The move toward value-based reimbursement is shaking up traditional healthcare in all kinds of ways, as connectivity and cost-effectiveness become critical attributes in care delivery. Proprietary PACS, used in image acquisition systems, are starting to feel the squeeze from this dual pressure, as vendor-neutral archives take over many of their functions.
A recent study by Markets and Markets predicts a PACS-less Radiology world by 2018. Donald Dennison, Society for Imaging Informatics in Medicine (SIIM) Board director-at-large and the chair of the American College of Radiology (ACR) Connect Committee told attendees at the opening session for SIIM 2015, there are three external market forces that are trickling down into the imaging informatics world and leading to the demise of PACS: Money, EMR adoption and consolidation.
While PACS have traditionally been the workhorses of diagnostic imaging, providing workflows, viewing and archiving, their use of proprietary formats severely limited the ability of an organization to freely share images and created unnecessary and expensive complications in managing storage. They are a prime example of the episodic-care model, in which care delivery processes were created without regard to the broader needs of a patient. With the move toward value-based care, this episodic approach is rapidly being replaced by a patient-centric model, and proprietary silos are rapidly and rightly going the way of the dinosaur. In this case, value-based payments are the meteor strike that will so radically change the environment that these beasts are no longer equipped for survival.
Vendor-neutral archives (VNA), which can gather all the images into a standardized, patient-centered storage model, makes image sharing much easier. And VNAs have added on workflow and viewing capabilities that make PACS mostly superfluous. While having a VNA to unify all your diagnostic imaging is a good idea, it also has limitations. A simple VNA is more evolved than a PACS, but without more evolution and growth, it too will be unable to survive in the changed environment created by value-based payments. Fortunately, the VNA model is more adaptable than most PACS and is rapidly evolving to be far more than a DICOM-image repository.
An important part of value-based care is the ability to unify all data associated with a patient and deliver the right parts of that data where and when they are needed. That requires not only DICOM images, but also associated clinical data and documents and non-DICOM documentary images (such photos to document wound care). And all of that data must be integrated with the patient’s electronic health record. Finally, a layer of analytics is needed to ensure that relevant data can be extracted as needed.
Beyond individual patients, we have an opportunity to learn more about the progression of diseases if we can use this unified data in our predictive and population health analytics. In an article in Clinical Innovation+Technology, radiologists Eliot Siegel, MD and Gary Wendt, MD noted that this larger, unified data may soon offer unique value for diagnostic purposes and new clinical insights.
The article quotes Dr. Wendt (Dr. Wendt is the vice chair of informatics, professor of radiology, and enterprise director of medical imaging at the University of Wisconsin-Madison) saying
“Today when people are talking about big data and data mining, they are still talking about text. They’re not talking about actually mining content out of images. I think that’s probably the next generation, actually processing image data, not just text data. Ultimately, the clinical impact of such next-generation image archiving would come from the creation of more relevant reports [..based on data mining…]. This would be especially beneficial in oncology, where treatments can be modified based on tumor progression, and comparisons to similar cohorts of patients at an oncologist’s fingertips would be useful,”
As the VNA grows beyond image archiving, maybe a new name will be needed. The pre-release statement for a new IDC report (due out in December 2015) suggests a new description: Application Independent Clinical Archive. But I still like Dell’s name for our version of this archive (I work for Dell): Unified Clinical Archive.
By whatever name you call it, we are moving toward a truly patient-centered archive that will offer far more value than PACS or the simpler versions of VNAs. That’s good for all of us.
This article originally appeared on Autnminnie
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