Heathcare IT, Your Cloud has Arrived Courtesy of Intel (and Carestream)

Preparing for the next-generation of medical imaging data and analytics

Cristine Kao, Carestream Health

Today, the cloud is a grownup with a seat at the IT table. The major issues around the cloud (security, access and speed) have been satisfactorily resolved by industries outside of healthcare: technology, software, financial services, Cloud_imageand retail have been using the cloud for years.

Of course, healthcare does have its own unique issues of privacy, security and access that make it slow to adopt any new technology, and the cloud has been no exception. But progress has been made. In a recent annual study of 125 large and small cloud users, for the first time in 2016, security was not the first concern mentioned. Technology has jumped ahead to meet the challenges of healthcare’s journey to value.

The cloud is an essential part of the healthcare industry’s IT structure/restructure to reduce costs, increase clinical collaboration and speed up clinicians’ access to information. As larger study files boost storage requirements, Intel and Carestream have partnered in Intel’s Storage Builder Program. The purpose of the collaboration is to blend Carestream’s expertise in healthcare information systems with Intel’s technological prowess to increase the performance of Carestream’s PACS and RIS systems and to make them more useful to clinicians.  For example, Carestream recently deployed the new Intel® Solid-State Drive (SSD) Data Center (DC) Family for PCle® P3700 featuring Non-Volatile Memory Express™ (NVMe™) and observed a threefold increase in throughput in that portion of the Carestream Vue workflow.

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Diagnostic Reading #12: Five Must Read Articles on Radiology and Healthcare Technology from the Past Week

This week’s articles include: tips for providers who are changing healthcare information systems; University at Buffalo and UBMD Orthopaedics win a $2 million NIH grant to study concussion damage; the FTC increases protection for consumer health data; an international team builds a new type of low-dose xray detector; and two-factor authentication can help protect the security of your accounts.

Tips for radiology practices on changing information systems – Diagnostic ImagingCarestream Clinical Collaboration

Get a prenuptial agreement before partnering with your PACS vendor. That’s the recommendation of Steven C. Horii, MD, director of medical informatics in the department of radiology at the Hospital of the University of Pennsylvania. Horii says the agreement should include guaranteed access to your old database and – in the event the vendor goes out of business – access to their database schema. Also, when considering a HIS or RIS replacement, find out how prospective vendors will handle the conversion and desired workflow capabilities.

University of Buffalo awarded $2 million grant to study concussions – Health Imaging

Researchers at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo received a five-year, $2 million grant from the National Institutes of Health to study the impact concussions have on an individual’s body and brain. Physicians from UBMD Orthopaedics & Sports Medicine will conduct the study and are looking for teenage participants.

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Diagnostic Reading #6: Five Must-Read Articles From the Past Week

This week’s articles focus on the role information technology will play in the moon shot for healthcare, topics CIOs should consider when managing PACS technology, the persistent value of the stethoscope, a program in which radiologists learn how to give patients good and bad news, and a projection that U.S. funding for on-demand healthcare companies will quadruple to reach $1 billion by the end of 2017.

Health spending in 2015 eclipsed $3.2 trillion a year, or 18 percent of the nation’s gross domestic product. CMS projects healthcare spending to reach $4.3 trillion by 2020 (18.5 percent of Diagnostic Reading PACSGDP) and $5.4 trillion by 2024 (19.6 percent of GDP). Here are six critical components for a moon shot that would give healthcare a chance to reach the ultimate goals it needs to achieve. Information technology isn’t the only answer in many of these, but it can play a powerful supporting role.

PACS can represent a particular challenge for CIOs. The technology has evolved from being confined to a silo within the radiology Continue reading

Global Worklist and the Connected PACS

Cheshire & Merseyside PACS sites

Dark blue crosses are Carestream sites, and light blue other PACS sites.

I will be taking part in two presentations at the European Society of Radiology’s ECR 2015 Congress, and each one will be related to the use of our Carestream Multisite Virtual PACS.

The first is a poster titled, “Establishing a regional on-call radiology service using a shared virtual PACS,” and was completed with co-workers K. Slaven, S. Dyce, and L. Anslow

Out-of-hours radiology has been delivered by radiology residents working on-call rotations in individual hospitals. As the intensity of work has increased, out-of-hours work has seriously impacted time spent during the day in the department. The need for compensatory rest has led to significant loss of training in what is already a relatively short training scheme.

