Tuesday, December 25, 2007

Amicas + Siemens = ???

In response to my RSNA report about Amicas and Siemens, Anonymous asks this question:
Thanks for expressing your analysis on Amicas. I couldn't help but notice Amicas and Siemens in the same sentence. Do you think this would be a good acquisition for Siemens with the recent GE / Dynamic Imaging aquisition?

Interesting thought. The speculation on who will buy whom runs rampant, especially around RSNA time. I'll give you some rudimentary (read: uneducated) analysis about the topic, and follow that with what I hope actually does happen.

With that large company having just acquired the smaller company as mentioned by Anonymous, there aren't too many operations left that need a new PACS, let alone have the resources to afford one. Those that come to mind immediately are Siemens and Cerner. Philips bought Stentor a few years back, Fuji has their own, and Kodak has spun theirs off as CareStream (still sounds more like something the urologists should be dealing with than a PACS.)

Cerner had at one time a solution written by Cedara, now owned by Merge. I looked at it briefly in 2003 and wasn't terribly impressed. Neither were many others, as there were very few ever installed. Today, Cerner's ProVision™ PACS offering (which I didn't bother to look at whilst at RSNA) has these features according to their web site:

The Cerner ProVision™ Workstation is a comprehensive solution for diagnostic softcopy reading of digital images. In order to provide you with increased flexibility, the workstation supports multi-monitor configurations, "set up and save" viewing protocols, global user preferences, and comprehensive MPR features eliminating the need for specialty workstations.

In addition, the Cerner ProVision Workstation allows you to:

  • Increase productivity and physician satisfaction with decreased report turnaround
  • Generate continued returns from legacy investments and compliance to DICOM standards
  • Provide increased patient safety with synchronization of patient, procedure and image information when configured with Cerner’s RadNet including voice recognition and access to the EMR
Uh, well, nothing really distinguishing there, I'm afraid. Some of our hospitals use Cerner's Millenium RadNet, and since this is a kinder, gentler blog, let me simply say that I really, really like using Empiric's Encompass.net. I'm not sure how Cerner feels about its latest PACS, nor if it is thinking it needs a replacement. But, it pays to keep one's eyes open on such things.

Siemens has had a somewhat irregular history in the PACS field. SIENET Magic PACS came and went, and I don't think anyone would consider it particularly beloved. There was much hype in recent years about SIENET® Cosmos, which was a combined RIS/PACS product using Siemens syngo® common user interface, and e.soft which Siemens in 2000 defined thusly:

"e.soft is the first medical imaging computer that will adapt itself to the way the system's users work--and then do the work for them. . ."

So, syngo is an environment of a sort, that runs under Windows. e.soft is the programming language, although some of the definitions seem to be a little fluid.

Today, Cosmos has evolved into the syngo® Suite. The environment works something like this when integrated with the Siemens Sorian RIS:

It's an interesting concept that attempts to place a common interface on everything from the order entry to the scanner to the PACS. This is a good idea in theory, but most rads don't run the scanner, and most clerks don't read the images. I use the syngo/e.soft system on my Leonardo, I mean syngo workstation on which I read my PET/CT's. It is usable, but more than a little esoteric, and quite frankly, I would find it difficult to use as a PACS. That's my opinion, and I'm sticking to it. Sales of Cosmos/syngo PACS have not been great. I suspect I'm not the only one who can't quite get used to the idea. There are those who think that the Siemens back end is bullet-proof (see this thread), and I won't dispute that per se, but I'm not sure a PACS needs to be bullet-proof in this day and age. Anyway, the bottom line to me is that Siemens really should consider a new PACS. Let the common interface idea go.

Now comes the editorial part of my answer. PACS is one tough business. Many of the small fry are either bought out or go under every year. Anonymous of course cites one of the largest PACS acquisitions, probably followed closely by Philips' buying Stentor to create iSite. As near as I can tell, iSite is doing well under Philips' stewardship. (And Sectra, the "jilted" product, is doing OK itself.) If Cerner or Siemens wanted to buy a company, who is left? I would leave out the much smaller players, such as eRad, and so forth, and make a rather short list of Amicas, Emageon, and Agfa. Yes, Agfa PACS is apparently for sale, as I noted earlier, although it has yet to be sold. I have no idea how many suitors have approached Agfa, but I suspect the number is quite small, as it is probably a very expensive purchase indeed. Emageon has had its troubles, but its stock price has stabilized this month, albeit at a rather low level. The last time I looked at the product, it seemed good, and I'm looking forward to seeing it again in Seattle at SIIM.

And Amicas? Well, that's a different story. Amicas has a lot of cash in the bank, a new product in the works, and a veteran manager, Dr. Steve Kahane, at its helm. If I were giving Siemens (or Cerner) advice, I would say buy it, buy it NOW. Siemens, in my humble opinion, needs a new interface, and Amicas has a really good one. BUT, if I were giving Amicas advice, I would say, "Stay independent!" Being your own company allows a degree of lattitude that prompts development of innovative products. I know the folks at Amicas, and they know what they're doing. Would they survive under a large company? Most likely, as long as they were given a very long leash, but a leash is still a leash, isn't it? This is one of those "if it ain't broke, don't fix it" situations.

I realize that Amicas' stock hasn't done spectacularly well, either, and it just goes to show that the market doesn't understand the PACS business too well. For what it's worth, Amicas is buying back some stock:

"AMICAS chose to repurchase under Rule 10b5-1 because a 10b5-1 plan allows us to focus on the business rather than worry about timing and trading of our stock. This plan also allows us the flexibility to repurchase shares when the company may otherwise be precluded from doing so under insider trading laws," said Stephen Kahane MD, CEO and chairman of AMICAS.

Do the Big Companies do that? I suppose so. But I'm not interested in buying the stock (sorry, Steve), but I am interested in a PACS that works. Would Amicas PACS work as well (and be as affordable) if it were Siemens Vision Series PACS? I can't answer that. But I selfishly hope the status quo continues. It's working for me.

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