“Survivor 2010: What It Takes To Make a Trade Show Make It”

PACSman: The press release came out last week “Despite a weak economy, attendance at RSNA 2009 was very strong and even set two new records”. OK, I was at the 2009 Annual Meeting of the Radiological Society of North America (RSNA) just as I have been for the past 26 years in a row (and hopefully will be for the next 26 as well) so maybe I just missed something The headlines screamed “15,644 radiologists – new record!, 11,058 RSNA members – new record!, 9,060 International attendees – second highest ever!” Officially show attendance was down 4% from last year and 2008’s was down 5% from 2007’s numbers. That’s really not bad considering the economy and how travel budgets have been cut to the bone. But is it real?

RSNA is not alone creating as positive a spin on trade show numbers as it can. While attendance is only down slightly at RSNA, the makeup of those numbers varies a lot more than just 4%. While international volume is down only 3% over 2008, North American numbers are down 13.3% over the same period last year. Better than one out of three attendees (36%) were international attendees. That is great if you market overseas, but unfortunately a large percentage of the PACS companies out there don’t market outside the US. That means right off the bat 9,000 of the 26,000 professional attendees stated don’t hit the vendor’s target audience.

If you also factor out all those who aren’t decision makers, who are students, and others, the real numbers of people looking at PACS at RSNA is probably closer to 2,000, if that, with radiology executives who make up 4% of the attendees (589 attendees) a good quarter of that number as well. The numbers could be higher if you include “Radiology Support personnel” but how that is defined is anyone’s guess. Bottom line is it’s not anywhere near the 26,000 professional attendees stated. On the plus side spouses and family members were up 21% (7,881) from last year’s numbers (6,522) so shop owners on Michigan Ave need to take note. In this the Tiger era of trust it could also be a sign that momma doesn’t want daddy to go away for five days without her either (laugh).

Vendors also need to look at domestic coverage too. If a vendor has a strong presence in the Midwest, you are in luck because 35% of three RSNA attendees in the U.S. came from four states around the host state of Illinois - Indiana, Michigan, Ohio, and Wisconsin. No wonder they don’t want to move the show to Orlando (laugh). 20% came from the Northeast, 23% from 17 Southern states, about 11% from California and the Northwest. Hopefully you see what I am getting at here. From a quantity standpoint what you see isn’t always what you get…Quality, though, is another story.

Most shows promote quantity over quantity. Why they do this is anyone’s guess because it is simply wrong. As one vendor told me “I’d rather have 10 qualified leads that 1,000 whom I have to educate from the start.”

Few PACS vendors feel they can get away with not going to RSNA if for no other reason as the signal it sends to the marketplace once they have exhibited there. The same holds true with dramatically scaling a company’s booth size. But getting the attention they want and/or need with 700+ vendors in 3 different halls, especially given many attendees have limited time there makes it very rough. I’d love to think that the RSNA would create an area where PACS could be the focal point similar to an InfoRad ™ with equipment there- but then where do you draw the line? Should it also include RIS, speech recognition, DR, CR, 3D, etc.? You also know all the majors would scream loud and long to this arrangement as well.

For the most part the RSNA has proven to be a very good show for most PACS vendors despite the costs and numbers game being played. HIMSS (Healthcare Information and Management Systems Society) and SIMM (The Society for Imaging Informatics in Medicine) are different animals though. Both are IT-based shows, with SIIM the only one that is PACS-centric. Most of what is shown at both shows is IT-related so you would think both would offer a perfect venue to showcase to PACS. Unfortunately that is not the case.

HIMSS has almost completely ignored PACS and imaging for years and continues to do it this year as well. Don’t believe me? Go to the HIMSS web site http://www.himssconference.org/education/default.aspx and do a search using keywords like PACS, Imaging and Radiology. Of the half dozen or so presentations that even show up and of those only two really deal with PACS and that is stretching it. That is two out of 300 presentations- 0.7% for those who like statistics. To me what is most fascinatingly is in spite of this ongoing denial of PACS importance in the IT community PACS vendors keep attending HIMMS even though several of its own major IT vendors have bailed on the show in recent years. Why?

The dynamics of the PACS decision making has significantly changed in the past few years. Where radiology departments once stood apart from other clinical systems and with them the way decisions surrounding the vendor of choice were made, now nearly half (and in some cases more) of the final decision on the PACS vendor of choice falls to the IT department. And where does IT go to gets its information? Largely from HIMSS, who is a “comprehensive healthcare-stakeholder membership organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare...(with) 23,000 individual members, of which 73% work in patient care delivery settings. "I guess radiology/imaging doesn’t count in that definition - or at least so it seems."

