Taking advantage of new technology advances, severalradiology PACS, enterprise imaging andcardiovascular information system (CVIS)供应商正在发布全新的、完全改版的平台。This was a trend across vendors we visited at the the 2021Healthcare Information Management Systems Society (HIMSS)in-person meeting in August.
The newer platforms are increasing speeds to access images and report, better flow and integration with vendor neutral archives, use of zero-footprint image viewers for both radiologists and referring physicians, and deeper integrations ofartificial intelligence (AI)and third-party applications so they are seamless in the workflow.
"About 90% of new system installations are going to be cloud-based solutions," said Brad Levin, Visage Imaging general manager, North America and global head of marketing. He said the trend for enterprise imaging systems and PACS is clearly going moving to cloud based solutions because it solves several issues for hospitals.
Use of cloud-based systems also help with easier integration with large hospital electronic medical record (EMR) systems. These vendors explained they can now easily integrate with most of the larger EMR vendors, most notably Epic, Cerner and Allscripts.
Some vendors are also moving to larger cloud data storage platforms, such as Google Cloud and Amazon Web Services (AWS). The value in the larger platforms is that they can scale immediately for any since healthcare enterprise and the hospitals no longer need to maintain and upgrade servers. But the biggest asset is said to be the higher level of security with these mega cloud server companies. They have large, dedicated IT teams that monitor data security 24/7.
"The cloud is bringing a lot of scalability and physicians can focus on patients rather than on IT concerns," explained Tracy Byers, Change Healthcare general manager for enterprise imaging.
View video examples of new workflow efficiencies involving the platforms mentioned in this article in theVIDEO: Examples of Improved PACS Workflow to Aid Speed and Efficiency
Examples of New Cloud-based Enterprise Imaging Platforms
An example of one of the new systems introduced at HIMSS isGE Healthcare's new Edison Cloud PACS. It leverages AI and fully integrates it into the radiology workflow. It also has an updated structure to allow better operation in the cloud. It is replacing GE's older radiology IT systems.
Edison allows users to easily customize their own work lists. The work lists show if anyone is currently in a study, who they are and if they are dictating. Users can also go through the list and reserve the studies that pertain to their area of expertise. A messaging system allows radiologists to send text notes to others to see if they can go into a study or other communications. Users also can create and pin groups for specific subspecialty reads.
新的PACS云由AWS托管。这家大型云提供商拥有专门的IT安全人员，全天候工作以维护数据安全，这比大多数医院IT团队提供了更多的资源。
Siemens introduced its new syngo Carbon enterprise IT platformthat will serve as an umbrella to allow a single access view for all patient data across an enterprise. The cloud-based platform includes image and data management, an image viewer, and a storage container to feed in enterprise data from all departments. Similar to GE's Edison system, Siemens said Carbon also is optimized so AI functions can be added to enable for predictive workflow and an array of new technology applications.
Users will be able to call up syngo tool sets such as advanced visualization tools from anywhere in the enterprise. Auto quantification functions will be incorporated into reports. AI apps for various functions also will be fully integrated now, rather than sitting on top of the PACS or CVIS platforms as third-party interfaces. The system offers a zero-footprint viewer.
Visage Imaging introduced new cloud PACS solution, consolidating reporting, a multi-modality viewer, storage, and advanced visualization tools into one location and accessible from anywhere with an internet connection. The system is cloud native, so it is optimized for cloud operation, rather than an older system retrofitted to save and retrieve data from the cloud.
Change Healthcare introduced Stratus Imaging PACS在HIMSS，它的第一个云原生产品。这是一个全面的云软件即服务(SaaS)解决方案的放射实践。该平台将取代Change提供的老一代系统和它收购的前McKesson产品。
Change said cybersecurity is a major concerns by hospitals and radiology practices and moving to the cloud offers a mach more secure platform because the cloud providers have large teams monitoring and patching security issues.
On the cardiology side, Change is working on a completely new hemodynamic system, which will replace its older version that is missing parameters needed for new structural heart and EP procedures, and it was found to not be scalable between ambulatory surgical centers and large IDNs. The new demo system will be introduced in 2022.
A cardiology trend noted by Change Healthcare is the need to integrate easily with Epic and other larger EHR systems. Often hospitals use Epic Cupid for basic cardiology information, but they want the much more detailed CVIS reporting workflow offered by third-party vendors like Change.
Fujifilm recently released its new Synapse 7X enterprise imaging platform. The vendors acquired Hitachi's health IT segment and integrated its Vidastar cardiology reporting and image viewer and the Hitachi analytics models into Synapse. The cardiac segment is also tailored for specific pediatric cardiology reporting.
