tag:blogger.com,1999:blog-7255217464660592222024-03-17T20:03:47.847-07:00PACS-aholicAn intoxicating look at the PACS industryWho they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.comBlogger73125tag:blogger.com,1999:blog-725521746466059222.post-83419583443640751522010-08-05T13:08:00.000-07:002010-08-05T13:08:28.383-07:00A New Beginning (after the end)<b>PACSman:</b> I was doing a Google search for songs that have the lyrics “All Good Things Must Come to an End” in them and only two songs came up from people I never heard of — a country singer named Joe Nichols who has a song titled, “All Good Things” and Nelly Furtado’s “All Good Things (come to an end).”<br />
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My sons and I don’t live in Texas, so Joe Nichols isn’t exactly a household name here, even though I have one friend who does live in Texas and knows the lyrics to every yippee-kai-yeah song known to man — those “I Want a Beer as Cold as My Ex-Wife’s Heart” genre-type songs. I also have another good friend who has a horse farm here with ten horses, five of her own, who should know all these songs but, thankfully, has a much more balanced and well rounded musical taste than my Texas friend…But Nelly?<br />
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“God, Dad you never heard of Nelly Furtado? You embarrass me sometimes.” OK, so what else is new?….<br />
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Then I broadened my search to just the words “The End” and got to a few groups I had heard of, although most of the songs weren’t always familiar. These included The Doors and Black Eyed Peas, both with songs titled, “The End” (although BEP I know more for the controversies they cause than their music — people after my own heart), U2, Norah Jones (the romantic still in me lives), Linkin Park and 2PAC (heard of them, don’t listen to their music, though, although anyone who has PAC in his name can’t be all that bad), Traveling Wilburys, Breaking Benjamin and Smashing Pumpkins, and a few others.<br />
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I stopped at Boyz II Men to listen to their tearjerker song, “End of the Road” that I haven’t heard in years. I am a sucker for intricate a capella harmonies and these guys have it for sure…until my manhood was called into question by my sons as I sang along with Wanya, Nathan, and Shawn “… Although we’ve come to the end of the road. Still I can’t let you go. It’s unnatural, you belong to me, I belong to you….”<br />
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“God, you are sooooooooo gay dad!!!” OK so I’m gay and an embarrassment, while they invoked God’s name twice no less. Have I missed anything? I should have stuck with David Bowie’s “Changes” instead…”Time may change me. But I can't trace time”…<br />
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If you’ve read PACS-aholic with any regularity over the past several years, you have realized that Cristen and I had an interaction between us that was just like a married couple. Most times we loved each other — okay, we liked each other. Sometimes we hated each other, sometimes we did things without the other person knowing or even liking what we were doing and we never made whoopee, either. In the end, though, we still respected each other in the morning, even before that first morning cuppa Joe. So when Cristen unexpectedly elected to move beyond the great white world of publishing, it left me with a chasm to fill the size of the Grand Canyon relating to the PACS-aholic blog. Do I keep the blog or….<br />
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The answer was easy. I am not the PACS-aholic nor was Cristen. We together were the PACS-aholics, and so since there is no official “we” any more, Joe and Nelly both sang it right “….all good things must come to an end.”<br />
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And so it will right here, right now – with apologies to Jesus Jones as well. (Fuji used the band’s “Right Here, Right Now” song as its CR theme several years back, when John Strauss was the head of marketing there and Fuji allowed John’s creativity to flow unimpeded. He unquestionably had some of the best marketing ideas I’ve ever seen in this industry.)<br />
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Know though that just as God shuts one door, another one opens. Instead of watching what I say and how I say it, lest I offend a potential group as I have done more than once, requiring me to “set the record straight,” I have elected to start my own blog — The PACSMan Pontificates. You can visit it here — <a href="http://thepacsmanpontificates.blogspot.com">http://thepacsmanpontificates.blogspot.com/</a>.<br />
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I’m going to try to have at least 4-5 blog posts up per week — not as many as Dr. Grumpy does by any means (one of the funniest blogs I’ve read in ages by the way, http://drgrumpyinthehouse.blogspot.com/). But probably close to the amount of postings my good friend the Dalai does (http://doctordalai.blogspot.com/) when he is in his blogging mood and doesn’t have to work for a living, which lately has been more often than we both like it. Dalai is also helping me get this blog in order, so please be patient with us both. It, like me, is a work-in-progress.<br />
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The blog will be 80% about my life and 20% about PACS, or as I promote it, “The trials and tribulations of a middle-aged PACS consultant, father and garage sale junkie as he engages in his never-ending search for sanity in an insane world.” I’ve been having a lot of fun doing my own thing over the past few decades in the PACS arena and for the past nine years as a single dad to two teen sons. Many people who have read my private musings have said I should share it — and so I will. Should be interesting to see where it goes.<br />
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As for Cristen, we’re still friends — and always will be — that is, until she gets “involved” with someone and forgets her true friends, which happens all too often with women. That said, though I don’t think that will happen any time soon. She’s not quite as cynical as I am — hell, no one on this planet is. But she’s been on the Love Train often enough to know it’s not nearly as much fun as riding the El late at night like Tom Cruise and Rebecca de Mornay did in the movie Risky Business either. ”Joel, have you ever….” Someone cue Tangerine Dream please….”My name is Joel Goodson. I deal in human fulfillment. I grossed over eight thousand dollars in one night. Time of your life, huh kid?”<br />
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So, bookmark the site http://thepacsmanpontificates.blogspot.com/ and get ready for the ride of your life! Topical? Of course! Informed? I wouldn’t have it any other way! Opinionated? Moi? Please, bite your tongue! Censored? Nope. Irreverent? Well cointenly!! Politically correct? Well cointenly not!!<br />
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So this isn’t goodbye but rather “until we meet again,” which I’m sure we will. I’ll still be involved with ITN by being on its Advisory Board, doing the PACS, RIS and CR charts and maybe even a new category this year on storage options, which will include VNAs, Clouds, MSPs and others, if I can convince the new leadership to do this.<br />
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So I leave you with the immortal words from Risky Business, when Joel is being interviewed by the recruiter for his Princeton admission in the middle of his “party.” It reminds me so much of the times we had here on PACS-aholic and how it will be even more so on my own as well…<br />
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Recruiter: “Your stats are very respectable. You’ve done some solid work here. But it’s not quite Ivy League now is it?”<br />
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Joel puts his hand on the recruiter’s knee and says, “You know Bill, there’s one thing I’ve learned in all my years. Sometimes you gotta say what the…. Make your move.”<br />
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Cruise lights a cigarette.<br />
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Recruiter: “I beg your pardon?”<br />
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Lana: “So how we doing?”<br />
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Joel: “Looks like University of Illinois!!!!”<br />
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A li’l up-tempo music by Prince – D.M.S.R., if you please, as the curtain slowly closes on the PACS-aholics. I’m making my move to The PACSMan Pontificates…. Hope to see you all there!!<br />
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<i>NOTE: The ITN staff expresses its thanks to the PACSman, aka Michael Cannavo, founder and President of IMC, for sharing his opinions and insights with the PACS-aholic world for the past few years. We look forward to reading more from him in his new blog, The PACSMan Pontificates.</i> <a href="http://thepacsmanpontificates.blogspot.com">http://thepacsmanpontificates.blogspot.com/</a>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com6tag:blogger.com,1999:blog-725521746466059222.post-32281577718246825122010-05-26T14:11:00.000-07:002010-05-27T09:12:07.041-07:00Is Cloud Computing Annoying?<b>Ms. PACS:</b> Has anyone seen him? The <b>PACSman</b> I mean. I filed a missing person's report, posted his face on a milk carton, but still no sign of him. <br />
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Of course, he must be moonlighting on some other blog. I don't mind being cheated on, as long as you're honest about it (oxymoron?). <br />
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Well the only thing more frustrating about him running off with another blogger is the pretentious attitude of IT "geeks" (they love to be called that) when you talk to them about cloud computing. They act like you are so behind the times, or just a moron, because cloud computing has been around for awhile. Didn't you know?<br />
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Even when you say you realize <a href="http://aws.amazon.com/vpc/">Amazon</a>, <a href="http://www.pcworld.com/article/197253/why_do_we_trust_google_more_than_facebook.html">Google and Facebook</a>, which you've been using for years now, are clouds (because someone recently tipped you off), you're still scoffed at. But for you PACS admins, what business are you in anyway? This is health care. It's always been a decade behind the consumer curve when it comes to IT. Blame it on incentives; compared to consumer markets, there is less in health care. <br />
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Let's face it, much of the PACS user interface is a rip off of Adobe Photoshop anyway. How's that for being an early adopter? <br />
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Besides, cloud computing may be yesterday's news amongst IT geeks, but it is still relatively new to PACS and even advanced visualization for medical imaging. Ergo, it is relevant in radiology today. And should be in radiation oncology where image volumes are going through the roof. But who knows when the RT image management systems will catch on. And when it does in 2020...it will be relevant too. So lose the attitude. <br />
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Speaking of lost, have you seen the <b>PACSman</b>?<br />
<b><br />
What about cloud economics.</b> The adoption of cloud-based architecture is assured if it benefits hospitals financially. This makes it very relevant. <br />
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A cloud environment enables ubiquitous access to programs, reduces the dependence on the users’ bandwidth and computer power and eliminates the danger of obsolescence.<br />
This may be a scary step, but it would enable hospitals to share infrastructure with systems linked together. This would reduce cost, plus force interoperability, which is still lacking today. <br />
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Another benefit, you don't have to pay up-front costs for apps if it offers pay-per-use pricing. You don't have to upgrade your PC. You don't have to upgrade your hardware or networks. <br />
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If you don't like a vendor, you can easily switch - once there are enough cloud-based apps to choose from in health care. Another bonus is there is less of a threat of obsolescence because data centers and on-site technology can be continuously maintained and upgraded. That also removes barriers for vendors, allowing for more start-up Web services and more competition, which tends to favor the end-user. <br />
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It kicks in speed too. The cloud leverages available bandwidth and local computing power to optimize performance and speed. So now radiologist may be able to work faster and process more of those exams. That's what radiologists want - to be able to read more exams and make up for reimbursement cuts. Or is that the administrators' agenda? <br />
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Let's look to the cloud icons, and trend setters in IT. The <a href="http://code.google.com/appengine/docs/whatisgoogleappengine.html">Google's App Engine </a>will let you run whatever program you want - as long as you specify it in a limited version of Python and use Google's database. I can run everyday programs like Word and Excel on Google and store it all right there. But you can't save your document to a folder, and you can't start a new document in a folder. <b>That's REALLY annoying.</b> We suspect Google is trying to rid users of the concept of folders. But then how do you organize things? Through search? What if I can't remember the name of the doc? SOL? <br />
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Sorry to be annoying, but cloud computing is not just trendy, it is relevant in health care and will change how you use your PACS - it will now be a service you access online. Talk about disruptive technology - I guess that's annoying too.Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com4tag:blogger.com,1999:blog-725521746466059222.post-11327190589556717752010-05-11T09:40:00.001-07:002010-05-13T07:12:01.572-07:00Top 10…or 19 PACS Problems<meta content="" name="Title"></meta> <meta content="" name="Keywords"></meta> <meta content="text/html; charset=utf-8" http-equiv="Content-Type"></meta> <meta content="Word.Document" name="ProgId"></meta> <meta content="Microsoft Word 11" name="Generator"></meta> <meta content="Microsoft Word 11" name="Originator"></meta> <link href="file://localhost/Users/cbolan/Library/Caches/TemporaryItems/msoclip1/01/clip_filelist.xml" rel="File-List"></link> <style>
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<div class="MsoNormal"><span style="font-family: "Times New Roman";"><b>PACSman: </b>I love how I’m given a list of the "Top 10 PACS Issues" to comment on, and it’s 19 items long. Mars and Venus says it all, if it wasn’t a list drawn up by a guy. Although, maybe Ms. PACS translated it into 19, adding her own stuff that isn’t in bold, which makes more sense. Who knows.<br />
<br />
Here are the Top 10 PACS Issues, according to Richard (Skip) L. Kennedy, MSc, CIIP; Kaiser Permanente Medical Group, Sacramento, that will be discussed at the SIIM 2010 educational session on Thursday, June 3, 2010 in the "Practical Imaging Informatics Learning Track.” </span></div><div class="MsoNormal"><span style="font-family: "Times New Roman";"><o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="margin-left: 0.5in; text-indent: 0.5in;"><span style="font-family: Verdana; font-size: 7.5pt;"> </span><a href="http://www.scarnet.org/index.cfm?id=6910"><b><span style="font-family: Verdana; font-size: 10pt;">Top Ten PACS Problems</span></b></a><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></div><ol start="1" type="1"><li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“It doesn’t go through…” Part 1</b></span><span style="font-family: Verdana; font-size: 10pt;">: Network layer issues </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“It doesn’t go through…” Part 2</b></span><span style="font-family: Verdana; font-size: 10pt;">: DICOM layer issues </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“It doesn’t do what I want/need/expect…”: </b></span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Managing user expectations and user education </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Vendor feature requests and customizations </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“It’s really slow…”: </b></span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Performance management </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Scaling issues </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“That can’t be right…”:</b></span><span style="font-family: Verdana; font-size: 10pt;"> Data QA management </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“Everybody wants on board now…”:</b></span><span style="font-family: Verdana; font-size: 10pt;"> Imaging content outside of Radiology (Cardiology, Dermatology, etc.) </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“You didn’t tell us about…”:</b></span><span style="font-family: Verdana; font-size: 10pt;"> User community communications and change management </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“We need to get a new…”: </b></span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-PACS-to-PACS migration issues </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-PACS hardware refresh issues </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“We need to know…”:</b></span><span style="font-family: Verdana; font-size: 10pt;"> Dashboards and reporting issues with PACS </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;"><b>“What to do when the lights are out…”: </b></span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Availability and uptime </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Downtime processes and procedures </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
<li class="MsoNormal"><span style="font-family: Verdana; font-size: 10pt;">-Disaster recovery </span><span style="font-family: "Times New Roman"; font-size: 10pt;"><o:p></o:p></span></li>
</ol><div class="MsoNormal">About 3/4 of the items on the list are technical issues. For the most part, those are a piece of cake to deal with. While they may not be solvable right away, they are solvable nonetheless. The other issues aren’t so easy. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>My #1</b> is managing user expectations and user education. Will PACS solve every problem you have and meet every need? No. Will there be no downtime? No. Will it…the list goes on and on, and the answer typically remains the same - No. It’s even worse when you are replacing a PACS, expecting the new one to do things the old one didn’t do while you use the same RFP and get the same answers from the same vendors and expect the outcome to be different. Isn’t that the classical definition of insanity? </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>My #2 </b>would be creating a vendor neutral system or at least incorporating a vendor neutral archive (VNA). Despite 20 years of standards development, the vast majority of systems out there can still be considered proprietary or closed systems, each having at least one component from the database structure to the archive that locks in the end user. That is just plain sad. Vendors say they support a standard - all images are in a DICOM Part X format, for example, then they throw on a proprietary compression algorithm that only they provide. So much for an open system <sigh>.</sigh></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>My #3</b> would be making sure the system is designed right. That didn’t even make the list. When you buy a PACS you buy what the vendor says is the solution based on your needs. The question remains: did you adequately outline ALL of your needs and did their solution meet it? This is easily addressed contractually, but few people include the proper contract language to address this.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>My #4</b> would be…..well, you get the gist of it…problems are just masked opportunities for improvement. If you address #1, everything else is a piece of cake, but it’s like marriage - you never know what you are in for until you are in it so…Maybe that’s my #4. Once you make a decision to implement a PACS vendor, accept what you have and make the best of it. You are going to have it for a while, and getting out of it isn’t easy or cheap either. The upside of a PACS is that you get to choose a new one every 5-7 years without penalty. If life were only that simple <laugh></laugh></div><div class="MsoNormal"><br />
