Tuesday, November 30, 2010

RSNA 2010: lifeIMAGE

My first stop on the exhibit floor was a visit to many old friends at lifeIMAGE.  I have to resist the temptation to refer to LI as the New AMICAS, but you could forgive me if I did, for many new and recent AMICAS graduates have found their way over.  These are the people that made AMICAS what it was, and I have no doubt there will be a repeat performance, although with a slightly different destination. 

You may recall my piece about lifeIMAGE from August, 2009.  Since then, there has been significant progress.  Let me bring you up to speed.

lifeIMAGE has a simple goal:  "lifeIMAGE helps you break down the barriers and provide real-time access to trusted sites and individuals. Our solutions help you deliver results of recent exams or the entire imaging history to community physicians and patients alike."  This is the answer to the "portable patient" I have bemoaned on AuntMinnie and elsewhere, and quells the disaster I live through every day.  At our oncology clinic, for example, I have to compare at least 5 CD's of outside studies with the current exam on PACS most every day.  At the trauma center, not a day goes by without a trauma victim bringing in a CT on a CD; if it won't open, or if it got lost in the ambulance, the patient gets scanned again.  Can you say "radiation"? 

LI has about the best answer I have found for this very serious problem, short of wiring the entire country together:

Millions of patient CDs

Today, imaging information often arrives on CDs with patients visiting physician offices and clinics throughout a healthcare enterprise. With lifeIMAGE, users can instantly upload, view, and share the outside exams from any workstation. Busy specialists save valuable time with automated workflow for identity reconciliation and push to PACS features.

Secure transfer from referral sites

Ideally, imaging information should arrive before patients' appointments or transfers. The lifeIMAGE service enables physicians to receive the data from anywhere without requiring any software at the sending end. The service improves referral flow, creates opportunities for second opinion and distance consulting while saving time and avoiding duplicate and unnecessary scans.

Electronic delivery of results

Specialties such as Orthopedics, Cardiology, Neurology, and Oncology most frequently refer patients to facilities that deliver results with high quality of service. The lifeIMAGE cloud-based result distribution system sets a new bar for quality. With our service, results and notifications are delivered automatically or on demand and the referring physicians or patients can collect results from any facility in one place.
There are three basic components, which have evolved nicely since I last had a look:
1) For facilities that receive a high volume of outside exams (patient CDs) and/or perform a high volume of imaging exams with outgoing results, the ideal network gateway is LILA™ (lifeIMAGE Local Appliance).

2) For facilities that refer a reasonable number of patients to larger facilities and would like to electronically send patient imaging history to other sites, the ideal network gateway is LISA™ (lifeIMAGE Smart Agent).

3) For physicians, facilities, or patients who care to create a cloud-based account to receive and share a modest volume of imaging studies from anywhere and with anyone, a lifeIMAGE LINCS™ Account is the ideal means of communication.

LILA utilizes "Drop Boxes" to which a referring site can upload a study, assuming they are properly credentialled.  The exam appears of course in the "In Box", and can be nominated for upload to the local PACS, with the approval of the PACS admin in charge of such things.  There is a limited, but still VERY adequate viewer within the system (which is platform independent, appearing in your web browser.)  Non-DICOM images, document scans, etc, can be attached. 

LINCS, the lifeIMAGE Cloud, allows for real time sharing of annotations.  My PACS doesn't even do that. 

Future plans include LIVE, lifeIMAGE Virtual Enterprise, which will connect two LILA sites, and create a "trust" agreement for a particular user to see a particular patient's data.  That certainly goes a long way toward solving the portable patient problem, as long as we can get the various hospitals on board.

I was lucky enough to arrive not long after the announcement of a very important development for lifeIMAGE, integration to Microsoft's Health Vault.  A patient simply establishes an account, receives a security code and sets up a security challenge question.  Once uploaded via lifeIMAGE, his/her exams are available to whomever the patient designates:
With a patient’s permission, physicians using lifeIMAGE services will have the option to share medical image exams and associated reports directly with a HealthVault account. When an exam is shared, patients will be prompted to complete the transfer by logging into their HealthVault account to claim the exam or creating a new account, and then claiming the exam. lifeIMAGE’s HIPAA-compliant platform employs a series of security checks to ensure the privacy and security of all data.

