Thursday, December 31, 2009

Romanian Spam, And Other Thoughts On 2009

I hate Spam with a passion, the electronic kind, that is; I don't think I've ever tasted the Hormel version. The spams I hate most are those from the same source that keep coming and coming and coming. In the past several months, I've been receiving literally hundreds of Spam e-mails from some degenerate in Romania, and according to SpamCop, it's all being sent from the Romanian ISP, I've alerted them dozens of times at the email listed on their contact page, but to no avail. So, I sent an email to the Romanian Ministry of Communications and Informational Society, asking for their help in shutting this jerk down. We'll see what comes of it.

2009 has been a year of changes, some good, some bad. On the other hand, some things didn't change at all. Here are just a few items that come to mind from the PACS world, not in any particular order:
  1. AMICAS buys Emageon, and is in turn bought by venture cap firm Thoma Bravo. AMICAS comes out with a higher stock price than has been seen in years (although the vultures disagree with the valuation for some reason). They also gain access to a vendor-neutral database (joining several other companies), a cardiac package, and a large number of customers they hope to keep happy. Emageon was a pretty good system, as evidenced by the loyalty demonstrated by some of its users. There may be a few more elements that AMICAS could utilize before sending the Emageon GUI into the Ethernet for the last time. AMICAS Version 6, affectionately known as simply AMICAS PACS, is deployed, although it took quite a while to get from prototype to production. We hope to get ours sometime in early to mid 2010.

  2. GE continues to slog away with the reimagination of Centricity. To my knowledge, and someone please correct me if I'm wrong, Centricity IW, the GUI purchased with the Dynamic Imaging acquisition, has yet to be completely and successfully deployed. We'll cross our fingers for 2010.

  3. Agfa IMPAX is once again the bane of my existence. I'll give credit to Agfa for fixing some of it's problems, but many remain. I'm expecting an upgrade in early 2010. Frankly, if I were Agfa, I would concentrate all possible resources on IMPAX 7, and get it out the door. Assuming it actually works properly at that point, which is a major leap of faith for me right now.

  4. Cloud computing/storage becomes the rage, with offerings from LifeImage and even DR Systems, amonst many others. To me, this is truly the future of PACS. I'm going to get around to writing a full article about the cloud concept sometime in 2010. (That's about the only resolution I'm making this year.)

  5. Enterprise PACS, with universal worklists blanketing multiple sites and multiple systems, appear from several vendors, notably Intelerad, Carestream (with the boldly-named SuperPACS™), and eRad, amongst others.

  6. Thin-client advanced imaging packages proliferate, with varying degrees of integration to PACS. Visage takes a unique approach, touting the ability of their system to serve as an overlay, if you will, to a legacy PACS.

  7. Siemens revamps their IT offerings with the new syngo.x platform. Look for syngo.via advanced imaging, and syngo.plaza PACS in the near future.

The major medical story overall is, of course, the nearly-complete passage of the health-care bill by Congress. This abomination will certainly change health-care . . . for the worse. Yes, more people will be insured, at tremendous cost, with the eventual erosion of what once was the best system in the world. Please don't bother citing statistics that "prove" otherwise. Those "facts" are gerrymandered and twisted to make us look far worse than we really are. Infant mortality, for example, is "worse" in the U.S. because we count every single live birth in the denominator. Most other nations don't. Our cancer survival is significantly better than elsewhere. You are twice as likely to live through a myocardial infarction here than in many other countries.

Those celebrating the "historic" passage of the bill may be deluded into thinking they have done some good. Sadly, the real reason behind this legislation is power. The Democrats have just snatched 1/6 of the economy for themselves, and they won't let it go until death do them part. My trite little phrase, "If the government controls your health-care, it controls your LIFE," is quite apropos. Once the government steps in and manages, if not provides, health-care, the majority of the public will become dependent upon the ruling party, and will vote them back in again and again. Feel free to disagree, but you won't convince me otherwise.

