Is PACS Retro?

Ms. PACS: From vintage pumps to flashback lapels, the retro style is in revival mode with many new products coming out with a retro look. Many PACS people may be a little lost with this concept since it reflects styles from the 50’s, 60’s and 70’s, i.e., pre-PCs. But try this on for size because it was popular just on the cusp of the 80’s*, remember ATARI - that mind-dulling video game that everyone was hooked on - that is retro. Don’t forget about its equally simplistic companions PONG and SpaceInvaders. These video games helped pave the way for what the gaming industry is today. There are even retro gamers openly blogging about ATARI as we speak. But that’s not why ATARI is retro. Retro, says the almighty Wikipedia, describes culturally outdated trends, modes or fashions that have since become functionally or superficially the norm once again. So, in some circles, ATARI is retro.

Similarly, PACS is going retro with its latest hyper mode – unification. One of the mantras that resonated off the walls of the RSNA exhibit halls was “PACS Unite!” This is not because the 1,000 plus PACS vendors serving the same market have put down their arms and come to a Pax Romana for the greater good of the industry. That will only happen when they can no longer make a buck off of PACS. Watch out, a couple of vendors now give away their PACS for free, obviously making money on services and upsells. Nor does ‘PACS Unite’ have anything to do with Sally Fields in a factory – talk about retro.

The ‘new’ sales pitch I heard from several vendors is that they are unifying disparate PACS, offering an umbrella solution that interfaces imaging and data management systems across the healthcare enterprise. This is particularly useful for radiology groups reading for several different hospitals, and conversely, for a fast consolidating industry where hospitals are acquiring outpatient centers and radiology groups, using disparate PACS, which need to be interfaced to create a single worklist and have a common UI.

The technology requires a master patient index (MPI), which uses heuristic algorithm logic tools to match and cross-check names of patients residing on disparate PACS. The system searches across different proprietary PACS using a DICOM-based…wait a minute…DICOM, HL7 and the IHE? Haven’t vendors been celebrating the Connectathon for the last 10 years, each time taking one step closer to true interoperability?**

Seems to me these capabilities have existed for a while, and now these companies are marketing PACS unification solutions as a brand new technology. Or have they been holding out on us?

If so, then is unifying PACS retro? It was introduced about 10 years ago, and it was a cool idea then, however it never became popular…probably thwarted by those who wanted a piece of the PACS pie and did not want PAC systems to connect. Not sure how to best describe it – ‘retro’ or simply ‘what’s old is what’s new.’

I’m sure the PACSman will have a field day with this one - to use a very retro expression.

PACSman: Why would I use a term coined in 1747 for a military operation in my retort? Field day indeed…

I haven’t had my vintage pumps on in years although if I dig deep enough in my closet there may be some wide lapelled suits (and narrow ties too- if you hold onto it long enough everything comes back).

You say retro describes culturally outdated trends, modes or fashions that have since become functionally or superficially the norm once again. Is dating retro again and hooking up passé? Did I get rid of my ’98 Jeep too soon even though it had more problems than O.J.? PACSMan – always behind the curve.

I’m not sure where you have been the past several months, Ms. P. but most vendors ARE giving their PACS away for free or damn close too it and only making money on service and upsells (and let’s not forget installation and training too). Discounts start at 40% and 70-80% off list isn’t unheard of in a competitive deal. Kinda makes you wonder about how they come up with these prices doesn’t it, not to mention why some companies even bother to try and sell.

Unifying disparate PACS? I think you’ve been drinking too much Coke because the goal of unifying ALL disparate clinical systems let alone just PACS has been around since the Hillside Singers sang “I’d Like to Teach the World to Sing (In Perfect Harmony)”over 30 years ago. Great concept but the reality? We’re about as close to it now as we are to holding hands and singing Kumbya with Osama….

The big question is why should we have to PAY for integrating disparate systems? Isn’t that the goal of DICOM, HL7 and, of course, IHE? Last time I checked that I in IHE stood for Integrating as in Integrating the Healthcare Environment. Sure, there were lots of neat gee whiz integration products at RSNA but….at what cost? A single work list and common UI? It’s not rocket science by any means….and companies have been both promoting and doing this for years with varying levels of success. What is needed instead of overpriced unifying software is for every vendor to adhere to an etched-in-stone unification standard – not one like DICOM where you can take a Chinese menu approach – we support this, don’t support that (at least not yet), and will never ever support the other…. IHE is close but….how many times do we need to see a demo before people wake up and say – yeah, this is a good idea…After all, 2009 will mark the 10th year anniversary of IHE’s Connectathons. Ten whole years….Sorry, but it’s time the industry finally got off the pot and either support or abandon this cause…

In the IHE booth there were maybe 20 vendors demoing, with one major alphabet soup player occupying four of the 20 slots…In contrast, there were over 250 PACS and PACS-related companies out there showing their wears…I think Meat Loaf sang “Two Outta Three Ain’t Bad”,…not one out of ten…Show me an RSNA where everyone communicates with everyone else and not just offers a conformance statement few can understand and then I’ll be impressed…

“Holding out?” Nah – It’s like dating versus being married. When you are dating you never know when you might see that person again so you grab all the gusto you can every chance you can. When you are married your spouse tends to become or be treated like the couch – sometimes in more ways than one. They are always around, so there is no need for any gusto except maybe of the Schlitz Malt liquor variety. “Thwarted by those who wanted a piece of the PACS pie and did not want PAC systems to connect”. I’m impressed Ms P – going to RSNA really did teach you something. Now if I can just keep you from drinking the unifying software vendor’s Kool-Aid you might actually understand why I am as cynical as I am.

Pax Romana? I think I ate there once – they had a pretty decent antipasto too.. And Sally Field? She was much better in Absence of Malice, Steel Magnolias, Forrest Gump and others than Norma Rae. Remember what she said to Forrest… “You have to do the best with what God gave you.” This holds true when working with from PACS vendors….or was it “Stupid is as stupid does…” Hmmmmm….

*Pong and Atari 2600 defined the computer entertainment industry from the 1970s to the mid 1980s, but it was available for retail in 1977… the end of the 70’s…before Miami Vice aired. Image is courtesy of Atari Inc. (formerly Infogrames Inc./GT Interactive)

** The 10th Annual IHE North America Connectathon will be held February 23-27, 2009, at the Hyatt Regency Chicago, 151 Wacker Drive, Chicago, IL.