“The HealthVault platform is designed for ease of integration with third-party applications that bring value to the health consumer. lifeIMAGE’s image sharing application helps HealthVault account holders stay in control of their care and have an easier time obtaining second opinions from other physicians anywhere,” said Hamid Tabatabaie, president and CEO of lifeIMAGE.
This is a big, ummm, deal, to paraphrase the Vice President. 
As my hometown is of only moderate population, with five hospitals and various other imaging centers, I'm hoping to become the prototypical community to adopt the lifeIMAGE solution.  The problem we face is huge.  All I have to do is convince the powers-that-be that the answer is at hand.  I truly believe it is.
More to come from frigid Chicago.  I still don't get why anyone lives here...

RSNA 2010: Siemens Press Conference

There are various badges around RSNA, Blue for Members (like me), Crimson/Brown for exhibitors, and Pink for Press, to name a few.  I thought it might be amusing to have Press credentials, but Mike Cannavo, the One and Only PACSMan, and the good folks at AuntMinnie.com discouraged me from this ambition.  It seems the Members badge gets you in more places, so there really is no point downgrading.  Still, slumming might have been fun.  But no matter.

Someone on the Siemens publicity team thought I deserved to be considered a member of the press for a moment or two, and invited me to their press conference held this morning.  As it inclued breakfast, I hauled myself downtown for the 7:30AM event.  I sat at a table full of legitimate healthcare reporters.  To my left was a lady who turned out to be quite a professional writer, as I found sitting next to her on the bus back north.  She was once a producer for a BIG networrk and had interviewed five Presidents.  She endeared herself to me by relating how she had gone head to head with GE and won earlier in the day.  To my right was Robin Leach from Healthy Lifestyles of the Rich and Famous.  (Well, not reallly, but the gentleman did remind me of Mr. Leach.  We all had placards with our name and publication, and I proudly placed mine in front of my breakfast plate.  Robin looked at the card, looked at me, rolled his eyes, shook his head, and said, "A blogger, eh?"  I said, "Yes, Sir!" in my best South Carolina drawl, and let it go at that.

The presentation was quite well done, with Herman Requardt, President and CEO of Siemens Healthcare, leading the way.  The theme for RSNA, and Siemens in particular this year is "Personalized Medicine" which means "whom to treat how" or more likely "whom can we charge how much?"  The gist of the presentation is that more intelligent, tailored therapy is on the horizon.  We simply have to amass enough data (with Siemens scanners) and then process said data (with Siemens syngo.whatever) to find the best approach.  Despite my tongue-in-cheek attitude, this is truly exciting stuff, and I like the Siemens approach.  Siemens likes their approach as well, and the claim was made that the rest of the world does as well, with Dr. Bernd Montag, CEO of Imaging and Therapy Systems Division stating that Siemens is Number ONE in market share, installed base, and profitability in this space.  I don't doubt it.  Dr. Montag cited the new hybrid PET and MR scanner, the mMR, which will only set your hospital back $4-5 Million or so.  "We have the right culture," he said.  "Yes, there was an economic crisis, but we continued to invest in R&D, and this is the result."  He went on to elaborate on Siemens goals of improving patient safety through dose reduction measures and the use of imaging to facilitate minimally-invasive surgical procedures.  As an aside, he observed that there is a lot more animosity among radiologists whose imaging is stolen by non-radiologists than among surgeons whose invasive procdures are down-sized by radiology. 

With respect to dose-reduction, Dr. Montag took a shot at Siemens' larGEst competitor:  "WE use absolute dose numbers and don't try to fool people with this 30% reduction business."  Siemens' goal in this is to reduce the dose of ALL "typical" CT exams to less than 2.4 mSv.  And I'm sure they will do it.  And I'm sure we'll all have to buy new scanners to achieve this.