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</div><div class="MsoNormal"> </div>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com3tag:blogger.com,1999:blog-725521746466059222.post-54611525968937061622010-04-16T10:54:00.000-07:002010-04-16T10:54:32.937-07:00Splain Me Some More Ricky<b>PACSman:</b> I love how women like Ms. PACS bait me by putting things up on a blog, then tell me about it after the fact once it’s up, as a comment in an e-mail in a “by the way” fashion. This must be her way of playing the Wicked Witch of the West, “I’ll get you my pretty and your little dog too ah ha ha ha ha …..” only her version of it is closer to “I’ll get you (to post something up on here one way or the other) my pretty (PACSMan)…” Once again, using her feminine wiles, she has succeeded…although if she keeps this up I’ll have my little dog Elvis (not Toto) hump her leg, then pee on her bookshelves too…although she might actually enjoy the former (laugh). <br />
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Yes, Ms P., I have been following the Merge/AMICAS story closely, and a lot of what is going on has me completely stumped. That said, I am not an investor in either company - my objectivity in this market would suffer if I invested in either of these PACS companies. One look at the past six months is enough to make any investor cry, although Merge stock has rebounded $0.50 in the past two weeks - although why is anyone’s guess.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_6wlj_Yv6D2E/S8ih6mODTHI/AAAAAAAAAJc/ddnw-Y0OXc8/s1600/Merge+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/_6wlj_Yv6D2E/S8ih6mODTHI/AAAAAAAAAJc/ddnw-Y0OXc8/s320/Merge+1.jpg" /></a></div><br />
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Now we come to the good stuff. <br />
<br />
On April 2, Merge completed a private placement of preferred and common stock totaling $41.75 million, which is specified for use in funding a portion of the proposed acquisition of AMICAS. The merger agreement contains a commitment from Merge to provide $40 million in preferred equity to the acquisition. This private placement will satisfy that commitment and is scheduled to close prior to the close of the tender offer to AMICAS shareholders.<br />
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Merge entered this securities purchase agreement with 14 institutional and other accredited investors, pursuant to which Merge will issue an aggregate of 41,750 shares of Series A Non-Voting Preferred Stock and 7,515,000 shares of common stock for a total purchase price of $41.75 million, before fees and expenses. <br />
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Now here is what I don’t understand. 99.45% of the $40M in stock issued is common stock, while only 0.55% is preferred. So what’s the big deal? A couple of days later Merge then announced its intent to offer $200 million aggregate principal amount of senior secured notes due 2015, which will be used to fund a portion of the proposed acquisition of AMICAS. The notes will be senior obligations of Merge and will be guaranteed on a senior basis by all of Merge’s domestic restricted subsidiaries. <br />
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Now what am I missing here? Fourteen investors said: “Yup we are in!!” and get 7.5M shares of common stock with no guarantees attached to it whatsoever. Four days later, Merge announces its intent to offer $200 million aggregate principal amount of senior secured notes due 2015, “guaranteed on a senior basis by all of Merge’s domestic restricted subsidiaries.” So if I read this right, the $200 million comes with guarantees, while almost all the $40 million comes with nada since it is “common stock.” <br />
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I have many friends in the industry that have been issued common stock before as employees, as have I, so that is my only frame of reference. Some have even been former e-Med employees (now part of Merge coincidentally). They worked hard and long for many years in the hope that once their company was sold they would finally get their just reward. And they did, right in the ……This isn’t just e-Med folks who have had this happen to them, I can give you a list of at least half a dozen companies where the rich got richer (a.k.a. management and investors), and those who truly made the company what it was were left to squeal like a pig Deliverance-style…. <br />
<br />
So what happened? Once all the preferred stock was paid the old Italian proverb that goes “Con nulla non si fa nulla” got put into play. Translated this means “Of nothing comes nothing.” And that is what they got. Top management and investors got theirs, but what of the people who made these companies what they were? Niente….nothing…They couldn’t even use the stock as TP, which they needed after the “good lovin” they just got by the companies they sacrificed their lives, marriages, and families for, all in the hopes of achieving the Great American Dream called financial freedom. They had common stock - just like the 7.5M shares that were issued on the 4th are…..<br />
<br />
I hope I am wrong here, but….it sure seems to me like someone needs to be kissed. Would these 14 investors have ponied up and laid $40M on the bar knowing $200M in guaranteed stock would be offered a few days later? You’ll just have to ask them. But I bet a few are as confused as I am, if not outright pi$$d off. I know I would be, assuming my assumptions are right that is.<br />
<br />
The other interesting thing (to me, at any rate) is with the $40M “the securities to be issued in the private placement have not been registered under the Securities Act of 1933, as amended (the Securities Act) or any state securities laws and may not be offered or sold in the United States absent registration with the Securities and Exchange Commission (SEC) or an applicable exemption from the registration requirements of the Securities Act. Merge has agreed to file a registration statement with the SEC covering the resale of the common stock issued in the private placement, provided however, that pursuant to the terms of the securities purchase agreement the investors shall be restricted from transferring the shares acquired in the private placement without the prior consent of Merge (other than to an affiliate) until the earlier of the first anniversary of their issuance or the occurrence of a “change of control” as defined in the securities purchase agreement.” <br />
<br />
And the $200M? “The notes and the related guarantees will be offered in the United States to qualified institutional buyers pursuant to Rule 144A under the Securities Act of 1933, as amended (the Securities Act), and outside the United States pursuant to Regulation S under the Securities Act. The notes and the related guarantees have not been registered under the Securities Act and may not be offered or sold in the United States absent registration or an applicable exemption from the registration requirements.” <br />
<br />
One seems to be registered, the other isn’t. Now again I’m way out of my comfort zone here and have no idea what the difference nor can I explain it, but I’m not putting more than $250K of my hard earned money per bank account lest the FDIC not insure it. The same probably holds true here. Gimme a guarantee any day… Of course the FDIC will probably go bankrupt anyway, but at least I can say I’ve been prudent in trying…<br />
<br />
Now, if Merge has already obtained $200 million of bridge financing from Morgan Stanley and has also started a cash tender offer for all of the outstanding shares of AMICAS, has been extended to 5:00 p.m., New York City, New York time, on Friday, April 23, 2010, unless further extended, why then do they need all this money? That’s sorta like your wife asking you to wear a condom five years after you had a vasectomy - and she is on birth control to boot…Someone please ‘splain me that to me, Ricky, too… <br />
<br />
I’m not sure I buy the statement made that “The successful acquisition of AMICAS will enable Merge to acquire one of its main competitors and widen its customer base. This will in turn expand the company’s top line.” Merge and AMICAS competed in very few accounts in both the PACS and RIS arena over the past five years – a few handfuls per year at best that I know of if that - so who is coming up with a blanket statement like this is anyone’s guess. That is like me putting up my profile on Millionaire Match in the hopes of finding my very own gold digger once I hit my first million later this year (provided the FDIC doesn’t go belly up that is). <br />
<br />
That same report said the following: “In the past, Merge has been paralyzed by several issues like a dwindling cash balance, management turnover, accounting miscues and litigations. The real turnaround started in the second quarter of 2008 when the company received the much-needed cash infusion of $20 million from Merrick RIS LLC in May 2008.” Real turnaround? You mean from $0.26 to over $2.00? Oh yeah, my bad again. But how soon some people forget the past:<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_6wlj_Yv6D2E/S8ii3LnX_fI/AAAAAAAAAJ0/qwhHPOKWedI/s1600/Merge+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/_6wlj_Yv6D2E/S8ii3LnX_fI/AAAAAAAAAJ0/qwhHPOKWedI/s320/Merge+2.jpg" /></a></div><br />
Now let’s be fair and show the same time period they are referring to<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_6wlj_Yv6D2E/S8iiQ3VfNRI/AAAAAAAAAJk/s_HCjcqXyhY/s1600/Merge+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br />
</a><a href="http://4.bp.blogspot.com/_6wlj_Yv6D2E/S8ii6WbwsOI/AAAAAAAAAJ8/HpwT1ry5DlE/s1600/Merge+3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/_6wlj_Yv6D2E/S8ii6WbwsOI/AAAAAAAAAJ8/HpwT1ry5DlE/s320/Merge+3.jpg" /></a></div><br />
<br />
Wait!! Does that not show $4 a share in June 2009? Then a $3 a share in 2010? Below $2.00 a share in March 2010? Maybe jumping back up to over $2.50 is the turnaround they are referring to here but in my book this is more of Mr. Toad’s Wild Ride or a trip in the Tower of Terror at Disney than anything else. Turnaround? Look closer...<br />
<br />
<br />
<b>Income Statement: </b><br />
<br />
<b>View: Annual Data | Quarterly Data</b><br />
<b>All numbers in thousands</b><br />
PERIOD ENDING 31-Dec-09 31-Dec-08 31-Dec-07<br />
Total Revenue 66,841 56,735 59,572 <br />
Cost of Revenue 19,377 20,072 29,348 <br />
-------<br />
Gross Profit 47,464 36,663 30,224 <br />
<br />
<b>Operating Expenses</b><br />
Research Development 10,689 13,240 21,065 <br />
Selling General and <br />
Administrative 22,208 29,774 48,057 <br />
Non Recurring 2,838 11,816 124,131 <br />
Others 2,766 3,530 8,209 <br />
<br />
<b>Total Operating </b><br />
Expenses 38,501 58,360 201,462 <br />
<br />
Operating Income or Loss 8,963 (21,697) (171,238) <br />
Income from Continuing Operations <br />
Total Other Income/Expenses Net (6,097) (296) (481) <br />
Earnings Before Interest And Taxes 2,866 (21,993) (171,719) <br />
Interest Expense 2,716 1,750 89 <br />
Income Before Tax 150 (23,743) (171,808) <br />
Income Tax Expense (135) (60) (240) <br />
Minority Interest - - - <br />
<br />
Net Income From Continuing Ops 285 (23,683) (171,568) <br />
<br />
Non-recurring Events <br />
Discontinued Operations - - - <br />
Extraordinary Items - - - <br />
Effect Of Accounting Changes - - - <br />
Other Items - - - <br />
<br />
<br />
Net Income 285 (23,683) (171,568) <br />
Preferred Stock And Other Adjustments - - - <br />
<br />
Net Income Applicable To Common Shares $285 ($23,683) ($171,568) <br />
<br />
<br />
Um…. to me this looks like they still lost over $23.6M in 2008. I guess compared with losing $171M this is a turnaround for sure…but that’s like comparing me to John Holmes (God rest his perverted soul). <br />
<br />
This year Merge made $285K (K is the symbol for thousand for those economically challenged) on almost $67M in revenue - although they would have made more if they didn’t lose over $2M in the 4th quarter. To me that’s hardly worth getting out of bed for…Now let me say that given the softness of the imaging marketplace ANY profit is commendable - you go Merge, especially since big boys could have used some Viagra this year their sales were so soft - but I’d feel a lot more comfortable if Merge made their profit on actual SALES rather than through a $20M (that’s million) reduction on operating expenses. Still a profit is a profit so…<br />
<br />
Now I hear a lot about longs and shorts, and I’m not talking about anything other than Merge’s 2008 10K I found this:<br />
<br />
<b>Common Stock Market Prices:</b><br />
<br />
<b>2009 4th Quarter 3rd Quarter 2nd Quarter 1st Quarter </b><br />
High $4.25 $4.78 $4.48 $1.84 <br />
Low $2.93 $2.98 $1.25 $1.07 <br />
<br />
2008 <br />
High $1.75 $1.60 $1.37 $1.26 <br />
Low $0.26 $0.60 $0.26 $0.33 <br />
<br />
And this:<br />
<b>COMPARISON OF THE 5 YEAR CUMULATIVE TOTAL RETURNS</b><br />
<b>FOR THE FIVE YEAR PERIOD ENDED DECEMBER 31, 2009</b><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_6wlj_Yv6D2E/S8ii_GIZQaI/AAAAAAAAAKE/SBFCAyHebBI/s1600/Merge+4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/_6wlj_Yv6D2E/S8ii_GIZQaI/AAAAAAAAAKE/SBFCAyHebBI/s320/Merge+4.jpg" /></a></div><br />
Now for those who have a hard time interpreting what this means, $100 invested <br />
in Merge would bring you a $15 ROI today…Of course that is triple what it brought in 2007 and, yes, nearly as much in the turnaround year 2008 as well so again we have a turnabout…so to speak…<br />
<br />
<br />
<b>Index</b><br />
<br />
<b>Date Merge Healthcare Inc. Nasdaq Computer Index Russell 2000 Index </b><br />
<b> (Nasdaq: MRGE) (^IXCO) (^RUT) </b><br />
12/31/2004 $100 $100 $100<br />
12/30/2005 $113 $103 $103<br />
12/29/2006 $29 $109 $121<br />
12/31/2007 $5 $133 $118<br />
12/31/2008 $6 $71 $77<br />
12/31/2009 $15 $121 $96<br />
<br />
So what’s going to happen?<br />
<br />
Merge has a very very sharp, financially savvy management team that understands the financial marketplace. They are some of the best of the best from the finance world and know how to turn a profit. That, no doubt, is what they will do. <br />
<br />
So here are the PACSMan’s predictions. A few months after the sale goes through (assuming it does go through, that is), the boys up top will get out their Ginsu knives and slice and dice both companies to maximize the investment and show a decent ROI to the investors. They will keep what the products and services they feel they can grow and profit from and ditch the rest. And if a few (or more than a few) people happen to get hurt along the way, well that’s called collateral damage. “It” happens and no one, especially not the investors, give a rat’s…..It’s all about the buck. <br />
<br />
Now the burning question - will AMICAS PACS survive? I sure hope so. It’s a great product with even better potential - the best in the entire Merge/AMICAS portfolio.<br />
<br />
What about the other products in the line, including the ones that have the strongest OEM relationships i.e. Cedera, Camtronics, and eFilm? That remains to be seen… I’d put money that there are a few buyers lined up for some of these products already. Don’t ask me who, though, cuz I’m not saying, but I have some very strong hunches. <br />
<br />
In my hometown this week, we experienced nothing short of a miracle. A mere two miles from my house an 11-year-old girl who was lost in dense woods filled with snakes and alligators got rescued. Very near the 96-hour point where a search and rescue operation becomes a recovery operation, a volunteer from her former church, who really shouldn’t have been in there looking for her, found her - bug bitten and dehydrated, but very much alive… Everyone I know shed a tear or two. I have kids as well and know how it feels to not be able to find your child. When my “baby” Matt, who will be 17 on Friday, was age two he was “lost” for a whole 30 minutes, very well hidden in our house. During the time from when we called 911 until he was found, we had five sheriff’s deputies inside and out plus a chopper overhead looking for him. God bless these people. I can’t even fathom going for four days now knowing how or where our child is except being lost somewhere out there. <br />
<br />
Yet the girl, her rescuer, and her parents all quoted a single bible verse that sustained them, Proverbs 3:5 “Trust in the Lord with all your heart and lean not on your own understanding.” <br />
<br />
I put my trust in Him always and sincerely hope that the trust I have in Merge management to do the right thing for both its and AMICAS’ people, and not just the investors, is not displaced…<br />
<br />
Only time will tell…stay tuned…Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-59961850359296079452010-04-14T15:45:00.000-07:002010-04-15T10:32:44.668-07:00Merge/Amicas Deal: Place Your Bets<b>Ms. PACS:</b> It's time to place your bets ladies and gentlemen. <br />
<br />
The odds were in favor of Merge pulling off a $248 million acquisition of Amicas when it issued a statement guaranteeing it could back the offer. Morgan Stanley even put its good name behind the deal. But let's face it, this Merge/Amicas merger keeps dragging out...although it has provided hours of fun for the PACSman...and its getting a bit messy. <br />
<br />
According to the <b>PACSman</b>, <i>"They raised $40M from 14 investors on the 2nd then came out with another $200M offering on the 6th."</i> This would prompt anyone to wonder if their loan from Morgan Stanley has fallen through. Or are there some existing conditions in the loan, forcing Merge to raise capital from other investors?<br />
<br />
They say, never let them see you sweat, but it's pretty hard not to in a pickle like this one. So, if you don't mind a little sweat, and want to enjoy this as much as the PACSman does, then let's play a favorite game of mine, <b>Texas Holdem Poker</b>. <br />
<br />
<b>Get ready to place your bets.</b><br />
<br />
Lets look to an impartial party, Moody's Investors Service. Moody's recently demoted its rating of Merge Healthcare Inc. slightly to a B2 corporate family rating. Why did Moody's drop it five notches below its previous investment grade? Risk. Moody's said, in a nice way, it was due to "Merge's small scale, integration risk, and risk that it could continue to pursue growth through acquisitions are behind the rating." <br />
<br />
<b>Place your bets...</b><br />
<br />
