PACS-neutral Enterprise Archive – Who will build it?

I was rummaging through some search returns on Google today, when I caught an article written back in October 2006 by Nadim Daher, a Medical Imaging Market Analyst for Frost & Sullivan. What caught my eye was his observation about the makeup of a PACS.

“While the front-end clinical applications, already fairly uniform across PACS vendors, continue to evolve slowly to incorporate more features and integrate information from more systems, the back-end infrastructure of PACS is increasingly being shared across the enterprise. This growing ‘disconnect’ between the front-end clinical application and the back-end infrastructure creates room for an improved layer of middleware to manage enterprise data including, but not limited to PACS.”

The article, well worth reading, goes on to discuss the advantages of building a single shared Enterprise Archive that is capable of managing both DICOM and non-DICOM data objects and therefore capable of being the archive for radiology, cardiology, and other medical imaging modalities.

“Aggregating or better yet, integrating data on a patient-centric basis can constitute a sure first-step towards developing a comprehensive EMR.”

While I’m all for looking ahead to the data repository for the EMR, forgive me if I am presently more concerned about building an Enterprise Archive that can exchange data between different PACS. The ability to dynamically translate DICOM header tags in order to accommodate dissimilarities between PACS, would eliminate the need for costly and time-consuming data migrations required every time a PACS is replaced.

There are a number of Enterprise Archives currently in the market that can share their data between different PACS, but most of these systems can only share DICOM data objects, and they assume that each of the PACS are capable of interpreting all of the essential meta data that is stored in the DICOM header. Unfortunately, too many PACS in operation today treat one or more key meta data objects associated with the study data as proprietary objects, or they store these objects in private tags. Few PACS systems can actually interpret all of the data transferred from another PACS, and no matter how DICOM-conformant the archive may be, if it simply accepts, stores, and returns whatever DICOM objects it is given, that archive can not solve the interpretation problem.

Nadim talks about “enterprise archive management middleware”, that special software that would “fill in this new-found gap in the structure of the modern-day information system”. In my view that middleware has to go beyond DICOM object management and Information Lifecycle Management strategies triggered by patient and study specific information stored in the header. What must be included in this middleware is the tag morphing software that would dynamically translate header information is such a way as to make the data created in PACS A become completely understandable to PACS B, and vice versa. Not only would this make it possible for disparate PACS to simultaneously share a common enterprise archive, it would also eliminate the need for future data migrations.

I have come to believe that what we now think of as a Picture Archiving and Communications System is going to bifurcate into two distinct subsystems, each evolving as they become more specialized. The front-end or clinical part of the PACS would focus on work list management, display functions, and clinical information distribution, becoming the Picture Communications System (PCS). In this new paradigm, the “A” or Archive in PACS is removed and upgraded to become the Enterprise Archive subsystem.

There is considerable speculation on which companies will be drawn to which path. It is perhaps easy to see the bigger established PACS vendors, especially those with modality product lines, continuing to develop the clinical subsystem. They have the army of software engineers required to implement and support the clinical applications. But which companies will be drawn to the evolving Enterprise Archive path? Open systems is rarely seen as an admirable quality to either the big PACS vendors or the big Storage Hardware vendors, and the concept of an Enterprise Archive absolutely demands an open system approach. There are a few specialized medical archive software vendors out there, and I think the time has come for them to step forward. There are early adopters ready to take the right steps towards building the PACS-neutral Enterprise Archive.