Straight Talk From the PACSman: Radiology at HIMSS 2014

2014 02 05 15 59 49 6 Cannavo Mike Rsna13 200

If anyone ever questioned the power the IT department wields in the healthcare environment, the 2014 Healthcare Information and Management Systems Society (HIMSS) meeting in Orlando, FL, last week dispelled each and every one of those doubts. In two words, IT rules.

The show featured 1,233 vendors -- more than a quarter of whom were new exhibitors -- and occupied more than 500,000 sq ft of exhibit space. HIMSS also had the highest attendance in its history at just under 39,000 attendees, up 12.5% over the 2013 edition of the show in New Orleans.

PACS consultant Michael J. Cannavo.PACS consultant Michael J. Cannavo.
PACS consultant Michael J. Cannavo.

Above all, HIMSS had the people that mattered: the decision-makers and key influencers. There were more than 5,500 C-suite and senior management attendees, with close to that same number of IT professionals. C-suite attendance -- those who hold the key for IT-related purchases -- was up 18.8% over last year, while attendance of other IT professionals who recommend those purchases was up 17%, according to HIMSS statistics.

When compared with other meetings that also showcase PACS technology, HIMSS 2014 won nearly every category hands down. Of special interest was the fact that nearly every provider of vendor-neutral archive (VNA) and cloud software that exhibited at RSNA 2013 also exhibited at HIMSS 2014 -- as did all major and several independent PACS companies.

Supplanting RSNA?

Before anyone gets the wrong idea, it's not likely that HIMSS will someday supplant RSNA as the show to attend for evaluating radiology PACS in detail, any more than the American College of Cardiology (ACC) meeting will be supplanted for evaluating cardiology PACS.

Those shows, though, as well as the Society for Imaging Informatics in Medicine (SIIM) meeting, need to be keenly aware that they must demonstrate a much greater value for the investments being made in trade show attendance. This is especially crucial given that marketing budgets have been slashed and the return on investment in marketing efforts is being looked at much more closely by companies big and small alike.

HIMSS may, and probably will, command the lion's share of the trade show budgets for VNA and cloud companies from now on. Considering there were more than two dozen vendors playing in this arena alone, plus the majors who showed various central data repository (CDR) solutions, this can affect other trade shows in terms of booth size and revenue. Given that attendance at most radiology-specific shows has been flat or declining and time spent at the shows has declined each year, HIMSS poses even more of a threat.

IT's view of radiology

So how does IT view radiology? I surveyed the top electronic medical record (EMR)/electronic health record (EHR) providers at HIMSS and was told they could and have connected with most of the major PACS vendors. Getting to see that connectivity, let alone discuss it, was another story.

It could be that HIMSS wasn't the best venue for demonstrating this, but the most I was shown was what could marginally pass for an enterprise image viewer that allowed the display of PACS images along with a report, but little more. The graphical user interfaces I saw were awkward at best and required several keystrokes. Every company indicated they could also provide the equivalent of a hanging protocol by physician preference, yet no one demonstrated it. Sadly, in each company, there was usually just one person who could address the integration of all the other "-ologies" with the EMR/EHR, and even then it was a limited "we can do that" discussion, at best.

In contrast, radiology views IT as an integral part of the overall operation of the hospital. Most PACS companies have focused on launching their own universal viewers (apparently one for the entire industry isn't sufficient), and they try hard to get it integrated with EMRs/EHRs. This has met with varying degrees of success or failure. Having an enterprise viewer that allows PACS to be viewed outside the department and having the bigger companies integrate it into their EHR are two different entities, however.

Just like PACS companies need to qualify software before allowing it to be used in conjunction with their systems, EMR/EHR companies need to ensure that anything they place in their systems doesn't negatively affect overall performance. The investments in EMR/EHR systems are significantly higher than those made in PACS -- usually by a factor of 10 or more -- and the company with the largest investment usually wins. Sadly, the best viewers I have seen belong to the PACS companies, so how this is going to shake out remains anyone's guess.

PACS was barely a blip on the radar screen at HIMSS, although VNAs and the extended use of the cloud did have a fairly strong presence. Business analytics (BA) garnished the lion's share of interest at HIMSS 2014, followed closely by business intelligence (BI). One might wonder what the difference is, but the reality is that the difference is huge.

Business intelligence entails monitoring and tracking metrics in the form of standard and ad hoc reports, dashboards, cube analysis, and the like. Business analytics is making sense of the BI, relating it to other factors. This includes forecasting, trending, predictive modeling, and the use of statistical algorithms/analysis and optimization. These all relate back to IT and data readiness and help give a facility the factual data it needs for long-term planning.

