Michael J. Gray: News

Tue, 05 Feb 2008 01:18:10 GMT

Coming Up For Air

Here it is February. Where did January go? For that matter, where did December go? My bad! I've been so negligent with keeping my site up to date. It's not that I was chasing snow or anything. I've been very busy with a number of projects; two separate RFPs for Radiology PACS, a Project Plan for a large multi-site health system, and a PACS-neutral Archive project.

I really did want to publish a commentary or two on my RSNA '07 observations. There certainly was plenty of inspirational Material.

GE finally has a decent Radiology PACS (through acquisition). Now what?
A number of vendors start talking about PACS-neutral archives, but you really have to look hard for the vendors, and then look even harder for anyone who can speak to the subject.
It's truly amazing how few vendors consider themselves DICOM-conformant, yet they do not support DICOM Presentation States.
Apparently 3 MP color display panels are now the norm in Diagnostic display stations.

Let's just say I have some new things to say about some old subjects, and a few things to say about some new subjects. Sorry for the tease, but I need a little time to collect my thoughts. Check back in a few days and you'll find some posts on such subjects as:

The problem with proprietary data/object formats, their impact long after data migration
The beauty of media-neutral storage solutions
Cost-effective Business Continuity Solutions, so much more than data back-up
Double-check that quote configuration, because there are lots of hidden costs that sneak into the picture at contract time.

Thu, 27 Sep 2007 23:13:19 GMT

Take the Archive Out of PACS

Those of you that have been following my recent posts on the subject of PACS-Neutral Archive might find it useful to visit the HIMSS or Emageon web sites to access a webinar delivered today to an audience of 70+ members of HIMSS.

The seminar covered the subject of Tag Morphing and explained how some very common problems faced by Health Systems today can be resolved by deploying a PACS-Neutral Archive; problems such as the sharing of a single archive among multiple dissimilar PACS, and the elimination of future data migrations. The Emageon web site offers the visitor the option of downloading a collection of white papers that describe the concept of PACS-Neutral Archive and Tag Morphing in more detail.

Check it out.

Wed, 26 Sep 2007 18:37:48 GMT

Is new Stark Exemption an Opportunity?

I came across an article in Imaging Economics titled "Surveys Show Paper Legacy Tough to Shake"

What caught my eye was the second paragraph statement "A new Stark exception allows hospitals to donate health information technology in the form of an EMR to private physicians."

I was wondering if the definition of "EMR" could be extended to radiology web viewer? Is this possibly a mechanism for providing the necessary hardware (PC), software and connectivity services to the referring physician office to get them to stop requesting paper and film?

The article is worth reading as it explains why "more than 50% (hospitals) continue to print and distribute paper lab and imaging reports." This does not come as a surprise to me, but it occurs to me that if so many hospitals are still printing paper radiology reports, a similarly large number must also be distributing hardcopy images.

Clearly the success of a Radiology PACS depends on turning off a large percentage of hardcopy and getting the referring physicians to access images and reports from their offices electronically. I have long argued that the cost of providing a suitable PC and basic connectivity services is more than paid for by the value of the hardcopy. Many clients were concerned about the Stark implication. Is this exception an opportunity?

The article goes on to explain that 62% of hospital executives surveyed in February said their organization had no plans to donate technology. "They're waiting to see how the government changes the landscape. How will it affect their nonprofit standing, that kind of thing." Once again, I think this is a shortsighted point of view. The continued printing of hardcopy films is certainly affecting their bottom line. Why not take advantage of this opportunity to legally equip their referring physicians with a much less expensive method to access images and reports?

Wed, 19 Sep 2007 19:40:13 GMT

That Centricity Name is Quite the Catch-All

So what's in a name? A recent news item appearing in Imaging Economics boasted in its headline "Most US News & World Report Top-Ranked Hospitals Are GE Centricity Users". That came as surprise to me, because I immediately associated "Centricity" with the radiology PACS Imaging solution. When the article referenced Johns Hopkins Hospital at the top of this list, I knew something was up, because Johns Hopkins migrated all of its radiology study data from a Siemens Magic PACS system some time ago to an Emageon PACS. So I read on. Turns out that the Centricity name covers a wide range of GE IT products, mostly information/business systems. According to the brief article, only three of the eighteen top-ranked hospitals are using "one or more Centricity Imaging solutions". Just goes to show you how important it is to read the fine print.

Another way to interpret this information is that only 3 of the 18 top-ranked hospitals are Centricity Imaging Solutions users. This is well under the market share currently associated with GE PACS. I find that informative.

Thu, 12 Jul 2007 20:29:38 GMT

What was the Department of Veteran Affairs Thinking?

I came across a news article today announcing the VA's plan to establish a Disaster Recovery program for all of their Radiology Departments that had already installed the Philips iSite PACS.

"Royal Philips Electronics has announced an agreement with the Department of Veterans Affairs (VA) to provide disaster recovery services that are dedicated to VA users with Philips iSite. Managed and hosted by Philips, the VA disaster recovery services will provide automated backup of all Philips iSite Radiology image data."

It is well known that the Philips iSite PACS stores the image data in a proprietary (iSyntax) format. The Philips PACS is not the first PACS to be deployed by the VA and it probably will not be the last. When the time comes to replace the iSite PACS with something else, all of that study data accumulated over the years will have to be migrated to that next system. That is going to cost both time and money.

