We still are living in a world where...there's no intelligence with regard to combining information and asking questions and doing things prophylactically, having the computer automatically say, "Hey, you made this recommendation but no one ever followed up on it," or, "Hey, it looks like the impression that says there's disease is different from the body of your report, which seems to imply that everything is normal," or, "Hey, you issued a report that sounds like it has some important findings, but there's no record that anyone has opened up and read your report, much less acted on it."

Where are the vendors in this?

The problem is most of the vendors only have control of their own domain. An Epic or a Cerner doesn't really interface with a GE or a Carestream or a Philips PACS, for example. The vendors sound sympathetic, but to a large extent most of the people who buy these systems are relatively complacent, because they don't even think about the idea of having intelligence in the systems. People still think when they go to buy a PACS that what they really want is something that will, as fast as possible, display the images, allow them to generate reports and go on to the next study. But because this capability for smart PACS hasn't existed, radiology facilities do not know to ask for it. If imaging facilities made "smart" a criterion for purchasing or upgrading, it would accelerate this next generation of PACS.

Is there anyone that makes something that comes close to what you want?

The most interesting developments seem to be coming from non-traditional PACS vendors. There have been exciting advances in "artificial intelligence" systems. Apple's Siri has been improving rapidly and of course the IBM Jeopardy playing software, Deep Q&A has demonstrated the tremendous potential for software that can interpret complex questions and rapidly find answers using a dynamically changing database. Microsoft's, and now Caradigm's Amalga represented a user friendly/intelligent bridge between the EMR and other clinical information systems providing the type of functionality that I would love to see as part of a "smart" next generation PACS.

So how is the replacement process going along?

Our Chesapeake regional VA network, VISN 5, is about to make a selection of a new, hopefully next generation PACS. So our challenge is in some ways analogous to what we had with our first generation PACS 19 years ago; to select a PACS that will meet our future needs. Early PACS pioneer Sam Dwyer taught us to follow the "hockey pass" principle of not passing to where the guy is but to where he is going to be. Now we've got almost 20 years of experience, the question is where will the technology be in the next 5, 10, 20 years and how can we incorporate that into our next generation PACS. My best guess is that our best bet will be to purchase a system that takes advantage of advanced clinical as well as business intelligence in a new generation of smart and interoperable systems that will make us more productive, safer, and more effective..

Check back tomorrow for part two of our talk.

Back to HCB News

More Industry Headlines