Cheshire and Merseyside is a small but complex health economy in the North West of England. The system has the following facilities:

  • Seven acute hospitals
  • One tertiary cardiac hospital
  • One neurosciences centre
  • One tertiary paediatric centre
  • One cancer centre
  • One specialist obstetrics/gynaecology hospital

Six acute sites have resident radiology specialist registrars in rotations between four and nine in size.

None of the rotations were compliant with the European working time directive (EWTD). Four of the sites were on shared RIS/PACS, and the other two had PACS from different vendors.

The move to a shared global worklist (Vue Connect) and shared RIS has meant that the acquisition of images and reporting can be accomplished on separate sites. This also means that one resident can be on-call for more than one site at a time.

By combining the registrar workforce, we have been able to achieve compliance with the EWTD and significantly reduce the number of nights worked, hence allowing for a significant increase in training hours within the base  departments.

We are about to incorporate the last two acute sites. We have placed a Carestream agent on the last two sites, which allows image sharing seamlessly across all the sites including systems from other vendors. We plan to move to PACS-based reporting soon, so the residents will have a single workflow for their out-of-hours work, and to avoid having to work in three different PACS and three different RIS.

Our PACS has some unique features that makes this possible, and will be presented in the second presentation:

“Development of a shared multi-site virtual PACS”PACS - Cheshire & Mersyside

The co-authors for this presentation are S. Dyce, N. Pfirsch and S. Lomax.

As mentioned previously, Cheshire and Merseyside is a complex health economy. The previous system procured during the National PACS programme in England had PACS supplied by a single vendor in our region. However, image sharing was never a part of the programme and images had to be transferred by CD, DICOM push and latterly by a bespoke email-like system—the Image Exchange Portal.

There was a huge movement of patients from one acute site to another, or to specialist centres. Frequently, previous imaging was not available in a timely fashion, studies were reported in isolation, or even repeated when they could not be accessed. Regional multidisciplinary meetings were a massive effort to ensure all imaging was available for discussion, and image transfer was a huge overhead for all of our departments.

The goal was for all 10 trusts to have left the national PACS programme by June 2013 and this was achieved.

During procurement, we looked for a system that would behave as a single virtual PACS with seamless display of all current and prior studies. There was also a requirement to be able to view and report images from any site, and a requirement to support images from the two hospitals that had PACS from other vendors. A single mega PACS was a possible solution, but individual institutions wished to keep ownership of the images.

We selected our vendors based on these requirements:

  • Single master identifier – the NHS number
  • Acquisition and reporting are kept separated
  • Single instance of a study so annotations and reformats are applied to a single study
  • Seamless display of priors; the reporter could be unaware of the location of prior studies, but they appeared in local PACS

Carestream was chosen as a vendor that could support this workflow and deliver it in the six-month fixed timetable. The system was delivered before the cut-off date, and over 100TB of data was migrated into the system.

All of the above objectives were achieved, as well as the following:

  • Seamless multidisciplinary meetings with display of priors
  • Major reduction in overhead of image transfer
  • Specialist reporting e.g. paediatric, neuro is supported
  • Centralised on call centre for radiology residents
  • Significant Cost Reduction

The live presentation for “Development of a shared multisite virtual PACS,” will be given at ECR 2015 in SS 1805, on Sunday morning from 1030-1200.

Dr. Peter Rowlands, NHSDr Peter Rowlands, consultant radiologist at Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT).

 

 

Diagnostic Reading #7: 10 Most Popular Blog Posts from the Second Half of 2014

CARESTREAM Touch Ultrasound System - 1Carestream has worked hard to provide content of value throughout 2014. We have used our blog to deliver information about Carestream technology, address major industry trends, and inform readers about the medical imaging and IT fields. In this edition of Diagnostic Reading, we look at our most read blog posts since July. The topics include, the recent unveiling of our newest technology, industry infographics, image quality, digital 3D mammography, and dose reduction.

1) A LOOK AT THE NEW CARESTREAM TOUCH ULTRASOUND SYSTEM

Carestream unveiled its newest technology in Chicago at RSNA 2014. The CARESTREAM Touch Ultrasound System officially moved the company into the ultrasound market. This post contains information about the new technology, including images that explain its features and capabilities.

