Follow The Yellow Brick Road...The Centricity Upgrade Path

There has been a lot of rumour and innuendo concerning just where GE is going with its latest acquisition, Dynamic Imaging, and their IntegradWeb PACS. The discussion is further accentuated by mention of a Linux server upgrade to Centricity that will cost Heaven-knows how much.

I had the chance to speak with some very nice GE people who helped clarify all of this, at least to a significant extent. Some of it begins to make sense...

First off, as a site with Centricity 2.x and old Sun servers, we are, as they say, SOL. This is now an end-of-life product, a situation which GE blames on Sun for abandoning the hardware itself. So, to go to Centricity 3.x (presently 3.03 with 3.04 in the wings) we must replace the back-end with the new, flashy Linux server. I don't know off-hand what actual hardware this encompases, but the new server is supposed to be the lynchpin of GE's new IT-style approach to PACS and all things digital. Supposedly it is a more "robust" hub for connectivity of various things like Pathology and Cardiology images. How much will this cost? Well. . .we're not totally sure, but probably less than $200,000, but likely more than but closer to $100,000. It could have been worse, folks.

As it turns out, the Linux server has been a part of the plan for the last three years, and there are already 1500 of them out there.

I have speculated that 3.x is the end of the line for Centricity, but officially, that is not the case. Supposedly, there is a 4.x in the planning stages. GE is not yet ready to pull the plug on our old friend.

There is a laundry list of improvements that differentiate Centricity PACS 3.x from 2.x. These include:

1. Consistent Presentation of Images (CPI), part of the IHE profile
2. GSPS (Gray-Scale Presentation State)
3. Unreject Images
4. Hiding Images
5. Color Export
6. Go to Image
7. ROI Annotation (for multiple images)
8. Modality-defined left and middle mouse button assignments
9. DICOM Send-now sends GSPS and Key Image Notes
10. Keyboard Shortcuts (see this link)
11. Unlimited Status Changes
12. Voice Commands--Allows the user to control the PACS application and to dictate annotations and notes
13. Confidential Patients
14. STAT prioritization
15. PGP-Presentation of Grouped Procedures
16. Voice Clips
    

These upgrades apply to the main thick client, called the RA1000. A few will be ported over to the Centricity Web client as well.

These additions add some interesting fuctionality (I'm intrigued with the voice-control thing, although if it works as well as the voice-controlled navigation in my car, it won't be worth the disk-space it sits on.) There is now the option of integrating the Advantage Workstation into a viewport of the PACS. This is done entirely in software on the PACS workstation, with no client-server setup. The fundamentals of the viewer remain the same, however, and in particular, the worklist is still pretty primitive, and creating hanging-protocols, or DDP's, is still rather painful.

Now here is where things get interesting. We all know that GE bought the IDX company and thus acquired its RIS. (Of course, this led to the "old" GE RIS going EOL, but that's another tale.) Centricity's new RIS is as displayed is called the RIS-IC (maybe IC stands for IDX-created?) and in the implementation shown to me, it really takes the place of the worklist, and the text or demographic page. As a worklist, it does a reasonably good job, showing what's stat, what's locked by someone else, what's directed to you in particular, etc. It is very, VERY configurable. It isn't an Amicas RealTime Worklist, of course, but it is a huge step up for Centricity.

And how much more for the RIS-IC? Well. . . my understanding is that it will be included with the purchase of the Centricity 3.0 Linux server. Maybe I missed something. . .

A very interesting aside about the IDX RIS is the integration of speech recognition. Actually, I don't think you can get it right now, because GE/IDX has apparently had its share of problems with the Nuance engines. They are moving toward using something called M*Modal which does something called "speech understanding" rather than speech recognition, and requires no training. I'll believe it when I see it, but I'd like to see it!

Now that you've suffered through the other drivel, it's time to reap your reward, the UPGRADE PATH! There are actually several options to be available, and I don't know how much more each will cost. But here they are:

1. Don't do anything, stick with Centricity 2.x and scour junkyards for Sun server parts.
2. Immediate migration to IntegradWeb, or IW as they like to call it. Basically, this would be the same as buying the "old" Dynamic Imaging product would have been six months ago, except it now has a green GE on it. While the images will migrate, the annotations and what not won't. Not a great choice.
3. Buy the Linux upgrade, and round about November or December of this year, buy an IW to replace the Centricity Web for outside access. Yes, folks, this means that IW will be implemented as a web-appendage, a server grafted onto the Centricity 3.x database. If that bothers anyone. By mid-2009, remote dictation will be added to the IW, allowing one to actually use it for interpretation. I didn't ask the question, but I have to wonder if this means that one won't be able to click a study as dictated and have this propagate back to the PACS itself until this change occurs.
4. In late 2009, the IW will be available as an alternative GUI for Centricity 3.x

As the relationship with DI progresses, the two cultures will start to mix, and the designers from both camps will sit down together to create the next generation of GUI's. At the risk of offending my friends at GE (there might still be one, you know!), I have to hope that the offspring of this marriage favors IW more than Centricity. A lot more.

I'll keep you posted on where we go with all this.