But there was a tone of optimism. Moody's said, "We believe, however, that if the Amicas acquisition is well-executed, there could be substantial opportunity for cost synergies..."<br />
<br />
<b>Place your bets...</b><br />
<br />
"...And the combined company to generate strong free cash flow. Another beam of hope.<br />
<br />
<b>Place your bets...</b><br />
<br />
But Merge is a "relatively niche player" in an industry dominated by large imaging equipment vendors and IT companies. <br />
<br />
<b>Place your bets...</b><br />
<br />
Plus, it relies heavily on radiology.<br />
<br />
<b>Place your bets...</b><br />
<br />
In the meantime, while the company figures out how to diversify its consumer base, the $35 million to $40 million it will get following the acquisition's close will provide "adequate cash" over the next year. Whew.<br />
<br />
<b>Place your bets...</b><br />
<br />
Wait, one more thing, it’s lacking a “revolving credit facility,” which apparently could lead to the depletion of its cash reserves.<br />
<br />
<b>Now, show your cards</b><br />
<br />
<b>And you wonder what really happens on Wall Street.</b>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-60955071453346426562010-04-06T11:36:00.000-07:002010-04-08T10:41:40.261-07:00Beware of Ninjas<b>Ms. PACS: </b> It seems like everyone wants to be a black belt these days. Just go to Ballys Total Fitness, all you need to have is a bank account and a pulse to move up in the ranks.<br />
<br />
And while the ‘fitness’ business has sadly denigrated the art and the term black belt, business management has upgraded it to guru status -- as a rank for experts in Lean Six Sigma management methodology.<br />
<br />
I get it, it’s sounds more Ninja than just a boring old MBA. And now it is being adopted in PACS. Yes, radiologists can qualify for Ninja status too. <br />
<br />
One of the big adopters of Six Sigma is applying its industrial methodology to radiology workflow. The company is spearheading a study to improve radiology productivity by finding where they can enhance PACS. I know about this because I included it an article in ITN’s April issue: <a href="http://www.itnonline.net/node/36554">Best Practices in Radiology Workflow</a>. <br />
<br />
The goal of the project is “to understand the exact work efforts of a radiologist and make changes to products/solutions to take the wasted effort away through better software and/or configuration.” The company enlisted its team of Lean Six Sigma Black Belts (LSSBB) to watch radiologist, actually timing them with a stop watch, to analyze the workflow process. The plan is to then apply industrial engineering techniques combined with Lean Six Sigma methodology to the radiology workflow. Finally, the Black Belts’ is to find opportunities to reduce wait time, excessive mouse clicks, redundant actions, and repetitious movements. The idea is to help radiologists make a leap to increased efficiency - Hiyaa!<br />
<br />
I like the theory, but would karate chop my boss if he stood over me with a stop watch.<br />
<br />
But there is a colony of Power Rangers out there in the making. The other day, this guy who runs a marketing company called <i>Power…something</i> asked on a certain networking site: <b>“How can the Radiology industry use Lean Six Sigma? I am looking to market my LSSBB to a greater extent. Any suggestions?” </b><br />
There were suggestions. One that stood out was: <b>“The January 2010 issue Vol 65, Iss 1 of the ACR bulletin may be a good place to start.”</b><br />
<br />
I googled and i found: <b>“Get your black belt in ACR MRI accreditation.”</b> So the ACR has Ninjas too. In fact, a number of different organizations in the U.S., Canada and the UK are applying Lean/Six Sigma concepts to help improve efficiency, utilization, productivity, cost containment, etc. Between decreasing reimbursement rates, increasing imaging volumes, shortage of radiologists, etc. there is certainly growing interest in finding new ways to streamline and improve the delivery of imaging.<br />
<br />
According to another Radrounds participant: "While there is a lot of info on the web about Radiology process improvement, key performance indicators (KPIs), etc – there seems to be a technical gap in terms of how people are able to analyze results/performance." He said he is working on a new solution to take data from any source, combine it into useful perspectives, and help organizations to improve workflow, reduce costs, increase utilization, patient volumes, etc.<br />
<br />
Those are some useful tips, but is it just more pseudo black belt speak? <br />
<br />
One thing is for sure: everyone thinks it’s cool to be a “black belt.” And, every field has one - whether it's radiology, the music industry, or its the originator of Lean Management itself -- Toyota -- but look how that turned out. The term “black belt” is a business buzzword. What the heck, Ballys Total Fitness runs a “black belt” mill. <br />
<br />
For those who actually want to know, the real black belt is only the very beginning stage of becoming a master in either karate or tae kwon do or judo. It takes many, many years to move up the ranks and to understand it. That leaves just a few real Ninjas in the world - those who understand the real meaning of the belt (that does not include Yoda). So shhh...keep the secret. Kamsamida.<br />
<br />
I wonder how long it will take to get a black belt in PACS? Anyone know?Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-60995192900630778192010-03-11T09:01:00.000-08:002010-03-18T13:34:13.938-07:00PACS Divorce Rate Spikes!<b>PACSman: </b> So why aren’t second PACS purchases flawless? One only needs to look at marriage and divorce statistics to understand. It is pretty much agreed by most experts that first marriages end in divorce about 40 to 50 percent of the time. The PACS “divorce rate” is much higher than that. <br />
<br />
What surprises me is that the divorce rate increases with second marriages to 60 percent and more, while third marriages end in divorce at least 70 percent of the time. Does that mean third generation PACS are more doomed than second? <br />
One would think that an individual who has gone through a marriage and divorce would have “learned his (or her) lesson” and will, therefore, not repeat the mistakes of the past. Alas, this is often not the case. Those who marry to fulfill certain needs, but are not prepared to give in return, usually marry with the same intent the next time around. <br />
The same holds true with PACS. The second or replacement PACS becomes nothing more than a walk down a precipice, a courtship leading to fresh disaster, only because it involves a new partner.<br />
<br />
<b>Avoid Disaster</b><br />
So how do you avoid the disaster? Make a list of what you liked and didn’t like with your first PACS. Evaluate your new PACS partner not just by the freshness they bring to the relationship but by how well they performed during the time you were together. <br />
In doing the detailed evaluation and assessment, it is important to understand that while newer systems might perform better – after all it does run on newer hardware and is one of the primary reasons why you are upgrading – you have to also ask if the better performance helps you or hinders you? That may sound contradictory, but sometimes faster and cheaper isn’t always what you need, especially if you lose a feature you really used before. <br />
Look at the company’s track record in delivering what they promised relative to software updates and upgrades. Did they meet the promised delivery dates? Did it work right the first time? Did it include everything that they said it would or merely provided a fraction of what they said? <br />
<br />
Get the <a href="http://itnonline.net/node/36386"><b>Top 10 Considerations for PACS Replacement</b></a> here and read the complete article in the April issue of <a href="http://itnonline.net/node/36386">Imaging Technology News</a>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-92133085333366608182010-03-06T13:01:00.000-08:002010-03-09T18:16:23.688-08:00AMICAS Opts for the Bigger Diamond<b>Ms PACS: </b> I'm sure you've heard the expression: "A woman has the right to change her mind." That's just how we women explain our whimsical nature or, simply, our indifference when blowing someone off. Fact is, it's good to have options. Besides, who can resist the ego-trip of having several suitors making you offers. Sure, you probably know the one you're going to say yes to, the one who offers the biggest diamond ring, but you keep the other ones on the back burner, just in case.<br />
<br />
On March 5, 2010, Merge had the pleasure of announcing: <a href="http://www.itnonline.net/node/36335/3">"AMICAS Agrees to Merge Acquisition Offer for $248 Million."</a> Actually, it sounds like the release came from AMICAS. But whichever, the deal was sealed after AMICAS wavered between an initial offer from Thoma Bravo for $5.35 per share, and an offer from Merge for $6.05 per share, and entered into a definitive merger agreement (the “Merge Acquisition Agreement”) in which Merge will acquire all of the outstanding shares of AMICAS for $6.05 per share in cash, or an aggregate of $248 million.<br />
<br />
As you all know, AMICAS had rejected Merge's offer of $6.05 per share and urged shareholders to support a rival offer of $5.35 per share, or $217 million, from Thoma Bravo, which AMICAS had agreed to in Dec. But on Monday AMICAS said it considered the Merge offer superior.<br />
<br />
Finally, the Board of Directors of AMICAS unanimously voted to terminate its previous deal with Thoma Bravo and to enter into the "Merge Acquisition Agreement." Merge pulled the old "get her a bigger diamond and she'll say yes" trick - 13 percent bigger - and it worked.<br />
<br />
Together, AMICAS and Merge aim to become "a leading global healthcare IT provider" with a combined portfolio of solutions for cardiology radiology, management solutions for IDN’s, OEM solutions for pharmaceutical, biotechnology, medical devices....yada yada yada. <br />
<br />
Now, everyone's asking, just like with Branjolina (Brad and Anjolina), will it last?<br />
<br />
<b> PACSMan: </b> I believe the words for that are gold digger...And now you know why I am a confirmed batchelor....Thanks, but no thanks...Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-397419782430597172010-03-02T04:18:00.000-08:002010-03-04T10:24:00.386-08:00Merge's Bid for AMICAS - Gordon Gecko Style<b>Ms. PACS: </b>You've heard it before. From 1831, when he lost his job to 1858 when he was again defeated in a run for U.S. Senate, Abraham Lincoln experienced 12 major career setbacks. Finally, in 1860, he went on to become one of the most renowned U.S. presidents. <br />
<br />
Why do you care? It just goes to show we can all pull ourselves up by our bootstraps, get back on our feet and take another jab at whatever our obsession may be. In Gordon Gecko’s case, it would have been heading back to Wall Street or to a small island country to do some offshore banking once sprung from jail – lets hope Maddoff never gets out. For Lincoln, it was running for political office. For Mike Tyson, it took converting to a Muslim to get out of jail, and more recently appearing in The Hangover to win back respectability, kind of. Or what about Ford? The company is touting the all-new 2012 Ford Focus as the comeback kid. Their pitch is: "it's one of the greatest automotive comeback stories in a long time. After too many indifferent refreshes it's finally, and awesomely, everything enthusiasts have been begging Ford to build." Don't hold your breath. <br />
<br />
For Merge, it’s about acquiring a leader in PACS to become a larger player in the U.S. market. Merge widely OEMs internationally, but needs to regain its footing in the national market...to become another comeback kid.<br />
<br />
So, is your gripe, PACSman, really over fears that Merge is digging itself too deep into debt? Or do you have a special infinity for AMICAS, and the fact that its brand name will no longer be stamped on the packaging chokes you up? Does AMICAS mean quality PACS to you? That's great for Merge if it does because they are probably going to own it. Or is this a sentimental thing – AMICAS represents an impressive start-up that kind of makes you proud? I'm sure they planned to sell from day one. Even when <a href="http://www.businessweek.com/ap/financialnews/D9E60E000.htm">the company rejected Merge's offer of $6.05 per share and urged shareholders to support a rival offer of $5.35 per share</a>, it took no more than a good nap over the weekend to wake up and smell the offer. I bet the AMICAS' CEO is about as sentimental about selling AMICAS as Marshall Fields, a real historic landmark, which brought me warm fuzzies as a kid, sitting under the six-story Christmas Tree, as it did for many Chicagoans who loved Frango Mints. But what did their Board Members really care about when Macy’s made them an offer (especially if Fields was on the road to bankruptcy)? Or what about the historic Empire State Building? All they cared about was the green. As you reminded us, PACSman, green and greed is good. And we Chicagoans adjusted – albeit begrudgingly. <br />
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So, turn up the 70's Steve Miller classic, “Go on take the money and run.” Just remember, the delinquent, p*& smokin' couple taking off to Mexico successfully romanticized greed, as did Pretty Woman - she was after the bucks. Gecko - many a man would love to be him - and Maddoff - he just makes you sick.<br />
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Remember, it’s all "in good faith." Despite Merge upping the ante 13% to $6.05 to make Thoma Bravo's $5.35 offer look, well, meager in comparison, AMICAS is giving Thoma Bravo another chance at bat. <i><a href="http://www.businessweek.com/ap/financialnews/D9E60E000.htm">BusinessWeek</a> reported on Monday:</i> On Monday Amicas said it considered the Merge offer <b>superior</b>. Amicas said it will offer to negotiate "in good faith" with Thoma Bravo through March 8 under the terms of their agreement. Amicas' board of directors authorized ending the Thoma Bravo deal if the Merge offer is still superior after negotiations. <br />
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Who knows, maybe Thoma Bravo can rally before March 8 when its deal with AMICAS turns into a pumpkin. Even then, who doesn’t love pumpkin pie? Yummy☺<br />
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<b>PACSman:</b> Back when I was in my early 30’s, single, and living la vida loca I had these grandiose ideas of making a few investments, riding out the market for few years-buy low, sell high- and voila, the good life comes my way in the form of a lot of money. I’d be retired and enjoying life before age 50... Now that I’m over 50 I’m working more and making less now than ever before and what I get to “invest” is in a glass jar in the corner of my room- loose change- my “vacation fund”. Of course two kids, one ex-wife, a mortgage from hell and various other setbacks haven’t helped any but that’s just the American way. <br />
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Around the same time as I held onto my dreams the movie “Wall Street” came out. The movie starred Michael Douglas as Gordon Gecko, an extremely successful (but ruthless and greedy) broker who takes a young and naïve Bud Fox (Charlie Sheen) under his wing and explains his philosophy that <a href="http://www.imdb.com/video/screenplay/vi3774546201/">Greed is Good</a> despite it being one of the seven deadly sins. Taking the advice and working closely with Gekko, Fox soon finds himself swept into a world of "yuppies", shady business deals, the "good life", fast money, and fast women; something which is at odds with his family including his estranged father and the blue-collared way Fox was brought up. It’s all about “bagging the elephant”- getting a shot at the big-money brokers and learning how to make the big bucks.<br />
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I’ve been watching this “Wall Street scenario” develop with Merge Healthcare’s recent offer to buy AMICAS. At first I was majorly pi$$ed off at AMICAS - how can you let theses guys even make an offer when you have one on the table already?- but then I realized that they have effectively been rendered impotent by rules that are meant to protect the AMICAS stockholders. It’s all about getting the most return on investment. Does that protect the company? No. Truth be known, it could lead to its demise. But as Bruce Hornsby once sang “That’s just the way it is...some things will never change.”<br />
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Allowing a company that has a net worth of $137M (and dropping- as of this writing) to go in debt up to its ears spending $250M to buy another company is could be seen as obscene or just the American way…Listen to Gecko address the stockholders at Teldar Paper in the movie Wall Street:<br />
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<i>Teldar Paper, Mr. Cromwell, Teldar Paper has 33 different vice presidents each earning over 200 thousand dollars a year. Now, I have spent the last two months analyzing what all these guys do, and I still can't figure it out. One thing I do know is that our paper company lost 110 million dollars last year, and I'll bet that half of that was spent in all the paperwork going back and forth between all these vice presidents. The new law of evolution in corporate America seems to be survival of the unfittest. Well, in my book you either do it right or you get eliminated. In the last seven deals that I've been involved with, there were 2.5 million stockholders who have made a pretax profit of 12 billion dollars. Thank you. I am not a destroyer of companies. I am a liberator of them! The point is, ladies and gentleman, that greed, for lack of a better word, is good. Greed is right, greed works. Greed clarifies, cuts through, and captures the essence of the evolutionary spirit. Greed, in all of its forms; greed for life, for money, for love, knowledge has marked the upward surge of mankind. And greed, you mark my words, will not only save Teldar Paper, but that other malfunctioning corporation called the USA. Thank you very much.<br />
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Sound familiar? It could be just about any company...<br />
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So who is greedy here? Merge? Not really - they are just playing the game and doing it exceptionally well at that. Kudos to Merge here. At 7:50 a.m. Monday the headlines came across the PR Newswire “AMICAS Board of Directors Determines Updated Proposal From Merge Healthcare Is a Superior Proposal” (Sigh). <br />
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So it’s all over except the fat lady singing. Now Thoma Bravo has the right to make a counteroffer but will they? There is a lot of room between the $5.35 they offered and $6.05 Merge has offered - 13% to be exact. Yet the smart money who own AMICAS stock have already cashed their stocks, taking the $5.85, $5.90, and as of this writing $5.99 being offered for their shares of AMICAS in the event that the deal with Merge somehow falls through or Morgan Stanley finally wakes up. After all, what’s a nickel or dime in the grand scheme of things- and it sure beats the hell out of $5.35...<br />
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So for all intents and purposes, unless Thoma Bravo ponies up to the bar and matches the Merge offer AMICAS will now be a part of Merge.. Can that happen? Yes. Will it happen? Who knows. Unless it does though AMICAS, or at least AMICAS as we now know it, is gone. My friend the Dalai invited me up to Columbia to sit Shiva with him and I just may go. Not only do friends need to be with friends in times like these, but his wife Jane is an incredible cook and wonderful person as well and I love being with them both. <br />
