PACSman: Like many of us in the industry I was shocked to hear of the death of Sectra North America President John Goble. I both knew John and liked John and anyone who met John couldn’t help but like him. He has this thing about him that was just…well…..likeable.
Years ago, when Philips decided to go with Stentor as their PACS solution ending a decade-long relationship with Sectra, I asked John what he thought about it all and how it would impact the company. In typical Goble fashion, instead of cursing the darkness, John lit a candle. He said it was probably a good thing that it happened finally allowing the company to come out the shadow of Philips and stand on its own merits. I was astounded that a guy who probably just lost 80% of his company’s U.S. revenue could be so upbeat and positive. In my own politically correct fashion I asked if it upset him being dumped for a younger woman. He just smiled and again with that typical Goble response said, “We had a lot of good years together and a lot of good times. They are doing what is right for them, and we will do what is right for us and our customers. We will stand behind the Sectra customers who have our products installed and continue to move ahead on our own as a stronger, more unified company.”
He never had a bad word to say about Philips, even off the record, because these were his friends and just you don’t trash friends. That is the essence of John- straight ahead, honest to a fault, open, dedicated, and focused. In a market of full of schmucks, John was the anti-schmuck. That is probably not the legacy he envisioned for himself- to be labeled the anti-schmuck- but he’d probably just laugh about it knowing how I meant it in all sincerity.
The past few years the PACS industry has lost a lot of good people. Sam Dwyer, Phil Berman, John, and others all made their mark not just on the industry but on me personally.
I can recall a conversation many many years ago that I had with Sam Dwyer, sitting on the back screened porch of my rental house in Maitland where he elected to stay for a few days while he was in town. Now Sam could have stayed at the Ritz since a company was picking up his tab but elected to stay in the guest room at my house so he could help me set up my fledgling PACS consulting business. As we sat on the porch I shared with him my fears about the future and what it would bring. His answer was very simple and very basic- “Do what you love, Mike, have a good woman by your side like I have with Marylou, and when you have kids, be there for them”. I heard his stories of starting out in years past with so little money that it was frightening but his formula- love your work, love your woman, love your kids- worked. I loved my work- still do to this day- and love my kids- always have, always will- but I guess I need to put a little more effort into the woman thing.
Phil had the same simple formula for living as well. Love your work, love your family. He would always talk about his family with whatever new project he had cooking on the back burner, right up until the time he ran out of toes to paint. Another great guy gone way too soon.
John was cut from the same genre. I didn’t get to spend as much time with John as I wanted to- I’d see him at trade shows, he’d stuff my bag full of chocolate, and we’d talk on the phone and have dinner now and then- but I did get close enough to him to hear his war stories so that was closer than many. Love your work, love your family, and make time for yourself was his mantra. All day yesterday the old Laura Nero/Blood Sweat and Tears Song “And When I Die” ran though my head:
“I'm not scared of dying,
And I don't really care.
If it's peace you find in dying,
Well then let the time be near”
John died doing what he loved best, flying helicopters. While it was a terrible and tragic way to go how many of us can say the same- that we died doing what we love best? “
“Give me my freedom for as long as I be.
All I ask of living is to have no chains on me.
All I ask of living is to have no chains on me,”
That got me to thinking - when it’s my time how do I want to go? Now I know we don’t get a choice in it and that it’s all predestined and such (or so the guys in my men’s group at church keep telling me) but if I had my druthers I’d either be at a garage sale having just scored a killer bargain, taking pictures of my youngest son’s high school marching band or my oldest son’s BPA involvement, or watching the guys I’m worked with for 10 years enjoying the fun and fellowship that comes from playing a game of soccer. The very last way I ever want to go is behind my computer typing a report that will be read once- if that- and then discarded. Also know before God gives me the thumbs up or thumbs down, He and I are going to sit down over a pitcher of beer and some wings and talk about a lot of things. I won’t question Him or His infinite wisdom- after all He is God- but I just need to know a few whys and wherefores about my life and others for my self-edification, that’s all. This has the guys in my church praying for me harder still - the arms lifted high, “Praise Jesus!!” variety - and me instead asking, “Yo, God, can we talk?” But God knows it’s coming, and I’m sure he has the answers ready to the questions I’ll be asking, and most of all He’ll be cool with it too. My God is a loving, caring God and I’d be willing to bet He’d even pick up the tab for the beer and wings if they have tabs in Heaven. Heck, He might even meet me outside the Pearly Gates as well, since as it stands now, I can go in either direction and why waste time, right?
I have had so many opportunities to get a “real” job the past few decades- ones that would pay me three to five times what I make now - and each time I came close to saying “Yes” I ended up saying “No.” The sacrifices I would have to make by leaving my kids far exceeded any financial “benefits” I would have reaped. Do I regret it? The money would have been very nice as would the chance to be a part of a team, but I’ve found I get frustrated when people don’t share the same vision and enthusiasm I have in achieving a goal and learned that money doesn’t mean anything so I’d have to say No I don’t. I also have something that few can say in our industry- I was there for my kids. Almost every event that my kids were involved in, big and small, I was there for. I’d be willing to bet Sam, Phil, and John could pretty much say the same. If my kids had something going then they were my prior commitment. That is something I couldn’t do that with a “real” job.
I’m going through a hard time in my life now because suddenly my babies aren’t babies any more. My youngest son Matt at 16 scrimped and saved and now has his own car and can take himself where he needs to go without me taking him. For all the bitching and bellyaching I did about playing Hoke in Driving Miss Daisy, I miss schlepping him all over creation. I also realize what my mom used to say about the hen never sleeping until all the chickens are back in the roost when he is out. Thankfully he can’t drive after 11 pm until he turns 17, so I got the tour of duty for 1 a.m. pickups for him and his friends at Halloween Horror Nights a few weeks back. As tired as I was, it was heaven getting them even if they all fell asleep before we were even out of the parking garage.
My oldest son Nick just turned 18, and now he is officially an adult and will be going to college next year. Thankfully he is leaning towards our local community college, which means he’ll be living with either me or my ex until he hits age 27 or graduates, whichever comes first. He’ll also be getting his car soon enough and then will be in 15 different directions as well. He is my brilliant computer genius with half a dozen certifications already and is a Web site design guru as well, but I just wish he would fix my computer when I mess it up without making me feel like the idiot I really am.
I should be celebrating my new found freedom with the kids being on their own finally but instead have a very bad case of empty nest syndrome. I thought that only affected women….Maybe its time to consider a real job again but at least Elvis the Wonder dog still needs me to clean up when he gets an attitude and pees on my couch leg or the carpet so all is not lost. And someday, somewhere, I’ll meet the woman of my dreams (probably at a garage sale) and give love a chance again - or at least some heavy duty lust. Ms. PACS - where are you when I need you most!!
And when I die, and when I'm gone,
There'll be one child born
In this world to carry on,
to carry on.
I have two children that I love dearly to carry on and I hope they leave me a legacy that I’ll be proud of. And John Goble - in addition to his family and many many friends he has - also has an entire company called Sectra North America that he considered his “children” to carry on….. and carry on they will…
Tuesday, November 10, 2009
Wednesday, November 4, 2009
What the World Needs Now…
PACSman: …isn’t love, sweet love. Sorry to disappoint you, Dionne, but what we really need is fewer ego-centric individuals and companies who are looking out for themselves rather than the good of the industry or the individuals who actually have to use the systems. There, I’ve said it- sue me.
I’ve been in this industry for way too long and each day I wonder when “pro bono” actually will be “for the good of the people” and not for someone’s own good. It has always been my opinion that companies put representatives on committees not to help develop industry-wide standards like DICOM, HL-7, IHE, etc. but instead to protect their own interests. That is one reason why DICOM is the most non-standard standard that ever existed and you need a Ph.D. in reading conformance statements to understand what a company does and doesn’t adhere to relative to this “standard”.
IHE is another example. The concept of improving the way computer systems in healthcare share information is commendable, but do we really need 253 member organizations providing input, of which 177 (70%) are Healthcare IT and consulting companies? No. And how many of those 177 have adopted all or at least most if the IHE initiatives to date? Fewer than a handful. It’s all about the companies ego, being able to say “our company participates in…” .even if in reality they don’t do squat..
Now before you go off on me, yes I do have an ego although you mostly see my alter ego in print and not who I really am. The same can be said for Ms. PACS, many of my fellow editors, and even my good friend the Dalai. In print we can be anything and often are, but it’s all done in good fun. I am incredible outward and beyond bold in print but in reality I’m closer to 180 degrees from that. The same could be said for most people I know. The Dalai is one of the quietest most unassuming guys I’ve ever met yet when you read his stuff its like- “Whoa, wait a minute!! Are we talking about the same guy?” Yes I am. Opinionated? Of course. Correct? Most times. We are both Clark Kent in real life and Superman in print - individuals in search of truth, justice and the American way… trying to help out as we can even if we do resort to a bit of sarcasm now and then…And Ms. PACS - she can be like Rilke’s panther one minute and a pussycat the next…Yes it’s all a game…but a game about helping. All of the 350+ articles I’ve written on PACS have been done with the single intent to help, even if I do tend to inject a degree of sarcasm into them now and then. Most importantly, at least to me, all were also written without cost to the journals - pro bono, for the good of the people.