Our Attorney General, along with those of several other states, is investigating the legality and constitutionality of the gift given to Nebraska as a bribe to Senator Ben Nelson, and they are also looking into the propriety of forcing everyone in the country to buy insurance. We can only hope that the laws of this nation will be visited upon our out-of-control Democratic Congress with the same level of vengeance they have shown to us. And make no mistake, 2010 will be the year of revenge of the average U.S. citizen upon the power-mad Democrats who would have our nation emulate the socialism of their European idols.

Terrorism has reared its ugly shorts in the form of the Crotch-Bomber. We knew we were in line for more terrorist attacks, and I'm really surprised we haven't seen one until now. The Administration is deeply involved in the finger-pointing as to who didn't do what to prevent this near-tragedy. Sadly, until the Democrats acknowledge the fact that we are at war with the terrorists, we are in danger. It was with some trepidation that I put my kids on planes this week to visit friends. We aren't safe, and I don't trust our government to make much progress in this regard.

Climate-Gate should have altered the global climate warming change debate, but that was not quite the case. Emails, ummmm, liberated (supposedly by a hacker, but possibly by someone on the inside) from the Climate Research Unit at the University of East Anglia in England show that the data has been manipulated, altered, corrupted, and otherwise trashed to come to the anthropomorphic conclusion desired by these left-leaning "scientists". But the fact that there is now no "fact" in existence concerning mankind's responsibility for global warming (which isn't really even happening) doesn't bother those who are convinced of our guilt. Talking with these folks is a very surreal experience. "The data was faked," I say. "But we're killing the planet and we need to all change our ways!" the accolytes cry. "But there's no proof of mankind's involvement," I reply. "But we're killing the planet and we need to all change our ways!" the accolytes cry. What can you do? The only truth in all of this is that yet again, this issue becomes the excuse for a power-grab, a path to more and more government control and domination. And no, I don't think the government is acting in anyone's best interest.

You'll be amused to know that I intend to buy a hybrid vehicle when the time comes to replace something in my family fleet. I'm anticipating gas going up to European levels ($8/gallon) before too much longer, and once that happens, prices on hybrids will also skyrocket. While I don't approve of gratuitous pollution, I'm not convinced that my SUV and I are personally responsible for the death of the polar bears (which isn't really happening, either).

I haven't even begun to touch the specter of a nuclear Iran, the quagmire in Afghanistan, and many other critical issues.

Much is bleak on this New Year's Eve, but there is much promise as well. We can either look forward to the future and hope for change (not the hope and change delivered by Washington so far, thanks) or we can wallow in despair and anger over what is being done against us by our enemies, not to mention to us, supposedly for our own good. Best, of course, to choose life, hope, and optimism. 2010 will bring good things for the country and the world. We hope.

Maybe 2010 will deliver a working version of Centricity IW, and a more functional IMPAX 6.5. I can dream, can't I?

I'll be back next year, much to the chagrin of some of you, and perhaps the amusement of one or two of you.

And with that, I wish you all a most happy and healthy holiday! Don't drink and drive, by the way. Let me know if you need a cab, and I'll call one for you. Happy New Year, everyone!

Monday, December 28, 2009

Bravo, AMICAS!

Now that the press-release has hit the wires, I can reveal the nature of the "Big News" from the last teaser post:

BOSTON, Dec. 28 /PRNewswire-FirstCall/ -- AMICAS, Inc. (Nasdaq: AMCS), a leader in image and information management solutions, today announced that on December 24, 2009, it entered into a definitive merger agreement to be acquired by an affiliate of Thoma Bravo, LLC, in a transaction valued at approximately $217 million. The AMICAS Board of Directors unanimously approved the agreement and resolved to recommend that the shareholders of AMICAS adopt the agreement.

Under the terms of the agreement, AMICAS shareholders will receive $5.35 in cash for each share of AMICAS common stock they hold, representing a premium of approximately 24 percent over AMICAS' average closing share price during the 30 trading days ending December 24, 2009, and a 38 percent premium over AMICAS' average closing share price during the 90 trading days ending December 24, 2009. . .

"We look forward to continuing our mission to provide the best solutions for image and information management in healthcare," said Dr. Kahane. "We believe that working with Thoma Bravo will enable us to focus our resources on our business and our customers. With the additional capital and operational expertise available to AMICAS through Thoma Bravo, we will be able to grow as the needs of our customers evolve and will be enabled to better serve our market."

