Saturday, January 28, 2012 Second-Most Read Blog!

I have it on good authority that this blog is the second-most read publication of its kind at some large PACS companies.

I find this very disappointing. Don't you guys have anything better to do?

Seriously, thanks for reading. Your patronage is much appreciated.

(BTW, HISTALK is deservedly number one.)

Saturday, January 21, 2012


Do you own or operate a GE Logiq P6? I don't, although it looks like a very nice machine. But do be careful with yours. It seems there has been a bit of a problem...

From the FDA:

Class 2 Recall
GE LOGIQ P6 Ultrasound System

Date PostedJanuary 21, 2012
Recall NumberZ-0834-2012
ProductGE LOGIQ P6 Ultrasound System. The device is intended for use by a qualified physician for the evaluation of soft tissue and blood flow in the clinical applications of: Fetal; Abdominal; Pediatric; Small Organ (breast, testes, thyroid); Neonatal Cephalic; Adult Cephalic; Cardiac (adult and pediatric); Peripheral Vascular; Musculo-skeletal Conventional and Superficial; Urology (including prostate); Transesophageal (TE); Transrectal (TR); Transvaginal (TV); and intraoperative (abdominal, thoracic, vascular and neurological).

Recalling Firm/
GE Healthcare, LLC
3000 N Grandview Blvd
Waukesha, Wisconsin 53188-1615
Reason for
GE Healthcare has recently become aware of a safety issue associated with the Probe of your LOGIC P6 system that may impact patient safety. GE Logic P6 probe head has a possibility to cause burn injuries to patients or operators.
ActionGE Healthcare sent an "URGENT MEDICAL DEVICE CORRECTION" letter dated December 23, 2011 to all affected customers. The letter identifies the product, problem, and actions to be taken by the customers. The letter instructs customers to discontinue use of the affected product. Contact the GE Support Center at 1-800-321-7937 or your local GE Healthcare service representative for questions regarding this issue.
Quantity in Commerce2270
Whoops. So let me get this straight. The probe which might be used to scan breasts, testes, and other important parts might burn them? Ouch! I'm keeping my small parts away from this particular device for the foreseeable future. Check your serial number against the table published on the FDA page.

I suppose users could double-charge for thermography as well as sonongraphy...

Hat-tip to Dasmah of the Kuwait PACS Club.

Sunday, January 15, 2012

Dalai Meets The Next President

Mitt and Ann Romney
Charleston, SC 1/14/2012

Sometimes it's good to be in the right place at the right time, especially when you live in the state that boasts the First in the South Presidential Primary.

Mrs. Dalai, Dalai, Jr., and I were in Charleston for the wedding of a friend's niece, and had the day to wander around. It was a bit chilly, but we took a leisurely stroll through the revamped Market (slaves were never sold there, by the way) and had some rather good seafood for lunch.

As we approached the Charleston Place Hotel, we noticed the Romney-Bus parked outside, with a small crowd gathering, and we proceeded over to check it out. Yes, Governor Romney himself was to appear momentarily, and, indeed, after waiting only briefly, he and his wife walked around the corner. The Governor shook the hands of the twenty or so of us standing on the sidewalk. He got to Junior first, and then to me. He looked me in the eye, and shook my hand quite firmly. I nodded my head gently, greeting him as "Governor." Romney paused a bit, as if to give me a chance to say something else, perhaps something more intelligent. Now here's where you will all think I've lost it, and you may well be right. In that pause, in that hesitation, I sensed...humility. I can't totally tell you why, but I did. In my old age, I've learned to rely on my instincts, and they don't lead me wrong too often. Well, usually they don't.

Here is a very wealthy and powerful man, quite likely to be the Republican nominee, and then, God-willing, to be the President of the United States, displacing the accident of fate we have now. Do I think Mr. Romney is perfect? Heavens, no. He has a lot of baggage, just like every other candidate, and most of the rest of us, for that matter. But the man has presence, he has charisma, he has charm, and he does have the air of confidence. But my instinct, my gut-feeling, my sixth-sense, tells me that these characteristics are tempered by humanity, humility if you will. I didn't have the chance to meet any of the other fellows on the trail, so I can't put them through the same test. I'm not sure they would pass.

