Days of RSNA Thunder

HibbsThe green flag soon drops to begin RSNA once again. Every year it is the same; every year it is different. One year ago, I was impressed by the integration of RSNA and HIMSS and the transformation of PACS to IHE, or the Integrated Healthcare Enterprise. I was also impressed by Philips’ announcement that it had opened its pocketbook and purchased ATL, ADAC, and in a big move, Agilent Medical, the clinical spin-off of Hewlett Packard. Siemens countered with the purchase of Acuson, and GE emphasized new OEC C-arm products. This year we are expecting an announcement that the acquisition of Marconi — again — by Philips is complete.

The race between Philips, GE and Siemens for world market position is as hot and hard fought as a NASCAR race. And like NASCAR, people watch for the accidents as much as the winners.

The bigger the team, the more money they spend, the more successful they are. It’s tough for small independents and rookies to be competitive in the medical systems race today. It’s no longer an endurance battle with conservative left turns like the original NASCAR oval tracks. Now healthcare is a road course with twists and turns, some dead ends, and everyone has to make pit stops, just like Watkins Glen.

The IHE demonstrations proved that what was originally PACS (Picture Archive and Communications Systems) and RIS (Radiology Information Systems) are really IHE components. It also showed that nobody is always the winner. Successful vendors enter lots of races against lots of other competitors in situations with lots of different rules, and you must keep updating to run with the leaders. Old marketing presentations about image acquisition, teleradiology and digital storage protocols with “pre-fetching,” “post-processing,” and “compression algorithms” are not hot issues in this era of “broadband,” “Web-enabled,” and “off-site archiving.”

Medical equipment vendors now go to COMDEX, the huge consumer electronics show in Las Vegas, to get ahead of the pack in image processing, display and storage. They purchase technology from the video game commodity market. Network developers and business systems vendors now go to RSNA, the huge radiology meeting in Chicago, to get ahead of the pack in modality-independent image management systems.

The winners see CT, MRI, ultrasound, nuclear medicine and digital radiology as commodity image sources. “Top down” network technology development can display, move and store images better and faster than “bottom up” hardware systems development methods that were used by medical equipment vendors for years.

It’s become so competitive with commodity products that I expect sponsor logos will be the next step as imaging becomes the NASCAR of healthcare. We already have labels proclaiming SUN vs. Silicon Graphics and COMPAQ/

Hewlett Packard vs. Dell on workstations and remote displays. It is only a matter of time before we start seeing Baxter, Abbott and Bard stickers on power injectors.

After that, we will start seeing related sponsors: cigarette companies on the wall Bucky for chest films, diuretic advertising on the side of urological imaging systems, anticoagulant logos on the ceiling in cath labs, insurance company stickers on the HIS terminal in the admitting office.

Just wait until service technicians start dressing as pit crews and performing 12-second fixes with big rolls of silver duct tape. They already use remote diagnostics and swap assemblies instead of functional testing and component-level repair. The battle between in-house service and multivendor asset management is just as heated as Ford vs. Chevy on the race track.

In the near future, you will look at your new million-dollar special procedures room — covered with advertising — and the vendor will say, “You must keep service with the designer/builder if you want all the latest improvements to stay competitive.” In response, the in-house staff will say “When you have a million-dollar race car team, you don’t take it back to the dealer for an oil change.”

The world has changed. National security has changed. But healthcare remains the same — its always changing.

Finally, let me add, after years of working in the ICU and ER, I felt a special sorrow on September 11th and sympathy for those New York City hospital staff members who responded, had their IVs hung up and ready to triage the injured, but nobody came.