I am used to growing markets. Whether it’s cardiac ablation catheters or heart valves or heart closure devices the direction is usually up. This is driven by the aging population and physicians opting for more expensive devices, much to the glee of medical device companies. So when I was tasked to research the market for healthcare IT, I was surprised to hear that one segment has disappeared over the last few years.
Radiology Information Systems (RIS) are software used by hospitals and imaging centres to schedule patients, and report and track images. They do not store the images, which is the role of Picture Archiving and Communication Systems (PACS).
You may be asking yourself, ‘these RIS sound like what Electronic Medical Records are supposed to do.’ And you’re right. Over the past five years hospitals and clinics have rushed to adopt EMRs because of incentives set up by the Centres for Medicare and Medicaid Services, the biggest payer. This has left RIS products by the wayside; a relic of a not-too distant age when the majority of healthcare facilities were using paper.
Now RISs are modules of EMRs, sometimes given for free to lure clients. This is akin to how PowerPoint is a part of Microsoft Office. Except RIS won’t be used to kill you with boring presentations.
PACS are modularized too, but to a smaller extent than RIS, because PACS are more technically demanding and need to display high resolution images. The modularized PACS offered by EMR companies are generally regarded to be terrible. The last thing you want is a low resolution image because a diagnosis depends on telling which shadows of tissue are slightly darker than other parts. Not to mention that physicians hate EMRs and these companies are abusive, locking clients into long contracts and using proprietary code to prevent data sharing. So stand-alone PACS are likely not following their RIS counterpart to the grave.
So that is how make a market disappear: incorporate the product into another technology you are forced to get because the government told you to. Then give it away for free.
We also know how to prevent this from happening: offer a technically demanding product that can’t be easily mimicked. Make it a high stakes product whose use determines the fate of a patient’s life. It also helps if the mimicked version comes from a company everyone hates.
Important lessons for us all.