A shared Disaster Recovery program is a great idea, but why deploy a DR solution that stores another copy of the study data in a proprietary format? It seems to me that the deployment of a Disaster Recovery solution is an excellent opportunity to create a second copy of the data in a PACS-neutral format. Start copying the historical data already stored in the iSite PACS to a Vendor-neutral Enterprise DR (archive) solution. Call it a "pro-active" data migration. Then continue to store all new study data accumulated by iSite to this Vendor-neutral DR solution.

When the time comes for any of the sites to move on to their next PACS, there would be no need to migrate that site's study data over to the new PACS. A Vendor-neutral archive (server and storage) would be built and loaded with that site's historical data (in a Vendor-neutral format) and then shipped to the site. This local facility server would interface to whatever new PACS is being deployed. The new PACS would not have to be configured with a long-term archive. There would be no need for the time-consuming and expensive data migration.

A Vendor-neutral Enterprise DR solution could also be shared with all those other VA facilities that do not have Philips iSite PACS. What are those sites suppose to do for their DR solution? How many different DR solutions does the VA want to support? Could it be that all VA facilities will be encouraged to upgrade to the iSite PACS? No doubt that's the Philips plan.

Don't misunderstand, I think that iSite is one of the better PACS in the market, but data migration is an inherent problem with changing PACS, in some cases with the next generation PACS of the same vendor (Siemens Magic to Siemens Syngo). It simply doesn't make sense to build a DR strategy that doesn't take into account the high probability that some other PACS will be deployed somewhere downstream, and thus require a sizeable data migration project. A sensible plan would take reasonable steps to avoid that problem.

It should not be a matter of money. Hardware is hardware. Granted, the Philips software license for that second copy of the data is probably less than what the Vendor-neutral Enterprise DR software will cost. But the cost of all those future data migration projects would more than likely cover the premium charged for a Vendor-neutral Enterprise DR solution that could be shared by every VA site today.

I've written a few other posts on this subject that you might find interesting.

PACS-neutral Enterprise Archive - Who will build it?
Looking for a PACS-neutral DICOM Archive?
An Enhanced DICOM Archive would be the ticket!
PACS Vendors think PACS-neutral Archive is crazy idea
SCAR '06 Update

If you would like to have a tool to help you estimate the cost and time associated with your future data migration projects, just email me at graycons@well.com and ask for the Migration Prognosticator.

Tue, 29 May 2007 22:40:39 GMT

Looking for a PACS-neutral DICOM Archive?

In a news piece released today on auntminnie.com, it appears that PACS vendor Carestream Health and storage vendor Hitachi Data Systems have entered into a collaborative agreement to create a clinical information archive. The collaboration will combine Carestream's Versatile Intelligent Patient Archive (VIParchive) and the newly enhanced Hitachi Content Archive Platform into a single footprint.

This means that three of the top storage solution vendors (Hitachi, HP, and IBM) now have "partnerships" that add the all-important DICOM layer to an otherwise basic storage solution. This latest Carestream/Hitachi storage solution will enable multiple application servers (Radiology PACS, Cardiology PACS) from different vendors to share a common storage solution.

Unlike the DeJarnette/HP and Acuo Technologies/IBM combo systems, this new Carestream/Hitachi entry does not appear capable of modifying the DICOM file formats to accommodate differences between the vendor's use of the DICOM header. In this case the archive stores exactly what it is given and returns the same. If the requesting application server does not know how to interpret the DICOM header created by another vendor's server, too bad! Both the DeJarnette and Acuo software packages are capable of DICOM Tag Morphing, which effectively translates one vendor's DICOM header format into the other's.

The PACS vendor Emageon is also marketing an Enterprise Content Manager (archive) that is capable of Tag Morphing to accommodate any differences that may exist between the way two vendors store metadata in the DICOM header. A plus for the Emageon approach is the fact that their ECM software is hardware agnostic and can be hosted by a variety of platforms and is validated with a variety of storage solutions.

Is the Carestream/Hitachi agreement an indication that the storage wars are taking a new turn?

SCAR '06 Update

Tue, 02 May 2006 00:59:26 GMT

What's new in Radiology PACS? Well I attended the SCAR meeting in Austin last week to find out. The answer depends on which side of the street you spent your time. In the meeting rooms, the papers were mostly at extremes, some forward thinking but most a rehash of the same old topics. In the exhibit hall, most of the sales pitches sounded like those from the recent RSNA, but some were tuned to post-RSNA discoveries, and there were a few new subjects that caught my attention.

I thought it prophetic that the meeting rooms and the vendor exhibits were so physically separated. As it turned out, the respective subject matter was equally separated. Many of the papers went out of their way to avoid any commercialism whatsoever, to the extent that they seemed detached from reality. A few really interesting ideas could simply not be executed in a commercial product. For example, the keynote address introduced the idea of tagging studies with simple descriptive annotations in order to facilitate future searches, but that would be next to impossible to realize today. First because most radiologists refuse to spend the time to add annotations, and secondly because most of today's PACS treat these annotations as private data objects (not DICOM) and therefore they cannot be transferred to another server and they are not easily accessible to data mining.

Another innovative suggestion posed by a paper, is a neutral DICOM Storage Network (detached from the PACS vendor's system). This is a very interesting idea with both performance and economic advantages, but many of the vendors still don't seem to want to let their customers attach to a wide variety of self-administered storage, especially if they can't sell it. And I found the idea that there could be a methodology for migrating study data once and for all and only once (for the life of the data) to be very interesting. Given the state of DICOM conformance today, how do you suppose we could accomplish that? Well stay tuned and find out. Maybe we can cobble something useful out of this meeting after all.

Welcome to the 'blog

Thu, 04 Aug 2005 21:49:28 GMT

Welcome to the Gray Consulting Weblog!