The Unsettling Evolution of Advanced Visualization

“You keep same-in’ when you ought to be a changin’ … One of these days these boots are gonna walk all over you.”

— “These boots are made for walking,” Nancy Sinatra

Where better for the wisdom of Nancy Sinatra to take root than in Las Vegas, site of this year’s HIMSS conference. There the evolution of advanced visualization was in plain and startling view.

A couple decades ago, advanced visualization was a complement to picture archiving and communication systems (PACS); software running on workstations and thin-client networks that did what PACS could not; a vehicle for delivering eye candy to radiologists willing to push back the frontier of medical visualization one new application at a time.

Back then, those workstations and thin-client networks looked like luxuries. They met the needs of only the elite of medical imaging. Their visualizations skirted the periphery of medicine — beautiful, but limited in their utility. It seemed all but inevitable, at least to me, that they would eventually become radiology’s equivalent of an ornate buggy whip, made obsolete inevitably by automobiles, one that despite its beauty was fated to go belly up. But it hasn’t. And it won’t. At least not any time soon.

Advanced visualization has reinvented itself. It survives as PACS fades, flourishing as the new sidekick to the successor of PACS, enterprise imaging.

The company once known as Vital Images, acquired several years ago by Toshiba and reborn as Vital, was busy at HIMSS 2016 carving out a new role for itself. It expanded on its visualization platform to offer interoperability spanning information systems across the enterprise. At the conference, Vital launched what the company described as a “personalized HIE/EMR viewing platform.”

Recognizing the inordinate — and growing — power of the C suite, Vital presented its new enterprise interoperability platform as “the CIO’s best friend.” Defined largely by what it does for healthcare, this platform was promoted as the means to better outcomes in accountable care, accomplishing this goal by providing common ground for electronic medical records, health information exchanges, VNAs and PACS.

It is, according to the company, a “personalized viewing platform,” a kind of “missing link.” Its toolkit, called “Vital Box,” is designed, says the company, for chief information officers and information technology vendors to integrate processes associated with electronic medical records and various multimedia sources, including VNAs and PACS.  As part of its mission, this platform supports a next generation “universal viewer” that provides access to traditional medical images contained in PACS, as well as other content, such as the multimedia files from disciplines outside radiology.

Also wedging itself at HIMSS 2016 into the gap between images and electronic medical records was TeraRecon, which not long ago was a pure play, thin-client provider of advanced visualization, offering renderings that stunningly eclipsed any that PACS could do. This was its special niche. But at HIMSS, TeraRecon introduced image sharing solutions that “support multiple workflow and user management scenarios.” Amid the TeraRecon portfolio was an enterprise viewer that could be configured to provide simple views as well as complex post-processed ones.

A major goal, according to the company, is to expedite the exchange of images among facilities, eliminating the need to send CDs bearing medical images. This image sharing includes options for exporting images to PACS, as well as the ability to distribute them across the enterprise, leveraging standards that go beyond DICOM, ones that cover cross-enterprise data exchanges. It includes the means for integrating these images with hospital enterprise user management systems so as to ensure, according to the company, easy and secure image exchange with specialists throughout an institution.

TeraRecon’s transformation has been in the works for a while. At HIMSS four years ago, the company highlighted efforts to image-enable the EMR using a scalable thin-client solution for processing and distributing images. Among its features was a zero-footprint, multimodality, browser-based enterprise viewer offering advanced image processing for radiological exams. At the core of these options then — and now — is interoperability, the ability to seamlessly integrate with EMR, the VNA, PACS and other healthcare information systems.

The transformation of these two companies is a sign of change in the world of medical imaging. It is certainly not the only such sign, but it is one that bears close attention, reflective of the new reality of value-based medicine and its demand that imaging play an increased role in both outcomes and fiscal responsibility.

In short, the comfortable surroundings sculpted by DICOM are giving way to the complex and multifaceted landscape of the image-enabled enterprise. It’s been a long time coming, but it’s picking up speed … and fast.

Radiology has two choices: adapt or be prepared, as Nancy sang, “to be walked all over.”

Editor’s note: This is the second blog in a series of four by industry consultant Greg Freiherr on MR Balances Speed and Clinical Reach. To read MR is About to Get Faster, Cheaper and More Valuable: It's About Time, click here.