BA and BI can take many forms and address many areas, but the quote "knowledge is power" relates directly to both. Combine this with "big data" -- a treasure trove of data compiled from physicians, payors, hospitals, labs, and others -- and you have a much greater potential to understand not just where we have been and where we are, but where we are going and how to optimize what happens when we get there. With healthcare expenses making up almost 18% of the U.S. gross domestic product, using BI and BA together will help provide a solid road map for healthcare in the future.

While BI and BA had everyone excited, the potential to establish a single clinical data repository (CDR) by way of establishing a vendor-neutral archive or use of the cloud generated a lot of interest. Most of what the major PACS vendors showed was related to their use of CDR, although what they offered varied dramatically from vendor to vendor. The same could be said about the independents.

While nearly every company was excited about the number of leads they generated, if the messaging had been much clearer and, above all, more concise, that number of valid leads could have been significantly higher. HIMSS 2014 only had 21 hours over three days to look at products in 1,233 booths. By comparison, RSNA 2013 had two more days, 50% more hours, and 50% fewer booths to see. Messaging is and remains crucial.

So what about VNAs and the cloud? With very few, if any, exceptions, every vendor that displayed VNA and cloud solutions at RSNA 2013 displayed at HIMSS 2014. Several had much larger booths at HIMSS, in fact. There were also close to a dozen additional VNA and cloud solutions shown at HIMSS.

Are either VNA or cloud technologies setting the world on fire? Not from what I saw. Are sales being made? Absolutely. But as I pointed out in my previous article, there are a host of factors contributing to the delay that's preventing this market from taking off as it no doubt will in a few short years.

Thankfully and surprisingly, there was very little talk about meaningful use at HIMSS 2014, but it went without saying that most IT departments were focused on meeting the upcoming stage 2 requirements, as well as ICD-10, etc. Compounding this are other factors such as the lack of standards and concerns about security, especially from the cloud standpoint.

The presence of so many vendors offering cloud security solutions -- probably half again as many as cloud solutions themselves -- made me wonder what I was missing here. It could be they were abusing the FUD factor -- fear, uncertainty, and doubt -- but who knows.

I met with two companies who talked about how the third-party business associate agreements (BAA) that HIPAA defines just aren't enough, and how the Health Information Technology for Economic and Clinical Health (HITECH) Act has changed the health IT environment as we had known it. The HITECH Act addresses key policy areas regarding the privacy and security of personal health information and requires attestation that you are using a certified EHR to receive HITECH stimulus funds ... or is it certification that you are attesting to?

Questions still abound. What do we need to use the cloud? Security for sure, but at what level? That depends on whom you talk to on any given day. Is data encryption enough? Do you need a virtual private network? One or both? VNAs are a little easier because they have a physical presence, but again is a single VNA enough?

What about disaster recovery? You have to have a disaster recovery solution in place, but then the question becomes whether that's enough or should you spring for the significantly higher cost of business continuity.

Thankfully, I don't deal in that world, but as an IT manager you need the wisdom of Solomon and the patience of Job to both understand and deal with it all. That is also one of the stumbling blocks to the quick adoption of this technology -- too many questions still abound, with too many conflicting answers. I hope this will soon be a nonissue, but right now it has those who aren't uber-tech savvy looking closely before they leap.

Were there any surprises at HIMSS 2014? Technologically, there were actually very few; however, one item that was a pleasant surprise was the number of women who seem to play a strong role in IT decision-making. Having spent the vast majority of my career in the male bastion world of radiology, I've noticed that very few women are in leadership positions. In the IT world the opposite seems true. The number of female IT directors, VP-level management, and others is astounding and quite a welcome change.

HIMSS 2014 was a great show: long and tiring for sure, but it provided most attendees with a comprehensive overview of where the IT healthcare world is and where it's headed. IT knows its direction. Radiology will play a strong role in healthcare's future, despite it no longer being the favored son in the healthcare continuum. We just need to find our place and work together with IT so we can all harvest the rewards technology has to offer.

Michael J. Cannavo is known industry-wide as the PACSman. After several decades as an independent PACS consultant, he spent two years working as a strategic accounts manager with a major PACS vendor. He has now made it back safely from the dark side and is sharing his observations in this Straight Talk From the PACSman series.

His healthcare consulting services for end users include PACS optimization services, system upgrade and proposal reviews, service contract reviews, and other areas. The PACSman is also working with imaging and IT vendors developing both global and trade show-specific marketing programs using market-focused messaging. He can be reached at [email protected] or by phone at 407-359-0191.

The comments and observations expressed herein are those of the author and do not necessarily reflect the opinions of

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