An ability to recruit and retain top talent, a novel strategy for software development, and swift response to changing market trends are fuelling a Canadian radiology systems vendor’s stupendous business success.
Earlier this year, when Carestream Health Group in P.E.I. won the Frost & Sullivan award for “fastest market penetration” it wasn’t surprising. There are currently 600 organizations worldwide that use its radiology information systems (RIS), including 20 sites in North America.
RIS interfaces with multiple hospital systems, including PACS, lab systems and scheduling, and allows radiologists to access multiple systems from a single workstation.
Small is beautiful
And yet, right from the start, it’s never been just a numbers game for the P.E.I. firm.
It started operations eight years ago, as a very small outfit with just seven employees. Today it has 55.
Many of these are locals – returning after an extended stint outside.
Young people in this region tend to get an education and then move to Ontario, out West or across the border, said Dave Perry, the company’s director of RIS research and development.
“But there’s always been this desire to move back, whenever the opportunity arose,” the Carestream executive noted.
But he said many young folk are held back by what they perceive as a lack of a strong innovative environment in the area. “We’re one of a few that’s been able to offer that level of challenge.”
Carestream’s applications are created by a small team of software engineers, who use agile software development – a new product development methodology.
Perry said the method emphasizes face-to-face communications over written documents and corporate hierarchies. This allows for quick changes in direction, when required.
The ability to change direction on a dime is crucial in a field such as radiology, which over the past five years has undergone some pretty remarkable changes.
In the U.S. and other parts of the world, many more radiology images are being taken within private clinics, and that adds an entirely new dynamic to the business.
Imaging centres are doing a lot more digitizing, and showing a lot more interest in deploying these systems.
But such centres represent just segment of this market. Others include private industry, small community (as well as large university) hospitals.
An interesting trend is the banding together of many of these entities.
Instead of buying separate capture devices or information systems, they’re often pooling their resources and buying one for an entire jurisdiction (this was done in Atlantic Canada with PACS, its picture archiving and communication system).
“We’re seeing that happen on a global perspective at a much higher level,” said Perry. “The capture devices out there are producing a lot more data, a lot more images, so as a result you have to be able to handle larger volumes of data across geographies.”
Along with that, there’s an overall shortage of radiologists out there, which has pushed vendors to be more innovative and come up with new solutions.
Carestream uses an industry-standard IP telephony system for customer communications.
For data connectivity, it typically uses remote access over the Internet with a secured VPN tunnel, said Stephen Powell, senior software engineer with the company.
Apart from smart recruitment and agile development, another focus area for Carestream is quick response to changing customer needs.
One such need is for hosted RIS applications.
The past few years have seen the mushrooming of independent imaging clinics, many of which lack the infrastructure to support their own RIS solution.
So Carestream offers a hosted RIS option. This is already available for smaller organizations, but will be expanded to include organizations of any size – including countries.
For its latest hosted RIS offering, Carestream is working with its e-managed services business team to build partnerships with hosting companies in Canada and other countries. The results of these discussions will define the infrastructure that will be supported when the product is released.
Carestream already has some customers in the Nordic region that are using hosted RIS to provide mobile radiology services. Denmark, for example, sends vans out to various communities as part of its national breast-screening program.
“We expect that will also grow in places like Australia,” said Perry. But organizations have to be able to take the system offline from the main centre and continue to operate in a mobile environment, then sync back in at the end of the day.
The price of RIS products has dropped over the past few years, and it’s now a viable option for mid-sized healthcare organizations (200 to 300 beds), said Ross Armstrong, senior research analyst with Info-Tech Research Group.
It’s not a commodity purchase, but the price has dropped down to about $100,000 for a typical system, excluding implementation and maintenance fees (which can still be a lot for smaller hospitals).
In the past few years, we’ve seen tighter integration of health networks in the U.S. and Canada, where local hospitals band together to share data, eliminate duplicate testing and pool their purchasing power. The issue with sharing any piece of healthcare technology with other hospitals, however, is security and privacy.
“That is a bit of a stumbling block when it comes to creating a health network,” said Armstrong. “While there are cost savings to be had by pooling your resources, there are some governance issues that could muddy the waters a little bit.” But as times get leaner, the trend toward pooling resources is going to continue.
RIS is designed to work hand-in-hand with PACS, which captures, digitizes, stores and retrieves imaging outputs from the radiology department. RIS manages the flow of those digitized images by automating operations; without a working RIS, all patient data must be entered into the PACS system manually, which could lead to errors.
Now we’re seeing the hosted model emerge. The big issue with a hosted RIS solution is the same as with any hosted solution: availability.
What are the service level agreements? “If your RIS service provider goes down, you don’t want that bringing your radiology department to a grinding halt,” said Armstrong. “Healthcare is one of the only industries where outsourcing has a unique element of risk in that people’s safety and well-being can be directly affected.”
Any outsourcing arrangement of a vital IT service such as RIS has to include some strong assurances and technology safeguards, the analyst said. These should ensure the hospital is able to run, even if the provider is suffering from an outage.