SIIM should be THE preeminent show for PACS, since it is that is what SIIM is all about. But with marketing budgets cut to the bone, will others be far behind this year?

So what would be the ideal? From my perspective SIIM needs to be a subset of HIMSS where IT managers could see everything radiology/imaging related at one trade show, not two. At RSNA there should be a PACS area where attendees can easily do a compare and contrast easily without having to walk all over creation referencing a map just to get it done. And most importantly, every enterprise needs to expand their educational resources.

There is no money to travel to the dozen or more healthcare trade shows a year- one or two shows a year are most hospitals limits. Why not bring the trade show to the end user just as HIMSS is doing with its virtual conferences and expos? It may take a while to catch on for sure but it’s cheap, it’s easy, and most of all it’s effective.

Webinars educate end users in ways that no others can. At an average cost of less than $100 per attendee and oftentimes significantly less, they are cost effective, take little time -an hour at most), and most of present information to QUALIFIED end users, people who are willing to carve an hour out of their day to learn more.
The question is not so much will trade shows survive but in what form and function? With few exceptions, most notably RSNA, the days of the big trade shows are probably limited. Virtual trade shows will show a dramatic increase and information that end users need to make informed, objective decisions will come not just from those shows that survive but from Webinars and other educational opportunities as well. These will no doubt be provided by organizations like the AHRA (The Association for Medical Imaging Management, formerly the Association of Healthcare Radiology Administrators), RBMA (Radiology Business Managers Association), HIMSS, CHIME (College of Healthcare Information Management Executives) and others, bringing the message to the end user, not the other way around.

Bob Dylan was right - The Times They Are A-Changin', and if trade shows are to survive they need to change with the times as well...

Ms. PACS: One question for you PACSman. Would you rather be a big fish in a small pond or a small fish in a big sea? I don't know if you had guppy fish as a kid, but those are the first to go. Either by the larger fish or the cat grabbing a snack.

Point is, why would a radiology IT show want to get lost in a sea of general healthcare IT? I suppose some vendors might try to pawn off their PACS as an EMR, as long as you use it in a "meaningful" way? Just look for PACS or imaging in the "meaningful use" matrix issued last June. It's hard to find...I think the word "images" is tucked in there somewhere between parentheses. It took groups like the e-Ordering Coalition to form a representative voice, called the Provider Roundtable, to be heard by the ONC, and represent radiology’s views on how “meaningful use” should be defined.

At least in the latest version of the proposed "meaningful use" definition, Stage 2, it says it encourages the use of "CPOE and the electronic transmission of diagnostic test results, such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease.”

Don't get me wrong, HIMSS is worthwhile, but you have to weigh the value, and for radiology IT, it doesn't replace SIIM. Basically, you're not comparing apples to apples. That's like comparing Chicago to "Sn"Orlando. One has culture and the other is a shopping mall in the middle of a swamp...where a giant beast with enormous ears lurks...

If you click on "Education" on the HIMSS Web site, and do a search for PACS, you get 3 entries:
- Reducing Risk in Healthcare IT Purchases: Avoiding and Resolving Disputes
- Bringing the Hospital and Physician Clinical IT Together
- Integrating Medical Images and the EHR -- the Time Is Now

Now look up the "Educational Program" at SIIM:
- Using Dashboards and Business Analytics for Practice Improvement
- The Role of Imaging Informatics in the Next Generation of EMR/EHR
- Value Innovation Through Imaging Informatics
- Imaging Center PACS 24x7
- Image Sharing and Accessibility
- Automated Reporting Systems
- etc, etc, etc.....

Need I say more?

The point is, if you want to address radiology IT, SIIM is vertical, geared specifically toward radiologists' needs. Now maybe it could get a little bit more horizontal, and I think it's going in that direction. I just spoke with a GE IT guy who told me they are running a Lean Six Sigma study where they'll take a stop watch and a video of radiologists working. Wake up...I know it's not exactly Avatar. Oh, you slept through that too. But the idea is to create a value stream map that identifies workflow bottlenecks, and then find ways to make them flow faster. Because with reimbursement cuts, the only way to make up for that lost revenue is to work faster. That's a reality. Will those results be mentioned at HIMSS 2011? Maybe. But they'll definitely be heard at SIIM 2011.

I understand vendors need to watch costs, and maybe more virtual education is in order so you can become a TOTAL couch potato. But just recall back to your last date...got it...now tell me, is there any substitute for face to face encounters...oh, unless the date was virtual too:)