Crystal Ball: Toward True Enterprise Image Management
As the potential role of informatics in transforming health care gains national attention, how are IT tools for imaging and image management evolving to improve clinical efficiency and bolster quality of care? ImagingBiz spoke with Aaron Waitz, vice president of product development for FUJIFILM Medical Systems USA, Stamford, Connecticut, on the future of imaging informatics and the Fujifilm Synapse® product line.ImagingBiz: As the newly appointed VP of product development, what would you say is your driving goal/vision for Fujifilm product development? 
Aaron WaitzWaitz: What I’ve been driving home with our development teams is the need to focus on our mission: producing innovative, high quality products that exceed our customers’ expectations. While some might hear this and think it’s just a cliché, to me adherence to it will be fundamental to our future success. What we believe will make a high quality product is continuing to exploit our native Web-based architecture into new applications. We have already integrated our PACS, RIS and cardiovascular applications; continued concentration on taking advantage of the synergies in our infrastructure across the different modalities and clinical specialties we serve, while also providing unique user experiences for clinicians via the toolsets that aid their workflow, will be key. When you look at the architecture of enterprise information systems, the synergy of technology happens deep inside the system; as you come closer to the end user experience, that’s where you start to see differences, and those are because of the different clinical workflows between cardiology and radiology. Our Synapse clinical modules are integrated now: we run on the same infrastructure and a number of the software components run on the same hardware; the storage systems share infrastructure; and all the content switching that would take place at the front of the system is shared between radiology and cardiology. The user interface looks seamless to the end user, and we’re working on bringing more of that technology closer together to accelerate our new feature development and share workflow efficiency features across specialties. Finally, software development expertise will be a key differentiator in the market. Those vendors that not only collaborate with customers to deliver products, but that also deliver enhancements in a timeframe that is judged by customers to be responsive, will be the most successful. We intend to separate ourselves with our focus and capability in this area.ImagingBiz: You’ve personally been instrumental in Fujifilm’s entrance into and subsequent growth in cardiovascular imaging. Why is it important to be in this market? How has the addition of cardio PACS impacted your product portfolio?Waitz: Cardiovascular is the second-largest producer of diagnostic images in the hospital. Further, according to the World Health Organization, ischemic heart disease is the leading cause of mortality worldwide and expected to grow and stay in that position for the next 30 years. Cerebrovascular disease is another serious health concern. So it’s easy to see why there is a great demand for high quality cardiovascular imaging and a need for continued product innovation. In addition, imaging modalities like CT, MR and ultrasound are crossing the traditional boundaries between radiology and cardiology. Customers are looking for enterprise solutions that can present the entire patient record versus just the isolated departmental record. The emergence of CPACS has resulted in developmental efficiency synergies and a stimulus for new feature enhancement between the markets we serve. With the changing health care environment, our proven proficiency in quantification and lab accreditation in cardiology will allow us to leverage those learnings toward radiology. Conversely, the same is true for some of Fujifilm’s deep-rooted history in image processing and informatics innovation in radiology, which we can apply to cardiology.ImagingBiz: In 2008 you added RIS to the Synapse® portfolio. How has that added value to the PACS, and what can we expect to see in terms of RIS enhancements in the future?Waitz: That acquisition has proven to be a valuable strategic move that is really bearing fruit. A significant percentage of our sales are being combined with both RIS and PACS so customers can take advantage of streamlined workflow. We keep working on new product enhancements to improve overall efficiency, such as the addition of administrative tools that allow radiology labs to monitor the efficiency of their methodologies. We’ll also be expanding some of that into the cardiology platform, for handling lab results, so that approach will allow the results to be viewable within the CVIS.ImagingBiz: Another product addition on the horizon for you is in advanced visualization. Fujifilm elected to develop this in-house using your own software developers. Why is that? And where are you headed with this product?Waitz: Today it seems everyone is talking about 3D, with the excitement around the movie Avatar, 3D TVs and video games, and Fujifilm has even released the very first 3D consumer digital camera. Just like other advances that have happened in diagnostic imaging, we find that with 3D, there’s a synergy with what’s happening in the consumer world. A core technology for the future, 3D and visualizing in 3D is a natural extension for the radiology workflow process: it improves efficiency and overall clinical efficacy. There’s been a lot of discussion about using 3D visualization to look more quickly at large datasets. It’s the key to the reading process, so we’re making an investment in that core technology. We believe that server rendering techniques eliminate the need to move the data around the network; it can be rendered at the server and delivered to the workstation, and that delivers more efficiency in terms of network infrastructure. It also provides advanced capabilities to workstations that may be less powerful. 