So what then about egos? I’ve noticed more and more that certain individuals in our industry have adopted God complexes about themselves of late, and it’s not good at all. There seems to be no place for bantering or discussion anymore, and every day I see more of the “I am the great and mighty Oz!!” syndrome showing up. Why then is this happening? The answer is ugly too. We have looked up to these certain individuals for answers and called them Gods for so long that they now they believe that they are…Pull back the curtain as Toto did and you’ll see that academia produces some of the worse cases followed closely by executives at the large companies and lastly people connected with the smaller companies and individuals. Like everything there are exceptions though. I know some individuals in academia who will do anything to help others and be perfectly content to stand in the shadows while there are others where the spotlight can never be bright enough…
To understand ego we need to get a big technical so we need to go back to Herr Sigmund Freud. According to Wikipedia, the “id” acts as according to the “pleasure principle” seeking to avoid pain or unpleasure aroused by increases in instinctual tension. OK, that explains a lot.
The ego is that part of the id which has been modified by the direct influence of the external world. The ego represents what may be called reason and common sense, in contrast to the id, which contains the passions ... in its relation to the id it is like a man on horseback, who has to hold in check the superior strength of the horse; with this difference, that the rider tries to do so with his own strength, while the ego uses borrowed forces [Freud, The Ego and the Id (1923)]
The Super-ego aims for perfection. It comprises that organized part of the personality structure, mainly but not entirely unconscious, that includes the individual’s ego ideals, spiritual goals, and the psychic agency (commonly called 'conscience') that criticizes and prohibits his or her drives, fantasies, feelings, and actions. The Super-ego can be thought of as a type of conscience that punishes misbehavior with feelings of guilt (example: having extra-marital affairs).
The Super-ego works in contradiction to the id. The Super-ego strives to act in a socially appropriate manner, whereas the id just wants instant self-gratification. The Super-ego controls our sense of right and wrong and guilt. It helps us fit into society by getting us to act in socially acceptable ways.
So is it the ego’s fault or the id’s? Where does the Super-ego come in too? Socially acceptable ways? Where? Here? Guilt? Honey, I was raised in a Roman Catholic Italian house, while the Dalai was raised a good Jewish boy. We have enough guilty for any 10 of you - on a good day…
So what’s the bottom line? Let’s go back almost 15 years ago when Michael Jackson, Bruce Springsteen, Diana Ross, Bob Dylan, Billy Joel, Stevie Wonder and over three dozen other rock and pop superstars showed up to cut a record called “We Are The World.” The song was written by Michael Jackson and Lionel Richie to help starving kids in Africa. The great producer and Motown director Quincy Jones, coordinated the entire effort. All through the night the artists recorded and worked together for the benefit of others, with the net result being a record that hit the #1 position a mere four weeks after it was released. The recording stayed in the number one spot for a month raising almost $14M in the first four months alone and has raised $63M in humanitarian aid to date.
How did he get everyone to cooperate? “Q”, as he is known in the industry, put a sign out over the entrance because he had all these huge international stars there—and with them lots of egos too. The sign said simply. “Check your ego at the door”. They listened, worked together and collaborated and raised a lot of money to do good things.
At RSNA, SIIM, HIMSS the DICOM, HL-7 and IHE meetings, and everywhere that individuals can congregate we need to make a sign that say the same - Check your ego at the door. Maybe then we’ll finally achieve the goals with PACS that we have been desperately seeking for years.
Ms. PACS: “Q” is brilliant and while the whole world acknowledges that fact, he has the insight to know people – especially celebrities - need have have some humility to work well as a team.
The funny thing is, every time I have heard the instruction: “Check your ego at the door” - it’s coming from the one’s with the biggest egos…the one’s who are telling you to check YOUR ego at the door because there’s only room for their ego.
These are the Super-ego dictators – they’re going to dictate to you in their unchecked self-righteousness what’s socially and professionally acceptable and how you should act. It’s the people in power who slide under the radar of checks and balances who are most severe with their subordinates. That’s why it’s good to be a doctor – there are few people above you to kick you around. And fear of getting kicked is what drives and reinforces the “id” – which seeks to avoid pain. So remember that the next time you are dolling out instructions.
What I like better than “Check your ego at the door” is “Let go of the ‘e’ in ego and go!” A little cheesy, but the message is the Super-ego often holds you back from learning. It blinds you from recognizing your own shortcomings and prevents you from improving. It actually operates as a shield to avoid pain – the pain of the reality that you are, to a large extent, powerless – the realization of which unearths that underlying, trembling emotion – fear. And lord knows fear is what drives countries to war and places dictators in power. As Dr. Paul Chang explained to me once, in the context of improving healthcare IT, there is the dangerous combination of ignorance and arrogance.
These Super-egos plague healthcare IT and PACS. It is hard for the IT-savvy radiologist or other doctors to recognize they don’t know everything – even about how best to run their own departments. The realization that healthcare IT is 10 years behind other industries, such as banking and finance, is an embarrassment to the erudite. The id cranks up the engine to high-gear to avoid the painful realization that we weren’t born knowing everything, and the Super-ego further buffers the id by denying the truth. Again, ignorance and arrogance.
So what if the IT guy knows more about hospital IT networks than you - isn’t that his job? I know your response - but they don’t know Radiology workflow. So tell them how it works, but listen when they tell you how it might work better.
It’s simple, if you want to improve in life - don’t let your Super-ego blind you, and ignore that wimpy little ‘id’ when it tells you to stick your head in the sand. Why? Because it’s o.k. and even satisfying sometimes to have a slice of humble pie. So maybe a better motto would be – no pain, no gain.
I’ve been in this industry for way too long and each day I wonder when “pro bono” actually will be “for the good of the people” and not for someone’s own good. It has always been my opinion that companies put representatives on committees not to help develop industry-wide standards like DICOM, HL-7, IHE, etc. but instead to protect their own interests. That is one reason why DICOM is the most non-standard standard that ever existed and you need a Ph.D. in reading conformance statements to understand what a company does and doesn’t adhere to relative to this “standard”.
IHE is another example. The concept of improving the way computer systems in healthcare share information is commendable, but do we really need 253 member organizations providing input, of which 177 (70%) are Healthcare IT and consulting companies? No. And how many of those 177 have adopted all or at least most if the IHE initiatives to date? Fewer than a handful. It’s all about the companies ego, being able to say “our company participates in…” .even if in reality they don’t do squat..
Now before you go off on me, yes I do have an ego although you mostly see my alter ego in print and not who I really am. The same can be said for Ms. PACS, many of my fellow editors, and even my good friend the Dalai. In print we can be anything and often are, but it’s all done in good fun. I am incredible outward and beyond bold in print but in reality I’m closer to 180 degrees from that. The same could be said for most people I know. The Dalai is one of the quietest most unassuming guys I’ve ever met yet when you read his stuff its like- “Whoa, wait a minute!! Are we talking about the same guy?” Yes I am. Opinionated? Of course. Correct? Most times. We are both Clark Kent in real life and Superman in print - individuals in search of truth, justice and the American way… trying to help out as we can even if we do resort to a bit of sarcasm now and then…And Ms. PACS - she can be like Rilke’s panther one minute and a pussycat the next…Yes it’s all a game…but a game about helping. All of the 350+ articles I’ve written on PACS have been done with the single intent to help, even if I do tend to inject a degree of sarcasm into them now and then. Most importantly, at least to me, all were also written without cost to the journals - pro bono, for the good of the people.
So what then about egos? I’ve noticed more and more that certain individuals in our industry have adopted God complexes about themselves of late, and it’s not good at all. There seems to be no place for bantering or discussion anymore, and every day I see more of the “I am the great and mighty Oz!!” syndrome showing up. Why then is this happening? The answer is ugly too. We have looked up to these certain individuals for answers and called them Gods for so long that they now they believe that they are…Pull back the curtain as Toto did and you’ll see that academia produces some of the worse cases followed closely by executives at the large companies and lastly people connected with the smaller companies and individuals. Like everything there are exceptions though. I know some individuals in academia who will do anything to help others and be perfectly content to stand in the shadows while there are others where the spotlight can never be bright enough…
To understand ego we need to get a big technical so we need to go back to Herr Sigmund Freud. According to Wikipedia, the “id” acts as according to the “pleasure principle” seeking to avoid pain or unpleasure aroused by increases in instinctual tension. OK, that explains a lot.
The ego is that part of the id which has been modified by the direct influence of the external world. The ego represents what may be called reason and common sense, in contrast to the id, which contains the passions ... in its relation to the id it is like a man on horseback, who has to hold in check the superior strength of the horse; with this difference, that the rider tries to do so with his own strength, while the ego uses borrowed forces [Freud, The Ego and the Id (1923)]
The Super-ego aims for perfection. It comprises that organized part of the personality structure, mainly but not entirely unconscious, that includes the individual’s ego ideals, spiritual goals, and the psychic agency (commonly called 'conscience') that criticizes and prohibits his or her drives, fantasies, feelings, and actions. The Super-ego can be thought of as a type of conscience that punishes misbehavior with feelings of guilt (example: having extra-marital affairs).
The Super-ego works in contradiction to the id. The Super-ego strives to act in a socially appropriate manner, whereas the id just wants instant self-gratification. The Super-ego controls our sense of right and wrong and guilt. It helps us fit into society by getting us to act in socially acceptable ways.