2) INFOGRAPHIC: THE EVOLUTION OF RADIOLOGY REPORTING

This infographic follows radiology reporting throughout history. It covers traditional hand written reports, transcribed reports, and voice recognition. Pros and cons of these types of report are listed. Ultimately, the evolution brings us to multimedia reporting and highlights its benefits.

3) UNCOMPROMISED QUALITY: BONE SUPPRESSION AND CHEST X-RAY IMAGES

Since being FDA approved earlier this year, radiologists are 58% more confident in their ability to read chest x-rays with bone suppression software. Since the software produces 2-D images rather than 3-D images, it also reduces the typical dose for patients receiving chest x-rays.

4) DREAM JOB: APPLICATIONS ENGINEER, DIGITAL MEDICAL SOLUTIONS

This Q & A with Marty Pesce asks questions about his experiences as an applications engineer for Carestream. The interview discusses the nature of a job as a radiologic technologist. Pesce also had the opportunity to answer questions about his personal experiences in the radiology field.

5) IMPLEMENTING EFFECTIVE WAYS TO REDUCE AND TRACK RADIATION DOSE FOR X-RAY EXAMS

El Camino Hospital in Mountain View, California, has taken measures to dramatically track and decrease patient dose. The hospital attributes this success to their transition from CR to DR technology. It claims that better imaging software leads to less repeated imaging.

6) DIGITAL BREAST TOMOSYNTHESIS NECESSARY FOR IMAGING DENSE BREAST TISSUE

This post emphasizes the importance of Digital Breast Tomosynthesis (DBT), or 3-D mammography for women with dense breast tissue. Numerous studies are noted by the author, including a JAMA study that found that by using DBT, there was a 41% increase in the detection of possibly lethal cancers.

7) RADIOLOGY’S RESPONSE TO HEALTHCARE CONSOLIDATION – STEP ONE: THE GLOBAL WORKLIST

With hospital mergers becoming prevalent, this post suggests that interoperability will continue to be a challenge. The adoption of software such as CARESTREAM Vue Connect could ease the transition. Combining data allows for both institutions to access their own information, as well as having access to new patient information.

8) THE ROLE OF A FULLY INTEGRATED RIS-PACS: DREAM OR REALITY?

Seventy-eight percent of office based physicians use some sort of electronic health record system (EHR). This post addresses the possibility of  radiologists and physicians working together using RIS and PACS to document patient records. There are inevitable challenges, but ideally this could mean “one patient, one record.”

9) RADIOLOGY AND MACRO HEALTHCARE TRENDS PART II: COST

In a time when Americans find it difficult to afford medical bills, radiologists must be conscientious about cost. Inappropriate imaging exams and lack of quality drive up costs, this post discusses how imaging appropriateness and effective reading of images can reduce costs in the field of radiology. Additionally, the post addresses other ways that health IT can help lower imaging costs.

10) THE THREE-PHASE PROCESS TO IMPLEMENT A PACS-DRIVEN TELERADIOLOGY SERVICE

Innovative Radiology adopted CARESTREAM Vue Motion. Since the implementation, efficiency has been higher. Additionally, Vue Motion connected Innovative Radiology with more than 40 sites in early 2014.

Radiology and Macro Healthcare Trends Part III: Quality Care

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

Part II of this series explored how radiology can impact cost effectiveness at healthcare facilities.  In this final post, we will look at delivering quality care in our new healthcare environment.

New regulations, controlled costs for facilities and patients, and technological innovations have given healthcare providers the ability to more easily provide patients a high-quality level of care. Particularly in radiology, we see significant advances in the products and software that support the capture and delivery of images.

Patients expect that the care they receive will be of the highest quality.  To contribute to this, radiologists should think about the following:

  • Streamlining Communication
    • Making sure that getting to images and results is easy for technologists, doctors and patients. One way to do this is leverage new technology that provides a platform from which this is possible.  Doctor and patient portals are becoming more and more popular – and standard functionality – across many types of healthcare facilities.
  • Playing a Role in Patient Communication
    • Instead of seeing radiology outside of the healthcare continuum, facilities and radiology professionals can work to see how imaging has a direct impact on the quality of patient care. This understanding must be facility-wide so that radiologists have the support they need to become part of the continuum and to be educated on how to communicate with patients.

