Survival of the Fittest . . . Small PACS Companies

Hershey Ice Breaker PACS candy, courtesy http://www.likecool.com/

Any time Amicas is mentioned on AuntMinnie.com, there follows a wave of responses divided into two main camps. There are those of us who love the product, love the company, and will defend it to the hilt. That should gladden Steve K's heart no end. However, there are the usual nay-sayers that generally knock any company with revenues less than the nation of Panama.

So it goes on a recent thread, started by Michael D, who was interested in the latest Amicas offerings. Larry, the Cable Guy from Nebraska, posting as GITRDONE, immediately pounced:

Amicas is a very small, almost regional player in the PACS market, they have a decent product but that is where the positives end. They have very spotty support coverage, and their long term sustainability is suspect. They are still around because of a large infusion of cash a few years ago, otherwise they would be another Merge story right now. They have a me too product though that you can get from 15 or so other companies that all seem to be in the same boat. If you want to buy a simular product for a simular price from a company that will more than likely be around in the next 3-4 years I would look at McKesson, Fuji or Philips. I would guess that Amicas will be purchased or fizzle out in the coming years as they just don't have the scale or talent to play in the replacement market.

Larry later reveals that he works for a PACS vendor, apparently in Nebraska (my old stomping grounds!), and his main competition there is NovaRad. Larry keeps repeating his mantra throughout the thread:

1. Small companies will die or be assimilated.
2. Amicas has a me-too product, identical to 15 others.
3. You are far better-off buying McKesson, Fuji, or Philips.

Now, I'll be the first to agree that there are tremendous pressures on PACS vendors, especially the smaller companies. And yes, some will disappear. Having gone to many, many RSNA's throughout my career, I can vouch for the fact that a number of the products and companies that were there at the last meeting didn't survive to make the next.

Beyond this, I disagree completely and totally with Larry. Amicas' product is very different from the others, and really, it is only when you reach the next tier down from the likes of Amicas, Intelerad, and DI (well, they used to be at this niche) with some of the smaller fry that the GUI's start to look a little more alike. And even those products are unique. The IT types simply don't understand that radiologists don't all work in the same manner, and different rads and different groups will need different approaches. I'm not so much of a Pollyana to say that everyone would love Amicas if they tried it. (I would wager that lots would, but that's beside the point.) Me-too product? Not even close.

The small companies provide innovation that does not exist, at least to the same degree, within the large behemoths. Without Amicas, Stentor, Dynamic Imaging, and even ScImage, to name just a few of the small players, PACS would be probably be stuck back in the state of trying to immitate film, with tiled-displays on $50,000 Sun boxes. I don't think there's much question that the little guys, well, some of them anyway, have led the way in trying to give the customers what they want.

But Larry essentially paraphrases the old IT belief: "No one ever got fired for choosing GE." The large company is safe. It will be there tomorrow, and will always be available for service and to take care of me. Hmmm...sounds a little socialistic to me. Sadly, with this opinion borne out of fear of making the wrong choice and looking bad and/or getting fired for it, comes a complete dismissal of the needs of the folks for whom the product is being purchased. If the big boys understood the needs of the radiologists, and wrote their software with them in mine, there would be no smaller companies in this business. But that isn't the way it works.

With the shrinking number of dollars to spend, the PACS consumer has to be far more savvy than ever before. No longer can an IT committee hijack the decision, insisting on the "safe" purchase from the large company. Been there, done that, and the results are not pretty. Spending, oh, I don't know, 2-3 (or more) times what an Amicas installation would have cost easily bought us 1/2 the usable system. We can no longer afford to blow millions in that manner.

I find it most amusing that Larry repeatedly mentions McKesson, Fuji, and Philips as his "safe" choices. What happened to Agfa and GE? GE is the biggest PACS company of all, and I will absolutely guarantee in writing that they will be here 100 years from now. (And if they aren't, good luck collecting on that bet!) Why doesn't Larry mention them? Could it be that Larry thinks they can't GET'R'DONE? Maybe buying from the large company isn't always the best idea after all. Or does Larry work for Fuji?