So is it the ego’s fault or the id’s? Where does the Super-ego come in too? Socially acceptable ways? Where? Here? Guilt? Honey, I was raised in a Roman Catholic Italian house, while the Dalai was raised a good Jewish boy. We have enough guilty for any 10 of you - on a good day…
So what’s the bottom line? Let’s go back almost 15 years ago when Michael Jackson, Bruce Springsteen, Diana Ross, Bob Dylan, Billy Joel, Stevie Wonder and over three dozen other rock and pop superstars showed up to cut a record called “We Are The World.” The song was written by Michael Jackson and Lionel Richie to help starving kids in Africa. The great producer and Motown director Quincy Jones, coordinated the entire effort. All through the night the artists recorded and worked together for the benefit of others, with the net result being a record that hit the #1 position a mere four weeks after it was released. The recording stayed in the number one spot for a month raising almost $14M in the first four months alone and has raised $63M in humanitarian aid to date.
How did he get everyone to cooperate? “Q”, as he is known in the industry, put a sign out over the entrance because he had all these huge international stars there—and with them lots of egos too. The sign said simply. “Check your ego at the door”. They listened, worked together and collaborated and raised a lot of money to do good things.
At RSNA, SIIM, HIMSS the DICOM, HL-7 and IHE meetings, and everywhere that individuals can congregate we need to make a sign that say the same - Check your ego at the door. Maybe then we’ll finally achieve the goals with PACS that we have been desperately seeking for years.
Ms. PACS: “Q” is brilliant and while the whole world acknowledges that fact, he has the insight to know people – especially celebrities - need have have some humility to work well as a team.
The funny thing is, every time I have heard the instruction: “Check your ego at the door” - it’s coming from the one’s with the biggest egos…the one’s who are telling you to check YOUR ego at the door because there’s only room for their ego.
These are the Super-ego dictators – they’re going to dictate to you in their unchecked self-righteousness what’s socially and professionally acceptable and how you should act. It’s the people in power who slide under the radar of checks and balances who are most severe with their subordinates. That’s why it’s good to be a doctor – there are few people above you to kick you around. And fear of getting kicked is what drives and reinforces the “id” – which seeks to avoid pain. So remember that the next time you are dolling out instructions.
What I like better than “Check your ego at the door” is “Let go of the ‘e’ in ego and go!” A little cheesy, but the message is the Super-ego often holds you back from learning. It blinds you from recognizing your own shortcomings and prevents you from improving. It actually operates as a shield to avoid pain – the pain of the reality that you are, to a large extent, powerless – the realization of which unearths that underlying, trembling emotion – fear. And lord knows fear is what drives countries to war and places dictators in power. As Dr. Paul Chang explained to me once, in the context of improving healthcare IT, there is the dangerous combination of ignorance and arrogance.
These Super-egos plague healthcare IT and PACS. It is hard for the IT-savvy radiologist or other doctors to recognize they don’t know everything – even about how best to run their own departments. The realization that healthcare IT is 10 years behind other industries, such as banking and finance, is an embarrassment to the erudite. The id cranks up the engine to high-gear to avoid the painful realization that we weren’t born knowing everything, and the Super-ego further buffers the id by denying the truth. Again, ignorance and arrogance.
So what if the IT guy knows more about hospital IT networks than you - isn’t that his job? I know your response - but they don’t know Radiology workflow. So tell them how it works, but listen when they tell you how it might work better.
It’s simple, if you want to improve in life - don’t let your Super-ego blind you, and ignore that wimpy little ‘id’ when it tells you to stick your head in the sand. Why? Because it’s o.k. and even satisfying sometimes to have a slice of humble pie. So maybe a better motto would be – no pain, no gain.
Monday, October 26, 2009
Adam, Eve and PACS
PACSman: The very few people who know me know well know that for the past decade plus I’ve run a sports ministry. Now before you fall over yourself laughing at me being involved in either sports or a ministry know that it wasn’t my idea but God’s.
I was just minding my own business one day over a decade ago when out of the blue a voice echoed in my ears saying two simple words - “It’s time.” My immediate reaction was “Huh?” Am I late for a very important date like the rabbit in Alice in Wonderland or what? Who is this? No answer.
I said out to no one in particular out loud “Look Jack, don’t waste my time” and then fell back to sleep….
”It’s time” came the booming voice again…
I looked around expecting to see either George Burns or Morgan Freeman in my bedroom, then said ”Nah..no way….can’t be.”
Long story short, after much bantering back and forth with “the voice” aka “Him,” I caved in and took what was supposed to be a two-day job helping out at soccer camp at my old church. I thought nothing of it until I watched my role in sports ministry over the next several months and years increase dramatically.
Was that what He meant by “It’s time”? Who knows. All I know is every Friday night now I oversee 80-90 young adults playing soccer and have helped establish several sports ministries at various churches when I’m not playing PACSMan. I could care less about denominational theology - that’s for the elders to address cuz in my way of thinking it’s all one God - but it’s been a really interesting trip so far. I’m glad I came to my senses listening to the voices in my head because the reality is you can’t win with someone who knows the outcome of something before it even happens….. although God knows I sure tried.
So where am I going with all this? I have a client who calls me an “enigma.” He says that I’m a guy who could make a sailor blush with some of my comments and analogies, yet is surprised that I am one who also studies the Word. “It’s all about balance,” I said to him as we got to talking about his current bible study on Adam and Eve.
Now I’ve read Genesis more than a few times and have many of the guys in my men’s group praying for my heathen soul on a daily basis. Why? Because in my mind Adam was given a bum rap and got the blame for much more than he deserved.
My client/friend and I bantered back and forth on this. While he is a very open guy, he does tend to take the more conservative Baptist perspective that the man leads and the woman follows. Me, I’m a Billy Joel “Only the Good Die Young” ex-Catholic who goes to a PCA Presbyterian church and actually avows a more Unitarian kinder-gentler approach towards God than any specific denominational approach.
OK, back to Genesis. When I discussed the man being over the woman thing as defined in Genesis 3:16 with a very good friend of mine she said “Good luck with that (expletive deleted)!” I explained it to her that Eve had it all then blew it by listening to the serpent and then Adam blew it by listening to Eve yet somehow it always gets turned around that it’s all the guy’s fault The look I got said it all and it wasn’t one of endearing love either. Maybe I’ve been looking for love in all the wrong places but I’ve been told that “biblical wives “exist out there. I have never found one and truth be known I don’t really think I want to either. Just give me one who listens a little better than Eve did and I’ll be happy.
Most die-hard Christians say the Fall is all man’s fault but to that I say read the Word again. It never says that. The worst it says in Genesis 3:17 is "Because you listened to your wife…” with the implication “and not Me,” then we get all the curses put upon us because Adam was a dummy... Heck, that pretty much defines my life…
In my many roles I’m supposed to lead yet find people who just won’t let me. It happens in my business - Mike, you tell us what to do or how to do it, and then we’ll do it our way anyway and blame you when the outcome isn’t what we expected.
It happens in my personal life - you lead, I may or may not follow. Apparently Fred Astaire I’m not.
It even happens with the dog. “No, I want to pee here, not there, and if you lead me back there, I’ll just pee on the carpet again to spite you…”
That’s sort of the dilemma that Adam faced. God told both Adam and Eve the rules together, and while he was in the Garden with her doing God knows what she goes eating from the tree of knowledge of good and evil. Now he blew it too by listening to the lil vixen that was formed from his rib and as hard as it is to say he, too, got what he deserved. I won’t debate that. I also won’t debate that God wasn’t happy at all either. I honestly can’t say I don’t blame Him either, but was it all Adam’s fault?
Genesis 2:24 uses the words “one flesh” as in equals. It wasn’t until Genesis 3:16 did God say “Your desire will be for your husband, and he will rule over you.". So if both were equals before the Fall why did Adam take the blame for her mess up? After all, she knew the rules too, right?
Now let’s go a step further. Was Adam right next to Eve? In Genesis 3:6 it says “She also gave some to her husband, who was with her, and he ate it.” Was he right there next to her when she ate it the first time or just somewhere else in the garden and came back to find out that she blew it by disobeying God’s one and only rule? It doesn’t say. The conspiracy theorists could have a field day with this one. Was Adam mesmerized by the serpent and said nothing or had he just come back from being somewhere else in the Garden and found out what she did. I wonder what would have happened if he said “Eve- WTF!!! You dumb bunny. You knew the rules God gave us. You blew it!!. You’re outta here now babe!!.”. and didn’t cave in to her “offer” of a bite or two. Who knows who might have been her replacement. God may have even seen that maybe Adam needed all his ribs after all. Rest assured though whatever the outcome it wouldn’t have been Adam and Steve…and the sheep were safe too…
Now keep in mind in Gen 3:12 Adam even told God “..the woman you put here with me…”. This, at least to me this to me, implies that Adam really didn’t even want a mate but was he given any choice in the matter? Noooo….. God, in His infinite wisdom, decided to give him one. Adam probably could have asked for his rib back and his life would have been all well and good. Of course technically we might not all be here now were it not for Adam and Eve but…these are minor details. Did he ask for a “helper”? Nope….Some helper huh? Now you know why I’m still single…and probably will be for a long while…
OK so before I go straight to hell without collecting my $200 for passing Go, you need to know what all has to do with PACS. Several things:
1) Be content with what you have. Adam and Eve had it all yet in true female fashion Eve wanted yet more. I know a woman can never have enough shoes or chocolate but….Eve should have left the tree of knowledge of good and evil alone. All those trees and a good life to boot and yet it still wasn’t enough… Yes, there might be something better out there but if you have you are fairly happy with what you have why bother looking for something more?
