News and Trends

March 2000 - Healthcare Informatics

RSNA NEWS

Picture this: Outsourcing radiology on the 'Net

THE HOTTEST NEWS FROM THE RADIOLOGICAL Society of North America (RSNA) conference isn't a scanner or modality--it's a new business model. Radiology application service providers (ASPs) are ready to outsource image storage, retrieval, distribution and interpretations--and you don't need a pre-existing picture archiving and communications system (PACS) to use them.

Venerable and upstart firms alike are jumping on the potential in a market where capital budgets are tight, technology moves faster than a speeding RFP (request for proposal) and imaging systems can become obsolete before they're paid for.

The hook for CIOs and radiology directors: Electronic image access can be had almost overnight, and the hardware costs, upgrades and maintenance become someone else's problem.

Virtual warehouses
Only half the digital imaging equation is capturing the images. The other half is storing them, often for a five-year period. A single magnetic resonance (MR) study may consist of 200+ images, and eat more than 100MB of space. If you don't have rooms full of RAID storage, it might pay to use someone else's.

Some companies, such as InSite One, Wallingford, Conn., are offering themselves as image warehouses for those who don't want the cost of purchasing and maintaining huge archives themselves.

InSite's InDex image storage service, available in second quarter 2000, offers unlimited shelf space for current and historical images and their backups, retrievable on demand via a virtual private network (VPN) or any high-speed Internet connection. The client site is outfitted with a proxy server for short-term storage while an image is in its period of highest use.

The company plans to use flat-rate pricing, tiered by year of archival. The average image study costs $3.65 to store for the first year it's on the InDex system, and $0.24 a year for each subsequent year it remains in storage. Once a study is archived on the system, users can retrieve it as often as necessary for free. For facilities that simply want a redundancy warehouse and not the retrieval features, it's $0.48 per study, per year.

InSite's CEO Richard Friswell admits applying the flat-rate idea to the imaging world is still an entrepreneurial best-guess. "It's like we're in 1920 and are trying to figure out how to price airline seats."

Click and deliver
Watertown, Mass.-based Amicas, already rooted in the image server business, now offers an Internet-based image delivery service, enhanced by a partnership with the United Parcel Service (UPS). Amicas.net uses the UPS Document Exchange secure e-mailer to move images from one site to another, even if the recipient isn't on the same network. The subscription service comes in several packages according to use, with volume discounts for heavy users.

Managing image circulation can present hassles because of the large file size, the communication protocols and the FDA regulations on imaging-related devices, explains Adrian Gropper, Amicas' chairman and CTO. "It makes sense to outsource imaging components, whether you're a CIO or, for that matter, a vendor of medical IS."

Boston's Massachusetts General Hospital (MGH) was a beta site for Amicas.net, and now uses the delivery service to assist other hospitals and to streamline the workflow of its own 140 staff radiologists, sometimes transmitting images to a subspecialist at home in the middle of the night.

"It's impractical to keep five or six different subspecialists in the hospital 24 hours a day," says MGH chief radiologist James Thrall, M.D. "By being electronically connected, we can immediately send those images to the right radiologist."

Rent-a-radiologist
The outsourcing of radiological interpretations isn't a new idea, but using the Internet as the postal carrier is. Facilities with formidable radiology staffs and top-notch image management systems have discovered a new return on investment--renting their expertise and imaging functionalities to facilities that don't have after-hours radiologists and/or need quick access to subspecialty radiologists.

The Cleveland Clinic Foundation (CCF) offers Internet-based image interpretation services in eight subspecialties. The contract package includes the configuration at the client site and maintenance of a high-speed communications line, with browser-based access in the works.

MGH, already handling subspecialty and overflow image studies for other facilities locally and in adjacent states, is moving into pay-per-read radiology service further afield. Using Amicas.net as the delivery medium, MGH's radiology department has outsourced itself to Good Samaritan Hospital in West Palm Beach, Fla., for 24x7 primary or consultative interpretations.

As the outsourcing movement gains momentum, the current sticky point is the Internet connection itself. Most imaging ASPs welcome anything from a 128 kbps dial-up connection to a full-blown VPN to a T-1 line, but finding an Internet service provider (and judging its reliability) to reach the ASP is usually the client's responsibility for now.