Technological advances such as reporting platforms that offer native voice recognition, RIS or PACS integration, and advanced reporting, support internal and patient communication.  Having a strong, integrated reporting system contributes to reducing delays in processing and produces better, more contextual reporting.

One area in which streamlining communication and patient communication is having a greater impact is in the area of telemedicine.

Telemedicine, and to be more specific, teleradiology, has not entirely come to fruition because of laws and payment systems that are more encouraging for face-to-face doctor-patient visits. In the U.S., doctors are licensed by states, but the rules follow where the patients live, so doctors must also be registered in their patients’ states too. In the European Union, doctors are licensed by country and have the free reign to practice throughout the union, no matter where their patient lives.

While the U.S. may seem more conservative with telemedicine laws, telemedicine practiced within a state has its advantages. It can be difficult for those living in rural areas to have access to quality care. With a broadband connection, telemedicine can provide rural populations with high-quality care that many in more populous areas have access to. This is certainly the case in China, where it is spending billions on healthcare reform with an emphasis on teleradiology.

What do you think? Are you seeing radiology become an integrated, vital component of quality healthcare? Are there other trends to keep an eye on? 

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare is being published in three parts. Part I was posted in September and Part II was published in October.

 

Challenges of Stage 2 Meaningful Use Require More Allies

ONC, Meaningful Use, Stage 2

Click the picture to go to the HealthIT.gov website to learn more about Stage 2 meaningful use certification.

Stage 2 of Meaningful Use is a vital component to the initiative since it, as the U.S. government defines, “intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information.”

As reported by Hospitals & Health Networks, only 140 hospitals have achieved Stage 2 of meaningful use. Throughout 2014, hospitals have been claiming that requirements such as this are more difficult to implement than originally thought. Assistance is needed in the form of decreased time for reporting periods or providers fear that they will face the severe penalties.

From the vendor side, to properly help providers, it is clear that we must be able to provide the answers to two key questions:

  • Can the technology be optimized with the existing solutions in place?
  • One of requirements for Stage 2 states that more than 5% of unique patients during the reporting period must use the hospital’s portal to view, download or transmit their health info to a third party. Since patients will be using the technology, is it intuitive and secure?

For both of the questions, I feel confident that Carestream would be able to answer, “Yes.” Our Vue RIS platform recently achieved Stage 2 certification, making it one of the first RIS platforms to achieve both Stage 1 and Stage 2 certifications. This means that those facilities using the system can exchange patient medical records and clinical documents with other certified EHR providers.

Beyond just being having an integrated solution, working with your clinical departments can enable capturing specific clinical data required: i.e. smoking cessation, BMI etc. In the case of the University of Virginia, the organization shared that radiology helped meaningful use attestation because it was able to capture the data that would not otherwise be captured.

With the Stage 2 certification, Vue RIS includes the following capabilities: family health history, the transfer and sharing of health information, and online patient access to information and communication. Additionally, the RIS platform can also be coupled with the MyVue patient portal to allow for patients to view their exam results, view and reschedule appointments, and also share the exam results with their primary care physicians.

Stage 2 of meaningful use has been deemed so vital to the future of healthcare because it is the first stage that involves the patients becoming ingrained in the process. As the patients become more in tune with their own health, we must make sure that we not only provide them with the tools to take action, but also the guidance and education on how best to use them, as well as the benefits these tools provide.

What have been your biggest challenges when working to achieve Stage 2 meaningful use? What have you been doing to combat these challenges, and what successes have resulted?

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing manager, Healthcare IT, for Carestream.

 

 

 

The Role of a Fully Integrated RIS-PACS: Dream or Reality?

RIS_PACS Integration

The evolution of PACS makes it so radiologists are looking for more dynamic systems.

The EHR is playing an increasing role in the management of patients. In the U.S., according to a recent NHCS Data Brief, 78% of office-based physicians use some kind of EHR. Far from being just a collection of patient medical information in different storage systems, we need the ability to integrate all the information and to have it readily available, thus avoiding redundant tests and appointments. We also need to be able to manage sensitive data as well as to transmit it to health care decision-maker. It must be a dynamic system, constantly achieving more ambitious goals. However this vision is far from being shared by all the players, considering that even some national authorities view it simply as a data repository (or, to put it in bureaucratic jargon, “a set of digital data and documents relating to health and social health generated by present and past clinical events, relating to the patient”).