I can't expect any of you out there to feel what I felt, or to trust my intuition. Frankly, it's pretty much a moot point, as Mr. Romney is expected to win his third victory here in South Carolina, and with that set the tone for the rest of the primary season. Beyond that, I can only hope he learned his lessons about Romney-Care, and will do a little better spinning the Bain story. On various other issues, he says mostly the right things.

They say one casts a vote either for the candidate one likes, or against the fellow one doesn't. Come November, perhaps we'll be able to do both.

Wednesday, January 11, 2012

Decisions, Decisions...

Dear Vendors:

Yes, we've narrowed it down. No, I'm not going to tell you how just yet.

And while its always nice to see you folks, coming by to chat isn't going to have any effect on anything.



Tuesday, January 10, 2012

Speech Recognition Doesn't Even Work In Editor Mode!!

Image Courtesy
It seems I was part of an experiment and didn't completely realize it.

One of our in-house transcriptionists as been using speech-recognition in what I call "editor mode".  In other words, my dictation is run through an SR engine (I don't know which one) to provide the first draft of the report. She then edits it while listening to the dictation, and places the final report on the RIS for my review. This should give us the best of both worlds, the speed of SR and the accuracy of a human.

Except it doesn't work.

The particular transcriptionist is really superb at what she does, and before this little experiment, her reports rarely had any mistakes at all. But throw in SR, and all bets are off. Almost every report produced in this manner had at least two or three mistakes.  And these were NOT typos, making them much harder to spot. For example, I dictated something about activity in a stump of an amputee. The SR translated "stump" as "stomach" and this made it by the editor and would have made it by me if I hadn't remembered the case itself. I can cite dozens and dozens of other, similar glitches.

I asked that SR be turned off for this week as an experiment, and wouldn't you know it? Absolutely NO mistakes on our reports. None. Zero. Nada.

Once again, I'll yell it from the hills and the valleys: Speech Recognition is NOT READY FOR PRIMETIME! Period. Maybe in five years.

Even Siri agrees with me on this, although she knows I'll turn her off if she doesn't.

Friday, January 06, 2012

How Much Is An EMR?

MediNote EMR, courtesy Carson Doctors Group
I have to take a moment away from the compilation of the Advanced Visualization results to whine about something else: EMR's.

One of our hospitals is plunging headlong into the EMR quagmire, and I am on the EMR/EHR/EFR Committee (specifically the CPOE Committee) as a representative from radiology and things technical. You would think it a daunting task to upgrade a full hospital system to electronic status, and you would be correct. Fortunately, the IT types and physicians involved are very capable, and really interested in doing a good job, and I have been quite impressed with their efforts to date.

HOWEVER, we have a tremendous stumbling-block, and it relates to the software already in place. While not going into chapter and version (and not naming names, as I think I might have signed something that said I would keep my big mouth shut), years ago, a really bad decision was made to go forward with the version of HIS/RIS (what we used to call EMR/EHR/EFR) that was little more than a port of an old Data General green-screen terminal. In other words, we are stuck with 10-year-old technology emulating 20-year-old technology. It sucks. Period. And we now are charged with making a square CPOE peg, among others, fit in a rather ancient round hole.

You would think that in the process of upgrading, we might simply forklift out the old green-screens and buy something new. Apparently, this won't work. It seems that our small hospital system was told that it would cost $30 MILLION to replace the whole shebang. $30 MILLION. Yes, that would be MILLION with an M. Now, I'm not sure just who set that price, but it was accepted as gospel, and a heck of a lot of work is now predicated on the premise that we must update but not upgrade. Bah Humbug!

I need to poll the audience. Does it REALLY cost $30 MILLION to replace an EMR for a relatively small hospital system? We're talking 300 beds or so, not the Mayo or Man's Best Hospital. Really? Seriously? $30 MILLION!!???

If this is truly the case, somebody out there (I'm thinking Merge Healthcare has the wherewithal to do so) needs to reinvent this genre. I cannot believe that EMR/EHR/EFR's have to be this expensive, not to mention requiring a two to three year implementation period. It just doesn't make sense to me, and I insist there has to be a better way to do this. Right now, I think the software companies are frankly just fleecing their customers in their frenzy to comply with all the Meaningless Use crap from Washington. Please do feel free to prove me wrong.

$30 MILLION? I'm not buying it. Literally or figuratively.

