PACSmaker Make Me a Match

PACSman: Two weekends ago eHarmony® ran a weekend special where you can communicate free with the love of your life that you didn’t know was out there waiting just for you. Now I haven’t been on eHarmony for at least 3 years ever since it started hooking me up with nothing but die-hard Christians - and that was after taking their 400+ question profile twice - and frankly I am fairly content with my “life” as it is. I have some great people in my life yet just couldn’t resist answering one person’s questions on a Sunday afternoon though that turned out to be a race against the clock before I had to actually pay to chat. She was a doctor and I a lowly PACS consultant and besides, it was free so…..

The questions and answers flew back and forth in rapid succession over the course of two hours and all seemed well. While I must have scored A’s and B’s in the first and second set of questions as well as my “must have/can’t stands,” my last set of questions just before the open communication session I must have scored an F on it because I never heard back from her after that. Bummer. Or not. There were three questions I received and I think I blew them all.

Question #1 was: I am very impressed that you have your own company. This shows me that you are very ambitious and responsible. Tell me about your background, and how you came to have this expertise. I’ve gone to your website - WOW. Have your e-mail.

My answer: I wouldn't go that far- maybe it's just that no one would hire me for the past 26+ years. LOL. The website also needs to be updated...Bottom line for me is money doesn't mean as much as having fun, which is what I do - plus working from home in gym shorts and a tee is a bonus.

Maybe she’s just jealous that I work from home in my gym shorts and a tee…or wants someone who regales in his accomplishments and achievements instead of using self- deprecating humor like I do because I really don’t feel like I am better than anyone else…but for anyone who knows me knows, this is who I am so…M.D. to me doesn’t mean most divine either…I know way too many docs to know that. And the comment of being gainfully unemployed? I’ve never missed a house payment yet…and have plenty of money to go garage saling with as well, so life is very good indeed…

By question two I knew I was in serious trouble:
Question #2: During a typical week, what sort of physical activities do you enjoy?

My answer: I wish I could say more. Does walking the dog count?..... In a few I’m going to mow my own lawn - it’s not a money issue but a pride one - I need something that provides me with instant gratification…

Wrong answer again I’m sure. While I talked about how I used to play racquetball until my buddy Steve got hurt last week and now we do bike riding, etc., I probably should have told her that I used to exercise a lot more until I blew my right knee out white water rafting three years ago (I did)…...and how I run a sports ministry overseeing 80-100 guys and gals playing soccer every week among other events….and…and…and….The truth though is while I enjoy biking and racquetball my most consistent exercise is walking the dog and shampooing the carpet after he blesses it with his holy water…Maybe she was looking for a marathon man instead. The closest I come to being a Marathon Man is that 30+ year old film where Dustin Hoffman plays a graduate history student unwittingly caught in the middle of an international conspiracy involving stolen diamonds, an exiled Nazi war criminal, and a rogue government agent. Yeah, that’s my life….NOT! Worse than anything, though, is not only do I mow my own lawn but – gasp!!- no hablo español either!! Despite all that, that probably wasn’t it either. No doubt it was my “instant gratification” (IG) comment that did me in….but to me mowing your own lawn beats many of the other IG options too (laugh).

On to Question #3: Tonight you can do anything you want, no penalties, no reprisals, and the cost is unimportant. What are you going to do?

My answer: Fix my leaking garbage disposal (laugh) …
OK, so maybe that isn’t what she wants to hear, but I was thinking maybe it was a trick question too. The reality is just when I was about to answer something completely different my son Matt came to me and asked, “Dad what’s that brown stuff coming out from underneath the sink onto the floor?” Come to find out my garbage disposal chose just then to give up the ghost and…well…..you get the picture…I think the saying goes “When you are up to you’re a$ in alligators its hard to remember your initial objective was to drain the swamp.”

As a consultant I also learn to ask a lot of questions so my next comments in my reply were: “Would I be alone or with someone? If so, would I be with someone new? Someone I’ve dated for a short time (month or so?)? Longer time? Are we casual friends or in an exclusive relationship? Is it raining out or sunny? What are our moods, desires? What has to be done, what doesn't before I could enjoy the day? (there is that responsibility thing again). Do I have work tomorrow? Those can all be answered in about 2 minutes, but everything needs to be looked at so our minds can be where they need to be and not somewhere else…Too many questions I’m sure for someone who no doubt is a runner and probably takes the Nike approach - Just Do It!! - versus being methodical, although I thought a doc might have appreciated my methodical approach…Oh well…