3D is core to us, and our ability to integrate 3D directly into the product will provide simplified access and differentiated advanced clinical solutions.ImagingBiz: What is your integration strategy for all of these Synapse portfolio components?Waitz: Step one was providing a seamless user experience utilizing desktop and some integration infrastructure technology such as database sharing. Now we are working on leveraging common software components throughout our designs. This provides us significant developmental leverage, while providing our enterprise customers a solution that is easier to maintain, easier to learn and train on, while costing them less overall. We have also brought all development groups under single management structure to ensure consistency of design and process. Going forward, this will enable us to have one product portfolio direction and to share components where applicable. Customers will benefit from common platforms, databases and management methods across our products, which will lower their management and training costs.ImagingBiz: There are other places Fujifilm could take the domain specialization, such as CPOE and decision support. Do you expect you will you broaden your scope? Or do you plan to stay focused on imaging?Waitz: We do plan to broaden our portfolio, and we’ll start with areas that intersect with imaging. We’ll leverage our core competencies in image processing and combine them with associated clinical data and the patient record. There’s a trend towards outcomes-based medicine that will require mining aggregated data to help our customers and clinicians operate more efficiently. We can provide unique value to our customers here, and can deliver this in both the radiology and cardiology domains. When it comes to decision support, everybody thinks about it at the time of ordering; however, there are many steps during the clinical workflow where computerized decision support can help the process. It’s everything from reading protocols—how do I hang the images based on disease state?— to historical information about the patient that can help optimize reading. That’s a form of decision support that can be incorporated into the system. ImagingBiz: Do you have designs on another “ology”? What is your integration strategy for all of these Synapse portfolio components? Waitz: We always have our eye on the future, and the next step is offering more value to our solution and to our customers. We see a trend toward enterprise image management, so the management of images will start to become unified into a single enterprise system that handles that data.ImagingBiz: From a strictly product development standpoint, is the recently passed health care reform presenting any challenges? Waitz: The trends following health care reform will remain the same as they were before reform: we still need to contain costs; patients still need greater access; providers still need access to the complete patient record. One of the things the bill puts into action is being able to measure the results of that technology as it affects patient outcomes. Our solutions will still be developed to resolve these issues with or without health care reform. To take it a step further, you can look at the experience we gained in quantitative data and lab accreditation when we entered the cardiovascular market. We believe, with reform, that those learnings are going to be very helpful for Fujifilm and the clinical community. We see what’s being done in other medical specialties in order to get to more objective data; we see how access to patient records changes care. You’ll see a lot more synergy where these medical specialties cross based on this historical learning we’ve had, and we can apply that same innovation that we applied in cardiology to the radiology domain and beyond.ImagingBiz: How is your approach to product development different from your competitors’?Waitz: The marketplace has numerous examples of products (RIS/PACS/CPACS) delivered by vendors that are disjointed. One of the changes we made when I took this position was to bring the development teams under common leadership in an effort to harmonize the technology and the processes we’re using for better leverage of the technology across different domains. As you move closer to the end user experience, the applications tend to be different, but there’s a lot of technology that’s common across the domains in which we participate, and this new structure will allow us to take advantage of that with great efficiency.ImagingBiz: How far out do you need to be thinking? Where do you expect the product to be in 10 years?Waitz: Health care companies always need a view toward the future with a focus on the now. We’ll continue to adopt consumer driven technologies and devices—handhelds, iPads, instant messaging, and so on—for use in health care. We do see a growing trend toward mobile computing, and providing access to health care information regardless of where you are. I suspect that’s where products will be: functions that radiologists, cardiologists, and the realm of physicians do at systems will remain similar to what they are today, but the physical location will no longer be fixed. The work will come to the clinicians, rather than them having to go to the work. That computing paradigm is a trend in the consumer world and the clinical, professional world. There’s been a recent FDA announcement about classifying medical handheld devices as regulated devices, so it’s unclear how regulatory implications may enhance or retard that vision. Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.