Wednesday, January 04, 2012

The Advanced Visualization Caucus

"Glass View" on IntelliSpace, Courtesy of Philips.
(Note...this is NOT an endorsement of any particular product!!!)

The First (and probably Last) Annual Advanced Visualization Shoot-Out (a.k.a. Dalai's Advanced Visualization Caucus, Mini-RSNA) went off with only a few hitches, which I'll outline in a moment.

The vendors all arrived early this morning, and set up their wares in our hospital auditorium. The digs weren't all that fancy, but the cavernous room was nice and warm on an unusually cold day down here in the Deep South. Everyone found a corner with adequate electrical outlets, and within an hour, we had a Technical Exhibit Hall that rivaled some I've seen at relatively large meetings. OK, it wasn't quite RSNA, but this ain't Chicago, and thank God for that!

Pat, the PACS Goddess!
Before I go any further, I must express profuse thanks to Pat, our PACS Goddess. She juggled three dozen variables, kept vendors, docs, and administrators on time and on schedule, and just generally made this thing happen. I'll admit that I came up with the general idea and some of the specifics (mostly stolen from the Stanford PET/CT shoot-out), but Pat deserves the lion's (sorry, Tiger's!) share of the credit for her hard work that brought us all together. And I am extremely grateful to the vendors themselves who came down for this little shindig at no small expense. As proof of their attendance, here are non-Photoshopped images of each vendor team. Note to Corporate: they all actually did show up here to South Carolina, so please pay their expenses. Trust me, NO ONE would visit this particular spot if they didn't have a good reason! Here they are, in no particular order:

Team Siemens
Team Vital
Team Tera
Team Philips
Team GE
Team Techs

The last photo, of course, depicts two of our superb CT techs, who will actually have to use whatever we purchase. And I pity the fool who doesn't take their opinions into account. Needless to say, I will!

And that is really the bottom line. This is a decision that affects the way our techs and rads will operate, and so we have to pick the solution that is right for our particular shop. We are quite fortunate in that regard: each of the five contenders would do the job for us, and do it well. The key is to drill down to the one that will work best...for all of us.

Gathering five major companies in a room together is a monumental feat. One vendor suggested that their willingness to do so was related in some way! It seems that the majority of the attendees are devotees of my blog (one poor fellow even used the word "star-struck" which indicates that he needs to get out more) and thus wanted the chance to participate in this event. I'm honored and humbled, and glad that my reputation (good, bad, or otherwise) contributed to the chance to make a good decision for my hospital. 

I suppose you want to know which product won the competition, yes? Sorry...for that, you will have to wait. Pat the PACS Goddess and I will have to compile the questionnaires (and quiz those who didn't bother to fill one out) to see which system will take its place in our place. All of these systems actually work well; each does some things better than others, and better than the rest. 

Each of our participants watched the various programs put through their paces. We had intended to see only our own data run through the processing protocols, but not all of our cases exported properly to disk, which is our own fault and not that of the vendors. Frankly, I wish we had had a week or two more to set this up, but the auditorium was available TODAY, and not again for months, so it was now or never. We were able to view a mixture of our own cases and those from the vendors' stashes, and I think it all turned out well in the end.

I'm not going to go into minute detail about every facet of every system. The post would grow to epic proportions, and you would be bored silly by the end of it. Here are some rather vague tidbits:
  • The program I initially thought would be best...wasn't. 
  • The program I initially thought would be worst...wasn't.
  • The level of automation is quite high with all five. 
  • The more raw horsepower, the more complex the interface.
  • Several pieces of software are not yet approved (remember, RSNA=Real Software Not Available).
  • There are several ways to display transparent/translucent bones.
  • No one would give me one of the ubiquitous iPad's. 
  • There are vendor-specific iPhone/iPad apps that the vendors don't know about.
  • Everyone was anxious to know who won and when the P.O. would be cut, although some were more anxious than others.

So, without further ado, my personal favorite was:...........,,,mjkhgyuftdseaweqTWAYESURIDTOF

Note from Mrs. Dalai:  Hi, everyone. I found Dr. Dalai fast asleep with his head on the keyboard. You must have worn him out today! I'm sure he'll come back and tell you who won, eventually. In the meantime, I'm putting him to bed without his dinner.