I would love to have said: “I’d hop on a flight and visit my relatives in Sicily!” (Rosario, oh Rosario…Wherefore art thou Rosario!!), or “Take my 1930’s wooden speedboat (that I don’t own, but would love to someday) to the middle of Lake Dora with some candles, wine and cheese and enjoy a quiet moonlit night,” or “Dinner, dancing and decadent delicacies over an entire evening,” but hey….that’s not gonna happen anytime soon either, with her or anyone else (besides there are a few others in line ahead of you anyway who won’t allow cutsies ). I’d also love to go to Jade Mountain in St. Lucia where my friend the Dalai went on his vacation, but need someone special to go with. That’s not the kinda place you go to alone to or take your kids to either. The Dalai also makes about $1.50 an hour more than me so…

“No penalties, no reprisals and cost is unimportant?” That’s gonna take some serious thought….I have two kids going to college in another year, so cost is always a consideration from the $5.34 Hungry Howie’s pizza my son and I just split for lunch on down….Besides, everything in life has penalties and reprisals attached to them…and anyone who doesn’t believe that I probably wouldn’t want to date, let alone marry…But it’s a nice thought…One day I might even think this through more and answer it properly…. although I doubt I’ll get it right then either.

So 1,200+ words later what does this all have to do with PACS? Too many customers and too many vendors have both given the wrong answers lately.

I have one client who is using both himself (a radiologist) and his business manager as their site’s PACS Systems Administrator (PSA) because in his words: “We don’t need and can’t afford a dedicated PSA.” Wrong answer. True a PSA does cost money, but when you add up the time they spend doing PSA duties plus - and this is the most important part - the ticked off customers he had because things a PSA could have done to prevent some of the issues they had weren’t being done - it actually cost them MORE money…

Here is the reality - EVERY PACS and EVERY clinical IT system implemented has issues with it every single day. That’s why every PACS needs a systems administrator to deal with these. The PSA can be someone who is already in your IT department or someone you hire from the outside, but it needs to be someone. These are not optional areas - these are MANDATORY!! The vendor should also REQUIRE you to have a PSA before they sell you the system - not an option, but a requirement. Vendors, listen up. Have a PSA or no sale…

The second set of wrong answers came from a vendor who had one of my clients’ RIS and PACS systems down for almost six hours before anyone bothered to do something to bring it back to life and over eight hours total…on a Friday…It was Abbott and Costello’s “Who’s on First” routine all over again except my client lost over $15K worth of business that walked up the street during this process. He also ended up working well past midnight on a Friday clearing up 8 hours of backlog…. all the while his wife and three-week old baby waited on him to get home… The problems still exist three days later, only now different ones in different forms…And the vendors respond? “Aside from all this I hope your weekend was a good one.” I think I've heard this put another way before - "Other than that, Mrs. Lincoln, how did you like the play?" They need to do a whole lot more than say, “Aside from all that…” and put together a serious plan of action on how to prevent it from happening again, then make damn sure the penalties surrounding circumstances are sufficient if it does happen again.

That’s like my then wife and I finding out she was with child again with a 9-month old at home. After a brief discussion we went with a very permanent plan of action, a plan that involved sitting on a bag of peas for a day and all was good…and if we did have another, we would name him after the urologist since he would be raising him, not I.

So did I lose out on eHarmony? Did she? Who knows? I want someone who doesn’t like to date or at the very most has the intention of her next date possibly being her last. Unfortunately, my potential match is someone who has “been out with several men, and has enjoyed this process...” and “…find(s) the prospect of getting to know someone thrilling.” I don’t know if I find it thrilling or not - occasionally it can be exciting, but most times the thrill becomes a nightmare that I’ll moonwalk away. You just can’t be who you are - or answer straight from the heart either. Like her I miss female companionship in many ways, but am not quite ready to take a ticket from the deli waiting my turn to order either….

I’m not sure if I have as strong a personality as she does, but do find women with that quality very exciting - as long as it’s not overpowering. Finding out I’m on a date with Dominatrix Debbie is something I’m really not into... I also am not ready for any kind of marriage relationship either – I’m looking more to spend time together, just enjoying the relationship without the pressure of "is this forever?"

Maybe I’d do better if I if found a gal with as dry - or wry- a sense of humor as I have. After all, even if you are a born again, you should be able to appreciate that I’m not totally serious when I say: “The only time I want to hear ‘Oh God!” or ‘Oh Jesus!’ is in the throes of passion,” and not be appalled. I mean if you can’t laugh at yourself, who or what can you?

Money is not a problem here either, except when I don’t have it, and I, too, just love a good deal. Thank you Dr. Warren and your eHarmony cronies for making me an offer I couldn’t refuse.

I almost never look back - maybe briefly, as a matter of learning from mistakes - but as she shared with me you just can’t haunt yourself with too much of the hand-wringing. Move on. And so I shall. After all, she has my e-mail, and the answers that I gave weren’t right or wrong but instead just me…

Ms. PACS: How am I supposed to react to this PACSman...you are actively e-dating behind my back?! I'm crushed!

Or possibly – relieved.