2) Follow the rules. Most vendors don’t ask a whole lot out of end users- just that you have a PSA, do routine maintenance, load the upgrades, and report any known problems. Customers merely ask that a vendor provide responsive support and sell them a product that does indeed do what they said it would. Break the rules and there are consequences you both will face. Corollary: It only takes one person to screw it up for all the rest of us so…..
3) If it ain’t broke don’t fix it. Adam was perfectly happy in the garden with “the livestock, the birds of the air and all the beasts of the field as well” as the “trees that were pleasing to the eye and good for food”. Heck, the livestock even had names. Did he say “Hey God, how about stealing a rib from me and making me a helper? Nope. Genesis 2:18 “The LORD God said, "It is not good for the man to be alone. I will make a helper suitable for him." My pastor always says God never make mistakes but in this instance….it does make you wonder.
4) Not everyone is out there to help you. Just look at the serpent…..and Eve…who thought they were both helping out…I have a plaque that summarizes it all- trust in yourself- but since there are also 61 passages in the bible that tell you to trust in the Lord as well I’ll compromise and say trust in Him to help you trust in yourself…although I still wonder about His judgment with that whole creating Eve thing...
5) Without leadership you will flounder. If Eve knew Adam was in charge she might not have risked going against his wishes or God’s, but since she considered herself an equal she did as she pleased and look where it got them both.
Now you are probably praying for me right now thinking if I’m this bad with Genesis I can only imagine what he’ll do with Revelation. Psalms and Proverbs are probably a much safer and better bet for me to address though, although if I really wanted to stir up controversy I could quote from the Gnostic Gospels (Philip, Mary Magdelan, et.al.). I can just see it now- the elders and the deacons of my church are already on their way over to my house to hold a combined prayer meeting/exorcism for me…..
Nah….. Next time I think I’ll just play it safe and hit the tried and true Song of Solomon and see if I can get Ms. PACS all worked up….in more ways than one….
I was just minding my own business one day over a decade ago when out of the blue a voice echoed in my ears saying two simple words - “It’s time.” My immediate reaction was “Huh?” Am I late for a very important date like the rabbit in Alice in Wonderland or what? Who is this? No answer.
I said out to no one in particular out loud “Look Jack, don’t waste my time” and then fell back to sleep….
”It’s time” came the booming voice again…
I looked around expecting to see either George Burns or Morgan Freeman in my bedroom, then said ”Nah..no way….can’t be.”
Long story short, after much bantering back and forth with “the voice” aka “Him,” I caved in and took what was supposed to be a two-day job helping out at soccer camp at my old church. I thought nothing of it until I watched my role in sports ministry over the next several months and years increase dramatically.
Was that what He meant by “It’s time”? Who knows. All I know is every Friday night now I oversee 80-90 young adults playing soccer and have helped establish several sports ministries at various churches when I’m not playing PACSMan. I could care less about denominational theology - that’s for the elders to address cuz in my way of thinking it’s all one God - but it’s been a really interesting trip so far. I’m glad I came to my senses listening to the voices in my head because the reality is you can’t win with someone who knows the outcome of something before it even happens….. although God knows I sure tried.
So where am I going with all this? I have a client who calls me an “enigma.” He says that I’m a guy who could make a sailor blush with some of my comments and analogies, yet is surprised that I am one who also studies the Word. “It’s all about balance,” I said to him as we got to talking about his current bible study on Adam and Eve.
Now I’ve read Genesis more than a few times and have many of the guys in my men’s group praying for my heathen soul on a daily basis. Why? Because in my mind Adam was given a bum rap and got the blame for much more than he deserved.
My client/friend and I bantered back and forth on this. While he is a very open guy, he does tend to take the more conservative Baptist perspective that the man leads and the woman follows. Me, I’m a Billy Joel “Only the Good Die Young” ex-Catholic who goes to a PCA Presbyterian church and actually avows a more Unitarian kinder-gentler approach towards God than any specific denominational approach.
OK, back to Genesis. When I discussed the man being over the woman thing as defined in Genesis 3:16 with a very good friend of mine she said “Good luck with that (expletive deleted)!” I explained it to her that Eve had it all then blew it by listening to the serpent and then Adam blew it by listening to Eve yet somehow it always gets turned around that it’s all the guy’s fault The look I got said it all and it wasn’t one of endearing love either. Maybe I’ve been looking for love in all the wrong places but I’ve been told that “biblical wives “exist out there. I have never found one and truth be known I don’t really think I want to either. Just give me one who listens a little better than Eve did and I’ll be happy.
Most die-hard Christians say the Fall is all man’s fault but to that I say read the Word again. It never says that. The worst it says in Genesis 3:17 is "Because you listened to your wife…” with the implication “and not Me,” then we get all the curses put upon us because Adam was a dummy... Heck, that pretty much defines my life…
In my many roles I’m supposed to lead yet find people who just won’t let me. It happens in my business - Mike, you tell us what to do or how to do it, and then we’ll do it our way anyway and blame you when the outcome isn’t what we expected.
It happens in my personal life - you lead, I may or may not follow. Apparently Fred Astaire I’m not.
It even happens with the dog. “No, I want to pee here, not there, and if you lead me back there, I’ll just pee on the carpet again to spite you…”
That’s sort of the dilemma that Adam faced. God told both Adam and Eve the rules together, and while he was in the Garden with her doing God knows what she goes eating from the tree of knowledge of good and evil. Now he blew it too by listening to the lil vixen that was formed from his rib and as hard as it is to say he, too, got what he deserved. I won’t debate that. I also won’t debate that God wasn’t happy at all either. I honestly can’t say I don’t blame Him either, but was it all Adam’s fault?
Genesis 2:24 uses the words “one flesh” as in equals. It wasn’t until Genesis 3:16 did God say “Your desire will be for your husband, and he will rule over you.". So if both were equals before the Fall why did Adam take the blame for her mess up? After all, she knew the rules too, right?
Now let’s go a step further. Was Adam right next to Eve? In Genesis 3:6 it says “She also gave some to her husband, who was with her, and he ate it.” Was he right there next to her when she ate it the first time or just somewhere else in the garden and came back to find out that she blew it by disobeying God’s one and only rule? It doesn’t say. The conspiracy theorists could have a field day with this one. Was Adam mesmerized by the serpent and said nothing or had he just come back from being somewhere else in the Garden and found out what she did. I wonder what would have happened if he said “Eve- WTF!!! You dumb bunny. You knew the rules God gave us. You blew it!!. You’re outta here now babe!!.”. and didn’t cave in to her “offer” of a bite or two. Who knows who might have been her replacement. God may have even seen that maybe Adam needed all his ribs after all. Rest assured though whatever the outcome it wouldn’t have been Adam and Steve…and the sheep were safe too…
Now keep in mind in Gen 3:12 Adam even told God “..the woman you put here with me…”. This, at least to me this to me, implies that Adam really didn’t even want a mate but was he given any choice in the matter? Noooo….. God, in His infinite wisdom, decided to give him one. Adam probably could have asked for his rib back and his life would have been all well and good. Of course technically we might not all be here now were it not for Adam and Eve but…these are minor details. Did he ask for a “helper”? Nope….Some helper huh? Now you know why I’m still single…and probably will be for a long while…
OK so before I go straight to hell without collecting my $200 for passing Go, you need to know what all has to do with PACS. Several things:
1) Be content with what you have. Adam and Eve had it all yet in true female fashion Eve wanted yet more. I know a woman can never have enough shoes or chocolate but….Eve should have left the tree of knowledge of good and evil alone. All those trees and a good life to boot and yet it still wasn’t enough… Yes, there might be something better out there but if you have you are fairly happy with what you have why bother looking for something more?
2) Follow the rules. Most vendors don’t ask a whole lot out of end users- just that you have a PSA, do routine maintenance, load the upgrades, and report any known problems. Customers merely ask that a vendor provide responsive support and sell them a product that does indeed do what they said it would. Break the rules and there are consequences you both will face. Corollary: It only takes one person to screw it up for all the rest of us so…..
3) If it ain’t broke don’t fix it. Adam was perfectly happy in the garden with “the livestock, the birds of the air and all the beasts of the field as well” as the “trees that were pleasing to the eye and good for food”. Heck, the livestock even had names. Did he say “Hey God, how about stealing a rib from me and making me a helper? Nope. Genesis 2:18 “The LORD God said, "It is not good for the man to be alone. I will make a helper suitable for him." My pastor always says God never make mistakes but in this instance….it does make you wonder.
4) Not everyone is out there to help you. Just look at the serpent…..and Eve…who thought they were both helping out…I have a plaque that summarizes it all- trust in yourself- but since there are also 61 passages in the bible that tell you to trust in the Lord as well I’ll compromise and say trust in Him to help you trust in yourself…although I still wonder about His judgment with that whole creating Eve thing...
