80K Hits . . .and some interesting software

Image courtesy of: http://www.predig.com

Visit 80,000 was from a Sprint/United Information Service customer in Kansas City, Missouri, who found me via Google. They were trying to find out "who's going to buy GE business". . . I guess that remains to be seen, eh?

In the meantime, I just read about an interesting piece of software from BridgeHead Software. The product is called PACStore, and it supposedly

. . . helps healthcare organizations reduce the accelerating storage hardware and management burden imposed by the long term retention and protection of PACS (Picture Archiving and Communications Systems) medical image data.

The function that grabs my eye has to do with the old problem of uniting disparate PACS:

PACStore effectively unifies PACS data by enabling clinicians to search across stored medical images from different proprietary PACS systems. It does this through a search facility based on the Digital Imaging and Communications in Medicine (DICOM) standard used by most PACS vendors.

PACStore is storage agnostic, providing unlimited flexibility for selecting and deploying different types of storage media throughout the evolution of your data lifecycle management strategy. Storage costs are reduced as PACStore automatically moves data onto the appropriate storage media based on how available it needs to be. The most current, active PACS image data stays on the most highly available primary storage, while static data, which is viewed less frequently, is moved to alternative, lower cost media in line with compliance and protection requirements.

Sounds pretty good. I would remind the folks at BridgeHead that radiologists like to search too, not just clinicians. In fact, I think our needs are more important! And, they are a little too IT centric in their approach, or at least in their advertising:

The PACStore Solution

Traditionally, PACS vendors have provided internal standalone backup and offline archiving capabilities to address PACS data only. This created stovepipes within the organization, resulting in redundant technology assets outside the control of IT.

With a single complex study soon expected to consume upwards of 1TB of disk space, you can no longer afford redundant systems for medical image management.

PACStore from BridgeHead allows you to leverage your existing IT infrastructure, putting IT back in control of all your data.

Hey, wait a minute! I don't want IT in control of my data! But I get where they are coming from. This seems to be more of an internal fix than something to truly bring several external PACS together, but the idea could perhaps be redirected to that end.

Did they say 1TB per exam?

Indiana DalaiAnd The Archive Of The Lost RAID

Follow The Green Brick Road. . .The Official GE Version

I've been fortunate enough to make some good friends in the PACS business over the past few years. One of them is a great guy by the name of Brad Levin, whom I met while he was working for Amicas. Brad later joined Dynamic Imaging, and now, of course, works for GE.

Brad read over my previous post about the upgrade path for Centricity, and was kind enough to pen the official GE response, which follows unedited below:


I hope everything is well. On behalf of my colleagues at GE Healthcare IITS, I wanted to follow up on your comments from, "Follow the Yellow Brick Road ", posted on April 18, 2008. Per your inquiries, we wanted to provide additional detail and also clarify a few items referenced.

1. Centricity PACS version 3.X - As mentioned, our upgrade program for Centricity PACS 1.X/2.X has been offered for nearly three years, and (other than users running the latest Solaris hardware (V480)), requires a Solaris to Linux upgrade due to hardware end-of-life from Sun Microsystems.

2. To be clear, the advanced visualization solution you are referring to is marketed as “AW Suite” and is now available via software integration to Centricity PACS 3.X. Presently, the AW Suite embedded integration includes the following applications: CardIQ, AutoBone , CT Colon , Advanced Vessel Analysis, and Advanced Lung Analysis.

3. Since the acquisition of IDX by GE Healthcare, the ImageCast (IC) radiology information system has been marketed as Centricity RIS-IC. Presently, RIS-IC is ranked the #1 RIS by KLAS (Radiology (large) category, 2007 End of Year Report, 12/07, http://www.klasresearch.com/). As an integrated solution for RIS/PACS, this is marketed as Centricity Radiology. As a point of clarification, the Centricity PACS worklist is not changing to the interpretation worklist used by RIS-IC; however, customers using Centricity Radiology may choose to implement a RIS-driven workflow. Only in that case would the RIS-IC worklist be used. One last note about RIS-IC, the upgrades to Centricity PACS 3.X have no relation whatsoever to RIS-IC. Accordingly, Centricity upgrades do not include RIS-IC, and therefore, your comment about RIS-IC being “….included with the purchase of Centricity 3.0 Linux server…” is not accurate.