Yes, relieved to know that you’re finally catching on. If you want to come up with the right answer, you need to ask the right question. Whether it’s about knowing how to answer and get the attention of potential mates on eHarmony – discerning what he or she looking for? Or do you really care because it’s all about you anyway? Or whehter it's asking your PACS vendor the right questions – "Once I buy this thing, what’s it's going to cost to service it?" Or if it’s a frustrated PSA, wondering why the system continues to crash...over and over again….it’s all about asking the right questions, so that you can come up with the right answers.

But chose your words wisely when eHarmonizing. There are so many lyrics about choosing the right words. Just think of The Cure’s “Pictures of You” (You know it. The song enjoyed a revival from it’s 80’s roots in a late-90's camera commercial). Robert Smith’s voice is not only agnozingly somber…hold back the tears PACSman…but he makes you think. Because we have all probably lived these lyrics at some point in our lives:
“If only I’d thought of the right words
I could have hold onto your heart
If only I thought of the right words
I wouldn’t be breaking apart, all my pictures of you.”

The more philosophical PSAs occasionally come up with a few deep-thoughts of their own like:
1. As techonology gets better, does anyone think it could become a risk to keep data?
2. If something is missed using today's technology, but discovered years later, what are the risks?
3. What are typical refresh times for DMWL? Are there ways to tweak it?
4. If I shout in the woods, will anyone hear it? Just wondering.

So maybe a good answer to Question #3: Tonight you can do anything you want, no penalties, no reprisals, and the cost is unimportant. What are you going to do?
Should have been a question/response to your potential date, like:
What am I going to do? Whatever the doctor orders.

EMRs at Sam’s Club - Watch for Hidden Costs

PACSman: I like Sam’s Club. I’ve been a member for well over a decade back when buying stuff in bulk was much more pragmatic than it is now as a single dad to two teen sons who eat out five times a week. I also like Costo and BJ’s (Wholesale Club that is- get your mind out of the gutter Ms P.). But would I buy my electronic medical records (EMR) system from them? A copy of Turbo Tax maybe, but an EMR? Ah…no…

There are limits to what most physicians can do technology-wise (with the exception of my all-knowing friend The Dalai who is both a computer guru and now plays the role of Cesar the Dog Whisperer as well) but installing an EMR probably is beyond the limits of most docs I know. Heck, just taking it out of the box and plugging it in challenges the capabilities of most docs I know.

That leads me to wonder just what is incorporated in the “on-site technical set-up”. Open up the box and plug it in? Is installation “load the DVD in the DVD player and push play?” Does training consist of a call to Billie in Bangladesh who says “Thank you for buying eClinical Works. What questions can I answer for you?” Come to think of it that sounds like many PACS company’s installation and training programs that you are given the privilege of paying 40% of system list for….but alas, I digress…

Site assessment equals “Do you have power? Cable or DSL hookup? $25K extra in your checking account? We’ll make it work!!” Integration? With what? The operating system? Whoop tee doo!! George Wallace did better with integration than they seem to do. How about integrating the system registration, billing, and financial systems? Hmmmm….

Installment payments? What a novel idea!! Rent-A-Center, Drive Time, Cort, Buddy’s and others would go in shock. Just $49.95 a week for the next 152 weeks and the EMR you could have bought for $1000.00 cash can be yours for the low, low price of just $15,584.00, tax included! Of course it’s zero interest so we can’t say we’re charging you $15,584.00 for a single $1,000.00 CD. It’s a $15,584.00 CD that is interest free for 156 months!! Momma always told me there ain’t no such thing as a free lunch, and at our house if you were hungry you generally had to make that lunch yourself too!!

Working for what you get? My God yet another novel approach!! Send me some of that Bama stimulating money please!! Our President would be so proud that we are using our healthyimagination®. God bless our Obamination and the folks over at Generous Eclectics.

Now that HHS has published the definitions on “meaningful use” will anyone find anything meaningful about it? The matrix they put out identified with these priorities:

• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security protections for personal health information


Some of the criteria might be difficult to measure and validate, but PACS hits all of these……if you use your healthyimagination that is. So please send me my Sam’s Club coupon, Ms P. I already got my “free” cable conversion box even though my 52” flat panel 120 Mhz Sony LCD TV with 1080i, 4 HDMI ports, a 900,000:1 contrast ratio, four on the floor dual hemis and mag wheels doesn’t require it. After all Momma also told me you should never turn down anything for free…


Ms. PACS: Now that the ‘meaningful use’ definition has squeezed in imaging as “multimedia (e.g. X-rays),” it’s time to get the ball rolling – if you’ve got a roll of cash. So, how are physicians groups going to pay for the EMRs, or even large cash-strapped hospitals for that matter? Cut down on bed pans?