5) Without leadership you will flounder. If Eve knew Adam was in charge she might not have risked going against his wishes or God’s, but since she considered herself an equal she did as she pleased and look where it got them both.
Now you are probably praying for me right now thinking if I’m this bad with Genesis I can only imagine what he’ll do with Revelation. Psalms and Proverbs are probably a much safer and better bet for me to address though, although if I really wanted to stir up controversy I could quote from the Gnostic Gospels (Philip, Mary Magdelan, et.al.). I can just see it now- the elders and the deacons of my church are already on their way over to my house to hold a combined prayer meeting/exorcism for me…..
Nah….. Next time I think I’ll just play it safe and hit the tried and true Song of Solomon and see if I can get Ms. PACS all worked up….in more ways than one….
Thursday, October 22, 2009
Where are the Next Gen PACS features?
Ms. PACS: Research. Doing research on PACS or anything related to radiology will send you in 100 hundred different directions. Which is the very opposite of the PACSman, who will send you directly to @#%^&(*), if you catch him on a bad day.
Seriously, which is the best Radiology specific search tool:
- Radiology Research
- MyPACS.net
- Yottalook.com and Yottalook app for the iPhone
- ACR Case in Point
- Dr. K. MSK Cases
- EURORAD
- Journal of Radiology Case Reports
- Pediatric Radiology
- Rad Files
- radRounds Cases
How often are these tools actually used by rads, rad techs, PACS admins, and nerdy people who like radiology IT? I know one doc, Dr. Phillip Silberberg, a pediatric radiologist, who led MyPACS.net in reads. He's a real champ because all of that work is pro bono. But most rads are not so generous with their time.
What I was looking for was:
1. the most recently tallied average on the # of cases a radiologist reads in a day (in the U.S. - had to clarify as PACSaholic has become quite international as of late - bonjour Dr. Lambert).
2. I was looking for next generation features/tools that eliminate mouse clicks and improve access to data include. After meeting with one borderline angry healthcare adminstrator, who loved to squeeze as much out of his radiologists as he could, he did make an impression with this comment on PACS: “Anytime you add a mouse click, scroll, page forward/backward, open/close, every step you add to workflow is a design defect!”
After 5 too many interviews for my article, i came across one PACS admin (lady by the way) who said: "The radiologists are going to start billing for every additional mouse click they add to PACS!" Of course they would - anything to make a few extra bucks.
The next gen tools I unearthed from the bowels of "new PACS features" were:
- touch screen
- voice commands in RIS
- voice commands to navigate PACS
- automatic registration and matching of volumetric data at different time points on
- auto-structured reporting
- auto-loading templates mapped to procedure codes
- bookmark findings/optimal image
- one click to sign reports
- critical test results management solution to delivery of critical patient findings
These are more recent innovations thanks to Apple and Microsoft:
iPhone Apps:
- 3D rendering of CT scan: app developed by Ziosoft (www.ziosoftinc.com)
- Osirix iPhone: As difficult as it may be to give driving directions to an out of towner, it’s often more challenging for a radiologist to describe a patient’s imaging findings to a colleague. The Osirix iPhone app can actually help. The application brings a small and easy to use DICOM viewer to the iPhone. (www.osirix-viewer.com/).
- eRoentgen Radiology Diagnosis: developed by Constantine Brocoum, M.D., a neuroradiologist, the application is a compendium of textual information listing recommended imaging studies for each item from a voluminous list of symptoms and diagnoses. (www.iatrossoftware.com)
Microsoft Courier: two-screened hinged tablet with multi-touch capability, designed for writing, flicking and drawing with a stylus, in addition to fingers.
Thanks MAC and Microsoft. Meanwhile, are the PACS developers in hiding? Where are the 2.0 ideas? And how many radiologists have an iPhone (your kids' doesn't count). I guess GE's Jeff Immelt, a non-radiologist carrying around radiology apps, showed off his new iPhone ultrasound system called Vscan this week at the Summit 2.0 in San Fran. He called it a "smart phone" though. I thought Web 2.0 was all about collaboration. That's what Dr. Paul Chang told me in his interview Closing the Imaging Loop. When are Rads going to really explore the social side of technology - converse with their patients and referring physicians online or via Web cam embedded in PACS?! But that would mean you can't be in pajamas.
Thanks MAC and Microsoft. Meanwhile, are the PACS developers in hiding? Where are the 2.0 ideas? And how many radiologists have an iPhone (your kids' doesn't count). I guess GE's Jeff Immelt, a non-radiologist carrying around radiology apps, showed off his new iPhone ultrasound system called Vscan this week at the Summit 2.0 in San Fran. He called it a "smart phone" though. I thought Web 2.0 was all about collaboration. That's what Dr. Paul Chang told me in his interview Closing the Imaging Loop. When are Rads going to really explore the social side of technology - converse with their patients and referring physicians online or via Web cam embedded in PACS?! But that would mean you can't be in pajamas.
Friday, September 25, 2009
Déjà Vu All Over Again
PACSman: I was reading about yet another patent that got issued in the PACS world last week and starting thinking to myself what Yogi Berra once said: “This is like deja vu all over again.” This time a patent was issued for archives…or more specifically one that "provides for the management of clinical data using a scalable solution based on clinical business rules that logically or physically segments shared storage infrastructures.” Whatever you call it, it has me wondering what the heck is going on in DC?
Now I do not want to take away anything from any company who applies for a patent - after all, it is their right to apply for and even be granted one - but in the nearly seven years it took from the patent file date to the patent issue date it seems like an entire cottage industry sprang up around what they have patented. This seems to be endemic to our industry, a situation I have seen time and again.
Medical imaging companies have been issued patents for workstation hanging protocols, creating CD’s with embedded DICOM viewers, and now archive management. Normally this isn’t a problem if it’s something that isn’t used as part of the day-to-day operations of a PACS. The problem is most of these so called utility patents are. A utility patent is issued for the invention of a new and useful process, machine, manufacture, or composition of matter, or a new and useful improvement thereof, and generally permits its owner to exclude others from making, using, or selling the “invention” they got a patent on. In the case of many of these medical imaging patents that is tantamount to someone putting a patent on middle C of the piano, having seven years worth of music written around it, and then charging every author whose song hits middle C in it. The more you hit it, the more you pay…for the next 20 years. What sadder still is that 90% of all patents issued in the past few years by the USPTO have been design patents, those that address medical imaging.
Once a patent is issued getting it rescinded is virtually impossible. And what happens next? If typical, the patent holder sends notification to all companies who are using similar (or identical) technologies that might infringe on the patent letting them know that they may be in violation of patent infringement and will need to negotiate a licensing arrangement with them. And who ultimately pays for this? The end user.
Can you fight it? Of course you can and many of the majors have. But for many of the smaller vendors the risk of losing a patent infringement case and having to not only pay their own legal fees but that of the patent holder, plus back licenses, more often than not exceeds the value of just settling and paying the licensing fees up front.
Is this wrong? Legally no. Morally and ethically though it can be considered a gray area. Companies that apply for a patent typically have to state that a patent is pending, yet most patent applications aren’t published until at least 18 months after the filing date of the application. In the healthcare field, that length of time is an eternity - and that’s just to find out that it’s been filed.
After the patent application has been published, a member of the public may request a copy of the application file, but getting this was not an easy process. It wasn’t until late 2004 that the U.S. Patent and Trade Office (USPTO) made patent searches available via the Net, using the USPTO’s Public PAIR (Patent Application and Information Retrieval) system. Unfortunately, until the patent was actually granted, you had to know a fair amount of information about the patent to be able to search for it. This put an unfair burden of responsibility on companies who may have developed technology that was similar but perhaps not identical to that which was under review for a patent. You also never knew if the patent was going to be granted, sent back for revision, etc., until it happens, so why hold up the development of a product for three, five, or seven years or longer on a maybe? It’s also not until after the patent is issued that the application and all correspondence leading up to issuance of the patent are made available in the Files Information Unit for inspection by anyone, copies of of which may be purchased from the Office.
One source said each year nearly 50,000 patents are issued - 137 per day - yet the number of patent reviewers isn’t nearly enough to cover the number of patents being applied for, let alone granted. This creates a situation where patents are issued years after they are filed, allowing a cottage industry to spring up in the interim. If the 50,000 number is indeed correct (I’ve seen numbers anywhere from 20,000-50,000 bantered about on various sites, including the USPTO’s website), this means 350,000 patents were approved before the most recent one in medical imaging was. Even if only 20K patents per year were approved, that still leaves 140,000 who got their Golden Wonka ticket ahead of the latest medical imaging winner. And as Billy Shakespeare said about that in Act 1 of Hamlet: “Something is rotten in the state of Denmark”- or at least in Washington, DC.
The problem as I see it is fourfold. First there are not enough patent reviewers to act in a timely fashion. Seven years is way too long to take to get a patent approved. By the end of seven years, PACS is usually in the third generation of products…and so many systems have been put into place that any retroactive licensing will cause an undue financial burden on companies.