These goals can be fairly easily met either within homogeneous populations, or within a health system, which is allowed to set the rules of the game and to enforce them. However, this is an extremely complex task in all those environments where different systems are allowed to coexist and no rules are set/enforced to reach the ultimate goal of “one patient-one record.”

The end-solution to this goal lies probably, at least for the near future, in the vendor neutral archive (VNA). However even in its definition, VNA is a compromise solution: a medical imaging technology in which images and documents (potentially any file of clinical relevance) are stored in a standard format with a standard interface, making them accessible in a vendor-neutral manner by other systems. It can be considered an evolution of the original RIS-PACS concept, where no longer are radiology and nuclear medicine the sole players, but on the contrary, all the medical and surgical specialties are involved, as long as they are capable of providing images or documents to be managed within the same archive.

This makes the contribution of a fully integrated RIS-PACS of paramount importance. We should no longer rely solely on the principles of improved productivity, more efficient staffing, optimization of the financial management of the department we are running, and the backbone of the RIS as we have been used to consider it. Instead we should try to put under the same enterprise-wide umbrella all the images and documents which could fit in the system, with positive outcome in the patients’ management. I believe that the key word to this approach to the digital world in health management should be “share”—overcoming the still too common fear to make data accessible not only to the patients but also to “competitors” in the health business. Far from being just a tiny dot within the digital world, the fully integrated RIS-PACS should be a cornerstone not only to the VNA, but also to the EHR.

In fact, as long as we shall not be able to integrate within one single framework all data concerning all patients, whatever the source (private, public, national, trans-national as it happens in the European Union), the talk about a real EHR will sound just as a simple exercise in debate. Unfortunately, these same doubts are shared by other thinkers, such as Gary Drevitch in his short editorial, “Will we ever have universal electronic health records?” published last year in Forbes.com.

Dr. Ivo Bergamo- Andreis is Chairman, Department of Radiology/Diagnostic Imaging at Legnano City Hospital, Legnano, ItalyDr. Ivo Bergamo- Andreis is Chairman, Department of Radiology/Diagnostic Imaging at Legnano City Hospital, Legnano, Italy, and is a member of Carestream’s Medical Advisory Board

 

 

[eBook] The Three-Phase Process to Implement a PACS-Driven Teleradiology Service

A PACS-driven workflow has proven to be beneficial in offering teleradiology services, while still allowing referrers to use the HIS/RIS they prefer.

The story of Innovative Radiology is a common one experienced in the diagnostic imaging sector. The organization was experiencing an increasingly busy workload serving over 40 Houston-based hospitals, physicians’ offices, clinics, and imaging centers, which totaled about 300,000 procedures per year.

For about 10 years, Innovative Radiology was linked electronically to referring physicians through a single RIS to create multiple registration centers. Physicians had to manually register patients in the RIS and workflow was guided by it since the images and patient information went right to the radiologist. This was arduous and required an immense amount of coordination and system integration. On a given day, thousands of images would be sent to the organization from dozens of different systems. Since reporting was not integrated, the radiologists would have to log on to the RIS, select the study, then log on to the PACS to read the cases.

It was the adoption of Meaningful Use that forced Innovative Radiology to move away from its RIS and look for a PACS-driven system. By accomplishing this, the organization now has options—a referrer can still communicate with Innovative Radiology with its HIS/RIS, but it is no longer mandatory.

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

To implement the PACS-driven teleradiology system and services, Innovative Radiology needed to partner with Carestream to go through a three-phase transition process, which is outlined in the eBook, “Increased Capabilities: Do More with Vue for Teleradiology”:

Transition Phase #1: Innovative Radiology’s use of teleradiology began August 4, 2013. Phase 1 lasted two weeks during which two radiologists at Innovative Radiology were connected with two low-volume sites. About 40 studies from up to seven referring physicians were read daily. All involved digital radiography (DR). Report request order entries were created at Houston Medical Imaging (HMI) using Carestream’s Vue Motion. Report distribution was by fax. There was no email distribution and neither billing nor interface with the Houston healthcare information exchange (HIE) was possible.