Here’s a more hygienic solution: You can buy an EMR at Sam’s Club! It’s true: Sam’s Club, eClinicalWorks and Dell are offering a “turnkey” electronic medical record (EMR) and practice management package for small physician practices. Dell will provide necessary hardware and site assessment, onsite technical set-up and training as well as integration of the eClinicalWorks software with the operating system, along with hardware warranty support. And it comes at the low, low price of $25,000 - for a three-provider practice - and up to $10,000 for each additional provider. What a deal – right?

But before you reach for your wallet, a PACS veteran with a Belgian accent commented to me over lunch yesterday: “You can buy an EMR in Sam’s Club. But if you try to implement it, you’re on your own.” Good point – especially if you need it to interface with all of the rest of those systems – like PACS.

While you can rely on Sam’s Club for excellent frozen wild-catch salmon, I wonder about EMRs. Here’s an alternative – pay in installments. One of the big three came up with its own EMR-finance program. They call it “Stimulus Simplicity.” Sounds a little like Obama and Philips on a date.

No, they are not dating, but GE is offering its own flavor of a stimulus package. As part of the healthymagination program: “GE’s Stimulus Simplicity program helps physician offices and hospitals that invest in GE’s electronic medical records (EMR) products, GE Centricity EMR and Centricity Enterprise solutions, maximize the potential benefits of the increased focus on EMR under President Obama’s stimulus funding bill…. GE is now offering its HITECH Warranty for Centricity EMR and Centricity Enterprise solutions and zero-interest funding with deferred payments to qualified buyers so they can have immediate access to this technology without the up-front capital costs.”

But before you take out that second mortgage, the public comment period on ‘meaningful use’ is open until Friday, June 26, and as such, we still don’t know for sure what the ‘meaningful use’ language will wind up saying in the end. So, most likely, no one will be rolling the dice on EMRs this week, at least not until they get a coupon in the mail from Sam’s Club.

All Roads Still Lead to PACS

Ms. PACS: Just a quick comment for the PACS “pepes” post the SNM and SIIM shows. There are new client-server solutions for nuclear medicine invading a PACS near you. And I’ll preface it by saying: “No – this is not a commercial – just an update.” So don’t blow a gasket PACSman….just breathe.

At both SNM and SIIM, I kept seeing the integration of nuclear medicine imaging with multimodality PACS.

Just this week, Siemens showed its Symbia.net client-server solution that’s designed to work with an existing SPECT or SPECT/CT system, RIS and PACS infrastructure. Image uploads to the server database are performed automatically. Additional remote users can be added at any time and installed remotely to grow with the needs of the imaging facility.

The biggest show stopper took a step beyond PACS - a preview to the future of PACS - was 3D modeling. Often used in architecture using AutoCAD software, you can create any complex 3D model - a building, a brain or a SPECT/CT system in a nuclear medicine suite. Thanks Dominic (ala Philips) for the demo and good thing you gave me the cliffnotes.

Then there’s the one from GE Healthcare, I saw this at SIIM a week ago. GE Healthcare integrated Xeleris Suite for Nuclear Medicine into the GE PACS RA1000 workstation. The big push here is enterprise connectivity. This platform provides a single database for patient selection, reporting and archiving for multimodality review, including nuclear medicine tools and reprocessing capabilities. According to GE, the Xeleris Suite enables nuclear medicine physicians and radiologists to do nuclear image reviews together… holding holds…on the Centricity PACS RA1000 workstation.

Here’s one for the small private practices or a Nuclear Medicine or PET/CT department – a new patient scheduling and workflow manager that interfaces with the RIS. Numa made a lot of noise about its new NumaManage – “designed to replace the traditional static whiteboard with a digital, touch screen interface.” It is also a DICOM worklist provider, so the user only needs to input patient information once, and the information is distributed throughout the department.

So what does this all mean – PACS is still important and still the principal imaging management tool. While the EHRs will become the hospital image and data exchange center, offering a unified viewer for all physicians to view all images and media, there is something the enterprise viewer will not be used for – diagnosis. So, PACS maintains its position of importance because – at least for now – it’s the only platform for storing and viewing diagnostic images.

So, can anyone guess what's the next ology to integrate into PACS?

Would You Like Some Cheese With That Whine?

Ms. PACS: When Radiologists, PACS admins, IT folks, students and residents hit a show like SIIM, they leave each session chattering about what peaked their interest in the discussion or they compare notes on their own workflow issues – all the while happy to know they are accumulating CME credits. Below the mumbles, gurgling hunger pains instinctively steer them toward the exhibit hall floor where the herd bee-lines for coffee and donuts or lunch boxes, depending on the time of the day. Can you blame them after enduring imaging bootcamp?

