Wednesday, April 1, 2009

PACS in the Asia Pacific

The Third International PACS and Teleradiology Symposium held earlier this month in Singapore was a big success. It was clear that there is a great need for education and training in the Asia Pacific region as users are trying to implement digital imaging and vendors are working to support their efforts. 

There are basically two markets for PACS in this area: the first caters to the middle and upper class in these regions as well as the support of medical tourism. This is a growing business in the region, where foreigners from the Middle East, China, and even as far as the U.S. travel to the area to have medical procedures performed. For example, a $40,000 hip replacement might cost less than $10,000 here. This market is very well served by the same products and manufacturers as you see in the U.S. and Europe. 

The second market is the public sector, which needs affordable equipment, often capable of sending images to a referral or for second opinion. These types of systems are often served by local vendors as western vendors do not seem to be able or willing to address this market segment. An analogy can be drawn with the car manufacturing industry whereby it takes an Indian company such as TATA to come up with a $2,000 vehicle (the NANO) to address this segment. 

The need for further education and support became clear to me through several comments and questions from the audience during a DICOM workshop. For example, one radiologist asked me whether a PACS should be able to support color images. He was told by his vendor (one of the big three) that his Doppler Ultrasound only could be displayed in grayscale on his million dollar PACS. 

Another user asked me what the limitation was in data migration. Her vendor told her that when she migrated her data, it has to be "all or nothing," which meant that even though many of the images were past the legal retention time (five years, in this case), they have to be migrated. 

Yet another user asked my advice about repeating HL7 orders being sent from their scheduling system which messes up their worklist. I told her to work with their IT department and look at the logs, to which she responded that her organization does not have an in-house IT department. 

It rapidly became clear to me that many institutions are on their own when it comes to the support of advanced digital imaging systems. That was also probably the reason I had so many radiologists in the DICOM workshop, a group I rarely encounter when teaching in the U.S. or Europe. These medical professionals have to be a jack-of-all trades in their departments; and they want to make sure they understand the underlying technology so they can challenge their vendors when problem occur. 

I was frankly surprised by the poor level of support that these customers receive, even though the major vendors have development centers in Bangalore, India, which could easily be used to support the region. I heard far too many stories of systems being down due to a lack of response and a slow escalation of problems to service centers in the U.S. and Europe. 

How can we help to empower these users whose health IT goals are as aggressive as those of their colleagues in the rest of the world? Training, education and accompanying certification is an obvious first step. In addition, manufacturers need to educate their sales and service support staff, because the half-hearted solutions that they are currently offering do not help to create momentum for digital imaging solutions. 

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