Second, and most importantly, patents are being issued by reviewers who, in my opinion, really either do not know or do not understand the medical imaging community. Adding a DICOM viewer to a CD that contains DICOM images isn’t - or at least shouldn’t have been - patentable. Both DICOM images and DICOM viewers existed separately well before this “patent” was granted. How hard can it be to add software like a viewer to a CD? Not rocket science by any means and not patentable either. And hanging protocols? People have been arranging icons since Windows 3.0 introduced the concept of a Graphical User Interface (GUI) way back in 1990. What makes this special besides this being used in medical imaging? It’s the same concept applied slightly differently. Now, admitted, I am oversimplifying what no doubt is considered a much more complex process by the patent owners, but hopefully you catch my drift here. I need to read the current archive patent a few times before it sinks in, but I’m sure I can distill it to a few simple points of relevancy and commonality as well.
Third, there needs to be a way of letting companies know in plain English when a patent has been filed, what it encompasses, and if their any technologies being in the industry impinges or infringes on it. This should be the responsibility of either the USPTO or the patent applicant, not the end user to figure out, sorta like a guy who gets ambushed on Maury - “You ARE the father…”
Fourth, patents shouldn’t be retroactive to the file date. Penalizing companies for a patent they might not have even known about just isn’t right again in my opinion.
Bottom line - we need to take a closer look at the way patents are issued. We can’t change the way things work overnight, but the input we provide just might make a difference and keep this industry from tripping all over itself as it is now…
Yogi summed up the situation best: "If you can't imitate him, don't copy him." There ya go….
Now I do not want to take away anything from any company who applies for a patent - after all, it is their right to apply for and even be granted one - but in the nearly seven years it took from the patent file date to the patent issue date it seems like an entire cottage industry sprang up around what they have patented. This seems to be endemic to our industry, a situation I have seen time and again.
Medical imaging companies have been issued patents for workstation hanging protocols, creating CD’s with embedded DICOM viewers, and now archive management. Normally this isn’t a problem if it’s something that isn’t used as part of the day-to-day operations of a PACS. The problem is most of these so called utility patents are. A utility patent is issued for the invention of a new and useful process, machine, manufacture, or composition of matter, or a new and useful improvement thereof, and generally permits its owner to exclude others from making, using, or selling the “invention” they got a patent on. In the case of many of these medical imaging patents that is tantamount to someone putting a patent on middle C of the piano, having seven years worth of music written around it, and then charging every author whose song hits middle C in it. The more you hit it, the more you pay…for the next 20 years. What sadder still is that 90% of all patents issued in the past few years by the USPTO have been design patents, those that address medical imaging.
Once a patent is issued getting it rescinded is virtually impossible. And what happens next? If typical, the patent holder sends notification to all companies who are using similar (or identical) technologies that might infringe on the patent letting them know that they may be in violation of patent infringement and will need to negotiate a licensing arrangement with them. And who ultimately pays for this? The end user.
Can you fight it? Of course you can and many of the majors have. But for many of the smaller vendors the risk of losing a patent infringement case and having to not only pay their own legal fees but that of the patent holder, plus back licenses, more often than not exceeds the value of just settling and paying the licensing fees up front.
Is this wrong? Legally no. Morally and ethically though it can be considered a gray area. Companies that apply for a patent typically have to state that a patent is pending, yet most patent applications aren’t published until at least 18 months after the filing date of the application. In the healthcare field, that length of time is an eternity - and that’s just to find out that it’s been filed.
After the patent application has been published, a member of the public may request a copy of the application file, but getting this was not an easy process. It wasn’t until late 2004 that the U.S. Patent and Trade Office (USPTO) made patent searches available via the Net, using the USPTO’s Public PAIR (Patent Application and Information Retrieval) system. Unfortunately, until the patent was actually granted, you had to know a fair amount of information about the patent to be able to search for it. This put an unfair burden of responsibility on companies who may have developed technology that was similar but perhaps not identical to that which was under review for a patent. You also never knew if the patent was going to be granted, sent back for revision, etc., until it happens, so why hold up the development of a product for three, five, or seven years or longer on a maybe? It’s also not until after the patent is issued that the application and all correspondence leading up to issuance of the patent are made available in the Files Information Unit for inspection by anyone, copies of of which may be purchased from the Office.
One source said each year nearly 50,000 patents are issued - 137 per day - yet the number of patent reviewers isn’t nearly enough to cover the number of patents being applied for, let alone granted. This creates a situation where patents are issued years after they are filed, allowing a cottage industry to spring up in the interim. If the 50,000 number is indeed correct (I’ve seen numbers anywhere from 20,000-50,000 bantered about on various sites, including the USPTO’s website), this means 350,000 patents were approved before the most recent one in medical imaging was. Even if only 20K patents per year were approved, that still leaves 140,000 who got their Golden Wonka ticket ahead of the latest medical imaging winner. And as Billy Shakespeare said about that in Act 1 of Hamlet: “Something is rotten in the state of Denmark”- or at least in Washington, DC.
The problem as I see it is fourfold. First there are not enough patent reviewers to act in a timely fashion. Seven years is way too long to take to get a patent approved. By the end of seven years, PACS is usually in the third generation of products…and so many systems have been put into place that any retroactive licensing will cause an undue financial burden on companies.
Second, and most importantly, patents are being issued by reviewers who, in my opinion, really either do not know or do not understand the medical imaging community. Adding a DICOM viewer to a CD that contains DICOM images isn’t - or at least shouldn’t have been - patentable. Both DICOM images and DICOM viewers existed separately well before this “patent” was granted. How hard can it be to add software like a viewer to a CD? Not rocket science by any means and not patentable either. And hanging protocols? People have been arranging icons since Windows 3.0 introduced the concept of a Graphical User Interface (GUI) way back in 1990. What makes this special besides this being used in medical imaging? It’s the same concept applied slightly differently. Now, admitted, I am oversimplifying what no doubt is considered a much more complex process by the patent owners, but hopefully you catch my drift here. I need to read the current archive patent a few times before it sinks in, but I’m sure I can distill it to a few simple points of relevancy and commonality as well.
Third, there needs to be a way of letting companies know in plain English when a patent has been filed, what it encompasses, and if their any technologies being in the industry impinges or infringes on it. This should be the responsibility of either the USPTO or the patent applicant, not the end user to figure out, sorta like a guy who gets ambushed on Maury - “You ARE the father…”
Fourth, patents shouldn’t be retroactive to the file date. Penalizing companies for a patent they might not have even known about just isn’t right again in my opinion.
Bottom line - we need to take a closer look at the way patents are issued. We can’t change the way things work overnight, but the input we provide just might make a difference and keep this industry from tripping all over itself as it is now…
Yogi summed up the situation best: "If you can't imitate him, don't copy him." There ya go….
Wednesday, September 16, 2009
So, What’s the Damage?
Ms. PACS: We might finally get the bill. I’m talking about the latest proposed healthcare reform bill from Congress - this one hovers around $856 billion.
Many said the proposal still spends too much, and it does too little to cut healthcare costs. But the final details were etched out by a bipartisan group of senators so that in the end – we’re all to blame.
This latest proposition in healthcare reform does not provide for a ‘public option,’ but would require everyone in the U.S. to purchase health insurance by 2013. So what are the option for diagnostic imaging?
For starters, the bill would levy $4 billion in annual fees on medical-device manufacturers beginning in 2010. Fees would be proportioned according to each company’s market share. Some say the government believes device makers will actually benefit from an overhaul thanks to wider insurance coverage, which will bring them more customers. So, it’s sort of like paying insurance to the White House to help pay for the package.
What a more widely insured population will do is grow the volume of diagnostic imaging exams. But at what cost?
As government scrambles to cut healthcare costs, it repeatedly targets medical imaging reimbursement. Fortunately, there is some reprieve – this version of the healthcare reform bill would set the equipment utilization rate for Medicare reimbursement of imaging studies at 65 percent, significantly lower than the 90 percent level proposed in original versions of the legislation.
If this passes, it will be a relief to radiology and radiation oncology alike. In the recent Medicare physician fee schedule proposed rule, Medicare payment rates for physician services, including radiation oncology, proposed cutting radiation therapy services by nearly 20 percent.
As we all know, what is at stake is the sustainability of freestanding and community-based cancer centers, as many would be forced to close, stop accepting Medicare patients and reduce critical services to cancer patients. Obviously not a healthy prescription for anybody.
So, PACS people, how does this relate to you - but, really, you should ask, how doesn't it? One of the best healthcare plans, albeit unofficial, to surface in the ‘media’ thus far comes from a concerned radiation oncologist who got it posted on another popular PACS blog - the Daili PACS Blog. Not surprisingly, he suggests scrapping most of HR 3200 proposals.
Many said the proposal still spends too much, and it does too little to cut healthcare costs. But the final details were etched out by a bipartisan group of senators so that in the end – we’re all to blame.
This latest proposition in healthcare reform does not provide for a ‘public option,’ but would require everyone in the U.S. to purchase health insurance by 2013. So what are the option for diagnostic imaging?
For starters, the bill would levy $4 billion in annual fees on medical-device manufacturers beginning in 2010. Fees would be proportioned according to each company’s market share. Some say the government believes device makers will actually benefit from an overhaul thanks to wider insurance coverage, which will bring them more customers. So, it’s sort of like paying insurance to the White House to help pay for the package.
What a more widely insured population will do is grow the volume of diagnostic imaging exams. But at what cost?