Once appetites are calmed, they meander through the exhibits, sheepishly revealing interest amidst fears that they will be roped into trying out a workstation by a charming marketing guy/lady with a big bright grin and long legs. After a 10-15 minute attention span, they regroup, check their watches/iphones/blackberries and scurry back to the sessions to listen to experts discuss "economic stimulus package funding opportunities," or to argue over "who owns imaging" – radiologists, cardiologists or IT – and to ponder the convergence of radiology and pathology PACS. Why, because that’s what they came for, and they seemed pretty content too. That's the attendees' version.

The reality is, however, it’s not just about the attendees' needs. Whether they like it or not, the trade shows have to cater to the vendors too.

Now, here’s the vendors' version. At most shows, while attendees are off the floors, the press are the ones buzzing from booth to booth, "talking shop" with vendors on the latest and greatest in PACS and IT. Inevitably, they end up talking about the status of the show. Gum cheeewing: “So, how’s the show’s going?,” i.e., "Are there any attendees?" "Did you get any new orders?"

In the last two years, the resounding response among vendors has been: “There were more people last year,” “I don’t know if we’ll be back next year,” “Why do we have to come here?” After all their moaning and groaning, a light goes off, they remember it’s a trade show – and decide what the hell, let’s have some fun. “So, where are you going tonight?” The next day, the same thing, whining…maybe it has more to do with their hangover, but let me tell you, it’s never enough. Or have they just had enough?

How effective are the trade shows for the vendors? One PACS vendor veteran noted:
“I used to go to these shows to learn about the latest in PACS innovation. Now it’s an educational session, and you can’t demo workflow on your workstation. I’d rather sponsor an educational grant than bring down 20 people.”

Well, maybe that’s a good idea. The attendees want CME credits and they seem to pay a lot more attention to the educational panels than to the vendors’ new gadgets. Ergo, educational grants may get you some attention.

SIIM just released a statement on their show (6/12/09), saying: "While attendance was less than in previous years - mostly due to a decrease in international and corporate registrants - vendors in the exhibit hall had a successful show as far as quality of interactions and ability to have substantive meetings with customers and partners....Feedback from attendees indicated that they found the educational program and sessions highly engaging and practical."

You can blame the show organizers all you want, but there were attendees, albeit less. Quality of interactions for vendors? You'll have to poll the vendors. What does seem clear is that it's time for a tactical marketing move. Here’s a suggestion to the vendors – change your approach in reaching your audience. Give the buyer what they want. If it’s education, educate them or at least sponsor popular sessions. If show attendees tend to stick around at these sessions a lot longer than the booths, if you see them high-tailing it back to imaging bootcamp mid-marketing speak, then learn to speak their language.

PACSman: I didn’t attend SIIM this year. Truth be known I haven’t attended any SIIM meeting since it was held in my hometown of Orlando a few years ago. The same holds true for HIMSS, AHRA and most other shows. If I can drive there, if I’m speaking there, or someone is paying my way I’ll go, but if not, I’ll read about it in the trade journals. The RSNA is the only exception to the rule and that is because people look forward to reading my tongue-in-cheek PACSMan Awards® and have made it one of the top read pieces from the show on another e-journal I write for.

So why don’t I go? For the same reason many don’t. How you spend your time and money is getting harder to justify. You go where you will get the most bang for your buck. Frankly the smaller shows just don’t seem to provide that any more. TEPR (Towards the Electronic Patient Record) pulled the plug this year when their crowds failed to materialize once again. I’ve been to TEPR before - I even spoke there once - and sadly its time has come and gone.

The smaller shows seem to be the most impacted by a bad economy, but no one is immune. Attendance at HIMSS, the big IT show, was down 6% this year, yet still drew nearly 27,500 attendees and 907 exhibitors. The RSNA had 58,800 attendees yet showed a 5% overall decline. Interestingly they had only a 1% drop in professional attendance, with 12% vendor declines making up the difference. Still they pulled in over 27,500 professional attendees.

So can the smaller shows survive? And will the vendors continue to pony up the bucks to exhibit at shows that bring in less than 1,000 attendees? If the bigger shows are in trouble, you know the smaller ones will be too. Meditech pulled out of HIMSS this year citing the expense for the company and attendees. Total exhibit square footage declined 4% at RSNA this year with a concomitant reduction in the number of vendors. And Fuji, one of original founders of SIIM back when it was called SCAR, pulled out from the show it helped organize, this year as well.

Most of the feedback I got from attendees at SIIM was that it was fairly good show content-wise…but the vendors weren’t so sure if they really got the bang for the buck they wanted. From a sales perspective one needs to ask: does SIIM deliver the right people? Information in the 2009 exhibitor prospectus shows indicated that 81% of the attendees are involved in the purchasing decision, 68% plan on purchasing, replacing or upgrading their equipment next year, and 65% will spend $1M or more. On the surface that sounds great, but is it reality? Seven out of 10 SIIM attendees were either PACS Systems Administrators, Researchers, Technologist, or Vendors/Consultants. Yes, they may be involved in the decision-making process, but few carry any decision making clout. The true PACS decision makers - Health Care Administrators (including C-suite level), IT managers and Physicians (I assume they mean radiologists) made up the remaining 30%. That means out of 800 total attendees only 240 were in decision-influencing positions. When you figure out booth space costs (>$3K for a 10x 10, over $12K for a 20 x 20), exhibition-related costs, personnel costs, travel and entertainment costs, etc., you are talking a minimum $20K for even the smallest booth and a six figure investment for the majors, all to reach fewer than 250 people over thee days with a mere 17 hours exhibition time (two full, one half day). Is it worth it? Many are asking that very same post-show question - are we getting the most bang for our buck.