"Thoma Bravo is excited to partner with the AMICAS management team to continue growing the company into the leading provider of image IT solutions for the healthcare industry," said Orlando Bravo, a managing partner at Thoma Bravo.

"Thoma Bravo will further strengthen the industry leadership position of AMICAS through organic growth initiatives, acquisitions, and implementation of operational best practices," added Seth Boro, a principal at Thoma Bravo. "We look forward to helping AMICAS better serve the evolving needs of its healthcare industry customers."

This bodes well for AMICAS, while delivering a late Christmas present to their shareholders (which I am not). Based on my perusing of investment chat rooms and bulletin boards over the years, the market has absolutely no idea what PACS is or does, or which companies to trust. Being freed from the demands of shareholders should be very good for AMICAS. I guess time will tell.

When I heard the details of the merger/acquisition, I breathed a sigh of relief. The call to me and several other long-term AMICAS customers came on a Sunday evening during a holiday weekend. I had the sinking suspicion that AMICAS had been bought, and in my limited view, the only likely suitor left was Cerner. That would have spelled doom for AMICAS. Fortunately, I was wrong about that part. I just wish I had purchased some stock over the years, especially when it was below $2.00. But then, I would have lost credibility with the crowd that thinks I'm an AMICAS spokesman, which I'm not. And besides, I'm always skittish about putting my money where my mouth is. . .


My friend Mike Cannavo, the One and Only PACSMan, let me know about a couple of lawsuits pending on this merger/acquisition. A quick Google shows several somewhat predatory-smelling listings. Here is one example:

(Lawyers-R-Us) has commenced an investigation into possible breaches of fiduciary duty and other violations of state law by members of the Board of Directors of AMICAS, Inc. ("AMICAS") (NASDAQ: AMCS) in connection with their actions in causing AMICAS to enter into a definitive merger agreement with an affiliate of Thoma Bravo, LLC ("Thoma Bravo"). Under the terms of the agreement, AMICAS shareholders will receive $5.35 in cash for each share of AMICAS common stock they hold. AMICAS expects the transaction to close in the first quarter of 2010.

(Lawyers-R-Us') investigation concerns whether AMICAS' Board of Directors' acceptance and recommendation of the offer was fair and designed to secure the best possible price for all AMICAS shareholders.

If you are a shareholder of AMICAS and would like more information about your rights as a shareholder, please contact attorney (Mr. Lawyer) at 800-BITEME or by e-mail at

Lawyers-R-Us is a law firm with significant experience representing investors in merger-related shareholder class actions, shareholder derivative actions, and securities fraud class actions. For more information about the firm, please go to

Many of these gentlemen are stating that AMICAS should be selling for $6/share, even though the stock price hasn't been quite to that level in quite a long time. And people wonder why we don't have any respect for lawyers. . .

As an aside, I've been posting about AMICAS for years without properly using all-caps. I shall endeavor to do it right from now on. Sorry about that, guys.

Sunday, December 27, 2009

Big News

I'm sworn to secrecy, but there is big news coming tomorrow morning about a major PACS vendor. Watch the wires. You heard it here first!

Friday, December 25, 2009

Christmas Musings

Being Jewish, I don't do Christmas lights, but if I did, the display would look (and sound) something like this:

More information on this holiday extravaganza can be found at this link.

I'm on call for the day, working from 8AM through 11PM. Business is slow but steady, with a number of chest radiographs ordered for cough, various extremity studies for "pain", and a dozen or so exams for the aftermath of a fall. Overall, I think falls bring us more business than car wrecks, although the latter usually prompts a full-body CT. Of course, today's carnage includes head CT's on two 95-year-old's. Both showed atrophy. Imagine that.

I continue to be amazed at the minimal symptoms that bring someone into the ER, especially on a holiday like Christmas. Americans have been trained to seek care for the slightest twinge. We'll see how we like it when the lines are longer and the pampering is eliminated. That's where we're headed.