Am I mad at AMICAS? I was before but I also understand that this is pretty much out of their control, so apologies to those in management who had to endure what may have seemed as my misguided anger. It’s just that Sam and I both stuck our necks out to here trying to save a company that we both felt was worth saving yet not realizing that the lamb had already been brought to the table as the sacrificial offering. The Dalai even made a post in AMICAS’ Yahoo Finance message board titled “Don’t Do It’ yet the first responses back pretty much summed it all up. “One way to keep your patients from SUFFERING would be for Thomas Bravo to match MERGE's offer. Yes, this is all about money. As I mentioned before I could care less who buys this company!” The next post was equally adamant “Who ever pays the most will win the day. Now if Bravo was a publicly traded company and offered in share, there may be some consideration for future growth etc. but none of that is a factor here.. Bravo better up the bid or they lose the company.. As simple as that..” <br />
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Yet one more quote from the movie Wall Street - “The main thing about money, Bud, is that it makes you do things you don't want to do.” I’m not Jewish, but like the Dalai he and I might both smear some blood on our door posts hoping whatever wrath God (or the stockholders) take on the company after this deal is done spares both our souls...<br />
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If I were Morgan Stanley I’d also do a lot better due diligence than they obviously have. Last time I checked $200M wasn’t peanuts although the feds have bailed out the banks before so I have no doubt they will again - using our money, of course. It, too, is the American way...<br />
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So what's the big deal with a company in the PACS marketplace buying AMICAS? All we need to do is listen to the words of George Santayana who said “Those who cannot remember the past are condemned to repeat it.” Look to the past as to what can- and probably will- go wrong here…So much can go wrong- and so few companies are prepared to deal with it, especially a company the size (and income) of Merge. And while sales were up in a down industry the past two quarters the company still managed to lose $3M. They are no alone either as everyone in this industry is struggling by introducing one solution….after another…and another is not the answer in my book.….So Morgan Stanley- please cover your tails and call me. The first hour is free and with $200M on the line how can you afford not to call? <br />
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Merge investors also stand to lose as well but then maybe that’s why Merge stock has tanked from $2.46 on February 22nd to under $2.00 today. Memories of May 12, 2008 aren’t that long ago and this is a move that redefines risky for any company in this market…In a way it’s a shame too because Merge has had a Phoenix-like revival of late. It will probably never get anywhere close to the $26.00 days it enjoyed just four short years ago, but $2.00 is much better that $0.29 too. And despite my having issues with those at the top in the past who seemed to lookout for themselves more than the company - not with those who work there or those in control today- I do love rooting for the underdog, something Merge has been the past few years. I also honestly never thought Merge would make it this long but they had a great PR and marketing team behind them pumping them up every chance they got. They played it perfectly and still are. Unfortunately this play may indeed be their undoing. Only time will tell.<br />
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Santayana also said “Injustice in this world is not something comparative; the wrong is deep, clear, and absolute in each private fate.” This just seems so wrong, but how can something so wrong happen? Maybe it’s time for me to re-read Rabbi Kushner’s book “When Bad Things Happen to Good People” or balance it out from the Christian perspective with Dr James Dobson’s (Holding onto your faith even) “When God Doesn’t Make Sense”. There has to be an answer somewhere.<br />
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Three years after Wall Street came out another movie premiered that has become one of my all time favorites even though it’s sappy as all get out. It, too, featured a ruthless businessman who specializes in taking over companies and then selling them off piece by piece. The guy meets a gal who has a rather unusual occupation yet refuse to compromise her values. Edward Louis, played by Richard Gere, said it best to Vivian, played by Julia Roberts “You and I are such similar creatures Vivian. We both screw people for money.“. In the end it is Vivian who wins out by holding fast to her dream. “I want the fairy tale”, she says, and in the process changes Edward from a man who was about to dismantle and sell off yet another company piece by piece as he had done in the past to a man who is shown another way of being - taking time off and enjoying life - and working. He wants to create things rather than just making money. “Mr. Lewis and I are going to build ships together, great big ships.” Gere tells Philips, one of Edward’s handlers. Of course Philips, who is ONLY in this for the money, goes ballistic on both Edward and then later Vivian for the impact she had on him, leading to his ultimate demise with Edward.<br />
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Contrary to what the AMICAS stockholders might think or feel there is more to this deal than just money. Thousands of AMICAS users are going to be impacted as well. The same can be said for Merge users. The same can be said for the entire PACS industry. Think this completely through. Please. Think.<br />
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In my opinion, and this is just my opinion, the deal with Bravo would have allowed AMICAS to mature as a company and made the company more money in the long run, getting it out of the public eye and allowing it to focus where it needs to focus. The problem is, when one PACS company acquires another, it may just exacerbate any problems AMICAS has today. It’s not just about the buck. It’s about so much more...<br />
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So the vote happens on the March 4th. I hope I am contacted before then by Morgan Stanly, by both AMICAS and Merge investors, by someone, anyone who wants to know just what they are in store for. But in the absence of that the Dalai and I can both hold our heads up high saying that we tried. <br />
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Wall Street had another good quote that is something that everyone involved in this deal needs to think about - "Man stares into the abyss, and there's nothing staring back at him. That's when man finds his character. And that's what keeps him out of the abyss." We’ll see where everyone’s true character is at the end of this week...Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-73509290131469163512010-02-23T16:32:00.000-08:002010-02-23T16:40:23.801-08:00Digital Imaging Delivers Modern Medicine to the Third World<b>Ms. PACS: </b> I want to share a very special experience and a huge trend in PACS and radiology - delivering modern medicine to developing countries. Just how do you go about doing it? Well, sometimes a primary care physician can show a radiologist the way. In this case it was Dr. Jeffrey Heck, Founder and Executive Director of Shoulder to Shoulder, a non-profit charitable organization, and Professor of Family Medicine at the University of North Carolina.<br />
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<i>Before opening the doors of a new medical clinic in a remote region of Honduras, Dr. Jeffrey E. Heck, founder of the sponsoring NGO Shoulder to Shoulder said, “It’s important to offer the same services here as if it were a clinic in the United States.”<br />
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Dr. Heck’s vision became a reality when he installed a suite of digital radiology and telemedicine equipment in a clinic serving a resource-poor community of 30,000 plus inhabitants. To drive home the message that Web-based medicine could revolutionize a healthcare system like the one in Honduras, which allocates just $12 per person annually, where patients walk several hours to receive medical treatment, and where digital imaging is virtually non-existent, Dr. Heck arranged a live demonstration. The guest of honor was Honduran Minister of Health Arturo Bendaña.<br />
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Once the Minister’s helicopter landed and Bendaña set foot in the new clinic, Honduras took its first step toward delivering modern medical care to its predominantly rural population. The crowd of locals cheered on the Minister who was escorted into the clinic to tour the room labeled Rayos-X/Ultrasonido.</i> <b>Read the <a href="http://itnonline.net/node/36253">Full Story</a> or support <a href="http://www.shouldertoshoulder.org">Shoulder to Shoulder</a></b>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-73376815670682460082010-02-12T14:30:00.000-08:002010-02-12T14:34:44.974-08:00PACS Drives the Image Exchange<b>Ms. PACS: </b> <b>"This was the year that imaging exchange went mainstream at the show,” </b>said Elliot Menschik, M.D., Ph.D., who sits on the IT Infrastructure and Radiology planning committees of Integrating the Healthcare Enterprise (IHE) International and has served as a member of the SSS-U study section at the NIH Center for Scientific Review.<br />
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Cross-enterprise document sharing (XDS-I) is the profile for medical image exchange that the U.S. Health Information Technology Standards Panel (HITSP) has adopted. The profile was also presented at “The Document Sharing Focus” at RSNA 2009 IHE Demonstration. <br />
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To understand the critical role PACS plays in driving the medical imaging exchange, Imaging Technology News asked Elliot Menschik, M.D., Ph.D, who sits on the IT Infrastructure and Radiology planning committees of Integrating the Healthcare Enterprise (IHE) International and has served as a member of the SSS-U study section at the NIH Center for Scientific Review.<br />
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<b>Why is XDS-I the most appropriate profile for a medical imaging exchange?</b><br />
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<b>Dr. Menschik:</b> For vendor-neutral exchange among disparate facilities/organizations, there is no interoperability alternative to XDS-I. DICOM alone is insufficient to manage issues such as multiple patient identities and federated, peer-to-peer publishing, discovery and exchange. <br />
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<b>At the RSNA 2009 IHE Demonstration, PACS showed the benefits of driving images to the EHR and enabling provider and patient access to radiology images and reports. How is this beneficial to referring physicians?</b><br />
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<b>Dr. Menschik:</b> Referring physicians today struggle with either, one, managing a flood of inbound CD-ROMs or, two, logging into multiple Web-based PACS portals. The CD problem is particularly acute among surgical subspecialties - inbound CDs often don't run on the local PCs, when they do each one has a different viewer that is unfamiiar to the doc, and importing images off the disc is time-consuming and inefficient even when it can be accomplished (some CDs do not even store in DICOM). From the perspective of operational efficiency, referring physicians have much to gain from network-based access to outside images, whether in a patient's personal health record or a direct network connection to the imaging provider.<br />
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<b>ITN: Do you think that PACS and radiology is driving the image exchange?</b><br />
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<b>Dr. Menschik:</b> For years, the radiology community has largely sat out of the health information exchange revolution despite having led healthcare for decades with novel applications of IT. This now seems to be changing...<br />
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<i>Read the Full Article in the March issue of </i><a href="http://www.itnonline.net/">www.ITNonline.net</a>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-8615891359352692162010-02-07T14:28:00.000-08:002010-02-08T08:45:25.791-08:00Setting the Record Straight<b>PACSman:</b> It took about three to four days before the calls started coming. “We aren’t very pleased with Mr. Cannavo’s comments about us.” The calls started and the plotting began. You- get the wooden stake. You- find the right mallet. And you- find a hit man who can do a job on the Anti-Christ here. And through it all, including the inevitable call from Ms. P. asking me what she should tell those asking questions about this posting, all I could think about was that silly early 80’s movie Stripes. You know the one, with Bill Murray, Harold Ramis, John Candy, et.al. and that memorable scene between Psycho and Sgt. Hulka.<br />
<i><br />
Psycho:</i> The name's Francis Soyer, but everybody calls me Psycho. Any of you guys call me Francis, and I'll kill you. <br />
<i>Leon:</i> Ooooooh. <br />
Psycho: You just made the list, buddy. And I don't like nobody touching my stuff. So just keep your meat-hooks off. If I catch any of you guys in my stuff, I'll kill you. Also, I don't like nobody touching me. Now, any of you homos touch me, and I'll kill you. <i><br />
Sergeant Hulka:</i> Lighten up, Francis.<br />
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So to those who see me as the Anti-Christ because I dare make suggestions about (OMG! Gasp!!)change I offer these three words - “Lighten up, Francis.”<br />
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Before I submitted what I wrote I read, re-read and re-read my reread to make sure I put as positive a spin on things as I could. This is a blog site and not a journal page. So why the uproar? Got me, but if I were a betting man I would say that people are just way too sensitive about ANY press that isn’t Pollyanna sugar-coated positive.<br />
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The powers that be need to go back a re-read this blog posting again. Sure I talked about numbers and how most focus on quantity over quality (which when you get to be my age is not an important feature) and said “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.” Is saying that certain trade shows don’t market themselves properly considered wrong? Mea culpa then…but I did say how you need to market instead and even cited an example from a vendor friend of mine (and yes, I do have a few remaining in this industry). I also ended this on a positive note 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.” Maybe had I said “all” instead of “most” it would have gone over better. Ya think?<br />
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This isn’t the first time I’ve given HIMSS a spanking for ignoring PACS and won’t be the last either. Frankly I’m at a loss on how radiology can get HIMSS’ attention. If I thought that putting the leadership of HIMSS through a session with Mistress Margo in the Dungeon of Doom with her black whip and high heeled boots would do it, I’d pop for the expense, but somehow that doesn’t seem like the answer - or maybe it is. All I know is while several PACS companies have discussed not going to HIMSS or at least scaling back their presence, few are willing to take that chance because at HIMSS they can actually get the IT managers’ attention. Why? Read again..."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...". Now just being at HIMSS and getting IT managers’ attention are two entirely separate animals, but as Woody Alan once said, “80% of success is just showing up.” I’m sure even the most challenged marketing departments can figure out how to make up the remaining 20%, but if not, give me a call and I’ll show you how. And for the record, I did give HIMSS a pat on the back while I was kicking them in the a$$ as well, saying "Why not bring the trade show to the end user just as HIMSS is doing with its virtual conferences and expos?"<br />
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SIIM. What does the PACSMan possibly know about SIIM? Besides being one of the original members of SCAR way back when and active in it for several years back when Sam Dwyer (God bless his soul) and Ron Schilling and others were involved, absolutely nothing (laugh). <br />
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Now let’s set the record straight - I like SIIM, I like the members in SIIM, and SIIM is the pre-eminent PACS organization in this market and I said as much too. SIIM has also made several strides in the past year to make its annual show a lot more end-user and vendor-friendly which I applaud. These include having 11 hours of unopposed time in the Exhibit Hall (not having this was a biggie with vendors in previous years), new roundtable discussions (which our illustrious Ms P was invited to be a part of), private demo rooms, a networking lounge and much more. <br />
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I never said that any of these shows sucked or wouldn’t survive. Never. The closest I came to implying or inferring there would even be change necessary was my comment "The question is not so much will trade shows survive but in what form and function?" Read it as it was intended. Yes, trade shows WILL survive but they need to adapt to these changing times. And unlike many who simply bitch about a problem without offering a solution, I offered several possible solutions as well. Read back. Those were obviously my thoughts and perspectives and people don’t have to agree with them. Truth be known some don't (but many do). That said the last time I checked there was just my mug and Miss P’s on the masthead and no one else’s. Anyone is free to express their feelings on in the comment section- it's open to all- or if you feel strongly enough make a post on your own web site. I'll visit it if I hear about it and may even comment on it too. After all this is America and she is a berry good country allowing things like free speech. <br />
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So to all those who want to kill the messenger instead of listening to the message I offer yet more insight from Stripes. Substitute the word Army for PACS or Imaging and you get the idea. We are all different and all share the same visions - we just have different ideas of how to get there.<br />
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John Winger:</i> Cut it out! Cut it out! Cut it out! The hell's the matter with you? Stupid! We're all very different people. We're not Watusi. We're not Spartans. We're Americans, with a capital 'A', huh? You know what that means? Do ya? That means that our forefathers were kicked out of every decent country in the world. We are the wretched refuse. We're the underdog. We're mutts! Here's proof: his nose is cold! But there's no animal that's more faithful, that's more loyal, more lovable than the mutt. Who saw "Old Yeller?" Who cried when Old Yeller got shot at the end? <br />
[raises his hand] <br />
<i>John Winger:</i> *sarcastically* Nobody cried when Old Yeller got shot? I'm sure. <br />
