Dalai's note: As my earlier post was prompted in large part by my friend Brad Levin's discussions of PACS deficiencies, I gave him a heads up upon its publication. Brad zeroed in on this snide comment..."As an aside, some have suggested that IT-savvy departments assemble their own PACS from off-the-shelf components. To that, I can only say, "BWWWWAAAAAHAHAHAHAHA!" Good luck, folks. Not going to happen for the foreseeable future, at least not in my enterprise.” He wrote the following response which is most worthy of your attention. Without further ado, heeeeerrrrrrreeeee's Brad!
Clearly you are skeptical, but I assure you, this is not the future ---it is happening now in a big way. In fact, the strategy of "Viewer + Worklist + VNA" is largely representative of Visage’s target market in the US, where dozens of the largest systems, outpatient chains and rad groups are contemplating (and contracting) this approach to imaging. We’re breaking down barriers and conventional wisdom, but hear me out. It first started with VNAs, right? No one thought you could disassociate/separate the archive from PACS, but that’s just what happened. Emageon’s Super DICOM Archive (now Merge) did it first, and was very successful. Then Acuo and TeraMedica, and several other players did the same. It’s an anomaly for large systems today not to have a VNA, or not to have a strategy to get one. Most of the VNAs out there are at large, complex systems, that have now centralized their images (almost all of these are DICOM centric, but increasingly non-DICOM images are being (or are wanting to be) stored too). With the rise of EMRs (mostly Epic) and the demise of RIS, it’s natural for workflow either to be totally removed to a third party system with a universal worklist, or to have workflow driven by the EMR. Visage 7’s integration to Epic, for example, is really, really good and is as good, or frequently better than, many traditional RIS integrations. Today, there are several options available for dedicated universal workflow engines – Medicalis, Clario, Primordial, PS360 to name a few. Everything else that you would traditionally consider PACS functionality, less workflow and archive, can be found in a single enterprise viewer. Of course I am partial, but that viewer is Visage 7. [Note: I haven’t found any so called zero footprint viewers that come even close to comparable functionality, and while legacy PACS vendors try to disassociate their viewers to compete for new business in the “Viewer + Worklist + VNA” model, they typically fail, because their viewers were not designed to be backend agnostic.]
Visage 7 has all of the “typical” native services for ingest of all radiology and cardiology modalities/images (DICOM and non-DICOM), DICOM Modality Worklist, QA, DICOM forward/routing, integration, multi-dimensional viewing, viewer customization, mobile support, hanging protocols, user management (AD integration), federation, high availability, and incredible speed for massive scale. A single platform, thin-client viewer for all workflows: diagnostic, clinical (EMR launch), advanced viz, mobile. We also offer an archive, but in today’s US market, most customers have their own VNA and aren’t interested in an archive from Visage. That’s perfectly fine. In other global markets, VNAs are not as prevalent, so our archive is more frequently implemented.
…For example, it’s very liberating for us to tell customers that have gone to VNA, and gone to Epic (or another major EMR), that they can replace the army of viewers they’ve assembled over the years with one viewer, one thin-client for everyone.
…We’ve architected a single central instance of Visage 7 (e.g., one backend server, plus “x’ number of render servers powered by GPUs), to serve imaging across large distributed systems, serving up millions of studies per year, to thousands of users, eliminating the need for PACS silos at every location like legacy approaches. ... Imagine the savings and access benefits this delivers? There’s no routing of data to desktops, it’s all server-side and streamed as users need it incredibly fast. When new versions of the viewer are available, it’s a simple automated update of the client. Visage 7 doesn't run in a browser, so there’s no conflict with the minutia of the version of this browser and that browser, and the adequacy of HTML 5 support, or the need of a specific plugin. Visage 7 runs on both PC and Mac, with exactly the same client. Because we’re server-side, we NEVER tell users to upgrade their workstation disks, RAM, processors, operating systems, etc. We don’t care, since we’re server-side. Performance is not related to the client capabilities. The savings are huge and a real transformation.
This is the future, at least in the large systems. It provides the liberation from a single vendor, single PACS silo approach that has strangled the industry since the early days. Will this propagate to the local independent community hospital and small outpatient practices? Probably not, but consolidation is eating up the small practices anyway into larger groups that are gravitating to this approach. PACS is fun again when you’re changing how PACS is perceived and delivered. It really is.