One of my friends was working the ER this morning, and we had a nice chat about IT's control over our lives. My friend is a very reasonable and easy-going guy, who orders far fewer CYA-type scans than some docs I know. This morning, however, he was not in a good mood. It seems his password quit working, and he couldn't get into the PACS system. Several calls to our "Help(less) Desk" yielded the message, "We are experienceing technical difficulties. Please leave a message." This did not go over well. I had to let him access the system with my login (don't even think of punishing me or him for that) while waiting for someone from the PACS team to get him back on. In the course of this snafu, he made a rather ominous statement, something we all need to think about. I'll paraphrase it and remove the expletives.

"IT needs to help us," he said. "Standing in the way of me getting to see the data and images on my patient will lead to someone getting hurt. And if that happens, I'm not going to take the rap for it."

I have to try to see both sides of this, but in the end, we have to err on the side of patient care. I understand that all the rules and regulations, and HIPAA and so on are there to protect the patient's privacy and that is critical. However, in an emergency situation, there has to be some compromise, some mechanism to go above and beyond the rules, for the good of the patient. If IT takes its rightful place as master of the computer/network end of PACS, then it has to be there with us to solve problems like this, even at 8AM on Christmas morning.

And now, if you will excuse me, I have to go look at the next dozen images of a 95-year-old who fell down while coughing. And as noted above, I am Jewish, not Christian, but I have great respect for the faith of my friends. After all, Jesus was just a nice Jewish boy who went into His Father's business. To Christians, the greeting of "Merry Christmas" conveys their joy and happiness of the birth of Jesus. It is a greeting borne of caring and not of malice. So, while it isn't politically correct, and I don't celebrate the holiday per se, I still want to wish everyone a very Merry Christmas and a Happy New Year!

Addendum: I just stumbled across this clip from the old TV series Northern Exposure. I hope you enjoy it as much as I did. (Many said at the time the show was running that I bore a strong resemblance to Rob Morrow, who played Fleischman. Of course that was one beard, and many pounds and gray hairs ago...)

Sunday, December 20, 2009

Dell, Windows 7, and Faulty Drivers

My wife LOVES Facebook, and she is, in particular, addicted to FarmVille, the game that glorifies shoveling manure and milking recalcitrant cows. To be fair, I play it too, but mainly because I can't let her beat me at a computer game! (And it's kind of relaxing in a mindless fashion.)

As CIO of the Dalai household, I get to decide who gets what computer. My wife's old Dell Dimension was starting to get a little long in the tooth, so off to the Dell Outlet site I went, and found a lovely Dell Studio Slim, with 6 (SIX!!!) G of RAM, a 600 Gig hard drive, and a 2.9 MHz Intel Core Duo processor. Not bad for the price I paid.

This morning was grand opening time for the new baby. I untangled all the wires and cables from the old installation, teased the old CPU out of the mess, rather like removing a dying heart in preparation for a transplant, and then gingerly plugged in the new, sleek Studio. Everything powered up nicely, and I walked through the preliminary set-up without difficulty. BUT. . . then came the attempt to connect to the internet. Epic Fail! To make a long story short, the RealTek (straight from Taiwan) network card wouldn't admit that it was connected at all, but it did claim to be otherwise functioning normally. I spent two hours on chat (on a different computer, obviously) with Dell, trying various possibilities, none of which seemed to budge anything. We tried uninstalling and reinstalling the NIC, and downloaded the latest software from the Dell site. Nada. (The RealTek site wouldn't even download the latest drivers, having links that just endless-looped back to the main download page.) I did discover an Ethernet service that wasn't on, and asked if that might do the trick. But at this point, the rep simply gave up. He said via chat,

I would have been glad to help you in this regard but I am sorry to inform you that we are not trained on Software issue because we are Hardware technicians. As I see that your system warranty only covers the Hard ware support, where in the current issue with your system is a Software issue and it is not covered under your system Hard ware. All the Software /Wireless /Virus /E-mail support /Data backup will be provided by the Dell DOC team and it is a Fee based support. They shall charge you a nominal fees only. (I would personally suggest you to go with DOC option). DOC will firstly determine the issue and than provide you the Fee details. If you feel the Fee as economical you can provide payment details and proceed with the resolution (or) you can decline it. Please let me know if you are interested, I can provide you the DOC Team phone number (or) Transfer chat to DOC support?
I was not impressed. This is a brand new, just out of the box (OK, it was refurbished, but they are supposed to be good as new, right?) machine, and I was not about to pay MORE for warranty support. Either it works today, or back in the box and back to Dell. My agent backpedalled a bit, especially after I mentioned that I was personally responsible for the purchase of hundreds of thousands of dollars worth of Dell equipment. After a pause, he suggested that I reinstall Windows 7, as that "might help".