As an industry we tend to focus on quantity over quality. Why else would more and more PACS vendors sign up to exhibit at HIMSS when the show virtually ignores PACS, at least from a presentation standpoint. Out of 300+ presentations at HIMSS this year only two – TWO – focused on PACS, and one was from a vendor. So why do PACS vendors exhibit there? Because it attracts IT people, the people who are being pinged about PACS at the C-suite level and will ultimately have a major role in the decision-making process. The same can be said about RSNA, which attracts a high percentage of radiologists. These are the primary users of PACS and will have a major role in the decision-making process, even though their time at the show might be divided among 4,000 other entities. And SIIM? It’s PACS-centric to the max, yet each year we can barely scrape together 1K attendees…

SIIM is a great organization and puts on a good show. Unfortunately, many would say it doesn’t target the right demographics for exhibitors who want to sell products. Or does it? It only takes one sale to pay for itself, but how many sales are made or even influenced by SIIM? I would venture to say very few.

I personally recommended SIIM attendance to several clients who are looking at PACS. It is the only place where you can see most of the PACS vendors’ products side by side, unimpeded by other products that might redirect your attention. But it just doesn’t seem like that’s enough to drive people to the show. Those who attended the educational seminars seem to have been PSA’s looking for CEU’s. Interactive sessions are a plus. But exhibits? Who knows…..

SIIM needs to reinvent itself as the PSA-centric organization. Perhaps the answer is piggybacking itself with other shows like HIMSS. After all, the II in SIIM does stand for imaging informatics so…. Or doing a virtual conference like HIMSS is doing….or a Webinar…Why you ask? I counter with why not?

Like many smaller standalone shows, SIIM will continue to be hard pressed to draw the right crowds year after year. I hope the show - and organization - stays alive, I truly do. To do that though SIIM needs to take a closer look in the mirror on how it is received by the market, what it’s doing right, and what needs to be changed. As a former SIIM (SCAR) member, I have some definite ideas. They can call me - my contact information hasn’t changed since I was a member years ago - or they can just look in the book under PACSMan….

GE's Big Investment

PACSman: Before anyone accuses me of being anti-humanitarian I think GE investing $6B to help “lower the cost of health care and improve the quality of medical care in underserved regions of the United States and abroad,” is commendable, especially if it gets into the hands of the rural regions of the U.S. who really need financial help.

On the surface this investment looks great. Of the stated $6B donation, $3B is slated for “spending on new, lower cost medical technology,” $2B in financing and $1 billion for partnerships, patient education and other services. Now here is where it gets interesting.

The $500 million per year earmarked for Healthymagination® technologies will account for half of the $1 billion GE plans to spend on R&D in each of the next six years. Launching these 100 innovations will “lower cost, increase access and improve quality by 15 percent.” But even GE acknowledges that, “These actions will strengthen GE Healthcare’s business model.” (http://www.genewscenter.com/content/Detail.asp?ReleaseID=6760&NewsAreaID=2)

This then leads to the question: “What makes this investment so newsworthy that it generates over 35 pages of hits when you Google ‘GE $6B’?” Now $6B over six years sounds like a lot of money, and it is, but it’s all relative. GE Healthcare generated $17B in sales last year alone, so this comes out to an investment of just under 6% of the company’s total gross revenue.

Increasing R&D spending to make better products is commendable, but again what’s the big deal? Admittedly most companies spend between 12-15% of their sales on R&D and GE is now upping the ante in this area considerably in the hope that they will be able to reduce the cost of modalities by 15%. But isn’t this just making the company more competitive? And isn’t reducing health care costs the aim of the DRA and other programs that CMS has so wonderfully graced us with? It’s great to say the company will “reduce by 15 percent the cost of procedures and processes with GE technologies and services, increase by 15 percent people’s access to services and technologies essential for health, reaching 100 million more people every year, and improve quality and efficiency by 15 percent for customers through simplifying and refining health care procedures and standards of care,” but how does this really benefit the end user? If the costs of modalities are reduced 15%, will these savings also be passed on to the end users, especially when most single modality outpatient diagnostic imaging centers are struggling just to stay alive in the face of DRA cuts? “Mr. Customer, GE allowed us to save 15% therefore we are passing the savings on to you…” Um….I’m not holding my breath on that one…

I also fail to see how “expand(ing) its employee health efforts by creating new wellness and healthy worksite programs while keeping cost increases below the rate of inflation” and “increasing the “value gap” between its health spend and GE Healthcare’s earnings to drive new value for GE shareholders” affects anyone other than the GE employees. Isn’t this better served in the company newsletter than a press release?

