Data-driven Versus Workflow-driven Choices

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The influence of hospital information services on imaging IT technology decisions has been growing for several years now, as has the presence of big IT on the RSNA exhibit floor. For these companies, it’s all about data management, architecture, and what Dell calls application rationalization. On the data management front, companies like Dell, which acquired InsiteOne several years back, have been instrumental in pushing the vendor neutral architecture concept. “It is really growing,” says Dan Trott, sales & business director, Unified Clinical Archive Solutions. “As a result of the investments Dell has made, we are now one of the most successful groups with some of the highest margins in all of Dell.” New this year to health data management is a vendor better known in this space as an imaging modality vendor, Hitachi, which introduced a clinical repository at the RSNA. “It’s not new, it runs the national archives, it runs Google, it runs the Department of Defense,” says Ray Wtulich, manager, marketing communications, Hitachi Medical Systems. The strength of the system, also used in banking, is its ability to handle any type of data file through an advanced indexing capability that wraps each file in metadata. “In the hospital you have more than 400 types of data files, Wtulich says. “In MU 2, you need patient access to data within 30 hours, and you can do that here. The file format can be accessible anywhere in the network. We can start in the radiology department, but let's go see the CIO because we have a great enterprise solution.” Another message that resonates at the CIO level is reducing the overall number of applications that must be supported by IS. “The average hospital in this country has 2,400 applications,” says Andy Litt, MD, Dell medical director. “We have a team called application rationalization and they take it down to about 800. In most of those situations there is one guy who has to have his application, and that's fine, but previously no one had the will to even try.” Traditional imaging IT vendors, however, are focused on building workflow-driven IT platforms. “It's all about how you improve the workflow,” says George Kovacs, senior marketing manager, medical imaging, McKesson. “How do you bring a huge amount of data stored in the VNA, each physician requiring a different view of the world, but bring it to them in a useful, meaningful, augmented way?” Through strategic acquisition, McKesson has added peer review and critical results to its platform and recently enhanced its enterprise image clinical reference viewer with the capability of mining false positives and false negatives. All sit on top of the company’s vendor-neutral clinical image repository. “We believe workflow is the battleground,” he says. Radiologists—as well as well as other physicians—will find themselves at the center of this tension between general and health IT companies (which have the ear of the CIO) and imaging IT companies focused on the radiologist, such as McKesson, FUJIFILM (which has enriched its platform with critical results communications, peer review, advanced visualization applications, and VNA) and Intelerad, which announced a partnership with Blackford Analysis to automate multi-study image comparisons for more efficient follow-up of lesions, for instance. What is the destiny of nifty apps like Softek’s Illuminate, which sits on top of Epic and pulls up lab and path reports relevant to the current study on the radiologist’s reading station? Jason Hungate, VP, marketing and communications, says the application, which integrates exclusively with Epic, also has interfaced to seven different PACS. The app features productivity analytics, and new this year is a module that tracks incidental findings, enabling radiologists to go in and proactively manage these patients. Current trends suggest that time to acquisition will be considerably shorter than in decades past, but the question that occurs is which of the seven will acquire Softek? Or, will it be Epic, whose own Radiance RIS is making more and more inroads into hospital radiology departments? At the very least, and in the spirit of this year's RSNA partnership theme, we are likely to see more alliances between radiology and general HIT vendors, such as the recently announced partnership between Merge and athenahealth, which will integrate the former's iConnect Network with its national cloud-based platform.