To be complete, I should mention an excellent short review of Siemens mammography technology, including the yet-to-be approved tomosynthesis, given by Norbert Gaus, PhD.

Good stuff.  Maybe I'll be invited to more of these events, although I can guess which companies won't want me there.  Oh well. 

More to come.

ADDENDUM:  I spoke briefly with our GE CT rep just a few moments ago.  He said GE is shooting for a reduction to 1 mSv for all routine CT exams, and will no longer quote percentages of dose reductions.  That message sure got delivered quickly!  I can't imagine what's next.  Perhaps Toshiba will come up with a way to scan by drawing radiation out of the body, for a net dose of -5mSv.  You never know...

Monday, November 29, 2010

A Tale of Two Systems

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to heaven, we were all going direct the other way - in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only.  Charles Dickens, A Tale of Two Cities. 
I'm standing at one of dozens of laptops set up near the Technical Exhibit Hall B at McCormick Place, in sunny, frigid Chicago.  It's been an exhausting first day, and I have miles to go before I sleep.  Still, I want to commit to the ether my thoughts of the day.  I've visited a number of vendors, and I'll be discussing my observations with a series of separate posts.  Many have noticed the sparsity of my postings lately, and I.. can only apologize and try to make it up in one fell swoop.  I've just been to Florida for Thanksgiving with the extended family, and did a rapid turn-around to get here last night.  All things being equal, I'd rather be in Florida, but we all do what we must. 

Let me start the barrage with a post I've been composing for several days.  The Tale of Two Systems refers to the iterations of Agfa IMPAX I've dealt with recently.  We had, until a few weeks ago, version 6.3.x, and my friends in Western Australia had 6.4.x.  At least ours worked most of the time, which sadly wasn't the case in Perth and environs.  Definitely the worst of PACS, I mean times. 

Over the past few weeks, Agfa has been fine-tuning the next edition, version 6.5.  It has major improvements, but the greatest upgrade of all has been the way Agfa handled the upgrade.  Distilling it down to two words, THEY LISTENED.  This next step is far from perfect, and it still has a lot of the legacy garbage from the previous 6.x's (and 5.x's, and 4.x's, and 3.x's, and probably 2.x's).  Still there are a number of things that actually work very well, markedly better than what we had before.  I won't go into vast detail, but suffice it to say that linking thge series of a multiplanar study is nearly automatic, and not an exercise in agony as it was before.  We have spine labelling, albeit a somewhat more complex version than I would have liked.  (Yes, the complex parts can be turned off, and we are left with a nice simple version that could have been written in a day and not take 5 years to implement, but I digress.)  We have voice clip capability so we don't have to type long missives to the ER.  And there are other improvements.  There are still problems.  There is no usable hanging-protocol arrangement.  There is still the nasty old tool-toggling. And so on. 

So why am I so upbeat?  Because Agfa made an incredible effort to keep us radiologists in the loop.  We received a pre-sale (but still FDA cleared) version, which has been tweaked almost daily in response to our requests and observations.  There were Agfa personnel onsite for much of the time, and we rads were invited (invited!!!) to participate in conference calls to keep the developers informed.  (And I can tell you that Version 7.x is being assembled in the same manner with input from us and several other groups.)  This is what I'm talking about!

In our discussions, it became very apparent why progress has stalled up to this point.  We bantered about the proper way to block someone from taking away a study someone is reading.  Most every product locks out everyone after the first.  In other words, if I open up Mrs. Jones' CT, no one else can read it.  They can look at it, but they can't dictate it or annotate it, at least with most systems.  With IMPAX, however, unless I click the "Start Dictate" button, the next guy can jump in and snatch the study away.  Years ago, I spoke with some of the principals about this.  I was told that Agfa's academic customers wanted it this way, and so it would stay.  That is not what I would call listening to the customer, at least not the customer standing in front of you with a serious complaint.  I would like to think Agfa has turned over a new leaf in this regard.