Despite the rough spots, Thrall is convinced healthcare's use of ASPs will surge in the next few years. In weighing return on investment and the potential for faster, better care delivery, it may come down to a savvy business decision, he says. "We've already decided to outsource anything that isn't part of our core business or core expertise."

Pamela Tabar is the news editor at Healthcare Informatics.

IT ADVICE

Vetting the Vendors: The IT skinny for sale

IF YOU WANT TO BUY A HOME COMPUTER, TV OR car, a bewildering array of informational resources are available to help you make an intelligent choice: product reviews, user feedback, price comparisons and vendor service ratings.

But if you're a healthcare CIO charged with making decisions about information systems and e-commerce solutions, chances are you rely on word-of-mouth recommendations from colleagues, since your other options are trade show demos and sales pitches from vendors.

Plenty of white papers on IT topics, technologies and business trends are available online from consulting firms, marketing analysts and other organizations. But a recent burst of startup companies, some healthcare-specific, are making the word-of-mouth model electronic, championing the ability of CIOs to tell other CIOs about their experiences with the vendors as well as the systems. These services offer a variety of formats to give healthcare executives the inside skinny on IT vendors' reliability, service track records and client relation skills--and they're naming names.

KLAS Enterprises, Salt Lake City, has already launched its vendor-intelligence at www.healthcomputing.com. The site provides select amounts of information on healthcare IT vendors and systems for free, but subscribers gain access to in-depth details on 57 product lines and vendors such as Cerner, IDX, McKessonHBOC, QuadraMed, SAP and SMS (32 vendors and growing). The Consumer Reports-like format includes ratings on specific product features, comparison charts and detailed comments from healthcare IT professionals on particular products they've used and the vendor experiences that accompanied them.

Comments can be scorching at times. "Management changes have kept things completely haphazard," writes one user concerning a financial information system vendor. "They have no coordinated releases and just run around with bug patches putting out fires everywhere."

Another user comments on the same product: "Once the contract was signed then reality hit us. The hardware was undersized and they wanted us to pay for adding hardware... [and we] found out later they could not bring software that would load."

In contrast, a satisfied buyer gives a clinical software vendor high praise for its core electronic medical record system: "Tremendous solution to address the ease-of-use issues in an office environment."

For busy healthcare executives, the availability of this kind of market intelligence can help save time, effort, money and grief in the long run. KLAS' founders, executive director Kent Gale and senior vice president Ralph Reyes, stress that resources for knowledge-sharing are crucial to solid IT decision-making, especially in complex, still-evolving areas like clinical data repositories and the widening world of e-commerce. Letting executives hear from other executives facilitates a strong leap forward in improving the selection process for healthcare IS, Gale notes.

Jonathan Bogen, founder and CIO of HealthCIO.com, Duxbury, Mass., has a similar vision for healthcare IT knowledge-sharing. The HealthCIO service is focusing on product and service reviews of Web site development and other new e-commerce-based vendors online. Bogen says he wants to make it easy for healthcare executives to choose from among a host of new e-vendors by providing a detailed scorecard that tracks ease of interaction with the vendor, product functionality and scaleability, total cost of ownership, ease of use and other measures. Bogen says he envisions a wide audience for the service and its newsletter; not only CIOs and IT executives, but also clinical end users, vendors and consultants.

As the budding market experiments with how much CIOs will be willing to pay for such information, most are settling on the subscription model. Some are refusing Web advertising of any kind; others are keeping ads separate from the database services themselves.

There's no doubt that this market is set to grow, since at this moment there are no universally regarded, widely available and constantly updated services of this kind, says Erica Drazen, a vice president in the Boston office of First Consulting Group (FCG). Consultancies don't intend to miss the train; FCG will likely launch some kind of publicly available Web-based service for analyzing e-commerce vendors in the future.

Drazen expresses concerns about how services will gather their data. Small sample sizes of surveyed executives can be skewed toward more highly motivated respondents (including actively dissatisfied customers). Another issue is how various subscription and advertising models might affect the perception of objectivity. But if sample sizes and breadth of vendor surveying can be increased, she says, such services could be of real use to executives.