[hands are reluctantly raised] <br />
<i>John Winger:</i> I cried my eyes out. So we're all dogfaces, we're all very, very different, but there is one thing that we all have in common: we were all stupid enough to enlist in the Army. We're mutants. There's something wrong with us, something very, very wrong with us. Something seriously wrong with us - we're soldiers. But we're American soldiers! We've been kicking ass for 200 years! We're 10 and 1! Now we don't have to worry about whether or not we practiced. We don't have to worry about whether Captain Stillman wants to have us hung. All we have to do is to be the great American fighting soldier that is inside each one of us. Now do what I do, and say what I say. And make me proud.Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-12141770404727985222010-02-02T10:10:00.000-08:002010-02-08T13:21:21.673-08:00“Survivor 2010: What It Takes To Make a Trade Show Make It”<b>PACSman:</b> 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?<br />
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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. <br />
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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).<br />
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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.<br />
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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.” <br />
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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. <br />
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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. <br />
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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? <br />
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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."<br />
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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? <br />
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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. <br />
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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. <br />
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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. <br />
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.<br />
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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...<br />
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<b>Ms. PACS:</b> 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. <br />
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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.<br />
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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, <b>radiology</b>, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease.”<br />
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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...<br />
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<b>If you click on "Education" on the HIMSS Web site, and do a search for PACS, you get 3 entries:</b><br />
- Reducing Risk in Healthcare IT Purchases: Avoiding and Resolving Disputes<br />
- Bringing the Hospital and Physician Clinical IT Together<br />
- Integrating Medical Images and the EHR -- the Time Is Now<br />
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<b>Now look up the "Educational Program" at SIIM:</b><br />
- Using Dashboards and Business Analytics for Practice Improvement<br />
- The Role of Imaging Informatics in the Next Generation of EMR/EHR <br />
- Value Innovation Through Imaging Informatics<br />
- Imaging Center PACS 24x7<br />
- Image Sharing and Accessibility<br />
- Automated Reporting Systems<br />
- etc, etc, etc.....<br />
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Need I say more? <br />
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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. <br />
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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:)Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-27401820194445551212010-01-25T11:53:00.000-08:002010-01-27T14:18:31.051-08:00Wii Takes the Controls from PACS<b>Ms. PACS: </b> Wii may have just made it's way into medical imaging - in particular PACS. Now you can use Wii for more than just virtual <a href="http://newarklibrary.files.wordpress.com/2009/03/wiibowling.jpg">bowling</a>, tennis or any other Wii sport. The Wiimote lets you zoom, pan, scroll, and more, remotely. <br />
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The Wii remote is interfaced with GlovePIE, allowing the end user to interface with images, scroll through a CT volume data set. <a href="http://www.ehow.com/how_2165659_glovepie-use-wii-remote-pc.html">GlovePIE</a> is a program that lets you turn a <a href="http://hackawii.com/medical-wiimote-reporting-a-ct-scan/">Wii Remote into a mouse, joystick, or even script it for unique functions in games and software.</a><br />
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The developer says this is where Radiology reads a case in a “Minority Report" kind of way. Check out the video demo. The developer says, "This is a simple example of me interfacing for window/level, zoom, pan & slice scrolling features on a CT set of images." <br />
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Maybe you can be a WiiPACS beta site! According to the developer, he says, <b>"I’m open to suggestions!” </b>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-4315089118130392342010-01-18T06:02:00.000-08:002010-01-21T07:50:14.947-08:00Who do service agreements really serve?<b>PACSman:</b> Who do service agreements really serve?<br />
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PACSman: I’ve been helping a friend buy a car the past several months - obviously a female friend since a guy would have done his homework in advance, picked out the car online, negotiated the price by phone, and been home watching the game within an hour of pulling into the dealers lot - and came to the part about service agreements. Now contrary to what many might think I am not against service agreements or anti-extended warranties or anti-female- contrary to what Ms P might think or say. It’s just the nature of the beast, Ms P, so don’t get your panties all in a wad over it. When is the last time you saw a guy spend an entire afternoon shopping and buying nothing - unless he’s with his wife or girlfriend that is? When guys have something to buy we go in and buy it - end of story - not spending months going from dealer to dealer trying to figure out what we like and don’t like. That’s why they have the Internet…Now I know - women going shopping is no different then men sitting on their fat a$$es all day watching a football game drinking beer - it’s a social bonding thing - but I’m more an ESPN Highlight Zone kinda guy anyway so I really can’t relate. You know what they say in the South “Don’t bother me with the birthin’ pains, just show me the baby” . I’m sure I’ll hear it from Ms P. for that comment as well even though her babies are the four -legged kind. Blame it on my ADD or some other reason….they are all valid…Just keep in mind that no guy would EVER scratch a car from the list because it didn’t have a lighted visor mirror on both driver and passenger sides… True story…I mean, really, can we talk? <br />
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Now I have service agreements on both mine and my son’s car, one on the flat screen TV in the living room and extended warranties on both my waters heaters I replaced a few years ago (I have two in my house, a necessity with two teens living here who take extended showers). I also am getting quotes on 10 year parts and labor warranties on a replacement for my heat pump that decided to quit last week just before the coldest week in Florida history hit, leaving me with no heat and a $399 electric bill from using space heaters from hell. After all I can’t let the Elvis the Wonder Dog get cold now can I even if he is still peeing on my bookcase? And they say God has no sense of humor. Indeed!! So no, Ms P, I am not anti-service or anti woman at all. But I do have to ask who is really served by some of these self-serving contracts?<br />
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The car dealer we went to - best known for its “We make it simple” ads in the late 70’s and early 80’s who now believes in “The power of dreams” and makes a pretty damn good lawnmower too– presented a smorgasbord of what I felt was dramatically overpriced service agreements (SA) to consider, using the assumed close “Which of these do you want?”. The cheapest SA offered was around $800.00 for five years/60,000 miles coverage (actually two years 24,000 when you factor in the 3/36 coverage that comes standard with the car). The one my friend bought ended up costing her over $2,300.00 for eight years/120,000 miles (actually 5/84) of coverage. It was her decision and her money but I did let her know there were other options she could consider that would provide her with virtually identical coverage at a fraction of the cost. She wanted the dealer’s coverage though, so being the somewhat logical person I am I told the dealer we need time to consider this before making a decision (actually to give us time to shop around) and will make a decision in a week or so. After all, the car comes with a three year 36K bumper to bumper warranty on it so everything is covered by the warranty for the next three years and 36k miles, right? The answer - “Yes you can wait a week, but if you don’t buy the warranty RIGHT NOW the purchase agreement cost goes up.” I’m like, “OK, ‘splain me that one Ricky!! The car comes with a three year 36K bumper to bumper warranty on it so shouldn’t I be able to buy the warranty anytime before then without penalty?” Not so, Mrs. Ricardo!! Turns out if she waited six months their already hyper-inflated price goes up 30%; wait one year and the price goes up 50% and wait beyond a year and it is solely t the dealer’s discretion to offer a warranty it at all. <br />
Can it get any better (or worse) I thought to myself? “Why cointenly!!” was the answer that came back in my best Curley impression. I asked what happens if she decides to sell the car within the three year period and never gets to use the first lick of the service provided by the service agreement. Does she get her money back? Logic again dictates yes since the contract, while technically in force, was never used or billed against. Silly me again…”The agreement gets refunded on a pro rated basis” was their answer. Huh? Pro rated? We never even used it!! Basically every mile she drove cost her $.02 towards the service contract price which in plain English means she would be out $720.00 of her $2,300.00 (31%) BEFORE the contract even kicked in. My first reaction can’t be published without using a bunch of expletive deleteds (although I did keep my composure at the dealership) and then I just started to laugh. I thought to myself, yup, just like PACS, except PACS doesn’t give you a choice. Sure you have you Bronze Silver and Gold plans that put you light years above the 1-2 scumbags in all of PACS who - gasp!! - elect to go on a time and materials basis. But is a service contract really necessary? After all ,if you have a well trained PACS Systems Administrator (admittedly a big if at that) 90% of your problems can be handled in-house, 5% by the vendor’s technical staff and the remaining 5% are bug fixes that require the vendor to make changes to their software code. Of course to get these bug fixes you also MUST have a service contract as they aren’t offered without them. Once again, 'splain that to me Ricky… The evil empire at Microsoft sends me bugs fixes every week for free, most I don’t even know what they are “fixing”, on a $199 operating system and you are telling me that I just spent $1.5M on a system, 75% of that amount that is for applications software that has bugs in it (as all software does) and I need to pay you 15% of list price per year (actually closer to 20% what you actually paid) to make it run right? Yes I am, AND on top of that you also have to commit to a minimum five year service contract up front as well - again when you sign the contract to purchase and not a moment after. Otay, buhwheat!!! Yes, you heard it right…And yes, it even gets better still!!! If you had bought the hardware direct it usually comes with a three year warranty from the manufacturer but since you are buying the system from the vendor AS A SYSTEM you get the preferred one year warranty on the system - software AND hardware combined. If you want the other two years coverage that you technically paid for already, know they are part of the system service agreement price for years two and three. Now you might be saying “Didn’t I pay for a three year hardware warranty when I bought the hardware?” Yes, but that went away when we integrated the hardware and made it part of a “system” that we delivered. Arghhhhhhhhhh!!!!<br />
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PACS, cars, and ink jet printers all share one thing in common - they make their money after the sale on service. The system is the way to the service (on in the case of ink jet printers consumables). Since AMICAS went private Merge is only publicly traded PACS company remaining (outside of the majors who don’t specifically break out their numbers) yet I can tell you that at least 70% of the money that all companies bring through the door comes from service. Without those service dollars companies would be hemorrhaging worse than they are already. That is why they make you commit to along term SA when you buy - because when you see how little you actually use service and what it ends up costing you and you might actually end up saying “Why AM I spending this money anyway?”. <br />
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These three entities also get you coming and going. Ink jet cartridges are the highest priced liquids on the face of the earth running from $3,000.00-8,000.00 per gallon, and literally costing more than blood. In addition most ink jet cartridges have short expiration dates so if you buy them in bulk and don’t use them you are outta luck there as well - no deposit, no return. <br />
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With cars and PACS there are always hidden clauses as well. The dealer tried to get my friend to buy the $300.00 oil change “special” - 3 years/36K miles which would be an OK (but not great) deal if it were standard oil and she got the oil changed every 3,000 miles (12 changes total). Instead the “deal” she had was offered was 4 synthetic oil changes at $75 each (list price) although she easily could stretch out the interval from 7,500 to 10,000 miles in between changes since 90% of her driving was highway mileage. A rip off? You might say that. With PACS it’s the upgrades (not updates) that aren’t included in the service contract price - or travel time or….100 other small points the vendor neglected to tell you about.<br />
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Just like a PACS is often over-engineered, so too were the options she was told she just HAD to have. The $429.00 wheel and tire protection package (fixing a flat costs a whopping $20 - so that’s a whole lot of flats), the $399 “appearance” package (that she got for free anyway when she said no thanks to it), the $699 LoJac so she could find her totaled stolen car faster and easier (ever heard of insurance?) and the $120 GAP insurance offering that she paid her own insurance agent…drum roll please…$4.00 for.<br />
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Yessiree - Rosanne Rosannadanna was right- “It’s always something.”<br />
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<b>Who do service agreements really serve?</b>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-48729988452550559472010-01-13T15:12:00.000-08:002010-01-18T12:10:53.175-08:00Cloud Storage - More than Just Hot Air<b>Ms. PACS: </b> It's like, everyone catches on to a concept and it's the most incredible thing since the PACSman shaved his beard. <br />
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Seriously - cloud storage is the new BIG Idea...at least in Radiology...while the rest of the IT world has been raving about it...and we as consumers have been using it on Google and Amazon...but - with the exception of <i>tech-savvy you</i> - didn't realize how good we had it up there on cloud 9. In fact, the cloud computing craze has become as ubiquitous as its architecture. Did you know that there is a cloud computing magazine and trade show? Soon we'll see an action figure: Cloud Man, Cloud Ranger, or the Stormy Cloud Guy (the moodier younger brother). But first, before we cash in on the next Disney movie, let's take a step back. <br />
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When Amazon introduced its virtual computing environment, Amazon Elastic Compute Cloud or EC2, it created awareness about brought cloud computing in the consumer environment. What Amazon’s customers liked was they paid only for what they used. <br />
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The popularity of cloud computing has also reached new heights in medical imaging for its capacity to cost-effectively archive large volumes of imaging data. <br />
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How it works: Organizations pull up the image on their PACS, send it to a patient or another facility and send it to a cloud client that sits on their desktop. The image goes to an offsite server, is temporarily stored, until the receiving physician or radiologist accesses it. That provider, who is sent an e-mail notification, can choose to simply view the image on his or her desktop, burn it to a CD, or push it out to the facility’s own PACS.<br />
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As evidenced at RSNA 2009, several vendors staked their claim to cloud computing <i>(these were off of the top of my head - i'm sure there are many more - maybe we could start a NEW Radiology in the Clouds trade show:) </i> <br />
- <a href="http://www.candelis.com">Candelis</a> is an early adopter, leveraging cloud-based computing and storage to make its suite of medical software solutions available via cloud-hosted services. <br />
- <a href="http://www.insiteone.com">InSite</a> One Inc. was also one of the first to offer, pre-RSNA, medical data storage in a cloud environment. <br />
- DR Systems’ Electronic Medical Information Exchange called <a href="http://www.emix.com">eMix</a> is a cloud computing-based, vendor-neutral technology that eliminates the need for the provider facility to burn CDs, print films, or fax reports. It also facilitates universal access to medical imaging for a complete EMR. <br />
- <a href="http://www.accelerad.com">Accelerad</a>’s software-as-a-service solution (SaaS), SeeMyRadiology.com, utilizes cloud computing architecture to store all client images on a centralized cluster of servers, providing access to medical images across the entire healthcare continuum. <br />
- <a href="http://www.merge.com">Merge</a> Healthcare provides RIS, PACS and disaster recovery solutions in a cloud computing platform. The cloud-hosted solutions also enable rapid implementation of a RIS or PACS. <br />