Time will tell.

In the meantime, I'm going to do my best to have the "best of times" at RSNA.  More to come.  It's 6 PM, and they're kicking us out of the building

Sunday, November 21, 2010

Champerty and Maintenance

Image courtesy of ColoradoFamilyCenter.com

Have you heard about the latest hot investment?  No, it's not plastics, young graduate.  Lawsuits.  Yes, lawsuits.  But I'm not talking about prosecuting (or persecuting) litigation.  I'm talking about investing in other people's suits.   

Actually, it turns out there is nothing new about this practice, but like wide ties (or is it narrow ties this year?) some things do eventually come back in style.  What we are seeing is the resurgence of a very old feudal practice banned by British Common Law (upon which our legal system is based).  Let's take a look.

Jeffrey Segal, M.D., J.D, founder of Medical Justice, delivers the disturbing message.   
At one time, before many of us were born, plaintiffs had to bankroll their own lawsuits. There, they would pay the attorney for his time and counsel. The plaintiff bore the entire risk for the outcome. But, if he won, he kept the entire pile of money, minus his expenses paid to the attorney.

The next – and dominant – paradigm: contingency fees. There, the risk is transferred to the attorney. In exchange for accepting that risk, the attorney keeps a healthy portion of any settlement / judgment after expenses. That amount is generally 33 to 40%. Naturally, the plaintiff’s attorney must diligently assess the risk / benefit for each opportunity. If the attorney loses, the plaintiff does not go bankrupt.

Enter the modern age.

Third party financing of lawsuits, as reported in the NY Times on November 15th: 
Large banks, hedge funds and private investors hungry for new and lucrative opportunities are bankrolling other people’s lawsuits, pumping hundreds of millions of dollars into medical malpractice claims, divorce battles and class actions against corporations — all in the hope of sharing in the potential winnings…

Ardec Funding, a New York lender backed by a hedge fund, lent $45,000 in June to a Manhattan lawyer hired by the parents of a baby brain-damaged at birth. The lawyer hired two doctors, a physical therapist and an economist to testify at a July trial. The jury ordered the delivering doctor and hospital to pay the baby $510,000. Ardec is collecting interest at an annual rate of 24 percent, or $900 a month, until the award is paid. 
For decades, state laws prevented people from “betting” on other person’s lawsuits (scrabble word: “champerty”). The rationale: such interventions would stir up vexatious litigation. Recent changes in some state laws are propping open the floodgates.
The New York Times article fleshes out the practice a bit more, revealing some of the good and bad aspects:
Lawsuit lending is a child of the subprime revolution, the mainstream embrace of high-risk lending at high interest rates that began in the early 1990s.
(T)he founder of the LawFinance Group, practiced law for more than two decades before moving into finance in California in 1992. A lawyer friend called to ask if he would lend to a client who had won a sexual harassment lawsuit. The woman’s former employer had appealed, and she needed money for living expenses or she would be forced to take a smaller settlement. Mr. Zimmerman invested $30,000 in the case; the former employer almost immediately dropped the appeal and paid out the verdict. Mr. Zimmerman made $20,000. “I said: ‘That’s an interesting way to make money. Is there a way to turn that into a business?’ ” he recalled. The company he created has since invested more than $350 million in litigation.
. . . A review by The New York Times and the Center for Public Integrity shows that the inflow of money is giving more people a day in court and arming them with well-paid experts and elaborate evidence. It is helping to ensure that cases are decided by merit rather than resources, echoing and expanding a shift a century ago when lawyers started fronting money for clients’ lawsuits.

