Australian Adam Addresses Agfa Agony

I posted my article, "I'm Not The Only Critic of Impax 6.0" exactly two months ago. This morning, I received the following comment from Adam, who hails from Canberra, Australia:

This article regarding Impax 6.0 highlights many deficiencies in the product, but also makes obvious the user's lack of training and/or ability.

Many users of IT software continue with a particular product because of its familiarity. The direct port of the Image Area from previous version of Impax in Impax 6.0 appears to serve a useful purpose - it drastically reduces a radiologist's learning curve in a version migration. I personally think that the focus of the initial release of Impax 6.0 has been the change in architecture for the benefit of the enterprise, rather than a feature-list change for the benefit of the radiologist. Granted, many of the issues listed are valid and frustrating. However, complaining of series linking difficulties because the images switch size clearly demonstrate that the Lama does not understand Windows Control Panel mouse preferences. Similarly, had the Lama actually had his PACS people show him the Simple Search feature, he might then appreciate the simplicity of searches. Another - understanding the so-called tool toggling - can actually serve a useful purpose if one uses the extended tools attached to the selected tool (such as the variable W/L rate activated through the middle mouse button). The Lama is not the only one unhappy with various features, as would occur with any software. I think, though, that the Lama has focused too much on the effect on the radiologist and not enough on the benefit of his clinical referrers.

OK, let's examine this carefully. I have used Agfa products since the mid 1990's, going from Impax 3.0 to 3.5 to 4.5 to 5.2 and now to 6.0. I think I am familiar with how they work. Adam takes the usual defense that if you don't like my toy, it's all your fault, and nothing to do with the toy itself. In the process, he disparages me, as well as Nick and Darby, the Agfa trainers who did a great job for us. Anyway, those who have taken similar Agfa journeys know that there was a major change in many functions between 3.x and 4.x, when the toggling and clone windows and so forth were introduced. So, that was not an attempt to cushion the old users, but rather a deployment of new approaches. True, this has been carried lock, stock, and barrel into 6.0. As an aside, Agfa people did agree that the purpose of 6.0 was indeed to move to a different platform rather than change anything for the radiologists. Was this a good idea? I don't think so, obviously, but Agfa did. I like automotive analogies, and this reminds me a lot of Saab. They are known as rather esoteric, doing amusing things like placing the ignition switch on the center console by the gearshift. They have a loyal following, but the rest of the world is used to doing things in a different manner. You don't see too many Saab's out there relative to everything else, and no other company does the center console key.

In his rush to condemn me for having problems with Impax 6.0, Adam has ignored a few things. Agfa gave access to Simple OR Advanced search, and not both. Our IT people chose the latter, to our detriment. The image size thing that Adam alludes to was an acknowledged glitch in Impax. If one allows a double-click to resize an image to 1:1, it will override any other function. This is a poor design, and should be removed. Changing the double-click timing might help, but not much. And don't even start with me about toggling. I understand why it's there, but it just bogs me down, and I wish it would go away.

Finally, I just have to sit in amazement at Adam's last comment that I've focused too much on the effects on radiologists. Uh, sonny, I am a radiologist, and my viewpoint is pretty much ingrained. Now, don't get me wrong, I do understand that clinicians use the system, and I encourage them to do so. I have been in discussions with a very eloquent orthopedic surgeon, orthodr, on AuntMinnie, who is a very well-versed in PACS, and he is making me understand more and more of the clinician's needs. On the other hand, I'm not going to sacrifice functionality or put up with confusing, unintuitive tools in deference to the clinicians. I would submit that what works well for those that use it 24/7 to do their job should work pretty well for those who use it occasionally. At least the former group has to take precedence. For some reason, that is a controversial viewpoint, but I think it is very valid.

Impax 6.0 is doing a little better. The crashes have all but ceased, but much weird and esoteric behaviour continues. I am most troubled these days by very slow refresh of screens, as well as the propensity for the thing to open an older study when I want to see the patient's latest. And so on.

I do appreciate Adam's defense of Impax, although I'm sure Agfa appreciates it more. Sadly, he does fall into that same trap of blaming the user, when it is the product that has problems. There is a very strong current of "I'm from IT and I know far better how this thing works and how you should use it than you do." There is considerable condescension to radiologists as well, implying that they are unable or unwilling to learn a new platform, and no doubt that describes many of my bretheren. Still, even the least computer-savvy member of my group was able to sit down at an Amicas workstation and be proficient with it within 30 minutes. That should tell you something. Sorry, Adam, but the ultimate purpose of PACS is for radiologists, and clinicians, to care for their patients. This is not a possession of IT, and it cannot be treated as such. The Lama understands that much.