Advanced visualization vendorVital Images (now Canon)在过去的几年中，通过利用其Vitrea软件与各种供应商互操作的能力，已经得到了很大的发展。佳能将这一技术转变为全方位服务的企业影像平台。该平台现在被新奥尔良的Ochsner Health公司使用，集成了心脏病学、放射学和内窥镜。它允许自定义悬挂协议，例如添加自动MPRs，而不是在扫描仪上设置或在3D实验室中创建它们。它还提供了一个简化的基于web URL的查看器，供咨询医生访问图像和报告。
Vitrea Connect是系统的数据编制层。它没有将数据格式转换为系统容易吸收和存储的格式(如专有格式)，而是以本机格式存储所有内容。当打开图像时，它们将以原始格式打开。这允许将不同的数据组合到系统的VNA中，并从一个源提取数据。这还有助于规范化数据，以便以后可以将数据传输到另一个存档。它还完全集成了AI应用程序，而不是将它们添加为一个单独的层或模块。
Canon's Vitrea PACS data orchestration layer uses the original data formats for images. When images are opened, they are opened in the original format. The platform allows multimodality images and advanced visualization reformatted images to be displayed together in the same viewer.
Speed Has Become Key for PACS and CVIS Platforms
Another benefit of the newer generation web-based, cloud platforms is they offer much faster connection speeds. Large imaging studies can now be opened in less than a second or two, rather than waiting for long before the images appear and can be read.
Change Healthcare and Visage Imaging both used examples in their booth demos of 3D mammography tomosynthesis studies. In both cases, the vendors demonstrated they could open all the images in the study, from the cloud in less than 3 seconds. In the case of Visage, the exam was opened in Las Vegas from a remote server located in Iowa. This also included linked prior exams for the same patient.
Adapting Workflow to Better Fit Needs of Physicians
Adapting workflow to better fit radiologists was a theme explained by several vendors at HIMSS. Vendors displayed various workflow improvements on their systems, including automated hanging protocols, auto fetching and display of prior or related images of the same anatomy, and reducing clicks for various operations.
Change Healthcare展示了一个名为3-D Rotate的功能，放射科医生可以单击该功能并在CT扫描的任何解剖轴上添加一条中心线。然后，他们可以沿着这条线滚动数据集，而不是在标准视图上滚动通常的固定平面。它不需要放射科医生使用不同的观众或单独的程序，让他们继续工作在一个观众节省时间。
An example of an automated PACS hanging protocol that brings in relevant prior images displayed by Infinitt. The system pulls in comparable prior exams of the anatomy in the current exam. It shows a prior exam timeline at the top of the page and allows quick a quick review. The user can click on the preview images to take a peek so see if it is relevant before opening the entire exam. The images also sync to show the same slices of anatomy. As the radiologist scrolls through the current exam, the system will also roll through the prior exam at the same time. This offers a sizable time savings in reading the exam and prior. The hanging protocols also can be set to call up either MIP or MPR images automatically, based on the radiologists preferences.
To speed mammography reads on the GE Edison platform, as a patient's exam is opened, the system automatically fetches all prior mammograms. These are presented with the most recent prior side by side with the current exam. The radiologist can just click use one click at a time to flip through the other prior exams, which are numbered so they can access more information from if needed.
通用电气还展示了一项改进，通过在各种考试和之前的考试中创建一个小图标来改善图像的流动。在检查的缩略图上有一个小的绿色框，显示这些文件在放射科医生目前打开的多个屏幕上的位置。他们可以点击他们感兴趣的考试，它会自动填充他们的主屏幕，让他们更仔细地复习。
While having a large number of tools for image analysis and reporting may seem like a good things, Agfa said some hospitals, especially smaller center, are asking for easier customization to turn off many of the advanced features so they just have the common tools they need appearing in the main menus. Agfa altered its enterprise imaging system to allow easier customization, including a variety of choices with image hanging protocols.
通用电气还展示了一项改进，通过在各种考试和之前的考试中创建一个小图标来改善图像的流动。在检查的缩略图上有一个小的绿色框，显示这些文件在放射科医生目前打开的多个屏幕上的位置。他们可以点击他们感兴趣的考试，它会自动填充他们的主屏幕，让他们更仔细地复习。
Seamless Integration of Artificial Intelligence Into PACS and CVIS is Now a Trend
About three or four years ago, most health IT vendors realized they did not have the resources to develop in-house AI applications for every conceivable use. As a result, many began to partner with AI start-ups to offer their AI technology after they gained regulatory approval. The primary model developed was an App Store-like environment, where hospitals could pick and choose which AI apps they wanted and there was some level of integration guaranteed with the App Store vendor's primary IT systems.
However, vendors are now realizing that radiologists and cardiologists will not use AI apps if they are cumbersome, requiring extra logins, extra steps to access the AI, or the AI data being saved someplace separate from the rest of the past data. For this reason, many PACS and CVIC vendors are now looking beyond an App Store approach to full, seamless integration with the AI as if the app was developed as part of the system. This eliminated the need for interfaces, separate documentation, separate images, separate logins or opening software that sits as a separate layer on the main reporting or image viewing applications.
Companies that are now taking this approach include Agfa, Vital, GE Healthcare and Fujifilm.