Having nothing to lose but the added Dell trash-ware, I went ahead with the reinstall. And lo and behold, it worked! Green light on the Ethernet port, all systems go for internet and LAN connectivity!

Now, here's the interesting thing. I let Windows Update do its thing and install a newer driver for the RealTek NIC, and BAM...back to non-functionality. I rolled back the driver, and there we are, back online. At this point, I don't know if the driver is bad, the NIC is bad, Windows 7 is bad, or I've been bad and I'm being punished by the gods of Microsoft.

What lesson is there to be learned from all this? Perhaps most important is the power of the consumer. I was not about to pay extra for service on a brand new machine, and I made sure this was known. Maybe that made the difference and prompted the one suggestion that actually worked (mostly) or maybe that was just sheer dumb luck. But I was not about to keep a computer that didn't work, nor was I going to pay another $50 to make it work (and I'll bet the Dell DOC team wouldn't have found the problem anyway.) We should not accept expensive hardware and software that doesn't work, and doesn't do the job it was purchased to do.

What applies to a $500 refurbished computer applies to a $13 Million PACS system. Or at least it should. But somehow, the more we pay, the less likely we are to demand excellence. We don't want to admit that we made a mistake, and we swallow errors that we wouldn't tolerate in something we bought from Dell for $500. Or from Mercedes for $100,000. Does anyone see something ironic here?

For what it's worth, the Studio continues to run well, even after I turned it over to my wife. Her FarmVille farm has never looked better.

Tuesday, December 15, 2009

On The Twelfth Day Of PACS-mas, My Vendor Gave To Me...

A friend of mine is part of a large group in a large city, and they are none too happy with their Fuji Synapse PACS. As his (unaltered by Doctor Dalai) wish-list below nicely outlines, there are a number of features that are not found on their Fuji system (but are available from Amicas!) Without further ado...

1. I should be able to make custom window level settings so when I hit "7" I get MY bone settings.

2. I should be able to customize my right-click generated side bar. When I right click, there are probably 25 options and I only ever use 3 of them.

3. When I reserve a case from the list I should be able to see I've done so.

4. I should be able to pre-select cases on a list I do NOT want displayed if I start F8-ing through a list.

5. Synapse is very unstable. I've never worked with another program that spontaneously crashes at a rate near Synapse. It is unacceptable.

6. In the notes window there should be a single click button to add the word "dictated" without typing that also removes the case from the list and displays my next case.

7. We need a PACS that can support cine for ultrasound, especially vascular.

8. We need a PACS that has full Nucs and PET/CT capability to read on the fly as one reads all other cases.

9. I expect a customized worklist that populates every case I am responsible for covering and none that I am not, so I can access ALL of my cases from a single worklist (as Amicas does). I want a separate worklist also visible that shows any other cases I could read when my list is clean (as Amicas does).

10. I expect a smart worklist that allows me to move from one case to the next without ever returning to the list to look. A smart list needs to manage the order cases appear based on acuity and chronology (as Amicas does).

11. I want to perform MIP and 3D reformats on the fly, when needed, without having to request the study is sent to Terarecon. I expect to be able to SAVE those images (which Fuji can not do with its limited MPR function--Amicas can).

12. I expect images to pre-cache to my PC without me moving a finger. I want every case on my list to have every image loaded before I open it (as Amicas does).

13. I expect a single button click to send my case to OPS with notification to call ordering physician and transfer them to me (as Amicas does). I should never have to open multiple folders and drag a case.

