Interoperability heavy weights join forces

  

 Updated 2/5/19
Last November Life Image and DICOM Systems announced a strategic partnership aimed at streamlining clinical content access within and across provider organizations and health systems. Life Image is the world’s largest global network for sharing clinical and imaging data. DICOM Systems is the leader in enterprise imaging interoperability and workflows. PARCA eNews spoke with Life Image CEO Matt Michela to learn more about the partnership and what it means to PACS administrators and healthcare IT professionals, and how it advances interoperability, and ultimately patient care.

Q. Tell me a little about the Life Image Story. Why was the company founded and how much has it grown?

A. Life Image is 11 years old. It was founded to facilitate access to an exchange of medical imaging between disparate PACS systems. It initially worked within the institution among a variety of PACS. Then we quickly evolved to include exchanges between hospitals to outside referral facilities and other entities.

Today, we're the largest network that deals with information exchange and management here in the United States. We've got 9,500 facilities inside the United States that are connected or affiliated in our network and roughly 60,000 clinics overseas that we are exchanging information with on behalf of our U.S. based clients.

We now have roughly 85 percent market penetration in academic medical centers and tertiary care sites. So, we sit inside the most complicated environments and that explains our international connectivity. When you're working with an M.D. Anderson, for example, or you're working with Partners Healthcare in Boston where they do a significant amount of international research, you need to exchange medical data with research partners in Europe and Asia.

Over the span of the last few years, what we've done is to make significant investments in our platform so that it truly operates as a standards-based integrated network. This way any institution can exchange medical imaging and any type of associated clinical information with any other institution in our network. We always have access to imaging but we also may have access to lab or pathology reports or to the archives center.

Q. So you are right in the middle of and at the heart of the interoperability challenges that people have been working on for years. You're solving that.

Yes, Life Image is a completely standards-based tech stack. We obviously have DICOM, DICOMweb, and HL7. We also work with FHIR and the full XDS suite to meet global standards, especially within the EU. We don't do anything that’s proprietary inside our platform, although we do connect to many of those who have some level of proprietary features in their environments.

What we do is connect into those environments, translate the data, and normalize it in order to provide access to the information across the network. We were the company that worked with the Radiological Society of North America (RSNA) on its original Image Share pilot project. We built the architecture to support an interoperable gateway to allow vendors to connect to each other to exchange imaging. We have now replaced that gateway with a more current XDS-enabled gateway called Clinical Connector. Today, Clinical Connector is being used by approximately 100 hospitals in our network to share data directly with patients.

We removed the need for any kind of physical exchange of information whether it's on hard copy paper, film or CDs. The Life Image network is built in a way that allows connectivity even into other competing image exchange platforms.

We grew up inside the academic medical center world connecting with various PACS. Today, we are interoperable with every capture device whether it's a Canon camera in dermatology or it's the 19 versions back of GE's PACS. We're the only organization that can access any archive of any age on any software version at any enterprise level. Since we sit inside the firewall of major institutions, we have workflow configurability and are the only company that actually has the one platform with the ability to seamlessly integrate radiology cardiology, neurology, ophthalmology, etc.

So rather than most others in the space that might be modality-specific and have challenges in other areas, we grew up in an area where our customers came and said, “we have to be able to share data enterprise-wide without putting in multiple hubs, or multiple VPNs or multiple routers.” When you build a platform that does it all, that puts you in a pretty unique position. You must know how to bring data directly into the workflow in exactly the way that institution wants it or to bring data out and move it along.

Q. I think you just answered my next question, but just to clarify it. Those are the ways you make a PACS administrators’ life easier, you make all of that connectivity smoother and easier and efficient and improve workflow for the radiologists they serve.

A. Yes so we do a couple of things for the PACS administrator. The most obvious thing is that we can dramatically reduce physical media. While

healthcare hangs on, almost with a death grip, to CDs for image exchange, we have the ability to digitize that. For some customers, we've been able to eliminate upwards of 95 percent of the physical media coming in from referral sites. So that's a massive benefit at the enterprise level for a PACS administrator or provider. That's the most visible thing we do.

The second thing that we do is to allow for the reduction of multiple vendors. As hospitals have been consolidating, we tend to be the one that survives because we can connect into either the old systems or the new systems. We provide that interoperable layer so hospitals don’t have to worry about implementing a solution that requires brand new integrations into new environments because we’re typically already there.

During a consolidation, hospitals experience this really troublesome transition time of, “Oh, wait a minute I’m on EPIC and they're on Cerner,” or, “I’m on GE and they’re on Siemens, and we still have to exchange information…What do we do?” Life Image bridges that gap.