- **<a href="http://www.lifeimage.com/">lifeIMAGE</a> is a platform connecting patients and providers to medical imaging studies and reports through two core components. First, for hospitals and imaging centers, its a Local Appliance (LILA) to manage imaging exams introduced by patients on portable media such as a CD. Next lifeIMAGE.com is a <b>cloud-based environment for image sharing and storing between patients and referring physicians.</b> <br />
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**<i>I have to say The Dalai of PACS tipped me off to this one. Patient power is a good thing - it should make them more responsible and better advocates for their own health care. No more baby sitting. And they have more data when insurance companies try to re-neg on reimbursing patients for just breathing in a hospital. Do you ever notice how the insurance company bills you....even when they are supposed to cover the bill? Don't get me started:)</i><br />
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Now, you get <b>10 Bonus Points</b> if you can unravel this mystery lyric: <br />
<a href="http://www.youtube.com/watch?v=z_s0-Ujxq1U"><b><i> How do you catch a cloud and pin it down?</i></b></a><br />
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Is the future of PACS up in the air? You bet it is. Why? According to Mitch Goldburgh, InSite One, it's because: <br />
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1) The distinction of data storage and archiving have been blurred;<br />
2) There are no DICOM or HL7 messages for deleting data;<br />
3) Retention rules for digital information is about to become even more complex with the adoption of health information exchanges where retention requirements extend beyond any single institution. <br />
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That's why at HIMSS 2010 expect to see a resurgence of hosted solutions for primary applications and storage service providers. Revolving around the term ‘cloud’ are virtual services offering a lot of benefits for access to new applications, data storage, and imaging exams across the hospital.<br />
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So, do you think you got it nailed down?<br />
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<b>PACSman:</b> Every time someone mentions cloud computing I think of the Rolling Stones “I said hey! (hey) you! (you) get off of my cloud….” or Judy Collins from her song Both Sides Now (“I’ve looked at clouds from both sides now, from up and down and still somehow, It’s clouds illusions I recall, I really don’t know clouds…at all.”), not the Sound of Music like Ms P is fond of hyper-linking too. She is a true Maria in every sense of the word, waiting for some Austrian goober to sweep her off her feet so they can go hand in hand into the mountains singing Edelweiss together…Now I admit that the relationship that Christopher Plummer and Julia Andrews had was idyllic in every sense of the word but…it’s the movies…let’s get real…. <br />
Big idea? Since when? Like clouds, the CONCEPT of cloud computing in healthcare has been around for quite some time and got a lot of fluff at RSNA but it’s still a few years from being accepted by healthcare providers, insurance companies and others, with other areas like cloud-based archiving even further away. <br />
Yes I know there is a cloud computing magazine Ms P- I subscribe to it actually- and if you are out in San Jose March 15-18 and have $2,000 that isn’t earmarked for anything else you can attend Cloud Connect (http://www.cloudconnectevent.com/) one of several Cloud trade shows that are popping up like…well…...clouds…<br />
Craze? Not hardly. Most of what was shown at RSNA was either in the concept stage (RSNA= Real System Not Available) or just getting installed and at the alpha testing stage. I’d hesitate to say few vendors had that have even made it into beta testing yet….but they still were neat to look at.<br />
There are still way more questions than there are answers about cloud computing. The first is insuring that everything you get from one PACS easily translates to another via the common viewer. This takes much more than performing a simple DICOM query/retrieve. When you convert data from one PACS to another (or to a common standard like vendor neutral archives (VNA) have) you may lose things like grey scale presentation states (GSPS) or some database information. This hasn’t quite been figured out yet completely. Then there are the patient confidentiality issues, the HIPAA conformance issues, and a host of others. Some of the papers I’ve seen from clouds supporters are claiming cost savings against sending CD’s out to primary care physicians (PCP’s) at a cost of $30 or more, but is this claim real? For them obviously yes, but for the rest of the market its more a resounding no. Very few hospitals I know send out CD’s to PCP’s. Most use image distribution via the web that is inherent to most PACS allowing PCP’s to select the studies they want to see. Most outpatient imaging centers hand the CD’s to patients to BRING to their doctors as well at a cost of maybe $0.50, with most of this for the CD case and label. <br />
Clouds biggest claim to fame is that a PCP can do a single log and using a single viewer look at all images from multiple disparate PACS from different facilities without having to log onto several different systems saving time (and in the process, money). <br />
So how many showed cloud computing ar RSNA? Too many and not enough. <br />
Does cloud have potential? Cointenly…<br />
Is it ready for prime time today? Cointenly not. I give it a couple of years to work out the bugs then we can talk about clouds like it’s Jack Johnson (aka the Great White Hope) instead of just some overweight pugilistic punching bag full of hot air who wants to overthrow the existing incumbent PACS.Cloud computing has potential but it needs to spend some time in the gym yet working on establishing it’s knockout punch before it steps into the ring against established PACS that are working already. HIMSS should be interesting for sure but the end users have to feel comfortable turning everything over to an unknown and unseen enterprise and that may take a little getting used to…So time will tell….Stay tuned…Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com5tag:blogger.com,1999:blog-725521746466059222.post-8321823877851966112009-12-28T13:08:00.000-08:002009-12-30T10:22:14.060-08:00AMICAS Sale Goes Round and Round<b>Ms. PACS:</b> <font COLOR="#000000">Did you hear the news today: AMICAS has entered into a definitive agreement with an affiliate of Thoma Bravo LLC to be acquired for $217 million in cash. <br />
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This is good news for AMICAS' board since the company shelled out $39 million for Emageon Inc. this year. Time to recoup some of the green. But what does it mean for the PACS industry? <br />
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Not sure yet, but Stephen Kahane, AMICAS' chairman and chief executive, says it's great, but for whom? Kahane said the buyout will give AMICAS the "additional capital and operational expertise" that it badly needs to grow. The cash injection should help, especially after AMICAS shares hit a seven-year low late last year, reported WSJ.com. Actually, AMICAS stocks have grown steadily in 2009 thanks to rising sales and expectations. Again, what does it mean for the ailing PACS industry? Perhaps, what goes up must come down, and go up again?<br />
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Not so fast. Just 40 minutes ago, a New York law firm, Stull, Stull & Brody, opened an investigation on behalf of AMICAS shareholders over the price to be paid to AMICAS shareholders. And, they are also questioning whether AMICAS' board of directors breached its fiduciary duties to the shareholders by agreeing to sell the company at an unfair price. According to the firm: "Whereas AMICAS’ shareholders would receive $5.35 per share in cash under the terms of the proposed transaction, at least one analyst has set a price target of $6.00 per AMICAS share, representing a substantial potential discount to Thoma Bravo, LLC." <br />
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So is this something AMICAS' board should be concerned with? Only if they don't have leech powder to burn these guys off their ankles. This is just "Attorney advertising," looking for people to join a class action suit on behalf of the stockholders. It is no more than a bunch of leeches looking for a host. Every time a pending sale is made almost without exception they come out of the woodwork. Scratch your leg and another one comes up - this time its Levi & Korsinsky - making the same claim, pretty unoriginal.</FONT><br />
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<b>PACSman: </b> <font COLOR="#0000A0">AMICAS was sold to Thoma Bravo, LLC, a private equity firm who wants to put money into a sure thing and bring the company private and out of the public eye. That, in my opinion is great news. AMICAS is also now subject a class action suits from at least two firms in the past 12 hours claiming that the stock was undervalued and someone was playing games with the stock price. That, in my opinion, is old news…Yogi Berra was right- “It’s déjà vu all over again!” <br />
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Every company who has offered stock has to deal with these legal vultures trying to make a buck for themselves. This is the latest deal:<br />
<i>The current investigation concerns the price to be paid to Amicas’ shareholders and the process by which Amicas’ Board of Directors is addressing the transaction, including whether the Company’s Board of Directors breached its fiduciary duties to the Company’s shareholders by agreeing to sell the Company at an unfair price.</i><br />
<br />
AMICAS had to deal with this very same thing back in April, 2009 when it acquired Emageon:<br />
<i>The action…..alleged, among other things, that the members of the Emageon Board of Directors violated their fiduciary duties by failing to maximize value for Emageon's shareholders when negotiating and entering into the Agreement and Plan of Merger dated as of February 23, 2009 among Emageon, AMICAS and a subsidiary of AMICAS. The complaint alleged that AMICAS aided and abetted those purported breaches.<br />
</i><br />
<br />
In one statement they purportedly <i>"breached its fiduciary duties to the Company’s shareholders by agreeing to sell the Company at an unfair price"</i> while in the other <i>"they violated their fiduciary duties by failing to maximize value for Emageon's shareholders. Other than the words used, as Led Zeppelin once sang, the song remains the same…"</i><br />
<br />
So who wins? Did the stockholders get what they wanted? No. Did the vultures get what they wanted? Yes - at least for them..<br />
<br />
Here is part of the release from Health Imaging magazine:<br />
<i>On March 27, Emageon said that it and the other named defendants in a putative class action lawsuit filed by its shareholders on March 13, in connection with the proposed acquisition of Emageon by Amicas, have entered into a memorandum of understanding with counsel for the plaintiff.<br />
Under the terms of the memorandum, the parties have agreed to settle the lawsuit, subject to court approval, at which time the lawsuit will be dismissed with prejudice. Emageon and the other defendants maintain that the lawsuit is "completely without merit." Nevertheless, to avoid costly litigation and eliminate the risk of any delay to the closing of the tender offer and subsequent merger, the defendants have agreed to the settlement contemplated in the memorandum, according to Emageon.<br />
Source: http://www.healthimaging.com/index.php?option=com_articles&view=article&id=17000:emageon-acquired-by-amicas-settles-shareholder-suit</i><br />
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Now this is the part I don’t like: <i>Nevertheless, to avoid costly litigation and eliminate the risk of any delay to the closing of the tender offer and subsequent merger, the defendants have agreed to the settlement contemplated in the memorandum, according to Emageon.</i> <b>Score: Vultures- 1, Stockholders- 0, AMICAS- ?</b><br />
<br />
Take a look at how AMICAS stock has done over the past five years. Five years ago, on December 27, 2004 AMICAS stock traded at $4.45. It got as high as $5.54 on August 29, 2005 and never broke $5.00 a share after the week of February 6, 2006. From February 2006 to December 2009 is almost four years, for those who are mathematically challenged.<br />
<br />
From May, 2006 to September, 2008 AMICAS stock hovered in the high $2’s to mid $3’s, with the stock taking a significant hit in the 3rd quarter of ’08, closing at $1.89 share on December 28, 2008. Again, for those who are mathematically challenged that was just 12 months ago or one whole year, whichever you prefer. <br />
<br />
Due to some incredibly wise investments made by AMICAS corporate management as well as solid sales made by the AMICAS sales force in an incredibly challenging economy AMICAS stock closed on 12/24/09 at $4.42/share, a 177% increase in the stock price over the course of past 12 months. Thoma Bravo offered $5.35/share for the stock, a 21% premium over the closing share on the day the deal closed. <br />
<br />
The vultures say that <i>“The offer price is only a small premium over the $4.84 price the Company's shares traded at as recently as December 8, 2009 and below a $6.00 per share price target set by at least one analyst.”</i> Now break down the word analyst into two words- one four and one three letter - and you’ll have a better understanding of what exactly is going on here. These “anal-ysts” are truly clueless about this market. Why not just claim that AMICAS was worth the $34.44 it traded at nine years ago on 11/24/2000 even though less than three years prior to then (on 9/8/1997) their stock only traded at $2.22? Gee, back in 1989 I weighed 125 lbs…Today I weigh…um…a bit more. Does that make me worth twice as much since I am almost twice the person I was then? No. Again, these people are completely clueless. <br />
<br />
This is the exact same anal-yst mentality that has allowed Merge’s stock to get pumped up from $0.41/share on 11/25/2008 to a high of $4.67 of 7/7/2009. Again for those who are calendarly challenged that is over a <b>ten-fold</b> increase in stock price <b>IN JUST EIGHT MONTHS</b>. Merge has “settled back” into the low threes which is where they probably will stay until- God help us all- someone steps up and buys them as well. Of course the vultures will then say that Merge stock was undervalued too since Merge traded at $28.72 as recently as 11/28/2005, just four short years ago. Of course there was this little accounting irregularity they have dealt with since then but…why are we dwelling on minor details like that (laugh)?<br />
<br />
The bottom line is Bravo saw a good thing and bought AMICAS, to which I say, well, bravo!! They offered a fair price, which AMICAS management smartly took. It’s good for AMICAS, and it’s good for the marketplace. <br />
<br />
And the vultures? They always have and always will come out of the woodwork, especially since they stand to make money through something the do best - intimidation. As they have in the past AMICAS will no doubt pay, the vultures will fatten their wallets, pump up their chests and give those foolish enough to sign up for the class action suit $.03, $.06 or whatever a share, if that, and pocket the rest. I chose to ignore them and frankly you probably should too. <br />
<br />
Celebrate that a private equity firm would chose to invest in AMICAS and keep them as they are. This is a far better alternative than the company being bought by a major PACS vendor who no doubt would totally screw up a good thing as so many before have experienced (cough - DI - cough). <br />
<br />
Lastly, a personal note to the vultures. If you are going to show that you have the coglioni (as we Italians like to say), to sue on behalf of others, at least get the name of the company whom you are suing right. It’s AMICAS, Inc.- upper case A through S, little Inc., not – “Amicas, Inc. (“Amicas” or the “Company”) (Nasdaq: AMCS).”.</FONT><br />
<br />
Now sing a little Zeppelin along with me:<br />
<br />
<i>I had a dream. Crazy dream. <br />
Anything I wanted to know, any place I needed to go <br />
<br />
Hear my song. People won't you listen now? Sing along. <br />
You don't know what you're missing now. <br />
Any little song that you know <br />
Everything that's small has to grow. <br />
And it has to grow! <br />
<br />
California sunlight, sweet Calcutta rain <br />
Honolulu starbright - the song remains the same. <br />
<br />
Sing out Hare Hare, dance the Hoochie Koo. <br />
City lights are oh so bright, as we go sliding... sliding... sliding through.</i>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-38800851068767484472009-12-22T08:18:00.000-08:002009-12-22T08:28:46.058-08:00A Different Time and Place<b>PACSMan: </b> I love it when my kids ask me what my computer was like growing up. I show them a pencil. They ask about my cell phone. I told them the networks back then were very, very primitive, with our “Internet” back then known as MVR- the mom voice relay. My mom would open the door and yell for me. Another mom would hear it and relay it to yet another mom, and if you were half a mile away, you would know within 20 seconds that it was time to come home. Best of all, it was free and you never dropped a call either. Of course our town had at best 8,000 people, most of whom knew each other, and was only a mile square from end to end, but still...<br />
<br />
It was such a simpler time. When there was a home game on Saturdays around noon the band would march through the heart of town from the high school, down Maple Avenue and over to the football fields. You’d hear them and know...The civil defense siren would test itself every Saturday as well, at 11:55, and when there was a fire our volunteers knew where to go because the system they used based on siren taps told you which intersection it was at. So where am I going with this….Oh yes, the holidays…<br />
<br />
Back then we too had Salvation Army bell ringers, but they were actual members of the Salvation Army, and did it because they believed in collecting to help the poor, not because it was a paid position like it is today. They NEVER EVER sat down and EVERYONE was there always smiling and ringing the bells in their neatly pressed Salvation Army uniforms, not just an apron over blue jeans. Often times there would be 2-3 musicians with them, playing songs or singers singing next to the kettles as well - as the snow drifted down all around us. I tell my kids this and they look at me like I am crazy or have been looking at too many Norman Rockwell paintings…but that was the way it was...a different time and a different place…<br />
<br />
Now I’ve seen more shrinks in my life that any six people combined - mostly for my own edification in trying to be the better person that I truly need to be - yet a large part of my childhood memories have stayed locked up behind walls that as one counselor put it “made the Great Wall of China look like a picket fence.” I remembered very, very little of my life before age 12…until recently that is...when the wall suddenly developed a leak. I have no idea what has caused this sudden flood of memories to come back, but they have. At first it scared the living hell out of me, but now it’s almost calming in its own way.<br />
<br />
