Thursday, October 26, 2006

Doctor Dalai's Advice on Impax 6.0:

We are now several weeks into our Impax 6.0 upgrade. It has gone fairly well, but the glitches keep coming. At this point, I would recommend that anyone considering upgrading to Impax 6.0, or even a new purchase thereof, wait until some of these issues are corrected.

I want to differentiate between a glitch and a design problem. When my workstation crashes periodically due to an "application server error", that's a glitch. When Voxar 3D keeps launching and relaunching because the "Volume" button is pressed, that's a design error. More on those later.

The workstation crashes are intermittent today, although another (or maybe the same?) application server error brought the whole enterprise down for two hours a few nights ago. BIG glitch. I don't know if this is meant to fix that problem, but a hardware upgrade is planned for the weekend which will add "more processors" to the servers. Keep in mind, our enterprise required three complete application servers. Beyond the crashes, there is often a very perceptable (in other words, long) delay between clicking something like the "mark dictated" button, and the action occuring. Is this a network problem? A .NET problem? A Doctor Dalai problem? I don't know, but it is annoying, and can lead to multiple clicks which then can cause other problems, like prematurely marking a study as read.

Some problems lie somewhere between design errors and glitches. Bringing up a study that has a prior, or alternatively looking at a patient who has multiple studies can be an exercise in frustration. The Text pane on the left monitor shows the information for only one study at a time, and this is where one types in comments to the ER or whatever. You have to be very, very careful to ensure that the study that is selected in the Text is the one you wish to alter, because Impax does not seem to decide this in any logical fashion. The fetching of priors has, at least, improved considerably, but sometimes the study will open with an old exam presented on the primary monitor instead of the new one.

One major problem we are having is with the Series bar, which contains thumbnails of the sequences available, say for a multisequence MRI. Perhaps this problem would be solved with hanging protocols (which have not been made for us as yet), but we often find ourselves struggling to be certain that all sequences have been read. Amicas has a similar, but permanent bar (Agfa's can be closed), but somehow, it works better. Perhaps it is because Agfa's has all sorts of arrows and such, but just doesn't let you see all the thumbnails at once, even if you make them fairly tiny. This needs work. I'm still not too happy with the toggling, and the toggle-on/toggle-off nature of the Impax controls. This leads to the Voxar 3D problem. The integration of Voxar to Impax is almost perfect, and I have to say works much better than the integration of full Voxar to Amicas (which really isn't integrated at all.) The problem is that once the "volume" switch is toggled "on", every time you click over the image, Voxar is restarted. Who ever signed off on the doggone toggling mentality anyway?

I am hoping that all of the glitches and at least some of the design errors outlined in this and other posts will be addressed by RSNA. Until then....patience, young padawans, patience. In other words, wait a bit before you jump.


Anonymous said...

Does anyone have Cerner PACS? How would you rate them? We have Cerner PACS and I am not a happy camper. I have to reboot my computer twice a day. It can take up to 3 minutes to retrieve and load previous studies. The service is terrible. Everytime they make a software change the system goes down the next day. What does everyone else think?

bangima said...

Thank You Dr. Dalai for initiating a discussion on the difference between a Glitch and an Design Error. As a Pacs admin, i am faced with a lot of these on a daily basis - not much is done about a lot of glitches ( which are waiting to morph into Design errors). Vendors are usually very slow to react to any issues till you place a knife at their neck. . .As a recent PACS divorcee (we are scrapping one of the larger PACS vendors in the market for a slightly smaller player) i understand how frustrating Glitches and functionality can get.
I have also seen that radiologists, contrary to popular opinion, are relativly more tolerant to errors, glitches and people in general. . .I attribute that to dependent induced by inefficient technology- Any other Physician would not be as tolerant. . . Its funny that i am saying this.. . only yesterday. . i was rambling about babysitting users after getting a solid dressing down from my rads about a persistant snag in our system!!