4. Regarding the new Centricity PACS-IW, similar to our naming structure for RIS-IC, the “IW” stands for “IntegradWeb”, based upon the recently acquired IntegradWeb PACS from Dynamic Imaging. Centricity PACS-IW is presently the #1 ranked PACS by both KLAS (PACS-Acute Care (large) Report, 4/08, http://www.klasresearch.com/) and MD Buyline, for the past two years in a row in the MD Buyline Intelligence Report for PACS, http://www.mdbuyline.com/.

Also, just to clarify a few items related to your upgrade discussion:

1. Your first upgrade alternative is a status quo decision to remain on the Solaris platform of Centricity 1.X/2.X. As you are aware, all hardware has a similar cycle – in just a few years, hardware that was once state-of-the-art eventually turns end-of-life. The decision by Sun to move their server hardware to end-of-life was made independent of GE Healthcare; however, it does have a significant impact on Centricity customers, and the solution is to upgrade to Centricity PACS 3.X. By moving from Solaris (a proprietary platform) to Linux, GE is moving to a more mainstream technology that in the long term provides Centricity customers more performance, choice and flexibility.

2. The second upgrade alternative you mention concerns an upgrade to Centricity PACS-IW. Any upgrade to Centricity PACS-IW would include a traditional PACS migration of images and results. While migration is rather commonplace in the replacement PACS market today, you are accurate that many of the unique data elements (e.g., annotations, key images) from Centricity PACS would not be able to be migrated to Centricity PACS-IW. This consequence of migration is the same when migrating from just about any PACS to Centricity PACS-IW, as well as the consequence of migrating Centricity PACS to any other PACS sold today. Considering this limitation, we do not recommend this as an option. Whether in the future GE will be able to export all the unique data elements is unclear at this time, thus, we are taking the most conservative approach by not committing to it and not recommending it. The only way to ensure the protection of these data elements is to upgrade through the Centricity PACS (not PACS-IW) product family.

3. The third upgrade alternative you discuss protects your investment in Centricity PACS by upgrading from Solaris to Linux, upgrades you to the latest Centricity 3.X platform complete with the new features you explained to your online audience (nice, thorough list, thank you), while also leveraging the diagnostic capabilities of the IW viewer anywhere over the Web. Currently there is a worldwide engineering initiative leveraging the strength of the IW diagnostic viewer and Centricity PACS 3.0 [Note: Prior versions of Centricity will not be able to take advantage of this new product]. This new product, Centricity Web DX Viewer, which we announced at the SIIM 2008 conference just last week, is a work-in-progress (WIP). This diagnostic capability will enable diagnostic interpretation anywhere over the Web, powered by the IW viewer. The Centricity Web DX Viewer will directly connect to the Centricity PACS 3.0 database and enable radiologists to perform complex image manipulations to include 3D (MIP/MPR) along with all of the other features of the IW viewer, change study status directly in the Centricity PACS 3.0 database, while also being assured the appropriate study locking mechanisms are in place. As this effort was scoped earlier this year, our Centricity PACS beta partners have already been identified and engaged. Keep in mind that Centricity Web DX Viewer is not meant to replace any of our existing client technology, as we are continuing to invest and support those programs. The Centricity Web DX Viewer is an additional capability that our Centricity customers can soon choose to add to their Centricity PACS environment, without compromising the investments they've made to their Centricity PACS infrastructure.