As government scrambles to cut healthcare costs, it repeatedly targets medical imaging reimbursement. Fortunately, there is some reprieve – this version of the healthcare reform bill would set the equipment utilization rate for Medicare reimbursement of imaging studies at 65 percent, significantly lower than the 90 percent level proposed in original versions of the legislation.
If this passes, it will be a relief to radiology and radiation oncology alike. In the recent Medicare physician fee schedule proposed rule, Medicare payment rates for physician services, including radiation oncology, proposed cutting radiation therapy services by nearly 20 percent.
As we all know, what is at stake is the sustainability of freestanding and community-based cancer centers, as many would be forced to close, stop accepting Medicare patients and reduce critical services to cancer patients. Obviously not a healthy prescription for anybody.
So, PACS people, how does this relate to you - but, really, you should ask, how doesn't it? One of the best healthcare plans, albeit unofficial, to surface in the ‘media’ thus far comes from a concerned radiation oncologist who got it posted on another popular PACS blog - the Daili PACS Blog. Not surprisingly, he suggests scrapping most of HR 3200 proposals.
Tuesday, September 1, 2009
Get More Out of Your PACS Vendor with Guilt Trips
Ms. PACS: Guilt trips aren’t usually meant to hurt people but simply to get them to behave in a certain way. Let’s face it - it’s a way to manipulate someone. So, if it can work in your favor, then why not learn how to apply guilt trips, in three easy steps. (See Guilt Trips in 3 Easy Steps below)
But before you feel guilty, let me ask you this – have you ever walked into a store, and the clerk comes up to you eagerly waiting on you, unsolicited, and tries to help you make a selection. You ask yourself: Did I ask for help? Your shoulders clinch, and, for those more primal fellas, the hair on the back of your neck stands up. It’s as if someone scratched the nails on a chalkboard right in your ear. You grit your teeth in an effort to hold back from shouting in the clerk’s face: “I’m just looking – so back off!” Fortunately, before that happens, a whole subconscious dialogue transpires in a millisecond. The clerk acknowledges you’re completely irritated and grins back with a feeble smile. The very act of shrinking into a submissive pose is how the clerk plays a guilt trip on you – “Please don’t bark at me, I’m just a humble clerk trying to do my job.” Whether you like it or not, the shout softens into a whisper, and you respond: “Oh, I was just looking,” and tag on a thank you for good measure, “but thank you for your help.” So this clerk has tricked you into thanking him for pestering you. Basically, you have allowed this person to manipulate you – they provoked your sympathy by laying a guilt trip on you.
If you search guilt trips, you come across a reasonable explanation on ehow.com as to why we lay guilt trips. One big reason is manipulation. You play on someone’s sympathy to get them to do what you want. Another big reason is payback – you’re sick of someone laying a guilt trip on you, and want them to feel the same way.
Guilt trips can be very effective – take for example the “Daddy’s little girl” guilt trip. You know your beautiful smile pulls on his heartstrings. And you walk off with the car keys and the credit card. But does it work in the PACS world? Can you guilt a PACS vendor to give you added features for free, or not charge you for a service call, or to lower his asking price on a new PACS? You better know how to bat those baby blues, because if there’s not something in it for the PACS vendor, like more money, then you’ll have to know how to lay it on thick.
Assuming it’s a guy, with an ego (a novel idea) - start by getting inside his head. Does he feel important when people see him as a “good guy”? Does he take pride in being “fair” to customers? Could acquiescing to your demands be acceptable for him because it means building a long-term business relationship with you? If so, then you may have a chance.
How can you get more than the vendor bargained for? Start by breaking him down, but without nailing him to the wall. Tell him that on a few occasions the response to service was slow and/or inadequate, costing you in downtime. Dollars lost as a result of poor service is justifiable, if you can justify it - which may require proof.
Guilt Trips in 3 Easy Steps (if the first works, stop there):
Step 1
Hold your hands together and wring them lightly. Look very sad, as though you’re a bit hurt that he refuses to give you extra PACS licenses for free. Use the “you don’t care about me as a person” trip. “Haven’t we worked together for a few months now?” Add to that: “I thought we had established a working relationship?” Be as bold as to say: “Am I just another client to you?”
Step 2
Play the helpless victim. Tell him how much you are struggling financially these days –both business-wise and personally. The DRA hit you hard, and you don’t know how long you can stay in business. At this point, pull out your iPhone, mobile device, whatever, and glance at the photos of your family or significant other. Chuckle and show him pictures of your kids or your dog, so he identifies with you and internalizes your problem.
Step 3
Act indignant. This is the "Look at all the business I’ve given you” ploy. The best way to lay this guilt trip is by being indignant, such as "Don't worry, I’m not a charity-case,” even though you are in this scenario. This type of guilt trip works well for big and little jobs alike.
So give it a try…and let me know how it works.
PACSman: Guilt trips work for a lot of people. Unfortunately they don't on my kids ("Can you just do this one little thing I'm asking you?" "No."), they didn't in my dating past ("But we have so much history together." "And that's what it is now…history."), and they don't even on my dog ("Why did you pee on my leather couch again? I thought you liked it here." "I do, but the patio door was locked and I had to pee, so get over it..." )
I was raised in an Italian Roman Catholic household and made an honorary Jew by my good friend the Dalai, so I probably have enough guilt to last several lifetimes. I don't need any more. Because I'm older I also have less things to feel guilty about. I still screw up more often than I care to admit and feel guilty when I do even, if it's an inadvertent screw up, but on the whole I do OK. I haven’t been to confession in ages and can just see me going now. "Bless me Father for I have sinned. It has been way too long since my last confession - age 12 maybe- so let's do this the easy way. This is what I haven't done." And two minutes later I walk out a "free man" - after I say 124,179 Our Fathers, 36,825 Hail Marys, 11,527 Glory Be's that is. The Stations of the Cross will have to wait for another lifetime…Momma always said ain't no such thing as a free lunch…and apparently free sin falls into the category as well. Considering my past (thankfully I can’t remember most of my 20’s), I think I got off the hook pretty easily.
So let's talk about guilt, manipulation and payback...The salesperson example Ms. PACS gave has to be a female thing because most of the men I know don't go shopping just to look, unless it’s with a woman, and then it’s because they we’re guilted into it. They go shopping to shop.
Two weeks ago I went to Jacques Pennays to replace my “intimate apparel.” After five years they were finally stretched out just right and fit perfectly, but alas they had holes in strategic areas that could have been hazardous to my overall health and well being, so out they went...old friends tossed to the curb that served me so well. Still, I was in and out of the store in <10 minutes. Four of that was walking from the entrance to the men’s department (and back again), three minutes spent looking for extra-fat sized products, and the remaining three checking out and using my $10 off a $25 purchase coupon. After all, why pay $5 for a pair of britches when I can get ‘em for <$3 each, even if they do last 5 years...A buck is a buck. Did I feel guilty? Nope. And no, Ms. PACS, saving a buck on undies it’s not a guy thing either. You know you secretly raid your neighbors’ mailboxes when Vickies has their “free pair of panties” coupon specials too so…..
You really don't need guilt to buy a PACS these days - only a pulse...It’s worse than buying a car. True, you can find "Buy here, Pay here" car dealerships where you’ll pay as much for a 1998 Chevy Malibu with142,000 miles on it as you would a 2008 Mercedes SLK 250, if your FICO score wasn’t 425, but at least you got a car. So too it is with PACS.
When I went to buy my car last October. They got up and locked the doors on me as my son’s eyes got wide saying only, “We’re in trouble, Dad.” Trouble indeed - the dealership that usually sold 60 cars a month had sold 4 so far and here I was with a credit score in the very high 700’s. “We’re sorry sir, but you are not leaving until you purchase something.” Now, I loved the $35 and $40K wonders I saw, but being Mr. Pragmatic I ended up walking away with a 2003 Mitsubishi Diamante with 70K miles on it for just over $8K. But I did buy something so all was not lost.
PACS dealers are trying to do the same thing. You want a PACS? We’ll find a way to get you a PACS, even if you have a 425 FICO score. How often have you seen “Preferred customer discount” on the bottom line or something of a similar ilk. That’s subliminal guilt…even if you were a first time buyer for them. You weren’t necessarily a preferred customer but rather they preferred to have you as a customer, hence the discounts…With roughly 50% fewer deals currently being completed that last year and more competition for those deals, everyone is a preferred customer. You don’t need to try and get in the head because all they really want is to get into your wallet (and don’t make any analogies either here Ms P. It goes both ways….)
Good guys? Fair? Long-term relationships? That requires give and take on both parties and that just isn’t happening. Good guys usually finish last because most women tend to gravitate to bad guys so they can complain about how badly they get treated by men…In the meantime the good guy looks on and says “Huh?”. Just the way it is….And everyone knows good girls go to heaven but bad girls go everywhere…So much for that argument.