But the review shows that borrowed money also is fueling abuses, including cases initiated and controlled by investors. A Florida judge in December ordered an investment banker who orchestrated a shareholder lawsuit against Fresh Del Monte Produce to repay the company’s legal expenses, ruling that the case should not have reached trial.
Back in the good old days, when feudal lords ran the show in England, and life-expectancy was 35 for those few children who survived into adulthood, it was not uncommon for the nobility to dabble in such things.  From the Wiki:

The restrictions arose to combat abuses in medieval England. Unscrupulous nobles and royal officials would lend their names to bolster the credibility of doubtful and fraudulent claims in return for a share of the property recovered.[6] Gradually, judicial independence was established and by the early 19th century Jeremy Bentham wrote:[7]

A mischief, in those times it seems but too common, though a mischief not to be cured by such laws, was, that a man would buy a weak claim, in hopes that power might convert it into a strong one, and that the sword of a baron, stalking into court with a rabble of retainers at his heels, might strike terror into the eyes of a judge upon the bench. At present, what cares an English judge for the swords of a hundred barons? Neither fearing nor hoping, hating nor loving, the judge of our days is ready with equal phlegm to administer, upon all occasions, that system, whatever it be, of justice or injustice, which the law has put into his hands. 
Brings to mind the image of Denny Crane sauntering into the courtroom with an AK-47:

Well, you get the idea. 

The concepts of champerty and maintenance followed.  From AMLaw.com:
 “Maintenance” is assistance to a litigant in pursuing or defending a lawsuit provided by someone who does not have a bona fide interest in the case. “Champerty” is a form of maintenance in which a nonparty undertakes to further another’s interest in a suit in exchange for a part of the litigated matter if a favorable result ensues. 14 Ohio Jurisprudence 3d (1995), Champerty and Maintenance, Section 1. “The doctrines of champerty and maintenance were developed at common law to prevent officious intermeddlers from stirring up strife and contention by vexatious and speculative litigation which would disturb the peace of society, lead to corrupt practices, and prevent the remedial process of the law.” 14 Corpus Juris Secondum (1991), Champerty and Maintenance, Section 3.
Stated a different way,
"Champerty was a 'means by which powerful men aggrandized their estates and the background was unquestionably that of private war.'" Id. at 375 (quoting Max Radin, Maintenance by Champerty, 24 Cal.L.Rev. 48, 58-64 (1935)). In response to rampant champerty and maintenance in feudal society, the law came to sternly prohibit these practices....
Some US states still have laws prohibiting champerty and maintenance, but many do not.  My own beloved state of South Carolina is one of the latter, based on a decision in the case of Osprey, Inc. v. Cabana Ltd. Partnership:

The South Carolina Supreme Court held that champerty-an agreement to finance a party's litigation in return for a portion of the matter involved in the lawsuit in the event of a successful outcome--can no longer be used as a defense to void financing agreements between parties to a lawsuit and outside financiers...
An appellate court agreed with the trial court that South Carolina recognizes the doctrine of champerty. However, the court limited the doctrine based on the reasoning that times have changed since the medieval era when champerty was strongly disfavored...
Affirming, the state high court modified the appellate court's ruling and completely abolished champerty as a defense. Other well-developed principles of law can more effectively accomplish the goals of preventing financing of groundless lawsuits and the filing of frivolous suits than the outdated notion of champerty, the court noted. The court observed that lawyers are prohibited from prosecuting frivolous lawsuits and may face various sanctions for doing so. Also, the doctrines of unconscionability, duress, and good faith establish standards of fair dealing between opposing parties. In addition, the court continued, the legislature has made barratry-the promotion of groundless judicial proceedings-a misdemeanor.
The court cautioned that its abolishment of champerty as a defense does not mean that all such financing agreements are enforceable. When an agreement is challenged, a court must consider whether the fees charged by the financier are excessive or whether any recovery is vitiated because of impermissible overreaching by the financier, the court explained. To determine what is fair and reasonable, a court may examine, among other things, whether the bargaining positions of the parties were equal and whether the financier engaged in officious intermeddling. After analyzing these factors and any others that may be relevant, a court may enforce, modify, or set aside an agreement, the court concluded.
I guess "excessive fees" are in the eyes of the beholder.  I think 24 percent interest per year is a little high, personally.