4. In terms of next generation development, we have indeed brought together our research and development teams from Centricity PACS and Centricity PACS-IW, leveraging the best innovations from each team into a single next generation effort. The current iteration of the next generation solution was demonstrated at the GE SIIM Customer Event last Thursday evening and was extremely well received.

In closing, GE Healthcare looks forward to helping you and your colleagues leverage your investment in Centricity PACS for not only today, but for the future. We pledge to all of our customers that we will continue to ensure an upgrade path for Centricity PACS, as well as integrate and make available the best available technology in the GE Healthcare product portfolio. And lastly, GE Healthcare will continue to develop innovative technology, as well as canvass the marketplace for potential acquisitions of technology that both deepen and enrich today’s product mix for the benefit of our customers.

I hope this has been helpful, but it is only intended to provide a brief overview. I encourage you and your online audience to contact their GE Sales Executive to learn more since every customer has different needs and requirements. We will also be discussing more about the Centricity Web DX Viewer over the coming weeks and months, to include presentations at the GE Healthcare User Summit, August 18-21, 2008, in Washington , DC .

If you or your audience has any questions about the above, please have them contact me at brad.levin(AT)ge.com and I will see that their questions are answered.

Regards,


Brad
Brad Levin
VP, Marketing, Dynamic Imaging Solutions
GE Healthcare IITS

Kroger Becomes EMR Vendor

You know technology has progressed when you can buy it at the grocery store.

From the Enquirer (the Cincinnati paper, not that other Enquirer) comes word that the grocery chain Kroger will be selling this MedFlash device, a USB drive that will "store all of a patient's personal health records." This is not yet nation-wide, but will be offered in Kroger's 103 stores in the Greater Cincinnati and Northern Kentucky market. The little drive costs $29.95.

The Med-Flash device is made by a company called Connectyx. They appear to be primarily concerned with medical and billing software. While the Med-Flash could end up to be their biggest seller, their website touts other things such as the "Medical Revenue Manager" or

MRN Manager(tm) (which) provides a remarkable return-on-investment, accelerating your evenue cycle by putting you in charge of Medicare and insurance denials.

The easist and most effective tools to manage your denials are in the MRN Manager(tm) suite of tools! Over TEN-MILLION claims processed in last 12 months.

They seem rather sure of themselves. Anyway, Med-Flash stores your entire file, according to the website, and even comes with a "free Rx Card that can be used at any participating Pharmacy to help you save 50 to 80% on Generic Drugs." All this for $29.95!


And just how do you get your information into Med-Flash? Basically, you go online to MyMedflash.com and enter the information. Presumably, the patient himself takes care of this. Here is the on-line form:




Supposedly, "thousands" of images from MR's or CT's can be uploaded "via Internet Explorer," but I'm not sure how that works with respect to PACS. The site notes: ". . . the program includes a picture/document uploader that enables the owner to upload MRI/EKG/X-rays photos." Just where the average patient is going to score these images in a form they can upload is not specified. They could at least upload reports if they have a document scanner, and who doesn't these days?

I'm wondering if Med-Flash is more of a Flashy gimick at this point in time. Carrying a laminated piece of paper might accomplish the same thing for most people. However, I can certainly see the potential in carrying one's full medical dossier, especially for those with complex histories. I'm still wondering how Joe Patient is going to get his CT from the hospital PACS into the Med-Flash site and drive, but I'm sure someone over at Connectyx is working on that as we speak.

I guess the next step is an implantable RFID chip that the hospital reads by passing your head under the barcode scanner.

GE Sells Out ...Their Appliance Business

After 100 years of GE appliances, GE plans to get rid of this flagship division. It seems that the giant conglomerate is looking to improve stock prices after a rather rocky first quarter.

From today's Wall Street Journal:

Shedding the appliances brand would be a symbolically significant move for the Fairfield, Conn., company. GE entered the business in 1907 and boasts of milestones such as introducing the refrigerator, room air-conditioner and toaster oven.