14. I expect a separate single button click to send case to OPS for OPS to call the report (as Amicas does).

15. I expect a single click on my worklist to display all cases I've read that day so I can quickly go back to a case for a clinician (as Amicas does).

16. I want a completely customized hanging protocol that puts every series of my exam and the comparison exactly where I want them every time (as Amicas does).

17. I want to send a email or text link to the ordering doctor that takes them straight to my report and includes annotated images (as Amicas does).

18. When I open a report from Synapse in a new window, I should not have to resize that window EVERY time. It should remember the size I made it last time.

19. I want a way to see a case is cached on my PC before I open it (as Amicas does).

20. I should not have to tolerate sending suggestions like this for 2 years without any being addressed or getting concrete responses from my PACS vendor (as Fuji has).

21. I expect a PACS that mines all databases we access for relevant priors without the extra fee Fuji charges, I want it free like it is with Amicas.

22. I expect to be able to open extra comparison exams in new side windows so I don't have to give up my primary reading space on my layout for another old series (as Amicas does).

23. I want a side annotation that is visible but not distracting to indicate what studies are comparisons so I never have mis-arranged series and read the wrong date's exam as current (which I've done with Synapse). As you've guessed, Amicas has this feature.

24. A PACS system updating a list or exam in the back-ground should not disable our ability to continue scrolling through the exam we are reading, as it true for Synapse.

The interface with our exams is a critical component of our practice. We need to demand excellence. It is currently available.

Just not from Fuji, eh?

My friend went on to speculate that even beyond the above list, what we really need is " a bowling alley order button analog- push the button and help comes." This is probably one of the best ideas I have ever heard. Think about it... a help button that actually helps, either accessing the proper page of the manual based on the state of the PACS GUI at the moment, or alternatively patching one through to the vendor's (or hospital's) help desk, letting them see the problem at hand. This would be simple to implement, but incredibly powerful, much more user-friendly and downright useful than anything out there right now.

Once again, all the vendors have to do to make their customers happy is to listen to them! Simple? Apparently not for some of the larger companies.

On the First Day of PACS-mas, my vendor gave to me. . . a PACS that will work as guaranteed.

Thursday, December 10, 2009

The Dalai Can. . .

My Nuclear Medicine Techs have taken a page from my book of perverted songs, and wrote one about . . . me! Here it is with some minor changes to protect the innocent, and apologies to Willie Wonka, and Sammy Davis, Jr.:

Who can take an OctreoScan?
Actually read it, too?
Put in an impression
And add a suggestion or two. . .

The Dalai Man
Doctor Dalai Man can
Doctor Dalai Man can, cause he mixes it with knowledge and makes
The report sound good.

Who aggrevates scan patients,
With a multi-day delay?
Doesn't even matter if it's on a Saturday. . .

The Dalai Man. . .
Doctor Dalai Man can
Doctor Dalai Man can, cause he mixes it with knowledge and makes
The report sound good.

The Dalai Man makes
All that he dictates
Informative and insightful. . .
Talk about Technologist wishes,
He can even make knishes!

Who can run the Leo(nardo)
Better than the rest?
Set up a dummy button
That the other guys can press. . .

The Dalai Man
Doctor Dalai Man can
Doctor Dalai Man can, cause he mixes it with knowledge and makes
The report sound good.
And the report sounds good cause Doctor Dalai Man thinks it should....

Sunday, December 06, 2009

Up Against The Wall, iPhone Charger!

From the Department of Stuff You Need, But Just Didn't Know It, well actually, from FastMac, comes something really brilliant: the TruePower UCS Power Outlet With Built-in USB Ports! How many times have you needed to plug in your iPhone, iPod, or other USB-power-gobbling device, only to find the charger misplaced? For $10, you only have to worry about the cord being misplaced, as you can place USB power outlets throughout your home or business.

And, not that I'm all that green (except around the gills after a weekend of call), but this outlet does something most USB brick-chargers don't:
Please also note that the USB ports only draw power when something is physically connected to the port. We didn't want a vampire port that continually sucks and wastes power when not in use so this was one of the features on the top of our priority list during the design phase.
The outlet should ship in early 2010 after it receives final UL approval. You can preorder if you want to be the first on the block to get rid of your bricks. Hat tip to Engadget for this little gem.

