Monday, June 20, 2016

Bad Design Kills...

You might remember my post earlier this year concerning failed Kickstarter projects and bad EHRs. I also noted that even a big company such as Damlier Fiat Chrysler could embrace a really bad design, in this case, the gearshift. I quoted from Fox News at that time:

Electronic gear shifters on some newer Fiat Chrysler SUVs and cars are so confusing that drivers have exited the vehicles with the engines running and while they are still in gear, causing crashes and serious injuries, U.S. safety investigators have determined...

Agency tests found that operating the center console shift lever "is not intuitive and provides poor tactile and visual feedback to the driver, increasing the potential for unintended gear selection," investigators wrote in the documents. They upgraded the probe to an engineering analysis, which is a step closer to a recall. NHTSA will continue to gather information and seek a recall if necessary, a spokesman said...

In the vehicles, drivers pull the shift lever forward or backward to select gears and the shifter doesn't move along a track like in most cars. A light shows which gear is selected, but to get from Drive to Park, drivers must push the lever forward three times. The gearshift does not have notches that match up with the gear you want to shift into, and it moves back to a centered position after the driver picks a gear.

This particular adventure in poor choices has led to a very unfortunate consequence:  It seems likely that the mis-begotten gear-shift on his Jeep Cherokee led to the death of Anton Yelchin, which I talked about yesterday.

Again, from Fox News:

Gear selectors from 2014 Jeep Grand Cherokee (Left) and 2017 Jeep Grand Cherokee (Right) (Jeep)

The Jeep Grand Cherokee involved in the accident that killed 'Star Trek" actor Anton Yelchin in Los Angeles on Sunday was one of 1.1 million Fiat Chrysler vehicles worldwide subject to a recall to address a transmission design flaw that was cited in several similar incidents, though none fatal.

According to police, Yelchin died from blunt force asphyxia when he got out of the vehicle and it rolled down his driveway and pinned him against a brick mailbox and a security fence. His 2015 Grand Cherokee featured an uncommon type of electronic gear selector that works like a self-centering toggle to cycle through the transmission's modes (park, reverse, neutral and drive,) rather than a lever with notches or specific positions for each.

Hundreds of owners filed complaints with the National Highway Traffic Safety Administration that it was confusing to use. Several had exited their vehicles without having engaged Park as intended, leading to rollaway events despite warning lights and sounds designed to prevent this from happening.

In April, Fiat Chrysler reported that there had been 41 injuries related to the problem and issued a recall for 2014-2015 Grand Cherokees with the 8-speed transmission to update their software to give enhanced warnings and prevent the vehicles from moving if a door is opened when it is not in Park. The 2012-2014 Dodge Charger and Chrysler 300 sedans that used the same gear selector were also recalled. Fiat Chrysler now uses a more conventional lever in all three models.

It’s not yet known if Yelchin’s Grand Cherokee had been brought in for the recall service prior to the accident, but the LAPD says it is trying to determine whether or not the car was in Park when the accident occurred. TMZ has reported that the vehicle had not received the update and was in neutral at the time of the accident.

"FCA US extends its most sincere condolences to the family and friends of Mr. Yelchin,” the automaker said in a statement regarding the accident. “The Company is in contact with the authorities and is conducting a thorough investigation. It is premature to speculate on the cause of this tragedy.”

Police do not suspect foul play in the accident, and that toxicology reports could take months to analyze.
Here is a video of the gearshift lever in operation:

And here is the NHTSA summary:  "Drivers erroneously concluding that their vehicle’s transmission is in the PARK position may be struck by the vehicle and injured if they attempt to get out of the vehicle while the engine is running and the parking brake is not engaged."

And here is where Mr. Yelchin died. . . his own driveway:

My regular readers know what's coming. Maybe I don't even need to say it. But of course, I will anyway.

Poor design has the potential to kill. This should be obvious, self-evident, clear as day. Here, a rising star was snuffed because some engineer at Fiat-Chrysler had a cutesy idea about changing a fundamental part of a car that didn't need to be changed. The shifter needs to shift, easily and confidently, and it needs to be clear just what gear has been selected. Bottom line, it has to work, each and every time it is used. Or someone could die.

Software companies take note:  So it is with PACS (and EHR's). Don't let the engineers and software writers go wild. Don't throw in features just because someone on the team thought it might look good. Don't take an approach that gets between the user and his/her task, here, viewing patient images and information. Test your product with real users. Then test it again. And again. And again. Make sure it works in the hands of the drivers, I mean users...

And I must state this in the strongest, most litigiously slimy terms possible: Medical software has just as much potential to kill as does a faulty shift lever. Never forget that. Create the software you want used on your child or your spouse or your parent. Or on a young, rising actor, who should still be with us.

Sunday, June 19, 2016

Life Is Short, Play Hard...
Anton Yelchin, The "New" Chekov, Dies At 27

We've lost yet another Star Trek actor, and it is a sad occasion, indeed. Today, we lost Anton Yelchin, the 27-year-old Russian-born actor who played Chekov in J.J. Abram's reboot of Star Trek.

Image courtesy ILM/AP, LA Times
From the WikiPedia:
Yelchin was born March 11, 1989, in Leningrad, Soviet Union (now Saint Petersburg, Russia). His parents, Irina Korina and Viktor Yelchin, were pair figure skaters who were celebrities as stars of the Leningrad Ice Ballet for 15 years. His family is Jewish; in the USSR, they were subjected to religious and political oppression. Yelchin had said: "My grandparents suffered in ways I can’t even begin to understand under Stalin."

Nationally, Yelchin's parents were the third-ranked pair team; they thus qualified for the 1972 Winter Olympics, but were not permitted to participate by the Soviet authorities (Yelchin has said the reason was unclear: "I don't exactly know what that was – because they were Jewish or because the KGB didn't want them to travel").[7] His family moved to the United States in September 1989, when Anton was six months old, after receiving refugee status from the United States Department of State.[3][4]
Yelchin died in a freak accident, apparently while checking his mailbox, according to the LA Times:
Actor Anton Yelchin, perhaps best known for his role in the new “Star Trek” films, died early Sunday after his vehicle rolled down his Studio City driveway and trapped the actor against a mailbox, authorities confirmed.

Friends went to the 27-year-old actor’s home shortly after 1 a.m. Sunday, when he didn’t show up for a rehearsal as expected, L.A. police Officer Jenny Houser told The Times. Authorities believe Yelchin’s vehicle rolled backward down the steep driveway, Houser said, pinning him against a brick mailbox and security gate.
We've lost many of our screen friends from the Original Series, which as you know is now itself 50 years old. Leonard Nimoy died just a year ago at age 83, DeForest Kelly died years ago at age 79, and James Doohan (Scotty) a few years later at 85. (William Shatner, the real Captain Kirk, remains incredibly active and vibrant at age 85, same for 79-year-olds George Takei and Walter Koenig.) We can accept, though with difficulty, the loss of old friends. But to have such a young life snuffed out in an instant, in a senseless, and yes, freak, accident, well, it will take me a lot longer to accept that.

I am amused by the number of Jewish actors who have "gone where no man has gone before". The list is longer than I would have thought. I was not aware of Yelchin's Jewish heritage until today, but it should come as no surprise. Shatner, Nimoy, and Koenig, as well as Marc Lenard (the only actor to portray a Klingon, Romulan, and a Vulcan--Sarek, Spock's father), and from the spin-offs, Brent Spiner, Armin Shimmerman, Max Grodenchik, Aron Eisenberg, Wallace Shawn. Jews in Space! (With no apology at all to Mel Brooks!)

Indeed, life is short, as Anton Yelchin's tragic demise proves to us. Too short to tolerate malfunctioning PACS installations, but also too short to get one's bowels in a violent uproar over them.

You'll notice I've been silent lately. There hasn't been that much to say, or at least not that much I can or perhaps should say, if you grasp the nuance. I can tell you that several of our major problems with GE's Universal Viewer have been fixed, but several have not, with no obvious resolution in sight. Our other problem child has had a lot of talk, effort, and money thrown at it, with some improvement...but suffice it to say that a lot of what I've been talking about for the past eleven and a half years on this blog hasn't changed one little bit.

Godspeed, Anton...עליו השלום

Monday, May 09, 2016

YUVGE Disappointment

Our Universal Disappointment has been updated to the latest and greatest, Version 6.x. I should have been more wary, as a certain other Version 6.x has led to a lot of Pain And Constant Suffering. But no, I was optimistic. After a YEAR of having to reopen examinations four and five times to make all the images load, lo and behold, the New and Improved Universal Disappointment did indeed fix the problem. And even more exciting to us, it seemed to be more generous about showing saved measurements as well. We thought we were back in business.

Now, that's not to say that UV6 fixed everything. We still have windows covering over windows, and the measurement tool and the scrolling tool do not play nicely together. We could have lived for another year with that, if we really had to. But, no, we had to find another, far worse problem.

Last week, the second week of UV6 deployment, things started drifting downhill. We would get an occasional presentation state error when loading old PET's for comparison. No big deal.  But today, things took a nose-dive. We can no longer load ANYTHING, new or old. We get these rather cryptic messages instead:

Someone want to tell me WHO the F... Dakota might be? Are we talking about Dakota Fanning? What would she have to do with my PACS? North Dakota? South Dakota? Is that where GE keeps its cloud? Must be raining up there.

We are dead in the water, once again proving Dalai's First Law:  PACS IS the Radiology Department. No PACS, no exams, no patient care.

GE, you should be ashamed. You made us wait a YEAR for this update that fixed a "coding problem" that should have been fixed 51 weeks ago with a minor hotfix. NOW you deploy a faulty upgrade that has taken us down completely? Really? Don't you boys and girls ever even test your software before unleashing it on the masses?

GE took a fantastic product, Dynamic Imaging's IntegradWeb, and ran it into the ground. I can promise this particular site will NEVER purchase anything from GE again, and if anyone asks me in my waning years about GE products, I won't have much nice to say.

UV now earns the dreaded Dalai Do Not Buy designation. No surprise.


We're back up. The problem was "a setting got changed that made the system look in the wrong places for things." Perhaps it was checking Fargo and not Rapid City.

Friday, May 06, 2016

Siemens Health-Imagineers

From Siemens comes this press-release:
Today Siemens Healthcare unveiled its new brand name Siemens Healthineers. The new brand underlines Siemens Healthcare's pioneering spirit and its engineering expertise in the healthcare industry. It is unique and bold and best describes the Healthcare organization and its people – the people accompanying, serving and inspiring customers – the people behind outstanding products and solutions.

"We have an exceptional track record of engineering and scientific excellence and are consistently at the forefront of developing innovative clinical solutions that enable providers to offer efficient, high quality patient care. Going forward as Siemens Healthineers, we will leverage this expertise to provide a wider range of customized clinical solutions that support our customers business holistically. We are confident in our capability to become their inspiring partner on our customers' journey to success", explained Bernd Montag, CEO of the company. "Our new brand is a bold signal for our ambition and expresses our identity as a people company – 45,000 employees worldwide who are passionate about empowering healthcare providers to optimally serve their patients."

As part of its Vision 2020 strategy Siemens AG announced nearly two years ago that its healthcare business would be separately managed as a company within the company with a new organizational setup. Siemens Healthineers will continue to strengthen its leading portfolio across the medical imaging and laboratory diagnostics business while adding new offerings such as managed services, consulting and digital services as well as further technologies in the growing market for therapeutic and molecular diagnostics.

The name of the legal entities will remain unchanged.
I heard about this new moniker a few days ago, from a friend high up in the Siemens hierarchy. It took me a moment to place the term, and then I realized why it sounded familiar...From the Disney Imaginations website:


About Imagineering
Walt Disney Imagineering is the unique, creative force behind Walt Disney Parks and Resorts that dreams up, designs and builds all Disney theme parks, resorts, attractions, cruise ships, real estate developments, and regional entertainment venues worldwide. Imagineering’s unique strength comes from the dynamic global team of creative and technical professionals building on the Disney legacy of storytelling to pioneer new forms of entertainment through technical innovation and creativity.

The name “Imagineering” combines imagination with engineering. Building upon the legacy of Walt Disney, Imagineers bring art and science together to turn fantasy into reality and dreams into magic.
I really think this is an incredible way to view healthcare software, although maybe a little difficult to roll off the tongue. Still, I predicted a cooperative effort of this sort way back in 2008...

It's far better than someone else's motto..."ImaGinE It Works..."

Wednesday, April 13, 2016

Gomerblog On EHR's...

Gotta love Gomerblog. In fact, I urge all of you to subscribe for a dose of medical humor far more sophisticated than what I provide here.

Today's entry follows upon the heels of the wishful thinking April Fools' Day post. (I do have it on good authority that Apple really IS working on medical software, but my source would have had to kill me had he elaborated.)

The dirty little secret seems to be that the EHR programmers didn't know their software would be used on real, live patients!  Wow...

From Gomerblog:

EMR Developers Shocked to Learn How Their Software is Actually Used

By Gomerblog Team on Apr 12, 2016 07:00 pm
Several developers of widely-used electronic medical record (EMR) software were invited out of their cubicles last week for a much-hyped tour of the real-world health care system.
2341821_mA volunteer team of medical office managers showed the visiting programmers around inpatient hospital wards and outpatient clinics yesterday, carefully coordinating the visits so the programmers could witness physicians in the full swing of patient care.  Seeing their products being used in actual clinical settings for the first time, the general response of the developers was shock.
“Wait, wait, wait,” said Bingo “Bozz” Murdoch, developer of MediQuickChart Systems.  “They’re actually using our software to, like, keep track of real patient records,” he noted.  “And they’re trying to enter the data real-time.”
Murdoch simply shakes his head when asked about the many levels of inputs and multiple levels of exhaustive drop-down menus.  “You just can’t get all of medicine into a dropdown menu,” he said incredulously.  “It would just be impossible.  That’s why we just picked a handful of interesting diagnoses and codes to include in the system.  These systems were never meant to be comprehensive.”
EMR software has long been a source of headache and delay for physicians and associated health personnel alike.  Along the way, many have wondered what the heck the developers were thinking.
“Why would you list 63 different ophthalmology exam findings on this drop down menu, and yet require us to free-text ‘enlarged tonsils’ every single time?  It’s supposed to be a primary care EMR, for gosh sakes,” said Dr. Goodforyou, a physician who was noted to be running 90 minutes behind at the time of the interview.  “Ever since moving to electronic medical records,” he added, “my charting has bitten the big one.”
Patients and physicians have also been critical of the need for computers in the exam rooms, complaining that the screens introduce a barrier to personal communication.
“It’s like talking to my teenager,” complained patient Mandy Mayhow, when asked about her impression of EMRs.  “I feel like the doctor isn’t even there any more.  I’m just talking to the back of a screen.”
Dr. Goodforyou was no longer available to respond to Mayhow’s comment.  His office manager, however, noted that he probably feels the same way.
Again, the software developers were at a loss.  “We were never asked to consider doctor-patient interaction or clinic flow in our product development,” said Murdoch.  “We thought the goal was simply to try to maximize required visit documentation.  It was all supposed to be a game.”

Wednesday, March 30, 2016

PACS Tidbits

New stuff in PACS seems to be overwhelmed somewhat by the Trump-like stampede of EHR data. Still, I've got a couple of items which might interest my loyal readers, all four of you.

Let us start with GE. Our Universal Disappointment Viewer should be updated to the next version sometime in the next few weeks. For those who haven't heard, our current UV has a number of problems, not the least of which involves not displaying one or more slices from a CT series when scrolling through. Fortunately, we do see a blacked-out pane with the phrase "0% loaded..." to let us know that we might be missing something. That is a major step up from our earliest go-round with Centricity 2.x years ago, which would skip images and not be kind enough to tell us it had done so.

As it stands, the "0%" thing happens on nine out of ten CT's, forcing us to close and reopen the exam, sometimes three or four or five times.

So...let's run some numbers. It adds 30 seconds to the exam each time we have to go through the close-and-reopen cycles. The busy site has maybe 40 CT patients per day (I'm underestimating), and for simplicity's (not Centricity's) sake, let us say they operate 5 days per week, and 50 weeks per year. That would be 10,000 patient-exams per year. So that's 9,000 exams that need to be reopened, wasting 4,500 minutes or 75 hours wasted for this year of Universal joy. At $200/hour (EXTREMELY reasonable rate), that would be $15,000 blown because of this poor coding.

I am hereby submitting a bill for this amount, $15,000.00, to General Electric for our professional services and time lost. I would urge all other departments experiencing this sad software error to do the same.

GE, please contact me for the address to send the check. I'll let everyone know when it arrives. Or if it doesn't.

While we are waiting on the check that's certainly in the mail by now, let us turn our attention to Agfa. You haven't heard much from me about our situation there, and you won't for a while. But in my search for an image-sharing solution (I still favor lifeIMAGE for this purpose) I stumbled across the fact that Agfa has an offering in that realm. Which has been deployed exactly never. I've learned not to beta (or alpha) test when patients are involved, thank you. Also, I'm hearing that Agfa plans to standardize and unify all of its installations onto one uniform platform. I'll assume this platform will be Agility, but I have no confirmation of that as yet. Good luck.

Onward and upward. Apparently Fuji has released Version 5.0 of Synapse PACS, and in an article on, (which was sponsored by Fuji and written by Fuji USA V.P.'s), it was the "hit" of RSNA 2015. I must have missed that somehow, perhaps because I rarely wander over to the Fuji booth. But the Veeps do make the new version sound quite intriguing.

Our latest Synapse PACS has beefed-up archival and worklist/workflow-engine capabilities—from unique sharing features to EHR interoperability tools to workflow-optimizing options that take integration beyond the enterprise, into the cloud and, from there, wherever collaboration is happening—or should be happening.

In a nutshell, the need today is for a diagnostic-level PACS workstation that extends through the PACS to any desktop that a PACS might touch. That’s why the Fujifilm team came up with the Synapse 5 PACS viewer. It’s designed to help users keep up with the changes that have already taken place and, more importantly, to help them stay out ahead of what comes next.

Nice to hear this from the company that has the reputation of taking years to update things.

When I first saw Synapse in action in the early 2000's, I was told that the local group had insisted on three-second transmission times for any study. Of course, it turns out that the group itself figured out how to accomplish this without help from Fuji. But speed is indeed an important factor today:

Going into the Synapse 5 PACS design phase, our team knew the only way to achieve sub-second image access while also virtually caching large datasets and enabling reads from wherever, whenever—including with 3D—was to approach server-rendering technology in a whole new way. That’s why we came up with not just a new viewer but a next-generation viewing application, one combining architecture changes as well as technology advancements.

With the new Synapse 5 technology, there’s no client at the desktop, and the image rendering occurs on the server. This allows the technology to be far less dependent on the viewer side, and it allows users to simply log in and choose their interface as well as their screen—Explorer or Firefox or Chrome, desktop or smartphone or tablet—or work with any combination of preferences.

Yup. Server-side rendering and a zero footprint client. Nothing novel, but Fuji is the first of the big-iron companies to implement this on this scale. I think it's a good idea if done right.

One of our favorite aspects of Synapse 5 PACS is its brilliant simplicity. Like most cutting-edge websites and more than a few apps, it uses HTML5 and was largely inspired by what you’ve seen in the world of e-commerce. It’s got a user-friendly, intuitive GUI, with high performance, limitless scale and strong security.

Can you say "Hyperbole?" I knew you could.

Here’s another reason we were so busy answering questions at RSNA 2015: As “disruptive” a technology as Synapse 5 is, it’s barely a disruption at all for existing customers. It’s not a forklift of a database or a migration or a platform change. It’s just an upgrade to our current Synapse 4 platform. Current Synapse users will be able to light up an entirely new viewer that will work off of the existing database they already have.

An upgrade? Definitely. I'll bet money it is a HARDWARE upgrade, requiring a new server (or more likely many servers) added to the back end. I could be wrong.

We haven’t forgotten to take what we’ve heard from radiologists and apply it. That means, among many other things, that our new viewer makes it easy to look at a screen for eight hours a day. We’ve thought through ergonomic implications, right down to details like minimizing wrist strain, and we’ve geared everything toward greater efficiency and productivity.

Oh, still my beating heart! Someone cares about us poor rads? That would be nice...

But now a thinly-veiled slap at our competitors...

There’s been a lot of talk lately about “deconstructing PACS” in order to free it from silo-ed systems. Customers want fast image viewing, diagnostic integrity, flexible worklist, integrated 3D, platform independence and information lifecycle management. Legacy PACS does not perform all of these functions well, which is why Synapse 5 is so different.

Synapse 5 PACS inherently does what PACS deconstructors would do if they could: It helps transform healthcare organizations as they enhance collaboration and optimize workflows across the enterprise.

I'm not seeing anything that says Visage and TeraRecon can't do all that, too. In fact, Fuji's non-deconstructed PACS sure sounds a lot like Visage's deconstructed PACS. But I'm sure there are differences.

Remind me to stop by Fuji's booth next RSNA. If I'm still in the business, that is.