The other night in one dream I was back in kindergarten, age 6, and all the kids through 5th grade and their parents were in the playground at Oakland Street School. Dee Dee, the janitor, had moved the piano outside and Miss Broadmeyer led everyone - kids and parents alike - in singing Christmas carols as a light snow fell upon us. In my dream, I could even feel the cold air, even though mom bundled me up real well (we always walked to school, even that night). I could even taste the snowflakes on my tongue… What’s funny is everyone in the dream sang together and everyone wished each other a Merry Christmas. If there was a Jewish family or Indian family there (admittedly not that many in my white bread town of Red Bank though), we wished them happy holidays and they sang along. We didn’t need the government telling us we had to desegregate because everyone of every color and every creed all sang carols together and ate homemade cookies (I don’t think the stores even offered store made ones back then), while the milkman (yes, we had one of those too) supplied all the milk for free - poured from glass bottles. Some were Christmas carols, some Jewish songs (in the dream I recall singing “I have a little dreidel” so it musta been Jewish - and this was well before I knew the Dalai too), but all the songs had all one thing in common - they were happy songs sung by happy people. No one from the ACLU was there to monitor us because….well they probably would have been kicked out if they had been. <br />
<br />
Political correctness? What was that? We even hugged and kissed our teachers, and they hugged and kissed us back. They truly LOVED us, and we them. There was no such thing as sexual harassment back then either…<br />
<br />
There were no in-school or out-of-school suspensions. If the teacher called your house, you were in serious deepness. Guilty until proven innocent. Unlike our Southern counterparts, our teachers weren’t allowed to hit you - spanking was outlawed in the North by then - but it probably would have been less painful if they had. One call to home and mom and dad would be all over my case and my…... If they had a DCF back then, they too would probably join the hit force as well. <br />
<br />
The cops never arrested you when you did something stupid because they all knew your parents and knew that it would be much better if your parents addressed it at home than through the system. So in the car you went - scared um….to death what would happen as they talked in hushed tones, laughing on the inside, but so serious on the outside. Juvie was only for the really bad kids, and we were never bad kids, just stupid kids, or shall I say typical kids. Big difference. That is why it’s so hard for me to get mad at mine own kids for being stupid. I was stupid once…and many think I still am…or at least my kids feel that way. In another decade I may get smart again though…we’ll see.<br />
<br />
Christmas Eve we always ate an Italian feast complete with pasta fritte (fried bread dough) and suppa de peche (seafood spaghetti sauce) and all sorts of goodies, including incredible pastries from Caputtos Italian Bakery in Long Branch. Any time you traveled a whopping 10 miles to get pastries you knew they had to be good. We never knew half of what we were eating at the time, but ate it anyway - and it was delicious. Whether at our house, Mr and Mrs T’s, an aunt or uncles house, friends - anywhere, everywhere - we’d eat and eat and eat and laugh until it was time to go to midnight mass - and a high mass at that. That was another night’s dream as well - Christmas Eve - complete with midnight mass, the songs in both Italian and Latin, the incense, the stations of the Cross, and me there, sometimes in the audience, sometimes serving as an altar boy, although not until much later in life, since that was reserved for the “older” kids of 12 and up. In my dream I could actually smell the incense and hear the incense burner moving back and forth as we blessed the people. <br />
<br />
As I looked around in my dream, I saw all our friends and neighbors - everyone knew everyone - and looked up in the balcony and saw my Aunt Mary singing with the choir- “Oh bambino mio divino…” There were maybe seats for 300 if that and the church was always packed on Christmas eve. <br />
<br />
By comparison my kids go to my ex’s church that holds about 3,000 people and cost $46M to build, almost $10M of it on audio and video equipment alone. The worship team there consists almost totally of professional musicians – St. Anthony’s had parishioners with an average age of 67. I was proud putting my $1 in the collection basket Christmas Eve; at my kid’s church you feel like tipping the usher $20 for the magnificent Vegas-style production. Monsignor knew us all by name - my ex’s church only knows the top 1% of tithers and probably doesn’t even know half the church staff. I go to a much smaller church - maybe 600 people tops - and know most of the men and can call the pastor anytime, if I need him. That said, it’s just not the same as when I was growing up though. <br />
<br />
The last time I was in St Anthony’s was a few years ago at my Aunt Mary’s funeral where I delivered her eulogy. Before then the last time I was there was at my dad’s funeral nearly 6 years ago and before then mom’s funeral almost two decades prior to then….Yes, I am an orphan….BUT thankfully my life doesn’t read like a Dickens novel or anywhere close…although Dad did have an Ebenezer Scrooge attitude about Christmas which I never fully understood until I was in my mid 40’s. <br />
<br />
Even though I had been in the church just a few years before it had been over 40 years since I was last on the altar there. I just sorta froze for a moment as hundreds of memories came flashing back in rapid fire sequence. The altar always looked so much …bigger...and the priest so much more…imposing. We never had altar girls back then either - blasphemy!! - and never ever were we allowed to wear sneakers either - only polished black shoes. The church had changed immensely since I was a child - it didn’t even look the same - but I closed my eyes and could hear the songs, smell the incense, see everyone I knew…and then I had to speak. But I was speechless…my heart was broken at the loss not just of my dear Aunt Mary, but of my youth well….a time and a place that was so much better than the fast paced high tech world we live in today…<br />
<br />
Christmas day was always reserved for relatives and friends. Like the miracle of the loaves and fishes wherever we were- our house or theirs- there was always a steady stream of people in and out- some whom we never knew who they were and it didn’t really matter either- there were never any strangers in the house at Christmas and we never ran out of food or wine either. And Uncle Louie, God love him, you’d put a bottle of Sambucca in front of him and the laughs would get louder and louder as the night progressed. God how I miss that all…. <br />
<br />
So if I happen to chat with you between now and the December 25th and wish you a Merry Christmas, please bear with me for not saying Happy Holidays instead. I’m just flashing back to much a simpler time and place, where the heart always goes at the holidays…<br />
<br />
Have a blessed holiday season and, oh yes, Merry Christmas to you and yours!!….<br />
<br />
PACSManWho they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-76000805192546039212009-12-15T10:48:00.000-08:002009-12-16T07:51:59.679-08:003D is Not only Fun, It’s Coming to a PACS Near You<b>Ms. PACS: </b> If you’re still hemming and hawing over the uneventful technologies on display at RSNA this year, then you definitely missed the fun at the Fuji booth. It was fun and funny to see radiologists ogling over a tomosynthesis viewer, while wearing 3D glasses on top of their own spectacles. <br />
<br />
Does that mean 3D mammography plus 3D glasses adds up to 6D? I’m not sure, but they call it 3Dimensional Stereo Digital Mammography and the images definitely popped off the screen. Actually, they were viewing 3D images acquired from a full-field digital mammography system instead of individual slices displayed in 2D from 3D data sets. The idea is to see behind overlapping structures and read breast-imaging exams faster. <br />
<br />
McKesson also featured a 3D monitor for viewing 3D clinical images - a heart beating in the air. If this type of visual enhancement proves to be useful for diagnostic accuracy, there may already be millions of radiologists in training – but most of them busy playing <a href=http://www.imdb.com/title/tt0499549/>AVATAR</a>. <br />
<img src="http://ia.media-imdb.com/images/M/MV5BMTYwOTEwNjAzMl5BMl5BanBnXkFtZTcwODc5MTUwMw@@._V1._SX95_SY140_.jpg" width="225" height="151" alt="AVATAR"/><br />
<br />
Since, Mitsubishi made 3D video gaming a reality earlier this year with the release of Nvidia 3D technology on one of its 3D-enabled TVs, as well as on home entertainment PCs, with a souped up graphics card of course, software now creates 3D imagery from regular video games, and some day regular 3D volume data sets. <br />
<br />
By the way, Avatar is a new video game that uses the same 3D technology as the James Cameron sci-fi movie, also called Avatar. Talk about back to the future, it’s like 3D at the movies in the 1950s when Hollywood was losing viewers to TV and released 3D flics to regain popularity. Hmmm...sounds like Hollywood today is banking on AVATAR to do the same.<br />
<br />
Back to reality, in a study presented at RSNA 2009, and conducted at the Mayo Clinic in Rochester, Minn., researchers used 3D stereotactic surface projection (3D-SSP) software to improve accuracy in diagnosing Alzheimer’s disease. 3D-SSP has been used in some centers and is thought to improve the accuracy of experts, said Vance Lehman, M.D., lead author of the study, which included 54 patients (23 normal and 31 cognitively impaired individuals). Two readers with less than one year of experience and two nuclear medicine experts with at least 10 years of experience viewed and rated all the PET scans. The readers ranked the scans from 1 to 5, with 1 as a normal scan and 5 as severe dementia. They also evaluated the scans for diagnostic confidence, with 1 as uncertain diagnosis and 5 as complete diagnostic certainty. During the 3 to 3.5 years of patient follow-up, no one in the normal group developed cognitive impairment, which confirmed their initial diagnosis. To my knowledge, the images were not projected on 3D-enabled monitors nor were the clinicians wearing 3D glasses, but don’t be surprised if they do in a follow-up study. <br />
<br />
Now that it’s looking more and more likely that 3D technology will soon be a common modality to view volumetric, live images in radiology rooms and in the ORs, maybe they should hand out free 3D glasses at next year’s RSNA – and win back some its popularity. <br />
<br />
<i>Note: On December 3, LG Display Co. of Seoul, Korea, rolled out, the world’s first commercial launch of 3D LCD panel boasting full HD resolution. The new 23-inch 3D monitor LCD panel is used with shutter glasses that deliver full HD resolution.</i><br />
<br />
<b>PACSman:</b> Some women are easily impressed, and so too it seems to be with Ms P. and 3D. While tomosynthesis is a relatively new technology and has only been around 20 years or so, 3D has actually been around since 1922. Three D had its Golden Era in the mid 50’s, a revival in the 60’s and 70’s and went to a new dimension in the mid 80’s with IMAX film. Today many films can be found in 3D, including the latest from PIxar Studios, Up.<br />
<br />
I’ve seen nearly every iteration of 3D imaginable, and while it’s really cool and does have its benefits in healthcare, the costs are still fairly substantial, even though they have dropped in recent years. Processing requirements also remain fairly intense as well. Reimbursement will largely determine whether 3D thrives or dies on the vine, but for now, like its film counterpart, medical 3D is enjoying a revival of sorts.<br />
<br />
There was a lot shown at RSNA, but very little was what I consider earth shattering or that helped me justify the $1,500 it cost me to go this year. Unlike the vendors and even Miss P who works for a company, it all comes out of my pocket. Of course with the show being in Chicago Miss P also had the option of sleeping in her own bed at night and didn’t have to spend $225 a night to call some place home, so that’s yet another inequity I had to deal with. <br />
<br />
3D really didn’t catch my attention anywhere near as much as it did Ms. P.’s , but then I am the world’s biggest cynic as well and focused mainly on PACS. What did catch my interest was the promotion of cloud-based solutions as an alternative to image distribution via the web… We’re still a few years out from making this a widespread reality and with it commensurate pricing, but the concept is still intriguing nonetheless. So why show it if its not real? RSNA - Real System Not Available. Next question. A few vendors are doing alpha and beta testing of their cloud solutions so within the next year or two these will become more and more real…<br />
<br />
So what exactly does a cloud-based system do? Cloud-based systems allow multiple disparate systems to upload images and reports to a central data repository, or "cloud," and then resend them out to various clients from a single site. This is crucial in making a cardiologist, orthopedists or others’ job easier, especially since the clinician typically covers multiple hospitals. Instead of having to log into four, five or six disparate systems at various hospitals or deal with CD’s that all too often don’t work properly, they simply log into the cloud and viola - instant access to all their studies that have been downloaded for them. Of course, like everything, there is a cost associated with this that the hospital pays and currently that costs is quite high, but within a year or so once, these are more than a concept, then you’ll see prices drop. <br />
<br />
There were the obvious improvements to PACS that every vendor made a big hoopla over. VNA’s all over the place, data migration services being offered by a host of vendors, and, of course, a number of Rajivs in Ramanathapuram’s Radiology Renderings, Inc. who offered teleradiology services at a price that my dog wouldn’t even touch. <br />
<br />
Would I go to RSNA again? I feel the same way that vendors do - you have to go because if you don’t it raises more questions than not, and once you start you can’t stop even though each year its becoming harder and harder to justify the costs. Of course, over 100 vendors out of the 700 or so who displayed at RSNA 2008 didn’t show up at RSNA 2009 - so it does happen. I just can’t let it happen to me, especially since the PACSMan Awards are among the top five stories to come from the floor of the RSNA, and people look forward to a little levity in their lives. God knows we all need some after walking all over creation and back listening to so much bull I feel like I’m in Dallas instead of Chicago. But as I’ve grown to know after more than two decades of shows, it’s all a part of the game…and next year I may even get to see to see RSNA virtual - and in 3D!!Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com3tag:blogger.com,1999:blog-725521746466059222.post-60763653084259260532009-12-01T05:18:00.000-08:002009-12-01T05:55:34.372-08:00PACSMan´s Notes From The Floor<b>PACSman: </b> Another year another show...the weather is nice, but oy, my feet are killing me...Part of that is due to the decision of the powers that be to expand the technical exhibits from two to three areas to make the show look bigger. I had to look and see if Dr. Scholl was a new addition the Exhibitors Circle. <br />
<br />
Everyone IS talking about attendance at this year's show, especially since HIMMS, SIIM, and others' attendance numbers were significantly down from last year. According to RSNA published reports officially attendance is up over both 2007 and 2008, with the RSNA stating the attendance that ¨set a new record¨. Based on what most vendors saw that might be hard to believe, the RSNA registration numbers are like an NBA basketball game - paid attendance and actual attendance can sometimes vary significantly especially since most RSNA members register whether they come or not. This would be an interesting use of RFID tags that have come into play the past few years. The RSNA should publish how many people showed up on each day, how long the stayed on the floor versus attending the presentations and other areas, as well as what booths they went to...I bet the results are eye openers.<br />
<br />
Sign of the times - at least four majors and three others decided to cancel their parties this year. Surprisingly, those having parties could also have given the Secret Service a lesson in security given they were invitation only and were strictly enforced unlike prior years where all you had to do was show up. Thankfully I had the gracious and lovely Ms P. with me who opened as many social doors for me as I did for her.<br />
<br />
Contrary to Ms. P´s predictions, the lines in the ladies room closely mimicked the men's, which had no lines at all. This is fascinating, considering most women almost always go in groups, something I never did understand, and won´t go at all if alone, choosing instead to hold it. Maybe one guards the door or something...but there are either fewer women this year or they are drinking less...<br />
<br />
Speaking of women, with every third booth offering so many varieties of chocolate this year there is absolutely no excuse for bitchy behavior at all.<br />
<br />
Lots and lots of changes this year. I no longer have to squint through a bus ad covering the windows...yeah!!! And Captain Kirk is letting me name my own price on hotels for the first time in ages...There were more hotel vacancies than you can shake a stick at, with me not only able to get a great rate, but the room type I wanted AND able to check in at 10 a.m. as well. That has NEVER happened in the past. New record attendance, huh? Could have fooled me and the Chicago hoteliers as well.<br />
<br />
Lotsa big booths from the majors, but there is definitely more dancing area for sure...less equipment means less staff...and less staff means lower show costs...<br />
<br />
I´m beginning to wonder if I am at a radiology conference or cosmetology show. Yesterday I got my thumbnail professionally polished (and can do the other nine digits in the privacy of my hotel room for the low show special price of just $49.95), and was offered treatment for my dry skin as well. I missed the foot massagers they had last year, but haven't made it completely around yet...so let´s hope.<br />
<br />
I did see a dark haired beauty here who significantly piqued my interest, but alas Ms. P. said that I would have to buy her a meal to have her even remotely be interested interested in me and I just don't know if there is time for that. Her name is intriguing-Lola- which reminds me of that old Kinks song. I wonder if she´s a very kinky girl as well. Time will tell...<br />
<br />
Gotta love the overseas companies. Every year I wonder how much they paid translators to do such a wonderful job of making me laugh...<br />
<br />
OK, gotta get to the show. More tomorrow...And if anyone knows how to get Spanish characters off my laptop, please let me know. I let my love child use my computer last to do his Spanish project, and low and behold when I type in a character expecting one thing, Bobba Louie gives me another. Maybe it´s just getting me ready for the El Grande dinner tonight when many of us from various journals get together and share a laugh or three over lousy Mexican and wonderful drinks, while talking about the vendors in ways that will never ever see the light of day...Till tomorrow - Ole...Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-41356993628910722172009-11-23T09:59:00.000-08:002009-11-23T14:13:56.314-08:00RSNA 5-Day Forecast<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_6wlj_Yv6D2E/SwrRmliXo4I/AAAAAAAAAJM/cOEZ8hd0cJw/s1600/Willard%2BScott.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/_6wlj_Yv6D2E/SwrRmliXo4I/AAAAAAAAAJM/cOEZ8hd0cJw/s320/Willard%2BScott.jpg" /></a><br />
</div><b>Ms. PACS: </b> I was looking into my crystal ball, trying to see what to expect at RSNA 2009 next week, when I saw...a huge smudge - I needed Windex. So in my quest to seek out truth and wisdom, I turned on the TV. Clicked on the weather channel. To my surprise, standing in front of a large map, it was Willard Scott! I wondered if it was an old VCR recording…but realized it was in fact 2009. Maybe Willard’s 401K had taken a nosedive, forcing him out of retirement. In any case, despite his feeble yet rotund state, he did provide some sound data in his <b>RSNA 5-Day Forecast.</b><br />
<br />
Willard said: “You can expect to see:<br />
<br />
<b>1. Low res images sent from PACS to EMR:</b> If you go to the BRIT Systems booth, you will see their new <a href="http://www.rsnafastpass.com/rsna/articles/headlines/ehr___imaging_it_/35232/Web_Based_Viewer.html?article=1&site=rsna&sid=201">Webworks</a> solution. Referring physicians and their patients now have access to diagnostic images with a new browser-based application for viewing patient images and reports on any computer with an Internet connection and a browser. The new application also provides access to radiologists for low volume review. The platform uses AJAX for real-time updating of patient lists and clustering technology for redundancy and load balancing. <br />
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INFINITT <a href="http://itn.reillycomm.com/rsna/articles/headlines/pacs/35243/PACS_Drives_Imaging.html?article=1&site=rsna&sid=213">Accent</a> also allows PACS-based medical images to be accessed along with all other types of medical information on any Internet-enabled terminal. A new PACS offering for EMR, HIS and practice management vendors fully integrates the complete range of medical images with EMR software of almost any kind.<br />
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<b>2. Vendor-neutral archiving</b> will be one of the big themes on the exhibit hall floor. <br />
Carestream will show its vendor neutral PACS and storage/archive solutions, which brings disparate PACS and data systems into a shared, long-term data management solution that can streamline management tasks and reduce costs.<br />
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3. Bathroom breaks: </b> The bathroom wait times on the RSNA exhibit hall floor will be approximately 3 minutes long (which is a 2 minute drop from last year)…except in the ladies room - that will remain the standard 15 minutes. <br />
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<b>4. New PACS:</b> Siemens will introduce the new PACS that appeared on Dalai’s PACS Blog last week (<a href="http://doctordalai.blogspot.com/">http://doctordalai.blogspot.com/</a>)<br />
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<b>5. RSNA unveils structured reporting templates</b> – The RSNA has established a Radiology Reporting Committee to identify and promote "best practices" in radiology reporting. June 2008: RSNA convened a workshop to plan the future of radiology reporting. More than 50 radiologists, medical informatics specialists, and representatives of cardiology, oncology, and pathology participated. Consensus was reached on a global template for diagnostic radiology reports, including standardized radiology report headings.<br />
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December 2009: RSNA will release the first set of reporting templates, freely available for downloading and use. (<a href="http://reportingwiki.rsna.org/index.php?title=Main_Page">http://reportingwiki.rsna.org/index.php?title=Main_Page</a>)<br />
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Have you seen the Google “radiology-report” site with RSNA radiology structured reporting templates. It contains RELAX-NG templates for radiology-structured reports. The code is from the GNU free software operating system. Someone at Medical College of Wisconsin is developing it.<br />
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By the way, Stage 6 of the EMR Adoption Model requires structured reporting systems.<br />
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<b>6. Fuji 86's its annual House of Blues (HOB) party</b> – is it due to NEMA code of ethics? When did fun equate unethical behavior? Do you really think a doctor is going to buy equipment just because you buy him a beer…and it's only a buffet dinner – not an intimate candlelight engagement with a contract on the table. Granted, I have witnessed some embarrassing behavior at such events…but the moral infractions usually happen after the party, not on HOB premises. The silver lining is that like any enforced code of conduct, there’s a loophole, or a lawyer to find one for you. Some companies are keeping it ethical by throwing a charity event. At least some of the frivolity goes to those in need. It’s all about balance.<br />
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7. White flag: </b> The CT slice wars will officially come to a stalemate as attentions focus on lowering the dose. <br />
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8. Pocket diagnostics: </b> Ultrasound debuts as a new iPhone feature – for both diagnostic purposes and pure entertainment. Talk about consumer driven healthcare.<br />
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<b>9. E-Ordering imaging exams:</b> To meet with stage 4 of the EMR adoption, CPOE and CDSS (Clinical Decision Support Systems). Evidence-based medicine makes sense, but it’s hard to get physicians to actually use it. IT tools that provide decision support at the time they make decisions may help close that gap. Kind of like the little Einstein on PCs (or you can make it a cat) that alerts you when it has a suggestion or detects a potential error. I heard Bill Gates’ wife, Melinda, came up with the idea for that little alert icon – but man is it annoying. I have to use the cat icon so at least its cute and I don’t get as aggravated.<br />
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<b>10. Last, but not least.</b> While perusing the IHE demo exhibit, the PACSman will find his true love – she will not be a PC or a MAC this time. But one thing is for sure - she will have a pulse.Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com1tag:blogger.com,1999:blog-725521746466059222.post-14808168257647939882009-11-10T10:17:00.000-08:002009-11-10T10:17:02.016-08:00And When I'm Gone….<b>PACSman:</b> 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. <br />
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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.” <br />
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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.<br />
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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.<br />
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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.<br />
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.<br />
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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:<br />
<i><br />
“I'm not scared of dying, <br />
And I don't really care.<br />
If it's peace you find in dying,<br />
Well then let the time be near” </i><br />
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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? “<br />
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<i>“Give me my freedom for as long as I be.<br />
All I ask of living is to have no chains on me.<br />
All I ask of living is to have no chains on me,”</i><br />
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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? <br />
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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. <br />
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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.<br />
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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. <br />
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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!!<br />
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<i>And when I die, and when I'm gone,<br />
There'll be one child born<br />
In this world to carry on,<br />
to carry on.</i><br />
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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…Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com0tag:blogger.com,1999:blog-725521746466059222.post-44671307186115071402009-11-04T07:19:00.000-08:002009-11-04T10:20:30.245-08:00What the World Needs Now…<b>PACSman:</b> …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. <br />
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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”. <br />
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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..<br />
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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. <br />
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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…<br />
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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.<br />
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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)] <br />
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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).<br />
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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.<br />
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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…<br />
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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. <br />
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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. <br />
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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.<br />
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<b>Ms. PACS:</b> “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. <br />
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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. <br />
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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.<br />
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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.<br />
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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. <br />
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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 <i>listen</i> when they tell you how it might work better.<br />
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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.Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com3tag:blogger.com,1999:blog-725521746466059222.post-80020708095167733862009-10-26T08:26:00.001-07:002009-10-26T08:35:19.690-07:00Adam, Eve and PACS<b>PACSman:</b> 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. <br />
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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. <br />
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I said out to no one in particular out loud “Look Jack, don’t waste my time” and then fell back to sleep….<br />
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”It’s time” came the booming voice again…<br />
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I looked around expecting to see either George Burns or Morgan Freeman in my bedroom, then said ”Nah..no way….can’t be.” <br />
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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. <br />
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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. <br />
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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. <br />
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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. <br />
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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. <br />
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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.<br />
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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…<br />
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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.<br />
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It happens in my personal life - you lead, I may or may not follow. Apparently Fred Astaire I’m not. <br />
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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…” <br />
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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? <br />
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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? <br />
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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…<br />
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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…<br />
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<b>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:</b><br />
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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?<br />
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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…..<br />
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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.<br />
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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...<br />
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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.<br />
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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….. <br />
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….<br />
Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com2tag:blogger.com,1999:blog-725521746466059222.post-66330731400227733932009-10-22T10:11:00.001-07:002009-10-22T14:27:01.528-07:00Where are the Next Gen PACS features?<a href="http://4.bp.blogspot.com/_6wlj_Yv6D2E/SuCadQwMIjI/AAAAAAAAAI8/eOtwoLWYe5w/s1600-h/immelt_vscan.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395482181093827122" src="http://4.bp.blogspot.com/_6wlj_Yv6D2E/SuCadQwMIjI/AAAAAAAAAI8/eOtwoLWYe5w/s200/immelt_vscan.jpg" style="cursor: pointer; float: right; height: 132px; margin: 0pt 0pt 10px 10px; width: 200px;" /></a><br />
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<b>Ms. PACS:</b> <span style="font-family: Arial,Helvetica,sans-serif; font-size: small;">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.</span><br />
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</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">Seriously, which is the best Radiology specific search tool:</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- Radiology Research</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- MyPACS.net</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- Yottalook.com and Yottalook app for the iPhone</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- ACR Case in Point</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- Dr. K. MSK Cases</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- EURORAD</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- Journal of Radiology Case Reports</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- Pediatric Radiology</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- Rad Files</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- radRounds Cases</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><br />
</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">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.</span><br />
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</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">What I was looking for was:</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">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).</span><br />
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</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">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!”</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">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.</span><br />
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</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">The next gen tools I unearthed from the bowels of "new PACS features" were:</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- touch screen</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- voice commands in RIS</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- voice commands to navigate PACS</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- automatic registration and matching of volumetric data at different time points on</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- auto-structured reporting</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- auto-loading templates mapped to procedure codes</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- bookmark findings/optimal image</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- one click to sign reports</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- critical test results management solution to delivery of critical patient findings</span><br />
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</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">These are more recent innovations thanks to Apple and Microsoft:</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b>iPhone Apps:</b></span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- 3D rendering of CT scan: app developed by Ziosoft (www.ziosoftinc.com)</span><br />
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</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- 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/).</span><br />
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</span><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">- 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)</span><br />
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</div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><b>Microsoft Courier:</b> two-screened hinged tablet with multi-touch capability, designed for writing, flicking and drawing with a stylus, in addition to fingers.</span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_6wlj_Yv6D2E/SuDOHf6B6jI/AAAAAAAAAJE/CMgU0-WVNjk/s1600-h/Picture+1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/_6wlj_Yv6D2E/SuDOHf6B6jI/AAAAAAAAAJE/CMgU0-WVNjk/s320/Picture+1.png" /></a><br />
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<span style="font-size: small;">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 <a href="http://www.itnonline.net/node/30445">Dr. Paul Chang</a> 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.</span><br />
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</div>Who they really are...http://www.blogger.com/profile/06236511447759449224noreply@blogger.com2