“使用独立的应用程序太难了。爱克发的企业成像、放射学和临床应用主管Bob Craske解释说:“你需要与工作流程有一个坚实的集成。
Radiologists have become very accepting of AI in the past couple years as these algorithms gain clearance from the FDA. Craske said the discussion has moved from how the AI works to just having conversation on how this will help them in improve workflow. The areas where the vendor has seen most interest has been AI for chest CT lesions, chest X-ray bone removal, and indices of areas of concern identified by the AI to provide a backup review for the radiologists.
克拉斯克在人工智能方面看到的另一个趋势是，学术中心要求为一些用户(比如新居民)关闭人工智能，这样他们就不会依赖这项技术。
Siemens is creating a series of AI care pathways on its enterprise imaging platform, where the AI pulls in all the relevant data and prior exams for a patient just for a specific condition. This includes a dash board view of a cancer patient's data relevant just to their cancer. It also can be shown as a timeline flow chart, where the AI will suggest next steps for diagnosis or treatment based on the latest guidelines. The system also uses predictive analytics to suggest prognosis projections. At HIMSS, Siemens released its newest Digital AI Pathway Companion for lung cancer.
Cardiology AI Pathway Companion modules are being created for heart failure and coronary artery disease. Siemens also plans modules for infection diseases and breast cancer.
Change Healthcare introduced its first AI application to properly label body parts on all imaging exams, including prior images. The vendor is also developing an AI-driven worklist and hanging protocols.
Fujifilm's Reili AI platform is working with partners to improve its point-of-care-ultrasound (POCUS) offerings.
GE showed how its platform is using deeper integrations onto the vendor's PACs and cardiology reporting systems. They showed an example of partner iCAD's Profound AI computer-aided detection (CAD) for automated breast cancer findings in mammograms. This AI feature can be turned on or off. The vendor said radiologists that work with the system often want to read the studies themselves first and then turn on the AI at the end as a second set of eyes.
GE's iCAD Profound integration also includes text alerts at the top of the page for any automated findings the AI found. It also highlights suspected lesions with a colored field, showing what the AI thinks are the borders of the lesion. The radiologist can choose to bypass the suggested finding or accept it.
Fujifilm also expanded its automated anatomical identification in images from the radiology side into its cardiology imaging side of the system.
Siemens' Digital AI Pathway Companion for lung cancer uses AI to pull in all the relevant data and prior exams for a patient and offers graphics for the direction care should go based on current guidelines.
Deeper Integrations With Third-Party Imaging Analysis Application
It is not just AI, PACS and CVIS vendors are also looking at adding more deep integrations with third-party vendor applications. They say they want to move away from any interfaces that require opening a separate software, extra login, or workstation. This also will make everything seamless to improve workflow efficiency and the flow of data in the reporting system, archive and EMR access.
HIMSS的一个很好的例子是西门子医疗保健公司展示了一种新的深度集成超声心动图应变成像分析提供商Epsilon imaging。这种集成消除了单独登录的需要，Epsilon软件现在只是syngo系统中的一个工具选项。该软件自动量化右心室和左心室的壁运动应变，量化数字被带入西门子心脏超声报告。
Strain can be used to assess cardiac function more precisely than regular cardiac ultrasound exams. It has seen wide use in cardio-oncology programs, assessing a baseline cardiac function and performing serial exams over the course of a cancer patient’s chemotherapy regimen to catch cardio toxicity issues early, to avoid having the patient go into heart failure.
Reimbursement was recently added for strain in the U.S., which has caused rapid adoption of the technology. Epsilon is seen as the key vendor in this space, so Siemens and Fujifilm are now working with the company for closer integrations
HIMSS的一个例子是，西门子医疗集团(Siemens Healthcare)展示了与超声心动图应变成像分析提供商Epsilon imaging的新的深度集成。这种集成消除了单独登录的需要，Epsilon软件现在只是syngo系统中的一个工具选项，它可以直接将数据和图像传输到echo报告中。
Cerner在HIMSS上强调了与第三方供应商Quera在互操作性领域的深度集成。合作伙伴将医疗保健系统中几个不同系统的数据连接起来，创建心脏移植患者数据的单一视图，以便对该患者进行病例审查和持续护理。这两家公司表示，移植患者通常没有必要的数据来对他们的病例进行完整的审查，而且他们的护理覆盖了多个不同的医疗IT系统。这种软件集成将这些不同系统所需的所有部分集中到一个查看器中。
Cerner在HIMSS上强调了与第三方供应商Quera在互操作性领域的深度集成。合作伙伴将医疗保健系统中几个不同系统的数据连接起来，创建心脏移植患者数据的单一视图，以便对该患者进行病例审查和持续护理。
Related HIMSS Health IT Content:
VIDEO: Examples of Improved PACS Workflow to Aid Speed and Efficiency
VIDEO: Cardiology AI Aggregates Patient Data and Enables Interactive Risk Assessments
Photo Gallery of New Technologies at HIMSS 2021
VIDEO: Importance of Body Part Labeling in Enterprise Imaging— Interview with Alex Towbin, M.D.
HIMSS 2021 Showed What to Expect From In-person Healthcare Conferences During the COVID Pandemic
VIDEO: Coordinating Followup for Radiology Incidental Findings— Interview with David Danhauer, M.D.
August 01, 2022