But because the unit is now a relatively small part of the company, a sale might not satisfy investors who are pressing Mr. Immelt to improve GE's sluggish performance. Last month, GE reported an unexpected 5.9% drop in first-quarter net income and lowered its earnings forecast for the year, only weeks after issuing sunnier projections. The move prompted the biggest one-day selloff in GE shares in more than 20 years.

GE's shares finished Wednesday at $32.51 each in New York Stock Exchange composite trading, putting them near levels they traded at in 1999.

Ouch! So who's going to buy the fridge division?

GE has hired Goldman Sachs Group Inc. to run an auction for the appliances unit. It's unclear who might be interested in bidding this early in the process. But possible buyers for the division include appliance makers BSH Bosch und Siemens Hausgeräte GmbH of Germany and Haier Group of China, bankers said. Private-equity firms and GE's Mexican partner, Controladora Mabe SA, could also be interested, they said.

Siemens? SIEMENS? My GE fridge (the one in the garage that actually works unlike my overpriced SubZero) is now going to be made by Siemens? Well, I've never owned any Siemens appliances, except for an old model of their GigaSet cordless phone, which worked quite well.

OK, now, no one needs to blame me for this fiasco. I like my GE appliances. Really. I like my GE stock, too, and I'm pretty worried about where it's going.

Agfa Finds Buyer??

On the eve of SIIM in Seattle comes some good news for my friends at Agfa. According to printweek.com:

Agfa-Gevaert's battered share price, which has fallen around 70% in the past year, recovered slightly last week on the news that it may have found a buyer for its underperforming medical unit.

Agfa's shares rose more than 7% after chief executive Jo Cornu revealed the company had received many expressions of interest since appointing German merger advisory firm Lazard at the end of last month.

The share jump also followed the revelation by US private equity outfit Gores Group that it is interested in Agfa's healthcare division.

Gores said: "We find Agfa an interesting company with some great assets, and we are ready to speak about a partnership or a purchase."

The Gores Group is:

. . . is a private equity firm focused on acquiring controlling interests in mature and growing businesses which can benefit from the firm's operating experience and flexible capital base. Gores' offices in North America and Europe serve its active investment programs in these regions.

Here's a list of their holdings:

Current
Adventa ControlTechnologies
Aptiv Technology Partners
Avure Technologies
CompuDyne
Enterasys Networks
First Communications
Global Tel*Link
Diagnostic Health Corp.
Intelliverse
Lineage Power
Real Software
Sagem Communications
SER Solutions
Somero Enterprises
United Road Services
Wire One Communications

Prior
Anker
Aprisma Management Technologies
Artemis International Solutions Corp.
Brand-Rex
Connection Machines Services
Encore Real Time Computing
Farallon Communications
Goretek Data Systems
Humanic Solutions
Information Dimensions
Inmac
JAMIS Software
MPC Computers
ONEBOOK Financials
Proxicom
QuorTech Global Solutions
QuorTech Solutions
Revere
Select Business Solutions
Silicon Systems and Technologies
SSA Global Technologies
The Learning Company
VeriFone
Vicorp

Gores doesn't have a PACS company as yet, so this could certainly diversify their holdings.

I don't yet know the price tag for this little purchase, but I'm sure it's a good deal for Gores. Whether it's a good deal for Agfa and its users remains to be seen....

Survival of the Fittest . . . Small PACS Companies

Hershey Ice Breaker PACS candy, courtesy http://www.likecool.com/

Any time Amicas is mentioned on AuntMinnie.com, there follows a wave of responses divided into two main camps. There are those of us who love the product, love the company, and will defend it to the hilt. That should gladden Steve K's heart no end. However, there are the usual nay-sayers that generally knock any company with revenues less than the nation of Panama.

