in most situations.”


At the show, much attention will be paid, it is expected, to informatics interfaces.

“The tools have been getting better and better,” an observer comments. “These tools are such that we can really help a radiology department manage itself. These tools will provide better information, so the department can expect to run more efficiently. Some of the tools include the DICOM Perform-Procedure Step, which is now available with the modalities. Importantly, these interfaces will help PACS become an important piece of the electronic medical record (EMR).”

Do not be disappointed to discover that commercial versions of the EMR still are not quite ready for prime time.

“EMR will first require the deployment of a concept known as the digital dashboard that appears on the desktop computers of every user in the hospital,” says a technology guru. “Right now, all you have is basically the integration of disparate systems through various standards and technology, thereby giving the appearance of an EMR, but not a genuine EMR.”

Other potential sleepers at the show might well include:

  • JPEG 2000. Part of the new DICOM standard, JPEG 2000 is the next version of JPEG compression, which has been an unchanged standard for more than a decade. According to people in the know, JPEG 2000 will offer advantages for transmitting data across a network; using wavelet technology, the compression ratio is much greater than is the case for conventional JPEG.

“You can compress without losing visual data,” says a source. “Where before you started seeing compression artifact at low compression ratio with traditional JPEG, you can now go much higher before you see any artifact.”

JPEG 2000 will facilitate manufacture of inexpensive, easy-to-use diagnostic workstations-a key element in the goal of making images available anywhere, anytime.

  • Affordable and reliable satellite links for accessing the Internet. These links join cable modem and DSL in the competition for fastest Internet pipeline. However, the links remain difficult to use because of the complexities of connecting them.
  • More unbundling. It’s official. PACS and RIS hardware are now commodity items and no longer a proprietary component of the systems you buy.

“Traditionally, radiology workstations have been purchased as a box that has a single use,” says an insider. “Now you’re seeing more and more unbundling of hardware and software. You can separately buy a PC, a high-resolution monitor, and software-all for about a third or even a quarter of the price you had to pay before when this equipment was bundled.”

  • The ascendancy of practice assessment and practice improvement services. These service providers propose to help imaging centers improve revenues and profitability by using informatics to track which referring physicians, procedures, demographic groups, and geographic areas are generating the most business.

Adds a source, “They also can help you understand, as reimbursement levels come down, how to get the maximum value out of your equipment.”

Rich Smith is a contributing writer for Decisions in Axis Imaging News.