Friday, December 04, 2009

FTC's New Blog Controls

As indicated by the badge to the left, I am a member of Wellsphere's Blogging community. This morning, I received a note from Wellsphere, which I assume went out to all their bloggers, concerning some new guidelines put out by the FTC:

“We are writing to let you know about revised Guidelines issued by the Federal Trade Commission (FTC) on October 5, 2009 relating to endorsement and testimonial advertising. These new Guidelines go into effect on December 1, and reflect the FTC’s interpretation with respect to federal law relating to advertising. These new Guidelines specifically apply to bloggers and could impose liability on bloggers for endorsements or testimonials.

The revised Guidelines state that:

· The Guidelines apply to Bloggers and online word-of-mouth marketers and require them to disclose any material connection to a company when reviewing the company’s products or services (failure to disclose any payment or receipt of free product from an advertiser or someone acting on their behalf could expose you to liability);

· Both advertisers and endorsers can be liable for false or unsubstantiated claims made in an endorsement (if you were given a product for free or were paid to write a review, then the claims you make about the product must be accurate and substantiated);

· Advertisements containing consumer endorsements, or testimonials, must disclose what results a reasonable consumer could expect from the product and can no longer rely on a disclaimer that “results may vary”;

The full text of the new guidelines can be found here, and some further explanation from the FTC is found here. The salient points are:
The revised Guides also add new examples to illustrate the long standing principle that “material connections” (sometimes payments or free products) between advertisers and endorsers – connections that consumers would not expect – must be disclosed. These examples address what constitutes an endorsement when the message is conveyed by bloggers or other “word-of-mouth” marketers. The revised Guides specify that while decisions will be reached on a case-by-case basis, the post of a blogger who receives cash or in-kind payment to review a product is considered an endorsement. Thus, bloggers who make an endorsement must disclose the material connections they share with the seller of the product or service. Likewise, if a company refers in an advertisement to the findings of a research organization that conducted research sponsored by the company, the advertisement must disclose the connection between the advertiser and the research organization. And a paid endorsement – like any other advertisement – is deceptive if it makes false or misleading claims.
I have mixed feelings about this, like most things in life these days. I do believe the public needs to be protected from false advertising, which seems to be the main thrust of this program. However, this becomes rather intrusive on the individual, the blogger in this case, and in theory at least might infringe upon one's First Amendment rights. For example, I might want to say something like, "I love the New Nabisco PACS!" (I could have said I like the Nabisco product the late George Carlin mentioned with those Seven Words, but this is a family blog...) Here I am, with a disclaimer in my profile telling you that what I publish is my opinion, and nothing more. Well, that isn't good enough. Americans apparently aren't considered savvy enough to question the sources of their information, and must have legal protection against a rogue blogger like myself who might have received a shipment of Nabisco cookies to give a positive review of their PACS (which of course doesn't exist). What if Nabisco had rewarded me with cookies after I blogged about their fictional product? What if I'm lying about it completely? Doesn't the reader of a blog have some small duty to ask these questions? Do I have the First Amendment right to post anything I please, even if it's false?

It would be nice if the FTC (and the FCC) would have a look into the motivations of the mainstream media outlets, all of them, even Fox, in the same spirit of protecting the public from misinformation, but I suppose that's asking too much. I guess they have to start small, with measly little blogs. On second thought, the news outlets are supposed to be doing that to the government, not the other way around. And only Fox comes close to even trying.

To comply with the ruling, I now have to come clean. I am currently paid nothing by Amicas, or any other vendor. I have been flown to Boston and to Tucson for meetings of the (unpaid) Amicas medical advisory board. I recently traveled to Australia at the expense of healthinc, a redistributor of Amicas down there, and received a boomerang as an honorarium for giving a talk to some of their customers. It was a very nice boomerang, by the way. Visits to Koala Park and boat rides around Sydney harbor were paid for by me and not healthinc.

I have been taken to Israel and Germany several years ago by Elscint, just as they were being purchased by GE. I've had a few other equipment junkets, but no cash changed hands.