The courts today have decided for the most part that champerty is OK due to the far more transparent nature of our legal system when compared to that of feudal times.  Oh well.  I guess I'll have to defer to the judges, mostly former lawyers, who are the only ones in position to decide how current lawyers practice.  In some ways, champerty is a rather paradoxical thing.  Trial lawyers, mostly on the Left for some reason, love the chance to have someone invest in their cases, allowing more grandiose "evidence" and "experts" to be brought to bear, all for the benefit of their client.  Of course, this feeds the horrendous Capitalist greed of the investors at 24% interest.  So everybody wins.  Except for the concept of justice.

The whole point of the ban on champerty was to prevent undue influence on any particular case, the thwarting of justice in the name of profit or other motive beyond the scope of the situation itself.  In the old days, the mere presence of the feudal lord and a few of his cronies sitting in the back sharpening their lances was enough to sway the court.  Thus, a little investment of time and money went a long way.  Today, of course, the investors are paying surrogates to accomplish the intimidation, providing the finest "expert testimony" money can buy (literally) in exchance for their 24% interest.  This isn't justice, and it isn't fair or even particularly nice.  In addition, the plaintiff becomes beholden to the investor, and could be forced into a trial that isn't even necessary, in order to pad a judgement that never should have been made in the first place.  Yup, justice is served, alright.  On a silver platter with ketchup. 

The argument about tort reform always provided by the Left in general, as well as trial lawyers in particular, is that damage caps would unfairly limit "justice" in the form of compensation, and might not allow full recovery of damages.  While that might be true in a few cases, it is probably more reasonable to assume that the problem lies more with the amount of compensation the attorney will receive.  Human nature, folks.  Gotta love it.  Champerty, too, is touted as path to justice for those who otherwise couldn't afford it.  Balderdash.  In my book, this is simply a way to add a layer of profit to an already rigged system.  And yes, I do mean rigged.  As I have bemoaned before, our tort system is totally out of whack, and clearly encourages abuses such as champerty, since the folks with the most cash backing them up can buy the best testimony.  Remember, if testimony can be paid for, then it can be bought.  Human nature strikes again. 

Now don't get me wrong, I like profit.  But only when achieved on a level playing field.  I despise those who made money offering bogus investments like the derivatives based on bad loans.  (By the way, many thanks to Barney Frank for bringing down the US economy with his rabid insistance on the offering of loans to his constituents who couldn't possibly pay them back, leading the banks to try to dispose of the loss in this manner.)  Similarly, champerty is profitable because it is profitable to game the legal system, and thus deserves nothing but scorn.  No one will convince me otherwise. 

Since the courts and legislatures are filled with lawyers, champerty is likely with us to stay.  The solution, however, is simple, and provides an end-around run to bollux the lawyer's plans.  Sadly, it involves sacrifice on the part of physicians, and most will never go along.  Still, my logic is sound, and I think you'll agree I have a point.

To repeat what I noted above, if testimony can be paid for, then it can be bought.  The incentive to please those paying the exhorbitant bill leads one to testify to whatever it is that side wants to hear.  Testimony from an "expert witness" can run as high as $10,000-$20,000 per case.  This is ridiculous.  What I have proposed in the past is a simple decoupling of testimony from payment.  Witnesses must be subpoenaed, and brought to the court to TELL THE TRUTH, with no bias, and no incentive to say one thing or another.  They must not be beholden to either side, but rather be truly impartial experts.  The truth can only be set free if no one can buy it.

Clearly this will never happen unless legislated into law, and the chance of that is about as likely as my getting an invitation to Osama Bin Laden's grandson's Bar Mitzvah.  I know several litigators, and when I tell them of my idea, they laugh.  It seems that the first question any doctor asks when approached for testimony and case review is "HOW MUCH???"  Gimme, gimme, gimme.  We are no better than the lawyers in that regard, are we?  It's OK to take money for testimony, but it sure isn't any fun when you yourself get sued based on the evidence of some hired gun.  As usual, we are our own worst enemies. 

