Doctor "Hunter's" PACS

Thr image previously in this spot, which was properly credited to Destination360.com, has been removed after said website filed a complaint against me. Please feel free to contact Destination360.com and thank them for their vigilance. 

ADDENDUM...I have just purchased the rights to use the photo from iStock Photos...Destination360.com did not own exclusive rights!!!!!

I have the joy and educational opportunity to be on call on Father's Day, as I was on Mother's Day, and as I will be on July Fourth. I must be living right.

The good news here is that I got the chance to talk at leisure with one of my partners who has the wonderful fortune to be on IR call this weekend. Dr. "Hunter" as I will call him is a damn good radiologist, although not as computer-savvy as some of the guys. Fortunately, he isn't quite as bad in this regard as another partner, the inspiration for Dalai's Twelfth Law, "The PACS needs to be operable by the least technically-savvy radiologist on staff."  That would be Dr. Bill, who is also an absolutely superb interventionalist, but not so good with computers:

Anyway, as you might guess, Dr. Hunter's favorite hobby is indeed hunting, and he can discuss guns and hunting trips until the cows come home. (He doesn't hunt cows, fortunately.)

Hunter is based at our smaller, AMICAS hospital. He has been exposed to the new AMICAS PACS more than the rest of us, and has had some problems with it. When this morning's conversation rolled around to the topic of PACS, I was expecting the worst, a tongue-lashing about "my" PACS. Surprisingly, I found Dr. Hunter to be quite insightful on the current and future state of our enterprise. Let me elaborate.

AMICAS PACS, or AMICAS 6, or Merge PACS 1.0, is a considerably more powerful product than its predecessor. With power comes more buttons and settings, most of which are in the background. Sometimes, those settings don't get set right, or at all, for that matter, and that has been our problem. The hospital in question has had some transitions, and in fact just let go the PACS admin who had been trained up on AMICAS 6, but never had time to go through and customize it for us. The formerly junior PACS admin, who is now the Senior PACS admin, as well as a bunch of other things, has not been to training. Fortunately, he is wise enough to know what he doesn't know, and gave me super-user access. Thus, I've been able to do some fine tuning and improve the experience for my mates at work.

I'm not going to diss AMICAS 6, as I had a little to do with its creation. I can (mostly) honestly say that the parts of the program my partners dislike are those which were "inspired" by other systems, and which some other members of the now-defunct Advisory Board insisted be included. One particularly despised function is a more elaborate history listing that superimposes itself above the Real-Time Worklist, and basically takes up space that would be better devoted to the worklist itself. This, I believe, was modeled after Stentor/iSite. I didn't like it there, and I don't like it here. I've asked Merge to put in a control that will let us big-time super-dooper-pooper-scooper-users turn it off. The drive to appeal to a minority user (not a racist statement, I promise) illustrates the situation described in Dalai's Fifth Law: "Workflow is inversely proportional to the number of buttons on the PACS desktop." The desire to please everyone can ultimately lead to the Lego-PACS syndrome of hyperconfigurability.  Even Dr. Hunter gave in to this rationale, wondering if the PACS shouldn't just start out as a plain vanilla framework, to which one could add various modules.  He used the example of a white Ford pickup, of all things.  "Some want bucket seats, some want flame decals on the side, some want brush guards.  Let 'em build it the way they want it." Personally, I would never buy a Ford anything, but you get the point.

Dr. Hunter bemoaned the loss of simplicity (if not innocence) we had with AMICAS 5. But I can tell you that the advantages of the new program compensate for this, once the program is configured properly. Still, I hear what he's saying, loud and clear. I used the example of Hunter's new iPhone to illustrate. Apple takes the old AMICAS approach. The iPhone has some configurability, but not so much as, say, an Android phone. But the iOS works really, really well for the vast majority of people, and they flock to Apple so as to have something that works, and work well, right out of the box. Android requires a significantly greater degree of fiddling to get to where you want to be, and I understand that Blackberry's are sheer drudgery in this regard, which probably explains why RIM sales are plummeting. Most of my partners who suffered through various Blackberries now have either iPhones or some Android variant. AMICAS 6 tends to resemble the Android end of the phone spectrum. It works quite well, don't get me wrong, but it isn't as simple as it used to be. There is always a trade-off between usability and power.

Hunter then shocked me with the his home-grown ideas for where we need to go with PACS. In his own way, he has figured out a few things that took me quite a while to realize. He has some inkling of how an enterprise-wide system might work, inspired by the fact that some of our partners never seem to get around to helping with the lists at other sites. "Why not have some sort of window on your computer, or even something you could pull up on the iPhone," says Hunter, "so everyone can see which sites need help?  And make 'em link to the PACS programs so I can go right to where I need to be!" Good idea, although my personal thought is to simply (not really) connect all sites to one single unified worklist.  Let everyone chip away at everything.  Frankly, though, Hunter's idea would probably be easier to implement, requiring fewer permissions from IT and security types.  He had a similar idea for report sign-out amongst the various RISes we use.  Not a bad thought, really.

The lesson to be learned this Father's Day is of course not to be on call if you can avoid it. Seriously, though, my chat this morning illustrates what I've been saying for a very long time on this blog and elsewhere: PACS designers need to listen to how bread-and-butter, front line, out-in-the-boonies radiologists do things.  We use the stuff every day, day in and day out, and we have a reasonably-good idea of what we need the PACS to do and how we want it done.  Unfortunately, every PACS vendor feels the need to appease outliers sometimes, adding stuff that only a few really want, or even building something just to please the IT folks who hold the purse strings, and not the radiologists who actually use the damn thing. The disconnect is just something that has emerged over time, but doesn't have to be the way things are done forever more.

In the meantime, I'm jealous of Dr. Hunter.  He'll be off duty soon, and I'm sure he's going to go out and kill something.  Sounds pretty good after a weekend of call...