So it goes on a recent thread, started by Michael D, who was interested in the latest Amicas offerings. Larry, the Cable Guy from Nebraska, posting as GITRDONE, immediately pounced:

Amicas is a very small, almost regional player in the PACS market, they have a decent product but that is where the positives end. They have very spotty support coverage, and their long term sustainability is suspect. They are still around because of a large infusion of cash a few years ago, otherwise they would be another Merge story right now. They have a me too product though that you can get from 15 or so other companies that all seem to be in the same boat. If you want to buy a simular product for a simular price from a company that will more than likely be around in the next 3-4 years I would look at McKesson, Fuji or Philips. I would guess that Amicas will be purchased or fizzle out in the coming years as they just don't have the scale or talent to play in the replacement market.

Larry later reveals that he works for a PACS vendor, apparently in Nebraska (my old stomping grounds!), and his main competition there is NovaRad. Larry keeps repeating his mantra throughout the thread:

1. Small companies will die or be assimilated.
2. Amicas has a me-too product, identical to 15 others.
3. You are far better-off buying McKesson, Fuji, or Philips.

Now, I'll be the first to agree that there are tremendous pressures on PACS vendors, especially the smaller companies. And yes, some will disappear. Having gone to many, many RSNA's throughout my career, I can vouch for the fact that a number of the products and companies that were there at the last meeting didn't survive to make the next.

Beyond this, I disagree completely and totally with Larry. Amicas' product is very different from the others, and really, it is only when you reach the next tier down from the likes of Amicas, Intelerad, and DI (well, they used to be at this niche) with some of the smaller fry that the GUI's start to look a little more alike. And even those products are unique. The IT types simply don't understand that radiologists don't all work in the same manner, and different rads and different groups will need different approaches. I'm not so much of a Pollyana to say that everyone would love Amicas if they tried it. (I would wager that lots would, but that's beside the point.) Me-too product? Not even close.

The small companies provide innovation that does not exist, at least to the same degree, within the large behemoths. Without Amicas, Stentor, Dynamic Imaging, and even ScImage, to name just a few of the small players, PACS would be probably be stuck back in the state of trying to immitate film, with tiled-displays on $50,000 Sun boxes. I don't think there's much question that the little guys, well, some of them anyway, have led the way in trying to give the customers what they want.

But Larry essentially paraphrases the old IT belief: "No one ever got fired for choosing GE." The large company is safe. It will be there tomorrow, and will always be available for service and to take care of me. Hmmm...sounds a little socialistic to me. Sadly, with this opinion borne out of fear of making the wrong choice and looking bad and/or getting fired for it, comes a complete dismissal of the needs of the folks for whom the product is being purchased. If the big boys understood the needs of the radiologists, and wrote their software with them in mine, there would be no smaller companies in this business. But that isn't the way it works.

With the shrinking number of dollars to spend, the PACS consumer has to be far more savvy than ever before. No longer can an IT committee hijack the decision, insisting on the "safe" purchase from the large company. Been there, done that, and the results are not pretty. Spending, oh, I don't know, 2-3 (or more) times what an Amicas installation would have cost easily bought us 1/2 the usable system. We can no longer afford to blow millions in that manner.

I find it most amusing that Larry repeatedly mentions McKesson, Fuji, and Philips as his "safe" choices. What happened to Agfa and GE? GE is the biggest PACS company of all, and I will absolutely guarantee in writing that they will be here 100 years from now. (And if they aren't, good luck collecting on that bet!) Why doesn't Larry mention them? Could it be that Larry thinks they can't GET'R'DONE? Maybe buying from the large company isn't always the best idea after all. Or does Larry work for Fuji?

Dalai-Less In Seattle

Due to some last minute family stuff, I won't be able to attend SIIM after all. However, my PACS guru will be there, and since he is somewhat less infamous than me, he will be stealthily gathering lots of good stuff that will appear here upon his return.

I would also welcome reports from anyone else attending the meeting. Let me know what you thought of the new toys, what you felt was the most innovative, funniest, etc. I'm counting on all of you to be my eyes in Seattle!

I WILL see you next year in Charlotte!