Champerty and maintenance.  Just when you thought it was safe to talk to lawyers again. 

Oh, I almost forgot.  Happy Thanksgiving, everyone!  (Even lawyers...)

Sunday, November 07, 2010

The Interview

Dalai's Note:  My daughter, "Dolly," is a first-year medical student.  She wrote the following passage as an assignment for her Ethics class.  Clearly, she has a great deal more insight and understanding of what she is doing than most at her stage or beyond.  

The Interview

The sheath of plastic is a small barrier between the living and the dead.
Inconsequential compared to the caskets normally selected for those
Whose bodies have failed them.
Death is usually sequestered away,
In pretty patches of manicured grass
With carefully crafted stones and meticulously placed flowers
In artificial vases adjacent to their recipients.
Flowers seem incongruous in metal containers,
Like people in metal boxes, in metal tanks.
A strange tribute to a life once lived in chaos, in freedom, with complexity and complications.

The blade is new and harsh, anxious like the hand that holds it.
Unsure of what it will find in the first dive into this time capsule.
Almost nine decades, near a century, a vestige of a former time.
When voting was new for her gender,
The Civil Rights Movement merely a dream.
How interesting that now three women now stand over her,
Their skin tones blending with hers as they bridge the gaps between them.
Her greatest secrets are yet to come,
The mysteries that she revealed to no one are ours to find.
The most intimate details of her life and death,
The inner workings of her heart and mind.
She has sacrificed a peaceful sleep
For months of bright lights, probing and investigation
More invasive than the most driven reporter.
And thus begins the most intimate of interviews,
One woman’s life, death, and the vessel which bridges them.

Tuesday, November 02, 2010

Incensed Nonsense

Dr. Lisa from points west emailed me the other day:


I am a gynecologist who has left my big practice to start one on my own. I want to use technology to the fullest and have only looked at web-based EMR systems. I have not rented a big space, thinking that I was going to be cloud based and didn't need a chart room or a computer room.

I am looking at leasing the GE Voluson-e laptop ultrasound and GE is trying to upsell me a $12K software package that is essentially a hardwired PACS system. I can only hardwire a computer to it AND, if I want to look at images, must walk to that computer to pull them up. I really want a web-based system to store my images and the GE sales rep was 'incensed' that I would even try to find something like this.

Am I crazy? Is there something out there for gynecologists to use with our ultrasound machines? Do you have any referrals for me or areas you believe I need to do further research?

 I am looking for a web-based PACS for the following reasons:

My new office will be web based and I am only looking at products that have redundancy (more than one storage server and these servers must be in two independent locations - many EMR companies offer this), mirrored data (data is stored simultaneously), and secure. I will not have to lease any extra space for computers; have to worry about losing data with two separate servers (a flood could take out one and I'd have a back up in a different location - can your office server do that?); save on file room space and staff, and will be able to send reports and images on-line to referring docs;subspecialists; or to the patient, if she wants. I am a firm believer that web-based can be safe, secure, and a part of our future.

Thank you so much! Your website and blog are intensely helpful and I was relieved and grateful to find it!
Thanks for getting in touch, Dr. Lisa!  Welcome to the world of EMR, PACS, and the vendors thereof.
I'm not all that familiar with the Voluson-e, but it looks interesting.  Nice and compact. 

I'm also not familiar with this package they are trying to sell you for viewing.  However, your instinct is correct concerning a web-based PACS.  For the time being, your volume won't justify owing your own PACS, but the advantages of sending the images out to the web (or to the cloud if you prefer) are multitude. 

My group owns an AMICAS PACS which we farm out in this manner, and one of our clients is indeed a small portable (actually mobile) sonography service.  This sort of thing is certainly do-able.  We would be glad to help you out, although you would probably be better served by someone closer to home.  Alternatively, I believe some of the larger storage companies such as Co-Activ or InSite One could be of service here.

Best of luck with your new office!  And tell Mr. Incensed from GE that you're going to look at Siemens/Acuson: