Thursday, February 14, 2008

Microsoft Enters PACS Game

Microsoft has been dabbling in the Healthcare IT space, and the fruits of their labor (and acquisitions) will debut at HIMSS later this month. The press release notes" The package is called Amalga, which to me is all too close to the word "amalgam," the mercury-containing metal that used to be used in dental fillings.

Microsoft Amalga: The new version of the product formerly known as Azyxxi, Amalga is part of a new software category called Unified Intelligence Systems that allows hospital enterprises to unlock the power of all their data sitting in isolated clinical, financial and administrative systems. Without replacing current systems, it offers an innovative way to capture, consolidate, store, access and quickly present data in meaningful ways for use by clinicians and executives of leading-edge institutions. Amalga is designed for hospitals and health systems that have invested in a diverse set of IT solutions.

Microsoft Amalga Hospital Information System (HIS): The new version of the product previously named Hospital 2000, Amalga HIS is a state-of-the-art, fully integrated hospital information system designed for developing and emerging markets. Amalga HIS is built around an electronic medical record (EMR) with complete patient and bed management, laboratory, pharmacy, radiology information system and picture archiving and communication system (RIS/PACS), pathology, financial accounting, materials management, and human resource systems.

Microsoft Amalga RIS/PACS: The new version of the product formerly known as GCS Amalga is now available as a stand-alone system as well as an integrated component of Amalga HIS. The integrated architecture means that a radiologist can use a single application to manipulate and study images and access the patient medical record. The workstation interface is optimized for radiologist workflow, including support for predefined templates, an intuitive report editor and voice recognition capabilities.

Of course, I'm more interested in the PACS product. The Microsoft Amalga website emphasizes the interconnectivity of the Amalga software:

Most companies don’t integrate their PACS and RIS software, translating into a forced fit between the systems. This often imposes the manual matching of studies between the PACS and RIS.

The Integration of Microsoft Amalga RIS/PACS provides a powerful, truly seamless system that can deliver quick, high-quality data to any department, which, in turn, can help hospitals increase patient turnaround time and enhance the patient experience. Integration also improves data integrity between PACS and RIS, can reduce transcription errors and duplication of data entry, and optimizes report turnaround. The system fully supports paperless, integrated workflows and facilitates easy access to patient medical information and order, scheduling, and study information.

The radiologist workstation is designed to optimize radiologist workflow. This unified system provides access not only to standard image manipulation tools, but also to the patient Electronic Medical Record (EMR), without requiring the radiologist to log on to external systems. Available information includes all previous laboratory and radiology results, the patient’s medication profile, and clinical notes. In addition, all historical studies are stored online rather than archived, which means historical films can be reviewed anytime, as needed, helping providers to improve their patient care.

The "key benefits" are mostly what you would expect:

  • Automatic order management integrated from EMR and RIS.
  • Automatic scanning and attachment of hard copies to study orders.
  • Image manipulation tools include 3-D cursor location.
    Multiple language support provides patient demographic and screen label data in any Unicode language.
  • Integrated database ensures patient medical information is accessible directly from the PACS.
  • Template-driven options include reporting and voice recognition.
  • Intuitive Report Editor accepts written or dictated reporting.
  • Preference for radiologist worklist studies are customizable.
  • Instant Study assignment to radiologist at time of ordering.
  • Warning system provides real-time notifications to prevent radiologists from reporting a study that is being reported by another radiologist.
  • Online Historical studies make historical studies available for quick retrieval, regardless of study age.
  • Unlimited Study revisions save any or all key images, window-level settings, and image annotations.
  • CD creation for PACS studies, Reports, and Electronic Medical Record. Options include DICOM and JPEG images, reports, and all or selected portions of a patient's EMR.
Frankly, this doesn't sound that much different than most modern web-based systems, at least those with online priors.

Microsoft, like some other big companies that come to mind, sometimes innovates and creates its own product, but often will simply buy the expertise and the software lock, stock and barrel. Such is the case here. Amalga started life as Azyxxi, which according to the Wikipedia, was "is a unified health enterprise platform designed to retrieve and display patient information from many sources, including scanned documents, electrocardiograms, X-rays, MRI scans and other medical imaging procedures, lab results, dictated reports of surgery, as well as patient demographics and contact information. It was developed by doctors and researchers at the Washington Hospital Center emergency department in 1996, and in 2006 it was acquired by the Microsoft Health Solutions Group, as part of a plan to enter the fast-growing market for health care information technology." Washington Hospital is part of the MedStar Health system.

As for the RIS/PACS module, this has been borrowed/purchased/liberated (and expanded) from

GC RRITS SDN BHD (GCR), is a Malaysian Company, which provide integrated information technology solutions to the healthcare industry. The business is built around its core product, Hospital 2000, was developed and will continue to develop locally, based upon a proven international standards.

The RIS/PACS module of Hospital 2000 is called....drum roll, please..... Amalga! Here is a link to the full brochure, and here are some screenshots:

Interesting look. No doubt Microsoft will add its own touch to the interface. But how well does it work? How will it be marketed? I guess we'll have to wait and see. Anyone want to send in a report from HIMSS?


Based on Aunt Minnie discussions, the RIS/PACS and other parts of the program may have been written by Global Care Solutions from Bangkok in cooperation with Bumrungrad Hospital. GCR may therefore be GCS's Malaysian reseller. However, in the statement above, which is no longer on the GCR website, they refer to local development, and local for a Malaysian company probably means Malaysia rather than Thailand.

The GCS website ( now resolves to the Microsoft Amalga website.

In the end, it probably doesn't matter to anyone. Microsoft needed software in this space and found a reasonably good, and presumably reasonably priced product. Let's hope they learn the lesson from GE and avoid running it into the ground.


Anonymous said...

In fact the web site could have copy/pasted from any number of other sites. Every now and again an IT company which worried about growth in its tradional 'horizontal' market (like office automation) looks to break into verticals (like healthcare). HP had a bad experience a couple of years ago trying to bring 'digital paper' into healthcare - only to discover it didn't understand the use cases nearly enough. HP's ancestor Digital struggled with a number of such before capitulating to the market (and Compaq). MS will have all the same challenges that any new player will have - the cost of pre-sales (Mike Cannavo estimates up to 50k per RFP in recent AM article), the cost and logistics of pre- and post-sales support (which is very different to vertical markets).

Perhaps I'm being a little neurotic here - but not once on the Amalga web site is HL7 mentioned.

Anonymous said...

You won't be finding Amalga in any U.S. hospital anytime soon as Microsoft needs to get FDA approval before it can sell it to U.S. hospitals. Furthermore, it is striking similar to the first Windows based PACS I designed almost ten years ago!

Anonymous said...

As a further comment I'm not so sure that the Global Care Solutions FDA 510 approval is still good under the Microsoft name, only time will tell.

Unknown said...

From the website: "can help hospitals increase patient turnaround time "

This may be true, but I'm not certain that administration would consider this a selling point for a healthcare IT system... Ha! You'd think MSoft would have caught that by now.

Will it run on a Mac?

Anonymous said...

I just watched a show recently on the science channel called "Beyond Tomorrow" or something like that where they did a spot on this PACS and its use at the hospital it was developed at in Washington. To be honest, nothing seemed to revolutionary, and actually seemed old. Microsoft must have seen something, I imagine, or they got it for nothing...

Anonymous said...

I know it is nothing but the old Hospital2000 product. I am not saying it is "bad". In fact it seemed to meet my needs so I contacted MS and they got me in thouch with the head of their Europe, Middle East and Africa (EMEA) head. We exchanged several email and talked on the phone about price/implementation/etc and everything was agreed.. I asked him to send me some info brochures/demo but I was told MS will do a demo "live" when we wanted. So I went to my clients and they of course want to see at least a brochure which I don't have and after repeated requests none have been sent to me. My clients want to see a demo but but for two months now I have been trying to get in touch with them about setting it up but not only don't I have a demo, they have not replied to any of my emails. I then got in touvh with the Director for Hospital Solutions for EMEA and she replied to her email after a month giving the excuse she just saw my email and asked if the head of EMEA gotten in touch with ne by now. I informed her he had not and wondered if she could be of help. Well it has been two more weeks and not a word from MS.

I am wondering if MS does have a "product" or are they just going to dump it realizing they can't handle it???