Fair? To whom? If you read most PACS contracts they are anything but fair and that is all that matters in a court of law. I’d dealing with a client of mine now whose system hasn’t worked right in the 10 months since he’s had it “installed” and today is dropping yet more studies. Oops. The vendor’s answer is they will de-install it and give him his money back but they never comes back with any concrete details…and limits their liability to what was paid, if that…That’s like dealing with the manufacturer of Trojan condoms- sorry it didn’t work for ya and busted and now you have a kid to raise…but we hope the $0.42 we’re giving you back for the one that got away helps offset some of your costs…
I love the three steps Ms. PACS outlined. Step one - the answers are all yes. Step two - You’ll most likely end up giving them money as they lay it on thick about them being the helpless victim too. Step three - Indignant - feeling, characterized by, or expressing strong displeasure at something considered unjust, offensive, insulting, or base: Synonyms: angry, resentful, infuriated, mad. Doesn’t work…take it from someone who has spent a large part of his life writing about PACS with indignancy.
Daddy’s little girl? Good luck with that…I have much more patience when they are growing up and formidable than when they are grown up and manipulative…but I guess if it works, then that is what matters most….
But before you feel guilty, let me ask you this – have you ever walked into a store, and the clerk comes up to you eagerly waiting on you, unsolicited, and tries to help you make a selection. You ask yourself: Did I ask for help? Your shoulders clinch, and, for those more primal fellas, the hair on the back of your neck stands up. It’s as if someone scratched the nails on a chalkboard right in your ear. You grit your teeth in an effort to hold back from shouting in the clerk’s face: “I’m just looking – so back off!” Fortunately, before that happens, a whole subconscious dialogue transpires in a millisecond. The clerk acknowledges you’re completely irritated and grins back with a feeble smile. The very act of shrinking into a submissive pose is how the clerk plays a guilt trip on you – “Please don’t bark at me, I’m just a humble clerk trying to do my job.” Whether you like it or not, the shout softens into a whisper, and you respond: “Oh, I was just looking,” and tag on a thank you for good measure, “but thank you for your help.” So this clerk has tricked you into thanking him for pestering you. Basically, you have allowed this person to manipulate you – they provoked your sympathy by laying a guilt trip on you.
If you search guilt trips, you come across a reasonable explanation on ehow.com as to why we lay guilt trips. One big reason is manipulation. You play on someone’s sympathy to get them to do what you want. Another big reason is payback – you’re sick of someone laying a guilt trip on you, and want them to feel the same way.
Guilt trips can be very effective – take for example the “Daddy’s little girl” guilt trip. You know your beautiful smile pulls on his heartstrings. And you walk off with the car keys and the credit card. But does it work in the PACS world? Can you guilt a PACS vendor to give you added features for free, or not charge you for a service call, or to lower his asking price on a new PACS? You better know how to bat those baby blues, because if there’s not something in it for the PACS vendor, like more money, then you’ll have to know how to lay it on thick.
Assuming it’s a guy, with an ego (a novel idea) - start by getting inside his head. Does he feel important when people see him as a “good guy”? Does he take pride in being “fair” to customers? Could acquiescing to your demands be acceptable for him because it means building a long-term business relationship with you? If so, then you may have a chance.
How can you get more than the vendor bargained for? Start by breaking him down, but without nailing him to the wall. Tell him that on a few occasions the response to service was slow and/or inadequate, costing you in downtime. Dollars lost as a result of poor service is justifiable, if you can justify it - which may require proof.
Guilt Trips in 3 Easy Steps (if the first works, stop there):
Step 1
Hold your hands together and wring them lightly. Look very sad, as though you’re a bit hurt that he refuses to give you extra PACS licenses for free. Use the “you don’t care about me as a person” trip. “Haven’t we worked together for a few months now?” Add to that: “I thought we had established a working relationship?” Be as bold as to say: “Am I just another client to you?”
Step 2
Play the helpless victim. Tell him how much you are struggling financially these days –both business-wise and personally. The DRA hit you hard, and you don’t know how long you can stay in business. At this point, pull out your iPhone, mobile device, whatever, and glance at the photos of your family or significant other. Chuckle and show him pictures of your kids or your dog, so he identifies with you and internalizes your problem.
Step 3
Act indignant. This is the "Look at all the business I’ve given you” ploy. The best way to lay this guilt trip is by being indignant, such as "Don't worry, I’m not a charity-case,” even though you are in this scenario. This type of guilt trip works well for big and little jobs alike.
So give it a try…and let me know how it works.
PACSman: Guilt trips work for a lot of people. Unfortunately they don't on my kids ("Can you just do this one little thing I'm asking you?" "No."), they didn't in my dating past ("But we have so much history together." "And that's what it is now…history."), and they don't even on my dog ("Why did you pee on my leather couch again? I thought you liked it here." "I do, but the patio door was locked and I had to pee, so get over it..." )
I was raised in an Italian Roman Catholic household and made an honorary Jew by my good friend the Dalai, so I probably have enough guilt to last several lifetimes. I don't need any more. Because I'm older I also have less things to feel guilty about. I still screw up more often than I care to admit and feel guilty when I do even, if it's an inadvertent screw up, but on the whole I do OK. I haven’t been to confession in ages and can just see me going now. "Bless me Father for I have sinned. It has been way too long since my last confession - age 12 maybe- so let's do this the easy way. This is what I haven't done." And two minutes later I walk out a "free man" - after I say 124,179 Our Fathers, 36,825 Hail Marys, 11,527 Glory Be's that is. The Stations of the Cross will have to wait for another lifetime…Momma always said ain't no such thing as a free lunch…and apparently free sin falls into the category as well. Considering my past (thankfully I can’t remember most of my 20’s), I think I got off the hook pretty easily.
So let's talk about guilt, manipulation and payback...The salesperson example Ms. PACS gave has to be a female thing because most of the men I know don't go shopping just to look, unless it’s with a woman, and then it’s because they we’re guilted into it. They go shopping to shop.
Two weeks ago I went to Jacques Pennays to replace my “intimate apparel.” After five years they were finally stretched out just right and fit perfectly, but alas they had holes in strategic areas that could have been hazardous to my overall health and well being, so out they went...old friends tossed to the curb that served me so well. Still, I was in and out of the store in <10 minutes. Four of that was walking from the entrance to the men’s department (and back again), three minutes spent looking for extra-fat sized products, and the remaining three checking out and using my $10 off a $25 purchase coupon. After all, why pay $5 for a pair of britches when I can get ‘em for <$3 each, even if they do last 5 years...A buck is a buck. Did I feel guilty? Nope. And no, Ms. PACS, saving a buck on undies it’s not a guy thing either. You know you secretly raid your neighbors’ mailboxes when Vickies has their “free pair of panties” coupon specials too so…..
You really don't need guilt to buy a PACS these days - only a pulse...It’s worse than buying a car. True, you can find "Buy here, Pay here" car dealerships where you’ll pay as much for a 1998 Chevy Malibu with142,000 miles on it as you would a 2008 Mercedes SLK 250, if your FICO score wasn’t 425, but at least you got a car. So too it is with PACS.
When I went to buy my car last October. They got up and locked the doors on me as my son’s eyes got wide saying only, “We’re in trouble, Dad.” Trouble indeed - the dealership that usually sold 60 cars a month had sold 4 so far and here I was with a credit score in the very high 700’s. “We’re sorry sir, but you are not leaving until you purchase something.” Now, I loved the $35 and $40K wonders I saw, but being Mr. Pragmatic I ended up walking away with a 2003 Mitsubishi Diamante with 70K miles on it for just over $8K. But I did buy something so all was not lost.
PACS dealers are trying to do the same thing. You want a PACS? We’ll find a way to get you a PACS, even if you have a 425 FICO score. How often have you seen “Preferred customer discount” on the bottom line or something of a similar ilk. That’s subliminal guilt…even if you were a first time buyer for them. You weren’t necessarily a preferred customer but rather they preferred to have you as a customer, hence the discounts…With roughly 50% fewer deals currently being completed that last year and more competition for those deals, everyone is a preferred customer. You don’t need to try and get in the head because all they really want is to get into your wallet (and don’t make any analogies either here Ms P. It goes both ways….)
Good guys? Fair? Long-term relationships? That requires give and take on both parties and that just isn’t happening. Good guys usually finish last because most women tend to gravitate to bad guys so they can complain about how badly they get treated by men…In the meantime the good guy looks on and says “Huh?”. Just the way it is….And everyone knows good girls go to heaven but bad girls go everywhere…So much for that argument.
Fair? To whom? If you read most PACS contracts they are anything but fair and that is all that matters in a court of law. I’d dealing with a client of mine now whose system hasn’t worked right in the 10 months since he’s had it “installed” and today is dropping yet more studies. Oops. The vendor’s answer is they will de-install it and give him his money back but they never comes back with any concrete details…and limits their liability to what was paid, if that…That’s like dealing with the manufacturer of Trojan condoms- sorry it didn’t work for ya and busted and now you have a kid to raise…but we hope the $0.42 we’re giving you back for the one that got away helps offset some of your costs…
I love the three steps Ms. PACS outlined. Step one - the answers are all yes. Step two - You’ll most likely end up giving them money as they lay it on thick about them being the helpless victim too. Step three - Indignant - feeling, characterized by, or expressing strong displeasure at something considered unjust, offensive, insulting, or base: Synonyms: angry, resentful, infuriated, mad. Doesn’t work…take it from someone who has spent a large part of his life writing about PACS with indignancy.
Daddy’s little girl? Good luck with that…I have much more patience when they are growing up and formidable than when they are grown up and manipulative…but I guess if it works, then that is what matters most….
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