Held Hostage

PACSman: In the past three weeks I have had three clients come to me looking for help with image archive, database and data migration-related issues. In each case the vendors have held the customers hostage. Some were semantic issues involving contract language while others simply because the client elected to go with a different vendor rather than upgrading with the incumbent.

Vendor number one wanted a ridiculous fee to do the data migration so the client could go to a competing vendor (nearly double the cost asked by data migration specialists like Acuo and DeJarnette and it didn’t include data reconciliation or data cleansing either). Vendor number two refused to sign a contract saying that they would provide a vendor-neutral archive and had nothing proprietary in their design that would require third party data migration… And the vendor number three.. well... I won’t even go there but let’s just say that what they did to their client crossed the boundaries of decency let alone good business. These weren’t the smaller fish vendors either where you might imagine vindictiveness would be a given. These were some of the biggies…and the contracts dollars ranged from $250K to a several million dollar wonder.

Why then in a world where standards reign do vendors still hold customers hostage by not supporting standards? Simply because they can…

I fought tooth and nail for my multi-million dollar client to get the vendor to put something in writing that the 40 TB+ of data they will be archiving annually (this was a huge contract) would not be subject to the cost and time constraints of data migration. After a month after various contract language proposals going back and forth each which were rejected by both myself and my client time and again as worthless, the big vendor won out on a technicality- since the client never asked for a vendor neutral archive that would not require data migration specifically in their 540 page RFP (although they did ask for this several times in a roundabout way) the vendor indicated they could not be held accountable for meeting specifications that weren’t asked for and they deserved to get the bid. True, but….

The second vendor offered free data migration from a company they just bought if the client upgraded to their (the buyers) system. Here’s the kicker though- the buying company announced that it would no longer support the system they just bought after 90 days, so you either upgrade to our new system or you are outta luck. And, knowing that there is no such thing as a free lunch, the client asked how would this migration be paid for? The vendor was almost brazen in their response- why, from the margins we make on the new system, of course. The client opted to go with a different vendor and now is being held hostage by the losing incumbent vendor who will only migrate their existing data- data the client paid a premium to archive in the first place- at double the price.

As an industry we have lost our most valuable commodity- integrity. Very few vendors seem to play by the book of common decency any more and those who do make sure they are able to write their own rules. Witness the very nature of DICOM itself, the most non-standard standard that ever existed. Standards utilization means virtually nothing because we have no true standards. DICOM, HL7, IHE and others are not only optional (contrary to what one might think nothing dictates the mandatory use of standards support except some basic HL7 support that is mandated by HIPAA) but they can also be interpreted in a plethora of ways. You can write image data in DICOM Part X file format, yet throw on proprietary compression like some vendors still do and it all goes out the window. Data tagging can be done so many ways it makes your head spin and when you talk about tag-morphing people look at you like you are speaking Greek…It’s like the doc meeting the gal at one of several cocktail parties the vendors throw at RSNA. Both enjoyed the free food, booze and music and by the time the clock strikes 12 both are in a very good mood. She asks if his marital status. “I’m currently separated” he says, and after another drink or two they both smile and walk back to his hotel for a “nightcap”….Technically he is right- his wife is home taking care of their 3 kids while he is in Chicago chasing down anything with a pulse…but his statement is accurate- he is “separated”…And so too it is any more with vendors. They say what you want to hear just to get you in between the sheets…and God forbid you ask for something in writing….No can do, soldier boy…

There are a few vendors with integrity left- damn few- but the majority still sing along with Bachman Turner Overdrive:

“….and you'll find out every trick in the book
and that's there's only one way to get things done
you'll find out the only way to the top
is looking out for number one
I mean you keep looking out for number one.”

In their quest to merely stay alive let alone make a profit vendors are selling more yet making less. To quote another BTO song they are “taking care of business” but going about it all wrong. And in doing so vendors aren’t winning. Clients aren’t winning. End users aren’t winning. Everyone in this industry and the people we serve has lost- our integrity, our focus, or desire to do what is indeed right…to “first, do no harm”….And that, IMHO, is just plain wrong…


Ms. PACS: Your point on business ethics is very timely. Especially at a time when some of the wealthiest people in the world recently discovered they were totally ripped-off by Bernard Madoff.

Yes, indeed, business ethics is all over the mainstream media as of late. Just last night on The Office (a TV show which should be required viewing for anyone with a job), guess what the theme was – you guessed it – business ethics. In the show, one of the characters that the boss, Michael, is hot after is Holly. While Holly was doing an ethics seminar, she discovers that the office is hardly an ethical place. When everyone is given immunity to confess any unethical behavior they have conducted, it is revealed that in addition to such offenses as pencil-lifting and ‘time stealing,’ Meredith is doing something very unethical…swapping carnal favors for a discount on paper supplies, oh, and for gift cards to Outback Steakhouse – you can hardly blame her. Of course, this is grounds for termination, says Holly. But Michael defended Meredith declaring that no one should ever be fired from Dunder Miflin because it is a family, and that while her actions were wrong, they were saving the company money, and in these hard times they should just turn a blind eye. His tactics, however, didn't get Holly to bend on carnal favors.

But, PACSman, as far as ethical behavior in PACS - only if it closes a deal. So maybe if PACS vendors realized that ethical conduct paid off, they might employ that strategy. For example, DICOM, HL7, IHE and other standards are just optional, and if you throw in a little proprietary compression, you strong arm the client into staying with your PACS. I understand the vendor wants to keep the client, but if you put someone in shackles, resentment will grow and there will likely be a rebellion.

Are PACS vendors so scared of the competition and have so little faith in their own product that they turn to incompatibility to latch on to clients? I understand making a buck, but how about concentrating on giving the end-user a good experience. If PACS as a product becomes leveled out in price or ‘commoditized,’ then on what basis is the user going make his/her decision on which PACS to go with? It comes down to the end-users’ experience – that is the deal breaker. Have you ever had to get your cable set up? The company gives you a four-hour window of time in which you need to wait at home for the cable guy to show up. If he doesn’t show up, you have to reschedule, and there is little recourse. Sure, there are two other cable companies available in your town, but they all pull the same B.S. – aka, bad service. In the case of PACS, there are more than enough vendors to choose from if the service is poor.

So, how do you create a good experience for the end-user – offering sound support for PACS implementation, a reliable system, flexibility and throw in 24/7 service. A good experience with PACS is as important as a good bartender, keep pouring the good stuff and they get hooked - not by holding ‘customers hostage by not supporting standards.’ And look out – because open source PACS are gaining ground, and there, compatibility is not an issue.

As for ethics in general, part of President Obama's inaugural speech touched on a few:

Our challenges may be new. The instruments with which we meet them may be new. But those values upon which our success depends - hard work and honesty, courage and fair play, tolerance and curiosity, loyalty and patriotism - these things are old. These things are true. They have been the quiet force of progress throughout our history. What is demanded then is a return to these truths.

Oh, at the end of the episode of The Office, the staff enjoyed a free meal at Outback. Can you blame them?