Ready or not, the demand is high for user-centric feedback on the sellers as well as the systems. Expect to see a rapid proliferation of these kinds of services soon, as Internet technology meets the high demand for information on the part of IT purchasers.

Mark Hagland is a healthcare technology writer in Chicago.

EAI

New roles for old systems

HEALTHCARE ORGANIZATIONS HAVE LONG recognized the value of enterprise application integration (EAI). After all, many enterprises have legacy systems on multiple platforms that are too expensive to rewrite or replace, as well as newer systems, none of which talk to each other. EAI's traditional role has been to enable these disparate applications to converse, but that traditional role is changing.

EAI is graduating from its internal uses to Web-based outreach and is an innovative solution to a host of problems. Organizations feel the pressure to simplify transactions among partners and suppliers and to give consumers access to certain data. Giving providers easy access to information also helps to attract and retain the associates that keep the organization viable. "Healthcare organizations want to create Web-based facilities to give their personnel the information they need from any location," notes Paul Roscoe, vice president of sales for New Era of Networks (NEON), Englewood, Colo. "This can help justify the organization's foray into e-commerce."

The Web is an ideal way to satisfy all these needs, but Web-enabling legacy applications is a chore. That's one of the new roles for EAI: providing a Web window to otherwise inaccessible systems. Unlike traditional, internally-focused EAI, these Web interfaces make sense for external users (in terms of response and ease-of-use) and don't impede the normal processing of systems. NEON's e-Biz 2000 is one new tool enabling e-business and e-commerce.

Still, "there isn't an out-of-the-box solution for Web-enabling applications," says Jay Prakash, president of Milpitas, Calif., consultancy Strategic Focus. "Professional services may well be necessary to customize solutions." Research by Strategic Focus indicates that only 40 percent of the cost of Web-enabling such applications is the software itself, while some 60 percent goes for professional services, such as customization.

Another new use for EAI is in implementing enterprise patient IDs and/or enterprisewide access to all patient information. One model is to keep all patient data in a central repository from which the separate departments can use an EAI application to get what they need. Another is to allow each department to retain its pieces of patient information and use EAI to create a shell with pointers that identify where all the data portions reside.

EAI also can help healthcare organizations embrace HIPAA. In the past, streamlining the flow of data among providers, payors, clearinghouses and other entities often employed an EDI (electronic data interchange) solution. However, EDI is viewed by many as cumbersome, unnecessarily restrictive and resistant to change. EAI can provide the framework for such data exchange, often using the Internet. The idea is to provide data transactions in as effortless a manner as possible.

The need for privacy and security of patient records is a great concern for organizations, especially if they expose some of their information to Web access. "You want controlled access to data," Prakash asserts. "You don't necessarily want to let accountants see non-financial patient data, for example." However, it is nearly impossible to reengineer existing applications so they have the privacy and security features required.

One solution is to use EAI to envelop an application within a secure environment. In this model, information flowing to or from the application must pass through the EAI perimeter first, which performs the necessary privacy and security functions. The application runs as usual, and the EAI handles the additional concerns. For example, Marietta, Ga.-based HIE's new CloverNet product is a security gateway behind which an application sits, according to Rey Currie, HIE vice president of product marketing.

As healthcare tackles the challenges of integration and Web-enabling, look for EAI to continue breaking out of the back room and start taking on more diverse roles to simplify data access.

Edmund X. DeJesus is a freelance technical writer in Norwood, Mass.

ANNOUNCEMENTS

CHIM Elects Singh as Chairperson

The Center for Healthcare Information Management (CHIM), an association for vendors and consultants in the healthcare information technology industry, elected Simmi P. Singh as Chairperson of its Executive Board of Directors. She previously served two years as Director and one year as Chairperson-elect.

Singh is cofounder of the advisory firm of Majkowski & Singh Partners, Chicago, and vice president of worldwide Health Industry Services for SeraNova, Inc., a global provider of e-commerce consulting and Internet infrastructure services in Edison, N.J.