The only payment I have accepted was an honorarium from Daxor for giving a speech at a regional meeting discussing their BVA-100 blood volume system, which I had been using for several years before being approached to give the talk. Frankly, I didn't do a great job on the talk, as I tried to cram a huge amount of information into a small amount of time, and Daxor hasn't asked me to speak since!

The material I publish, aside from quotes, of course, is mine alone. It is my opinion, and it is not paid for. I do have my price, but probably only GE could afford me.

And that's the way it is. Have fun with that, FTC.

Tuesday, December 01, 2009


Close on the heels of syngo.via (did you get my subtle references in the syngo.x post as to the name of the new 3d product) comes syngo.plaza:

Welcome to syngo.plaza, the new agile PACS solution for the clinical routine from Siemens Healthcare. As the first Picture Archiving and Communications System (PACS) from Siemens where 2D, 3D, and 4D reading come together in one place, syngo.plaza is poised to change the way multimodality images are read today. Siemens is unveiling this innovation at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) from November 29 to December 3 at McCormick Place (Booth #825, East Building/Lakeside Center, Hall D) in Chicago.

“Customer-focused innovation runs in our veins here at Siemens, and syngo.plaza is a true example of that,” said Arthur Kaindl, CEO, Image and Knowledge Management, Siemens Healthcare. “For the first time, we are now offering fast and accurate multimodality reading on one single workplace, with one intuitive user interface. And we are helping to protect our customers´ investment, as already existing hardware components can be leveraged.”

Prepared Reading

Once an image is obtained, syngo.plaza automatically identifies the type based on the scanner that was used and then, in line with the case complexity, calls up the corresponding 2D, 3D, or 4D applications. Through no-click integration to syngo.via, Siemens new imaging software, users can access the appropriate syngo.via applications directly through syngo.plaza. Combined with a unified user-interface, this allows for a smooth transition between different applications and helps speed up the reading workflow.

With its wide application range, syngo.plaza even helps users master complex multi-modality cases through access to syngo.via and syngo Multimodality Workplace applications. And, with its Patient Jacket functionality, syngo.plaza makes it easy to view patient history at a glance – including prior exams, reports, and Digital Imaging and Communications in Medicine (DICOM) presentation states.

Personalized Workplace

In addition to its one-of-a-kind prepared reading capabilities, syngo.plaza also offers two viewing modes for users. The first is a pre-configured intuitive interface. The second is a customizable option that allows users to define and use the layouts they prefer. This role-based view helps streamline the reading workflow and helps eliminate time wasted adjusting to strictly one-size-fits-all PACS technologies. In addition, the time-saving SmartSelect tool enables users to access their most frequently used functions directly in the diagnostic screen without taking their eyes off the images. Plus, syngo.plaza’s innovative system architecture allows clinicians to access the software within their facility or remotely4.

Secured Investment

Finally, syngo.plaza helps to protect customers' investment by offering users the ability to leverage their existing hardware components, functionality, and storage configurations. The system supports the IT components that fit users’ needs and that offer an optimized price-performance ratio. In addition, users can easily adapt to changes in their own environment, enabling their PACS to grow in-line with their needs and budget – and with continuous technical innovations that keep them a step ahead. Furthermore, scalable storage allows syngo.plaza to adjust its shape to users’ requirements – offering multiple solutions ranging from dedicated to shared storage, from single to multiple archives, and from a single workplace to an enterprise PACS, all without compromising performance.

Sounds pretty good, although it still seems to act quite a bit like Amicas 6/Amicas PACS. My friend, Mike Cannavo, the One and Only PACSMan, has seen .plaza in person. He was about to accuse Siemens of rehashing the same old same old, but after viewing the new stuff in Chicago, he came away impressed. Siemens actually, finally, appears to have a working PACS and a good one at that. I'm intrigued by the "leveraging existing hardware" comment: does this mean that syngo.plaza can be used as an overlay to an existing PACS, such as Visage proposes with their PACS/advanced visualization product?

Let's see. . . We have syngo.via, and syngo.plaza. What's next? I know! How about syngo.worksproperlyanddoeswhatitpromises? That would be something quite new amongst the large PACS vendors. . .