Free My PACS

Walt Mossberg from the Wall Street Journal discusses problems caused by restrictions wireless companies place on customer's phones. Courtesy of http://www.wsj.com.

I generally agree with Walt Mossberg's technology assessments, published in the Wall Street Journal. I am not, however, a Palm Treo aficionado like Walt is, and I think he needs to get himself a new cell-phone. But that's a minor disagreement.

Cell-phones are the topic of Walt's latest rant, Free My Phone, published in today's WSJ. Walt is disturbed about the limitations placed on technology by the US cell-phone carriers:

Suppose you own a Dell computer, and you decide to replace it with a Sony. You don't have to get the permission of your Internet service provider to do so, or even tell the provider about it. You can just pack up the old machine and set up the new one. . .

This is the way digital capitalism should work, and, in the case of the mass-market personal-computer industry, and the modern Internet, it has created one of the greatest technological revolutions in human history, as well as one of the greatest spurts of wealth creation and of consumer empowerment.

So, it's intolerable that the same country that produced all this has trapped its citizens in a backward, stifling system when it comes to the next great technology platform, the cellphone.
A shortsighted and often just plain stupid federal government has allowed itself to be bullied and fooled by a handful of big wireless phone operators for decades now. And the result has been a mobile phone system that is the direct opposite of the PC model. It severely limits consumer choice, stifles innovation, crushes entrepreneurship, and has made the U.S. the laughingstock of the mobile-technology world, just as the cellphone is morphing into a powerful hand-held computer.

That's why I refer to the big cellphone carriers as the "Soviet ministries." Like the old bureaucracies of communism, they sit athwart the market, breaking the link between the producers of goods and services and the people who use them.

To some extent, they try to replace the market system, and, like the real Soviet ministries, they are a lousy substitute. They decide what phones can be used on their networks and what software and services can be offered on those phones. They require the hardware and software makers to tailor their products to meet the carriers' specifications, not just so they work properly on the network, but so they promote the carriers' brands and their various add-on services.

Now, the tie-in to PACS is obvious, and this really parallels the argument I presented in my older post, "Euros, Assumptions, and Greek Islands," wherein I bemoaned the fact that one cannot place an interface from Company A on Company B's archive.

It's somewhat ironic that I should be taking this stance. Remember my post about my visit with Dr. Bernie Huang? When I saw PACS in its infancy, it seemed to me that the only way it would be practical would be to package it in one box, i.e., sell the archive, the viewing stations, and probably the wires themselves as one package. I have to think I was right at the time, and in fact this approach represents about 99% of the PACS installs out there at the moment.

But today, PACS has matured and things have come full circle. There are vendors that make great GUI's, but are said to have weak back-ends, archive architecture, and some that have just the opposite reputation. Some use Windows components, and some use Sun/Unix based Oracle databases. There are SANs, NAS's, tape drives, DVD archives, and so on. Yes, I'm throwing a number of disparate elements into this mix, but you get the idea. Why should we be married to one company for every aspect of the PACS solution? Right now, the answer is that the vendors have us locked into the status quo. If you don't agree, just call your vendor and tell them you are going to migrate to another company's GUI. The only way to do so is to forklift out what you have and transfer all the data to the new system, GUI, archive, and all. Not so easy. It's just like trying to take your AT&T phone and migrating it to Sprint. You can't. It's not technically possible, because they are incompatible systems. At least PACS data can be migrated after a fashion, although any peculiarities in the way data is stored (like compression, for example) will bung up the process. (For a fantastic discussion of databases and archives and migration thereof, please have a look at Mike Cannavo's latest Aunt Minnie article, "Exploring PACS Secrets -- Straight talk about archiving and data migration.")

The thought of opening up PACS in the manner proposed is probably giving execs for the major vendors chest pain, or perhaps something lower. They will claim that this concept will interfere with patient care because their system won't work as it should. I respectfully disagree. Mossberg cites a similar decoupling in the telecom industry, that worked quite well:

We've been through this before in the U.S., though many younger readers may not recall it.

Up until the 1970s, when the federal government intervened, you weren't allowed to buy your own landline phone, and companies weren't able to innovate, on price or features, in making and selling phones to the public. All Americans were forced to rent clumsy phones made by a subsidiary of the monopoly phone company, AT&T, which claimed that, unless it controlled what was connected to its network, the network might suffer.

Well, the government pried that market open, and the wired phone network not only didn't collapse, it became more useful and versatile, allowing, among other things, cheap connections to online data services.

I suspect that if the government, or some disruptive innovation, breaks the crippling power that the wireless carriers exert today, the free market will deliver a similar happy ending.

And the same for PACS.