Recent conversations with companies vying in the image archive and management space reminded me of the case of the company that manufactured buggy whips, but defined themselves as being in the transportation business! Clearly buggy whips were at one time “transportation related” when the primary mode of transportation was the horse buggy. However, transportation quickly evolved to the “horseless carriage” and there was no longer a need for a device to spirit along the horses.
In the case of image management, there initially was a need to store images, dating to the earliest days of the CT scanner. Due to the limited capacity of spinning storage in those days, images were off loaded to magnetic tape and stored for a fixed period of time. If there was a subsequent need to see the case again, the study was re-introduced from tape back to the scanner’s disk for display.
This same philosophy continued with the earliest PACS. Again, spinning disk was still relatively expensive, so studies were off loaded to Tape, CD, or DVD media. The advent of automated “juke box” devices meant that access could be semi-automated, in that access didn’t require human intervention, but did require a longer wait time to access the study.
I am reminded of some of my earliest engineering “debates” with regard to the architecture of the CT scanner. Primarily due to cost, those early scanners did everything on the same device–acquisition, processing, display, archive, etc. There was no such thing as the distributed system. I used to argue that conceptually, the analogous state in a film-based world would have required an x-ray table to also embed a film dark room, processor, and view box tacked on its side!
It seems the industry defined itself as being in the x-ray business as opposed to the healthcare IT business! Had the designers thought of themselves from the broader perspective as being IT driven, who knows what might have evolved in terms of those early modality and PACS initiatives?! In many respects, the industry is still stuck in the same mold, and is not thinking from the broader perspective. Is the production of images its own industry, or part of the broader healthcare data management industry?
My recent conversations would lead me to the need to reassess the industry thinking with respect to the way we deal with image study management. For starters, those that define themselves as being in the image archive business are missing the point with respect to the reason for storing image studies. The whole point is to make them accessible to the clinical staff if and when they need them. The basis for redundant archive might again be viewed not from simply the perspective of the alternative storage of data, but more from the basis of how one insures accessibility to image studies in the event of a catastrophic failure of one storage device.
A case in point – ask any IT person responsible for data management about RTO (Recovery Time Objective) and RPO (Recovery Point Objective) objectives, and you get a straightforward answer of understanding the importance of data accessibility recovery. I am continually amazed at how few PACS vendors can properly respond to an RFP question involving RTO and RPO objectives. Because this typically is not the primary task of a PACS, their emphasis on recovery is lessened. Were PACS vendors to define their business more broadly as image study management and accessibility, perhaps there would be more attention to understanding the requirements for accessing and managing image data, including recovery requirements.
The key point I would like to make is to suggest that vendors step back from their current perspective and consider how their products are positioned in the bigger picture of healthcare information management. Perhaps if they did it might change the way they look at their business and insure they aren’t in the business of producing 21st century buggy whips.
