Thursday, February 03, 2005

PACS Selection Committee 2003, Part II

Klas 2003 Posted by Hello
A comparison of market share, etc, may be found at the Reilly Communication site: Several trends are apparent, but the most critical is that of web-based technology. This is where all vendors are headed, and all will admit this fact. There are only three companies among the major players that are at this point NOW: Amicas, Fuji, and Stentor. Most of the other vendors have told me that they will implement a web-based architecture sometime in the future, though only Siemens gives the timetable of 18 months or so to do this. Count on a significant hardware change out within the server to accomplish the move. All vendors now use PC/Windows for their workstations, but some still use Sun/Unix computers for database/server applications. By individual vendor: AGFA: Obviously, we have history with them, and they have done a superb job of prolonging the capacity of equipment well beyond the end of its useful life. We currently are one of three remaining IMPAX installs in the world. The system cannot handle data from our GE LightSpeed 16 CT scanner, necessitating an emergency interim solution, which likely will be provided by Amicas. Two years after our system was installed, AGFA changed their workstation platforms to Windows/PC from UNIX. An upgrade would have cost $2M. However, the upgraded system might have handled the 16 slice data. Agfa was once the market leader; in fact it dominated the market for many years. Its market share has slipped considerably, especially in the US, with far fewer new installations than GE or Fuji, the new leaders. As above, Agfa does plan to convert to a web-based architecture, though I was not told when this would occur. There would have to be a complete change of the server hardware to accomplish this. I tested IMPAX 4.5, and the client is actually quite good from my standpoint. It uses a limited form of Voxar 3D. Several AGFA sites are now using Amicas for web distribution. AMICAS: Let me state in no uncertain terms that I do NOT think this is the perfect system by any stretch of the imagination. However, this is a very versatile product from a very innovative company, and deserves further consideration. Amicas was purchased in the last week by VitalWorks, a fairly large company dealing in web-based RIS systems among other products. The purchase price was a fairly substantial $30M. VitalWorks has pledged to maintain Amicas as a wholly-owned but independent subsidiary. Rather than cloud the future of Amicas, I feel this acquisition ensures Amicas’ presence in the marketplace for the foreseeable future. The product is totally web-based; it IS a web-server at its essence, and it uses a non-proprietary form of DICOM which allows far easier migration than with other vendors. The LightBeam viewing client is one of the more user friendly out there, and it includes a worklist function that is second to none. There are monitoring and administrative functions for the PACS administrators and remote monitoring from Amicas. This company deals with software only, and hardware must be maintained by the hardware vendor (Dell, IBM, Compaq, etc.). Sites I have contacted have had little problem with this. (I would personally want Amicas to interface with the vendors such as Dell, to initiate any service call.) They do not have a Cardiology solution of their own, but can accommodate several third party programs. There is a limited form of Voxar 3D, with new memory management techniques to allow very rapid deployment of the 3D module (or optionally the full Voxar 3D program) from the viewer. Cerner: This system does one thing quite well: it interfaces with their Cerner RIS. Otherwise, there is little in its favor. Apparently they claim 20 installs; I have only been able to confirm about 5, and rumor has it that they never even mention one very troubled site (Detroit?)
Fuji: Synapse was the first web-based PACS system. Their architecture appears very solid. The viewing client is rather esoteric; many like it, some don’t. I have spoken to one of the senior Fuji VP’s in charge of the Synapse project, and a new version of the front end is in development. I have been less than impressed with the regional Fuji representatives. They generally do not know the capability of their system, and have to call back to the head office to get the answer to any question. At SCAR, it was made very clear that Fuji would monitor usage and charge accordingly. Fuji users I have met have been satisfied overall, but note that “you will get what’s in your contract, and absolutely nothing else.” Our site visit to Austin was billed as an example of Fuji interconnecting several hospitals. The system did seem to work well, although there had been a 5 hour outage the day before that no one could explain. The interconnection, and really the main functionality, had NOT been designed by Fuji, even though they implied otherwise, but rather had been set up by the group in Austin and Time Warner Cable. There is limited integration of Voxar 3D; clicking a button launches it but that’s the extent of it. They may be replacing it with their own 3D program. GE: The largest company in the business. Centricity version 2.0 has been touted for over a year, and might actually ship in December. The client is very well done, except there is not a set 3D solution. GE actually started selling Voxar 3D as an option after I got the two companies together. The underlying architecture is very complex, and I’m not even sure GE knows how it works. I spent about an hour trying to get their PACS people to tell me if it was web-based; finally, we conclude it is not, but it is web-enabled. This means there is internet access into the main database, provided by yet another box attached to the system, but the system is not a web-server in and of itself. They will change over eventually, and a new server and other associated hardware will be needed. Centricity is acknowledged to be the most expensive PACS system of all. A system was to be placed at Emory, but after GE’s price went up by several $M, Siemens was brought in instead. (GE tells me that Emory asked for a much expanded system accounting for the increase.) Installs at (local sites) have had numerous startup problems, according to the docs and techs. Radiologists at the hospital are now more or less satisfied with the operation of the system. Philips: Their product is made by Sectra of Sweden. Philips has more world-wide installs than any other company. The user client is quite user friendly, though not really particularly distinguished. It is modular, and will accommodate third party software for 3D, Cardiology, etc. Service and uptime are extremely good by report. Architecture is of the old style, distributed database. As with AGFA, GE, and Siemens, there will be a web-based replacement, though no one at Philips could tell me when this will occur. Siemens: Sienet uses a very unique client, though it is a match to their other eSoft components. (CT’s, gamma cameras, etc.) The architecture is of the old model, and as above a replacement is planned for about 18 months from now. Of all the vendors on this list, Siemens seems to get the most complaints. Summary: Forgive the long discourse, but this is a brief distillation of what I have learned over the past several months. In short, there is yet no perfect system. Several companies were eliminated by the initial Cap Gemini survey that likely should have stayed in the mix, including DR, McKesson/ALI, and Stentor. Even working within the Cap Gemini suggestions, the review committee’s recommended cut keeps AGFA, apparently for no reason other than the fact that we are familiar with it, and removes Philips and Amicas, which are still very formidable players. I understand the limitations of time involved in site visits, but I feel any extra effort required will be rewarded with a more optimal decision. Therefore, I strongly disagree with the current recommendation. The roll-out date has already been pushed from February, 2004 to May, 2004. I recommend we revisit the choice of vendors, and take the time necessary to utilize all information available. There is much expertise on this committee which has yet to be tapped.

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