I’d love to understand why GE plans to “expand clinics in Cambodia and provide additional funding for maternal health care programs in Bangladesh.” Now Bangladesh and Cambodia are pretty low on the totem pole in life expectancy at numbers 167 and 174, respectively out of 221 countries, yet they are still just a few years below the average life expectancy of 66 years for all countries combined at 63 and 61 years respectively. Of course ALL of Africa is much lower than these two recipients in life expectancy as are Haiti and Laos, but a Poppa Doc CT scanner probably wouldn’t be well received in most countries….. I’m figuring Bangladesh will no doubt give India a run for its money in call center technology in the ever near future and GE is just hedging its bets there. “Hello. Thank for calling GE, this is Bob in Bangladesh.” We also should not forget that GE gave a whopping $20M to Ghana, Ethiopia, Nigeria, Kenya, Rwanda, Senegal, Mali, Malawi, Tanzania and Uganda back in 2006 to “transform hospitals,” including providing health care and power generation equipment to water filtration systems, appliances and lighting. That comes out to $2M per country or less than the cost of two GE CT scanners.

As an aside, there are 44 countries that have a higher life expectancy than the U.S., which averages 78 years, including several U.S. commonwealths and the like. Maybe it’s time to move…

“GE Capital will provide $2 billion in financing to help health providers in rural and underserved areas get access to more innovation that improves health and reduces the cost of care.” Now $2 billion in financing is nice and is certainly a helluva lot more than I have in the bank, but last time I looked into it financing costs money - and the people lending the money typically make money from that as well. President Obama’s healthcare stimulus program will no doubt help. GE stated that making this money available “will focus financing to assist in the adoption of EMRs and health information exchanges (HIEs)…. GE’s financing will help healthcare systems adopt EMR and HIE before 2011 in time to qualify for federal financial incentives.” I wonder how much interest accrues on $2B in loans though – and how easy it will be to get this money as well with financial institutions all over clamping down. I wonder if GE Capital follow suit?

One billion dollars is slated for partnerships, patient education and other services, yet part of that includes GE using its NBC television networks, including NBC Universal, NBC News and MSNBC as a way to increase consumer knowledge about health, including launching a daily program devoted to health in June on MSNBC. Forgive the cynicism again, but isn’t that just taking money out of one pocket and putting it in another?

GE chairman Jeff Immelt summed it up well: “We don't run a charity at GE – we make money,” he said. “We are in business to earn profits for our investors. We think this is a growth program for the company.” And so it is…

I guess it's no...

Ms. PACS: So, I guess it's no. Medicare will not pay for virtual colonoscopies.

"Evidence is inadequate to conclude" that virtual colonoscopies are an appropriate colorectal cancer screening test for Medicare patients, the Center for Medicare & Medicaid Services (CMS) said Tuesday in a statement on its website.

Considering the resounding support from the medical community for the reimbursement of virtual colonoscopy, you have got to wonder what is truly behind CMS' decision. This move certainly does NOT facilitate early screening, which saves healthcare lots of money in the long run, and CMS is well aware of the stumbling blocks involved with optical colonoscopy as a screening tool. At least CMS could throw in a few centavos for a help hotline, providing psychological support for the large percentage of people dreading a traditional colonoscopy: 888-MY-COLON.

It could be the work of a strong gastroenterologist lobby that wants to hold on to the reimbursement for optical colonoscopy. Or this could be another move by CMS to restrict the use of medical imaging as a diagnostic screening method. But that wouldn't be too smart. Nor is this final decision by CMS in the minds of many radiologists.

VCT Debate Heats Up Pre-May 12 Decision

Ms. PACS: While I wait for the PACSman to respond to my email that I'm posting...he'll probably be up soon from his nap...I wanted to see if anyone is following the heated debate over virtual colonscopy.

How does it relate to PACS? First off, if it helps you get over the fear of getting a colonoscopy, it doesn't matter if it relates to PACS. The first step in overcoming this fear is to click on the image of the colon. But, also, it's about radiology imaging, which is managed on a PACS, and the question is whether the diagnostic quality of virtual colonoscopy (CT colonography or CTC) is at least equal to optical colonography, and if so, whether Medicare should reimburse for it.

As you know, virtual colonoscopy is a noninvasive colon cancer screening procedure with the potential to increase low screening rates and save lives. But to the surprise...for some shock...of many doctors, it did not receive good marks when reviewed by CMS and was subsequently denied coverag. So, now, right before CMS makes its decision on May 12, medical professionals are trying to get their voices heard by posting comments on the CMS Web site (https://www.cms.hhs.gov/mcd/viewpubliccomments.asp). But will CMS listen?

