Tuesday, June 24, 2008

Dalai Does Dallas

I had a rather quick turn-around last week. I arrived back home from New Orleans at 5 P.M., and had to fly out to the West the next morning. We were booked on American Airlines, and we knew this was going to be problematic when the ticket agent predicted American's bankruptcy within the next 6 months. Always reassuring before a flight. To make matters worse, I used my smartphone to check for the connecting gate in Dallas, and lo and behold, it had been cancelled. Fortunately, we were able to rebook on US Air to our destination, and all was well.

American blamed the cancellation on weather in Dallas, and truly there was a big storm there that day. However, the storm lasted less than an hour, and I personally think American was looking for excuses to suspend flights and save fuel. Maybe that's why they tell some of their gate agents to be nasty to the flying public; one less customer, one less gallon. However, given their rather unfortunate habit of letting their planes sit idling with the engines running while waiting for their gates to clear probably eats more fuel than they save with cancelled flights and lost customers. Scratch one more airline.

I actually wasn't planning to travel again quite so soon, but I received a call from Amicas asking me to fly out West to speak with some potential customers. They thought the doctor-to-doctor thing might be helpful, since the group was somewhat similar to mine, and what they wanted to do with the product was rather close to the way we use it. So, off I went. Lest anyone dare call this a junkett, I'll reiterate that I really didn't want to go anywhere at that time, and I certainly wasn't interested going West where the temperatures were well above 100 degrees. But faith in the product, and maybe a little vanity, made me decide to do it anyway.

The radiology group in question is sort of like mine, about the same size, with a few guys older than I am, and more that are younger. They are rather spread out, covering several towns rather far from their base, as do we.

Now, I won't reveal the particulars this group sought, but portability was a critical factor. They had narrowed their choices down to Amicas and another company, and they were having some trouble deciding beyond that. On the advice of my very wise, and occasionally politically-correct friend, Mike Cannavo, the One and Only PACSMan, I won't name the other company, but suffice it to say they are definitely one of the BIGGER players.

I had the chance to speak briefly with some of my counterparts in this Western group, as well as their IT guru. It became clear that they saw the viewers of both PACS as equal. They made the assumption that both could serve their needs, but they still had some hesitation about Amicas as a smaller company vs. the "security" of the BIGGER company. I'm not sure I got all of my points across in person, but I'm told that many of them read this blog, so here is everything I should have said, just in case I didn't.

First and foremost, Amicas is a scrappy little company that isn't going anywhere. I'm always seeing something on AuntMinnie.com about how little PACS companies are going to either die or be taken over. That's true for some, but I don't include Amicas in that pile. They have a great deal of money in the bank, the company is buying back its stock, and 20% of revenue goes into R&D. It is acquiring new technology such as RadStream (the acute-event reporting software from Cincinnati Children's that I have discussed elsewhere.) Sure, if some company like Siemens offered them double what they are now worth, I'm sure they would sell out (I would), but I don't see that happening any time soon. Let's put this takeover idea to bed for today, shall we?

Somehow, there has emerged the illusion that there is safety with purchasing from the BIGGER company. Hmmmmmm... Just ask anyone who bought Centricity in the last few years how safe that is. Or the old Philips PACS made by Sectra. Sadly, the BIGGER folks have an easier time of buying some new technology and requiring a forklift upgrade (usually hardware needs replacing as well as software in these circumstances) for you and me to get it. And, they are not worried (at least not as much as they should be) about whether or not you and I will pony up the charge for the next latest and greatest. After all, the BIGGER company was the safe bet, wasn't it? I can't see that we are particularly worse off dealing with a smaller company that isn't looking to swap out its product for something new, rather than improve and grow what it has. There are those who still believe the old "no one gets fired for choosing BIGGER" philosophy, but I guess I'm not in charge of their particular operation.

