The Mouse And The KeyboardA Radiology Fairy Tale

From my friend 23Skidoo:

THE MOUSE AND THE KEYBOARD

A Radiology Fairy Tale...

                     Or 

 - Adventures in Professional PACS Training and Customer Satisfaction

For my non medical or non imaging friends out there…

PACS stands for:

Picture Archiving and Communication Systems-PACS refers to all of the equipment and systems involved in viewing and storing your digitally acquired, medical images. (think Xrays, Ultrasounds, CT scans, MRi’s etc... )

 ON the viewing/clinical side we have the radiology technologists who generally acquire the images, while working in conjunction with the radiologists who subsequently interpret them. 

On the Archiving/Storage side of the equation, we have the IT/Computer/Technical folks who do their part to make the miracles of filmless viewing, virtual colonoscopies and 3D reconstruction a reality. 

Both sides of the house need each other and both sides often drive each other crazy while attempting to pull off the seemingly impossible. 

It should be noted however, that while it is common for individuals to transition from the clinical side of the house to the more technical, storage side, it is extremely rare for anyone innately technical, to make the clinical transition.

This speaks to the personality types involved, as well as the theory that data centers are probably similar in construction to The Hotel California…

Here we go with our story:

Once upon a time, there was a PACS.  This PACS was one of the finest in the entire kingdom.  Radiologists and technologists alike, spoke of it in hushed, reverent tones.  They were enchanted by its ability to enable physicians and healthcare professionals to manage, access and visualize multi-specialty medical content across the enterprise usingadvanced visualization tools, clinical content management andclinical workflow through a dynamic user interface.

As wonderful as this particular PACS was, it was also well established throughout the kingdom that the epoch of implementation, as it was referred to, was, at times, fraught with obstacles.  Many of these obstacles had nothing to do with the beauty and efficiency of the system.  Nay, it was often puzzling to the many Knights of the Implementation Council that the very radiologists who wanted and needed the system, were oftentimes, themselves the source of the conflict.  Many roundtable discussions were held in order to solve this mystery of conflict and customer dissatisfaction.

During these Roundtable discussions, legends and tales from Implementations throughout the land were shared in order that they might consult with one another to decipher the lessons contained within, such that quality solutions to problems could be revealed.

It was once upon a particularly illustrious Roundtable discussion, that the tale of the Mouse and the Keyboard was first told:

Legend has it, that it was during a session whereupon one of the Knights of the Implementation Council was bestowing upon a radiologist the wisdom and understanding of the PACS, that one particularly startling incident occurred.  

The PACS configuration contained 4, Grayscale, Resolution of the Highest Monitors, of the House of Siemens, in combination with a Color Monitor, descended from the Lordship of the House known as Dell.  It was this Dell, whereupon the exam list was displayed and the private healthcare information of the subjects’ of the PACS was made known. 

The cursor, which was the onscreen representation of the relative location of the mouse upon the desktop, had to travel vast distances across the 5 monitor expanse. 

{From the University of Rochester’s website}: http://www.urmc.rochester.edu/smd/Rad/nevents05.htm

Here is what a typical workstation might look like:

 The critical moment of this story occurred when the radiologist, who had been disregarding the amount of desktop space necessary for mouse movement, caused a collision of the Mouse, upon the Keyboard.  The cursor, which he desired to situate upon the patient list,was trapped upon the landscape of monitor number 4.  No further leftward movement was possible due to the keyboard’s impedance upon the mouse’s leftward most pathway. 

Observers gaped in amazement at the transgression, yea, many fled the room, in fear of witnessing what horrors might befall the ensnared cursor. 

The radiologist registered a customer dissatisfaction issue with the Knight of the Implementation Council that such behavior was an unacceptable feature of the PACS, and that it would need to be corrected by the Knights of the Engineering Council before he would ever again lay his hands upon the PACS. 

Silence fell upon the darkened room. 

All eyes were upon the Knight of the Implementation Council, whereupon, she most bravely and fortuitously reached towards the keyboard, with utter disregard for her own personal safety, slid it forward, in such a manner, as to disrupt the keyboard’s negative interference upon the Pathway of the Mouse. This swift action created more usable surface area, whereupon,the Mouse and the Cursor were then both easily returned to the first monitor, that of Dell.  

The radiologist nodded in satisfaction and the Project Manager, He of the Highest Order, confirmed that the solution was one of both quality and genius.   

The PACS was saved and the Dominion of the PACS Company prospered ever after. (Until such time as it was sold and the name was changed)

There are many notable and almost seemingly comical stories and fairy tales in the world of PACS Implementation.  The above story, while thematically framed, recalls an actual incident and challenge in the field. 

All fairy tales have something to teach us.  The mouse and the keyboard were functioning properly; there was nothing wrong with the application.  The doctor merely ran out of mouse manipulation room and did not know that he could simply pick the mouse up, move it several inches to the right, and recover his cursor. 

To those of us familiar with computers, this seems like such a simple and intuitive thing to do. It was not intuitive for this doctor. Covering for his embarrassment, he lashed out at everyone in the room and declared the system a failure. Immediate intervention was required, in order to convert a potentially sales killing, customer experience, to a more positive encounter.

The lessons in this, and the challenge to all of us, is to be prepared to take a creative approach, in order to be able to train people to utilize any system, regardless of the current level of computer literacy in which we find them.  

There have been times when I have had to start from the beginning and teach a radiologist how to point and click with a mouse.  I would start them off with solitaire and work my way back to the medical applications.

Conversely, many radiologists are very skilled and comfortable with computers and have presented me with different sorts of challenges.  Hyper-light speed mouse clicks, borne of impatience and the need for rapid throughput, can create unwanted situations and give the appearance of poor system performance as well.

 “Semper Gumby”- Always Flexible has been my guiding philosophy in this arena.

While I maintain a general lesson plan that I like to follow in order to ensure thoroughness, oftentimes the needs of the radiologist will dictate that the script needs to be abandoned, and spontaneity becomes the order of the day.  The less we, as trainers, regard this not as a threat, but more as an opportunity to shine, the greater the likelihood of high, customer satisfaction, regardless of industry.