Aaron WaitzWaitz: What I’ve been driving home with our development teams is the need to focus on our mission: producing innovative, high quality products that exceed our customers’ expectations. While some might hear this and think it’s just a cliché, to me adherence to it will be fundamental to our future success. What we believe will make a high quality product is continuing to exploit our native Web-based architecture into new applications. We have already integrated our PACS, RIS and cardiovascular applications; continued concentration on taking advantage of the synergies in our infrastructure across the different modalities and clinical specialties we serve, while also providing unique user experiences for clinicians via the toolsets that aid their workflow, will be key. When you look at the architecture of enterprise information systems, the synergy of technology happens deep inside the system; as you come closer to the end user experience, that’s where you start to see differences, and those are because of the different clinical workflows between cardiology and radiology. Our Synapse clinical modules are integrated now: we run on the same infrastructure and a number of the software components run on the same hardware; the storage systems share infrastructure; and all the content switching that would take place at the front of the system is shared between radiology and cardiology. The user interface looks seamless to the end user, and we’re working on bringing more of that technology closer together to accelerate our new feature development and share workflow efficiency features across specialties. Finally, software development expertise will be a key differentiator in the market. Those vendors that not only collaborate with customers to deliver products, but that also deliver enhancements in a timeframe that is judged by customers to be responsive, will be the most successful. We intend to separate ourselves with our focus and capability in this area.ImagingBiz: You’ve personally been instrumental in Fujifilm’s entrance into and subsequent growth in cardiovascular imaging. Why is it important to be in this market? How has the addition of cardio PACS impacted your product portfolio?Waitz: Cardiovascular is the second-largest producer of diagnostic images in the hospital. Further, according to the World Health Organization, ischemic heart disease is the leading cause of mortality worldwide and expected to grow and stay in that position for the next 30 years. Cerebrovascular disease is another serious health concern. So it’s easy to see why there is a great demand for high quality cardiovascular imaging and a need for continued product innovation. In addition, imaging modalities like CT, MR and ultrasound are crossing the traditional boundaries between radiology and cardiology. Customers are looking for enterprise solutions that can present the entire patient record versus just the isolated departmental record. The emergence of CPACS has resulted in developmental efficiency synergies and a stimulus for new feature enhancement between the markets we serve. With the changing health care environment, our proven proficiency in quantification and lab accreditation in cardiology will allow us to leverage those learnings toward radiology. Conversely, the same is true for some of Fujifilm’s deep-rooted history in image processing and informatics innovation in radiology, which we can apply to cardiology.ImagingBiz: In 2008 you added RIS to the Synapse® portfolio. How has that added value to the PACS, and what can we expect to see in terms of RIS enhancements in the future?Waitz: That acquisition has proven to be a valuable strategic move that is really bearing fruit. A significant percentage of our sales are being combined with both RIS and PACS so customers can take advantage of streamlined workflow. We keep working on new product enhancements to improve overall efficiency, such as the addition of administrative tools that allow radiology labs to monitor the efficiency of their methodologies. We’ll also be expanding some of that into the cardiology platform, for handling lab results, so that approach will allow the results to be viewable within the CVIS.ImagingBiz: Another product addition on the horizon for you is in advanced visualization. Fujifilm elected to develop this in-house using your own software developers. Why is that? And where are you headed with this product?Waitz: Today it seems everyone is talking about 3D, with the excitement around the movie Avatar, 3D TVs and video games, and Fujifilm has even released the very first 3D consumer digital camera. Just like other advances that have happened in diagnostic imaging, we find that with 3D, there’s a synergy with what’s happening in the consumer world. A core technology for the future, 3D and visualizing in 3D is a natural extension for the radiology workflow process: it improves efficiency and overall clinical efficacy. There’s been a lot of discussion about using 3D visualization to look more quickly at large datasets. It’s the key to the reading process, so we’re making an investment in that core technology. We believe that server rendering techniques eliminate the need to move the data around the network; it can be rendered at the server and delivered to the workstation, and that delivers more efficiency in terms of network infrastructure. It also provides advanced capabilities to workstations that may be less powerful. 