Most comments reflect a strong urging toward reimbursement for virtual colonoscopy.
Here's one from Kyle Kreinbring, M.D., of Advanced Radiology, S.C.:

“I am writing to voice my strong disagreement with Medicare’s recent denial of coverage for virtual colonoscopy. We are all aware that colon cancer is a major concern to all American’s age 50 and older, that colon cancer kills more Americans each year than breast cancer and AIDS combined, and that appropriate screening is the only way to prevent colon cancer.

"As radiologists who have reviewed the literature, we are shocked by the conclusion. Large, randomized and blinded studies have been published in well-respected journals. This includes several articles in arguably the most esteemed journal, The New England Journal of Medicine. Using updated technique and software, the results have been very clear…CTC is a valid, sensitive and safe modality for detection of polyps and cancer. The concerns over radiation and incidental findings seem to be a technique to detract from the real success of CTC. With new protocols and effective dose control the radiation dose is negligible, especially in this population of older patients....This technology has the chance to be a life-changing event for many Americans. It will encourage more patients to be screened, which is the ultimate goal,” he said.

Here's a scathing one from Mark Albright:

“History is replete with examples of governments, politicians, philosophers and businessmen making colossal blunders while clinging to mistaken ideals even in the face of significant evidence to the contrary…Any failure to approve reimbursement of CT Colonography (“CTC”) for colon cancer screening would promptly take its place as among the biggest, costliest and deadliest gaffes in the history of public health. The effect of such a decision will be that (a) more Medicare patients will die from colon cancer, and (b) the costs of Medicare will continue to escalate because Medicare will be paying for treatment and care of colon cancer patients, rather than preventative care for an extremely curable disease.”

Now, a more tempered, voice of reason from gastroenterologist, Dennis Ahnen, M.D., Denver VA Medical Center and University of Colorado Denver School of Medicine:

He starts by expressing his disappointment that “to learn of the proposal to not include CT colonography as an acceptable and reimbursable option for colon cancer screening. I think this is a mistake."

1. It is now well established that CT colonography, if done by well-trained radiologists with state of the art equipment, is a highly sensitive test for detection of both cancer and significant (>6mm in size) adenomas of the colon; studies have shown that it is as good as optical colonoscopy for detection of these lesions.

2. The concern about variable quality of CT colonography in the community is real but it is equally true or even moreso for colonoscopy. It is well established that colonoscopy quality as measured by cecal entubation rates, withdrawal times, adenoma detection rates and/or complication rates varies widely among endoscopists so that high quality screening is required for both CT colonography and optical colonoscopy.

3. The concern about the cancer risk of radiation exposure with CT colonography is appropriate but theoretical (back-extrapolated from exposure data to much higher doses or radiation) and is much less than the radiation exposure of a barium enema which is covered as a screening option by Medicare.

4. The concern about extraintestinal findings possibly leading to higher costs without better health care is also a legitimate concern, but it is uncertain whether the overall balance of these effects is harmful or beneficial nor what the magnitude of the effect would be in practice. A similar argument is not made for the unintended consequences of other screening tests like false positive fecal occult blood tests that lead to negative colonoscopies, which may be followed, by upper endoscopy and/or capsule endoscopy to look for a source of the blood in the stool. I think that issue of extraintestinal findings could be minimized by guidelines about which lesions should be followed up and which workups Medicare will pay for.

5. The inability to biopsy or remove lesions is a real disadvantage of CT colonography, so it would not be a good choice in a population that would have a high pretest probability of having a polyp seen but there are populations that have a low risk such as those with a negative previous colonoscopy where CT colonography would be a good and cost effective alternative to colonoscopy.

6. CT colonography has some distinct advantages over optical colonoscopy in that it is less expensive, associated with less of a risk of both the procedure and the sedation and is much more convenient for the patient.

Overall, it seems to me, that CT colonography is being held to a higher standard than other screening tests, and I would urge you to reconsider your proposed ruling.

To his last point, that sounds a lot like the trouble with coronary CTA - CMS is holding CCTA to a higher standard than other screening tests. I thought that Obama's plan was to encourage early detection as an effective way of cutting healthcare costs. Or is his ARRA stimulus package confined to investment in EHRs - for which PACS will probably not see a dime despite leading the way to streamlining image data in healthcare...oh well. Maybe you should have waited for the hand outs like the rest of healthcare.

The resounding message here is - "enough of this beaurocratic b.s.!" I think Mark Albright, whomever he is - maybe a 10 year-old child prodigy wearing an oversized suit? - hit the nail on the head when he said: It takes its place "among the biggest, costliest and deadliest gaffes in the history of public health."