Transition Phase #2: Continuing for two weeks, there was a leap forward in both study volume and sophistication. About 25 studies, including DR, PET, CT and ultrasound, were interpreted daily by three radiologists at Innovative Radiology. Studies were referred by 16 physicians from a single site, Oncology Consultants. Report request order entries using Vue Motion were created at the client site. Emails notified referring physicians that results were available via fax and Vue Motion. Billing and HIE HL7 interfaces were established.

Transition Phase #3: During this phase, the network was expanded to include about 30 client sites, including HMI and other large imaging centers. Within one week, 14 radiologists at Innovative Radiology were filing between 300 and 400 DR, PET, CT, ultrasound, MRI and nuclear medicine reports. Any of up to 2,000 physicians were referring studies for interpretation.

Today, Innovative Radiology uses a teleradiology solution that allows for an increase in study volume, workflow, and overall productivity. In early 2014, more than 40 sites were connected to Innovative Radiology via the teleradiology offering from Carestream.

For more information about Innovative Radiology’s story, and Carestream’s Vue for Teleradiology service, you can download this eBook, “Increased Capabilities: Do More with Vue for Teleradiology.”

What do you think about teleradiology? How is it improving care for the patients while also benefiting the providers that offer it? Did you experience roadblocks when implementing a teleradiology service? If so, what were they and how did you overcome them?

Kiran Krishnamurthy, Worldwide Product Line Manager, HCIS, CarestreamKiran Krishnamurthy is the Worldwide Product Line Manager for Carestream’s HCIS business.

 

Challenges to RIS+PACS Integration

Makori Arnon, Clalit Health Services

Makori Arnon, MD, MHA, Director of Imaging Informatics, Clalit Health Services, Tel Aviv, Israel

The world of radiology sees frequent use of the term “integration,” but this term can easily mean many things to different people. When used in conjunction with describing implementation of a RIS+PACS platform at a hospital, it demands we clearly define our expectations up front to minimize the challenges and disruption that can accompany integrating a new RIS+PACS platform into our workflow.

In the current environment we see that RIS, PACS and capture modalities are separate yet complementary entities that are really more bundled than they are integrated. We all know that RIS is a separate platform that is slowly being absorbed into the PACS or into EMR. PACS joins together both clinical information systems with the organization’s IT network and a successful implementation should have a very positive impact upon workflow.

Radiologists need to read images and dictate their findings, and being able to easily integrate images directly into the report via the RIS will help improve workflow. Integrating images into a RIS means that vendors will need to put more emphasis on developing improved RIS technology to provide higher-end throughput. By improving the RIS interface to better address workflow issues, a single-platform vendor will have a big advantage over another third party.

Carestream Radiology Information System

Integrating images into a RIS means that vendors will need to put more emphasis on developing improved RIS technology to provide higher-end throughput.

In the contemporary radiology department, knowledge is everything. This knowledge goes outside the walls of the healthcare facility with the advent of patient portals that allow patients to electronically access, store and share their medical images. With a well-integrated RIS+PACS platform, radiology professionals expect amplified clinical, business and IT benefits that include:

  • Greater value and insight resulting from the generation of clinically-rich reports
  • Improved workflow
  • Greater cost control and a streamlined data flow
  • Increased patient engagement and satisfaction with an intuitive patient portal; and
  • The ability to foster clinical collaboration without boundaries.

To achieve this, we need to improve upon the current integration process by providing a system or single platform for the reading and distribution workflow. Successful RIS+PACS vendors are making this a key focus of future product development activities.

Another issue to consider is that radiologists continue to change how they work. We are now seeing more “point of care” imaging where you have physicians creating medical images by capturing images with handheld ultrasound or endoscopy units. These physicians (not radiologists) are creating a workflow that is “orderless” or “non-scheduled”—and the organization will need to accommodate this workflow by supporting the input of these images into the PACS. Point-of care imaging is an integration point that we will need to see in future development efforts since it is clearly on the rise.

How is your organization handling the integration of RIS+PACS?

What will your RIS+PACS platform look like in the next 10 years?

Makori Arnon, MD, MHA, is the Director of Imaging Informatics at Clalit Health Services in Tel Aviv, Israel. He is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends.