Some Up-and-Comers..Building a Better Mousetrap?Chapter IV: Epilogue

The latest KLAS reports were very favorable for Intelerad and Dynamic Imaging, (and DR) and somewhat less so for Amicas, and Stentor/Philips. Now, neither Amicas or iSite did badly, but they aren't at the top anymore in several categories, and their trend indicators show downticks since Summer and Fall, 2005. We have seen similar patterns before with up-and-comers. In iSite's case, the problem likely has to do with the acquisition by Philips. This represents a major change in the way they do business, although I'm not really in a position to say if this will be a good or a bad thing.

Amicas likely has suffered from its success. When you grow too fast, there is some lag time before you can get adequate infrastructure in place, and I'm guessing that is the reason behind some of the changes in their KLAS indicators. Note that they are still showing a vast majority of green, and the report is not bad, but speaks a bit less enthusiastically than it has recently. Not that I believe totally in the (somewhat subjective) KLAS report.

I had some privacy over at the Intelerad booth, with just me and the VP going over the demo, although he was very interested in my reactions. For the Dynamic Imaging demonstration, just about the entire staff was gathered around me. They seemed to be hanging onto my every word and gesture...didn't they realize that I'm just an average radiologist in an average practice in an average town in the South? Oh well. Guys, you both have excellent products. From the user standpoint, they are both quite usable, although I have to give the nod to IntegradWeb for having a number of nice additions.

Now, here is where I make everybody mad at me, and I'll give my apologies up front.

Both InteleViewer and IntegradWeb, as well as Emageon, and even Impax 6.0, suffer from one common problem: they are hyperconfigurable. I am going to call this the Lego PACS syndrome. Keep in mind, Lego was my absolute favorite toy growing up, and my children love it as well, so that is not a derrogatory term by any means. In this setting, I am referring to the fact that you can make a tremendous number of adjustments to the interface of these PACS products, and I'm not sure I like that idea. This is why I am going to stubbornly stick to Amicas LightBeam as my favorite interface. Their initial approach is clean and clear, and it doesn't get in my way. Any radiologist smart enough to be reading films in the first place can be up and running in 5 minutes with minimal training. There is easy access to very powerful tools, but there is only a minimum of set-up necessary. I have no doubt that the other systems could be configured to work in similar fashions, or maybe even to work better, but sometimes less is more. (I hope my friends at Intelerad and Dynamic Imaging will remain my friends after that.)

I sit on the Amicas Physician's Advisory Committee, and I will actually have a say in where they go with their future PACS products. (If you are wondering, my compensation for attending the Committee meeting at RSNA was a very nice breakfast with juice, coffee, eggs, and turkey sausage.) There were distinct voices in favor of moving toward a Lego PACS with the next generation; several members wanted the system to allow more customization and various options, which would require more and more set-up time. Some of us, including yours truly, want the old approach, a simple, straight-forward clean interface, though revamped to take advantage of some of the newer software technology. This is what has always distinguished Amicas from everybody else, and this is what must be leveraged to stay ahead of the game.

Having seen some of the other stuff out there, I do have to cite a few deficiencies that Amicas has to address, and frankly I would like to see this done as a service release(s) to the existing LightBeam. First, they have got to start burning DICOM CD's. This is really an industry standard, with Amicas and iSite being among the last holdouts. I hear this is coming soon. Second, there needs to be one-button integration with Voxar3D. Apparently there was delay in acquiring the Voxar ActiveX controls, but these are now available, as seen with the IntegradWeb interface. If the embedded "baby Voxar" is still there, we need to have some way to save the images it produces back to PACS. Third, there needs to be an improved comment/note field, which I think could be tied to the order window. Finally, there should be detection of monitors with subsequent deployment of windows and hanging protocols. I have discussed these little problems with Amicas, and I am under the impression that most will be fixed shortly, even before the latest and greatest comes out this time next year.

I actually have a rather bold idea, although I doubt anyone involved will like it. The folks at Dynamic Imaging have some good ideas, and they have an installed base of 100 clients with 300 sites. What do you think about Amicas buying Dynamic Imaging? Hey, if it works for GE.....

Sigh. I met a fellow radiologist at the DI booth, Dr. B., who summed up everything perfectly. He said, "We need to line up all the radiologists and all the PACS vendors in front of a firing-squad, and make them come up with ONE single way to do all this." I couldn't agree more, as long as I get to hold the rifle.

In any case, let me wish everyone Happy New Year! May your PACS never crash, and your drives always spin. See you in 2006!