We provide that consistency that allows clinical care to occur without being delayed a year for an integration effort or reverting back to physical media with the hopes that you can manage it that way. And that helps the PACS administrators’ with that challenge  

With our newest solutions, Life Image automates requests for or sending records out to patients, we’re now really starting to make a significant dent in the outbound physical media and managing record requests for librarians for data from patients, which can be so burdensome, because they use exactly the same workflow they normally use within Life Image.

Another thing that we're doing, which is kind of exciting, is we're actually offering a platform for using our Interoperability Suite, as we call it, to facilitate access to artificial intelligence companies. One of the challenges that our customers came to us was, “There's all this AI that my clinical staff wants to use. My radiologists or neurologists want to use this solution and this one wants to use that one. We can't do 12 separate integrations into our PACS systems for the each one of these solutions. One department wants VPN and the other wants something that is proprietary.” Our customers came to us and said, “Can you just be the middleman and facilitate that?”

We have a very large hospital system in Boston here, as an example, that is a major research entity and is actively involved in the creation of more than a dozen imaging-centric AI companies involved with solutions development. The institution told every one of those companies, “We will not integrate with you. You go talk to Life Image they'll integrate with you in the cloud. They will facilitate movement of data out of our PACS systems against your algorithms and then your answers back into the workflow for us because they already provide that.”

This institution basically said it wanted Life Image to handle the integrations and their PACS administrators said “Oh my goodness, you just saved us three years of integration work for us because you're already integrated.” We're getting more and more of that kind of activity to help PACS administrators.

Q. Talk a little bit about the DICOM Systems partnership. How does that work? What is it that each of you bring to the to the table?

DICOM Systems is a great company. If you spin back even a few years, folks would have said, “Hey you guys (DICOM Systems and Life Image) compete in the image space right now. Why would you work together?” This is the first time that two of us formally came together and said we’re not worried about that, there is more complimentary value that we can add to the industry without worrying about competitive influences.

We’re stepping forward in the industry and saying, “Guys, knock it off. Being interoperable provides value to the patients and to the clinicians. Let’s not make them have to work with multiple vendors if they don't have to.”

That was in itself an important statement. DICOM Systems’ main product is their Unifier, which is a router that sits inside the institution that helps facilitate the exchange of information around PACS. It’s focused on order entry and creation of work lists. So it works at that level of workflow within the organization.

Life Image principally sits on a layer above that, where we deal with the exchange of information not just among PACS but other environments inside and outside the institution. So we're very complimentary.

As an example, in a very large customer like Kaiser, where we touch each other but haven't formally integrated into each other’s workflow, we are able to say, “This is what I'm doing with worklists and this is what I'm doing with exchange.”

By working together, we're able to allow the sharing of medical information inside and outside the institution directly from DICOM Systems using Life Image. So instead of having two workflows or two solutions, you can literally stay within the context of the patient within the workflow or a worklist and be able to say, “Let me send this image somewhere else or send this exam around the world.” We can do that because we're integrated together as opposed to operating separate workflows.

Those are the kinds of things that we can do together. It's a reduction in the number of workflows to create, and less steps for providers to be able to share information.

On a pure business sense, this allows us to bring the DICOM Systems network onto the Life Image network, which provides a lot of value. For the DICOM Systems customers who don't have Life Image in place, it allows them to have access to 9,500 sites that they wouldn't have access to otherwise, so it's a material enhancement .

We also have some large-scale technology research projects we're working on together.

I think the biggest piece of the partnership is the reduction of vendors and the simplification of the workflow, enabling DICOM Systems customers with (inter-network) image exchange, and enabling Life Image customers to work with DICOM Systems’ solutions with fewer workflows to manage, and a more simplified mechanism for sending data into the work list. Those are principally the drivers here.

Q. Are you both working within the same client base at the same time or are you bringing each other into different clients that each of you might have not otherwise been working with?

A. No, we have less than 10 percent overlap. Consequently there's a lot of growth for us to offer each other’s customers with our respective networks without duplication. And again that wasn't a driver for us, even if we had a 100 percent overlap and networking, we could still integrate.

With the relationship and implementation, we can allow hundreds of DICOM Systems hospitals to have access to the network and vice versa. That by itself is a pretty nice industry enhancement.

Q. From down-to-earth perspective, could you give me a scenario of how a provider working in a Kaiser office in a suburb would experience the impact of this partnership in terms of delivering patient care.