Only a few of the BIGGER folks have totally web-based technology, but most don't, and that is the case with the BIGGER company in question here. Is that a problem? Well, it depends upon how many software clients you wish to play with. Amicas has just one GUI, called LightBeam, which is deployed over the web to anywhere you happen to have a computer and broadband. To be totally accurate, there is a second client called LightView, that is simply LightBeam without a couple of features such as spine labelling. Which client and features are activated depends upon your status as a radiologist, clinician, tech, etc. Our friends at the BIGGER company seem to use several clients, some thin, some thick, and as I understand it, I could not put the thick client on my computer myself without help (authorization, I guess) from IT or the PACS team. Hmmmm.

How does the system distribute images? Most everyone is now going to a central repository. Amicas basically ties a web-server to a SQL database. (Note: Amicas now uses the IBM DB2 database which in turn runs SQL.) Why reinvent the wheel? This architecture works pretty well for other web applications, so why not use it? Is this what the BIGGER company does? Well, to some extent, but there seems to be a lot more complexity added, without necessarily getting a lot of additional advantage. This could be quite critical to my new friends out West, as their enterprise spreads far and wide, and the way the system deals with connectivity (or the lack thereof) could make or break the system. Amicas will allow a modality to automatically resume sending once a broken communication line is repaired. It seems that the BIGGER company requires a manual resend in this situation. Could be a problem.

Service should be a given. I've had a few glitches with Amicas service, but our downtime on our group's system has totaled only an hour or two in two years, and most things get caught before they cause chaos. I sure can't say that about some of the BIGGER companies I deal with daily. As for the BIGGER company I'm referring to here....well, I'll let someone else answer for them.

To me, the background operations don't matter as much as the actual interface, the client, the GUI. I like the way Amicas works. It doesn't get in my way, and it lets me bang through studies as fast as I feel comfortable doing so. Can we say this about the BIGGER GUI? I guess it depends upon which one of the options you actually use in practice.

Bottom line here is that BIGGER is not necessarily better. Look honestly at the products themselves, with no preconceived notions about BIGGER companies being safer than smaller companies, and the like. See what works for you and your group, and be sure they all get time on the GUI before you sign on the line. You might find that smaller works for you. I have lived through situations where the purchase was directed to the BIGGER, "safer" choice, and for three times the expenditure, we got half the product.

And no, I don't get a commission, so I have no vested interest in which way my friends out West decide to go. But I'm sure they will make an informed choice. They DO read my blog, after all!

P.S. No, the BIGGER company in question is not the one you think it is. I would have said bigGEr were that the case.


Anonymous said...

I thought Amicas uses an IBM DB2 database?

Anonymous said...

He said they used DB2. Additionally, SQL is a language not a brand. So essentially, you run SQL across all databases such as Pervassive, MySQL, Microsoft SQL, etc.

David Clunie said...

Hi Sam

Did you warn your friends in the West about the problems caused by unimportable non-DICOM CDs written by the Amicas Lightbeam ?

At least the BIGGER vendor complies with the DICOM standard in this regard.


Anonymous said...

Next version of Amicas will burn DICOM compatible CD's

Anonymous said...

We'll see how well Amicas builds to the DICOM standard. But why not build to the IHE standard? Oh, I forgot, Amicas doesn't participate in IHE.

Roentgen said...

Good post. This is a clear example of the big dilemma faced by radiologists / practices when choosing a RIS/PACS/Medical IT system. Fully agree that bigger is not necessarily better, although too small is a risk as well :P

Anonymous said...

Hey just for the record AMICAS does burn DICOM compatible CDs today with the Sorna CDR devices and has done so for a while. Most burn their CDs from this burner which is included in most AMICAS configurations. The perception that AMICAS cannot burn a DICOM CD today is just incorrect.

On the overall topic of "bigger" versus "smaller", there's a rich history of the customers of the "bigger" vendors in the industry getting burned, and badly. GE Centricity RIS customer? You've been burned. Philips/Sectra customer? You've been burned. GE Centricity PACS customer? You may very well get burned as the DI acquisition takes hold. The notion that choosing a "big vendor" is in and of itself a safe choice has been proven incorrect over and over. The customers who have bought the "modern technology" have come out whole in each case sited above.