3D is core to us, and our ability to integrate 3D directly into the product will provide simplified access and differentiated advanced clinical solutions.ImagingBiz: What is your integration strategy for all of these Synapse portfolio components?Waitz: Step one was providing a seamless user experience utilizing desktop and some integration infrastructure technology such as database sharing. Now we are working on leveraging common software components throughout our designs. This provides us significant developmental leverage, while providing our enterprise customers a solution that is easier to maintain, easier to learn and train on, while costing them less overall. We have also brought all development groups under single management structure to ensure consistency of design and process. Going forward, this will enable us to have one product portfolio direction and to share components where applicable. Customers will benefit from common platforms, databases and management methods across our products, which will lower their management and training costs.ImagingBiz: There are other places Fujifilm could take the domain specialization, such as CPOE and decision support. Do you expect you will you broaden your scope? Or do you plan to stay focused on imaging?Waitz: We do plan to broaden our portfolio, and we’ll start with areas that intersect with imaging. We’ll leverage our core competencies in image processing and combine them with associated clinical data and the patient record. There’s a trend towards outcomes-based medicine that will require mining aggregated data to help our customers and clinicians operate more efficiently. We can provide unique value to our customers here, and can deliver this in both the radiology and cardiology domains. When it comes to decision support, everybody thinks about it at the time of ordering; however, there are many steps during the clinical workflow where computerized decision support can help the process. It’s everything from reading protocols—how do I hang the images based on disease state?— to historical information about the patient that can help optimize reading. That’s a form of decision support that can be incorporated into the system. ImagingBiz: Do you have designs on another “ology”? What is your integration strategy for all of these Synapse portfolio components? Waitz: We always have our eye on the future, and the next step is offering more value to our solution and to our customers. We see a trend toward enterprise image management, so the management of images will start to become unified into a single enterprise system that handles that data.ImagingBiz: From a strictly product development standpoint, is the recently passed health care reform presenting any challenges? Waitz: The trends following health care reform will remain the same as they were before reform: we still need to contain costs; patients still need greater access; providers still need access to the complete patient record. One of the things the bill puts into action is being able to measure the results of that technology as it affects patient outcomes. Our solutions will still be developed to resolve these issues with or without health care reform. To take it a step further, you can look at the experience we gained in quantitative data and lab accreditation when we entered the cardiovascular market. We believe, with reform, that those learnings are going to be very helpful for Fujifilm and the clinical community. We see what’s being done in other medical specialties in order to get to more objective data; we see how access to patient records changes care. You’ll see a lot more synergy where these medical specialties cross based on this historical learning we’ve had, and we can apply that same innovation that we applied in cardiology to the radiology domain and beyond.ImagingBiz: How is your approach to product development different from your competitors’?Waitz: The marketplace has numerous examples of products (RIS/PACS/CPACS) delivered by vendors that are disjointed. One of the changes we made when I took this position was to bring the development teams under common leadership in an effort to harmonize the technology and the processes we’re using for better leverage of the technology across different domains. As you move closer to the end user experience, the applications tend to be different, but there’s a lot of technology that’s common across the domains in which we participate, and this new structure will allow us to take advantage of that with great efficiency.ImagingBiz: How far out do you need to be thinking? Where do you expect the product to be in 10 years?Waitz: Health care companies always need a view toward the future with a focus on the now. We’ll continue to adopt consumer driven technologies and devices—handhelds, iPads, instant messaging, and so on—for use in health care. We do see a growing trend toward mobile computing, and providing access to health care information regardless of where you are. I suspect that’s where products will be: functions that radiologists, cardiologists, and the realm of physicians do at systems will remain similar to what they are today, but the physical location will no longer be fixed. The work will come to the clinicians, rather than them having to go to the work. That computing paradigm is a trend in the consumer world and the clinical, professional world. There’s been a recent FDA announcement about classifying medical handheld devices as regulated devices, so it’s unclear how regulatory implications may enhance or retard that vision. Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.