A. Let’s generalize this to a hospital that uses DICOM Systems today. Typically what that means is, DICOM is doing a great job managing the workflow for radiologists and PACS administrators inside the institution, but the institution doesn’t have an exchange solution in place. As a result, they're dealing with a lot of physical media, which creates delays in scheduling because they don't have the records at the time of the patient’s appointment.

Internally, the organization has their workflows in place but this partnership is bringing Life Image into the equation and integrating into the DICOM Systems workflow. Now, those providers have significantly improved access to data outside their institutions. So the exchange of physical media can start to go down, costs can go down, the manpower to manage the data exchange goes down, and the time delays go down. And so the clinical flow can be much closer to where it's actually needs to be by decreasing delay and cost.

For customers that are Life Image customers that now have access to the DICOM Systems network, they can now look for data from new network sites. They now have 500, 600, 700, 800 new hospitals on the network that they don't have to contract with, which can take months or years, to bring that network on. They now have access, which means they can decrease the need for mailing CDs for patients coming in. So just in that data exchange piece, both parties get that benefit depending upon where they sit in that geography.

For a third customer, who may be a joint customer, that organization still gets the benefit of these networks that have come together, but now it’s going to get an added workflow efficiency over time because Life Image and DICOM Systems are integrating their platforms for data exchange seamlessly behind the scenes.

These customers get their data through the DICOM Systems Unifier platform, and their workflow doesn’t change. We sit behind the scenes and invisibly just enable our external exchange, just like we do with Cerner or EPIC, to give them access to broad sets of data they wouldn't have otherwise.

Q. How is your interoperability solution different than other people's?

Number one is the breadth and quality of our network. Just last year 2018, we brought two brand-new customers on to Life Image that had been with a competing solution for image exchange, specifically cloud-based exchange solutions. They had been working with that third party for five years and they could never get their utilization of outside imaging above the low double- digits.  So, under 20 percent utilization after five years is all that they could get.  

So the institutions came to us and said, “Can you help us? We’re willing to throw them out and have you replace them. You've got a much bigger network and we’ve never been able to get into any of your sites. Can you help us?” Our answer to that was, “Absolutely we can but you know, what we're not going to do is we're not going to rip and replace that work because you've already invested a lot of time building those connections and that network. You can use both of our networks and we can focus on you as the end customer who doesn’t have to be  tied into one solution. We can be your hub to facilitate more usage.”

For the first of these customers, within literally eight weeks, we doubled their utilization across the board, because our network is so broad. That‘s a huge difference.

The second difference is that we’re the only company out there in the image exchange management space that is interoperable with every enterprise-wide (vendor).

We are the only company in the space that can truly be enterprise-wide and touch every “-ology,” every department, every capture device, every PACS system, every viewer. That's a huge difference for us.

Third difference is our Interoperability Suite itself, because it is very flexible and configurable. In fact, it's hard for us to keep track of all the different use cases because our customers configure it in thousands of different ways. As an example, we have a major customer on the West coast that I went to visit. As we were talking to them about the product and what they're doing, they said “Oh, yeah, this is great because we use you to enable all of our tumor boards.”

They said, “We collaborate with 60 physicians at one time. We use Life Image to collect the information, the data, the pharms, the labs, the imaging, and put it all together. Then we use your viewer. We bring in 60 doctors and do a case review. It's a big part of our research and revenue stream.”

And, honestly, Life Image didn't know our platform was being used that way.

We find that kind of thing every day, which speaks to another point of differentiation. We adapt to our clients’ workflows.

Life Image goes in and says, “Show us what your workflow is and you can configure us to enhance your workflow, but you do it the way you want to.”

Radiology at Mass General (Massachusetts General Hospital) does it dramatically differently than radiology at Children's Hospital in Boston, and dramatically differently than radiology at MD Anderson or UCSF, all of whom are using the same platform, but they get to use it the way that they want to and that's a massive difference.

Q. I think that's all for me. Is there anything that I've left out or anything that you want to make sure that we emphasize in this article?

We (at Life Image) are a proponent for interoperability because it is the right thing for providers, the right thing for technologists, and the right thing for patients. If you’re working with a vendor that has proprietary systems, I encourage you to challenge them because in the long run, they're not helping you or the industry. So that's a call to action on our part.

I think the second would be to recognize there is a growing consumerism out there. Patients want access to their medical information. And PACS administrators need to think about that. Over the next three to five years they are going to be burdened with a lot more patient requests for data. They’re going to need to have a solution like a Life Image that directly helps deal with patient requests. Otherwise, they really risk being out of compliance with the federal government, or getting overwhelmed with new work efforts.

Consumerism is an issue to think about because it's coming, and it's coming strong so it’s important to deal with it now as opposed to getting crushed by it in a couple of years.