Tuesday, December 26, 2017

Dalai's XIIth Law

Some years ago, I created Dalai's Laws of PACS, a distillation of my observations of PACS over time. I managed to insult most everyone involved in imaging, including vendors, IT, radiologists, hospital administrators, and probably His Holiness, the Dalai Lama Himself. Ah, those were the days.

Perhaps my favorite among the Laws was number XII:

Which is graphically illustrated by this photo meant to remind us of some radiologists we know:

This Law was inspired by interactions with one of my former partners, now bosses, who happens to be a superb interventional rad. However, not long before I codified the Laws, he called me from a plane about to take off to ask how to adjust the volume on his laptop so his kids could watch a movie. 

The Law was also prompted by another partner, the one who is no longer with us, having gone to a far, far better place (no, he's not dead, he's in Florida!) This fellow inflicted upon us a very early advanced visualization program (it could do real-time MPR, and that's about it) that had a horrid interface. My friend didn't care about the latter, and insisted that we all use this piece of garbage.

And so the XIIth Law was born. You might say it is designed to appeal to the least common (technical) denominator, and you would be correct. But that isn't necessarily a bad thing. Usually. PACS and associated products are used for life-saving evaluations and they have to work for everyone. Simple, yes?

The late, great George Carlin once said, "Behind every silver lining, there's a black cloud." I now find myself boxed in by XII and the associated philosophy, and I'm stuck. 

As negotiations are ongoing, I cannot reveal the companies or even the product involved, so forgive me for the following, rather obtuse description of the problem. In brief, one of our sites is getting a new piece of equipment, and it comes with the option for new reading software. Another site has a similar device with older software. I am quite comfortable with the latter as I selected this package myself several years ago. But when we went on the obligatory site-visit to see the new machine, it was being used with a different package, actually not from the hardware vendor, that was highly recommended by all involved. 

In anticipation of the blessed event (the delivery of the new device) in a few months, we've had a demonstration version new software installed to get everyone used to it. And there begins the grief. 

To be fair, there has been some degree of miscommunication with the vendor, which was apparently not aware of the XIIth Law, and had the impression that they needed only to create a profile to my liking, and not worry about the rest of the boys. And they got my profile pretty close to what I wanted, ignoring a few things such as number of clicks to get from A to B that I figured would be ironed out in the final production install. 

But then I made the mistake of listening to myself. I polled the peanut gallery audience to be sure everyone was on board with the new program. And lo and behold, they were most emphatically not. The other rads far preferred the older, less-powerful program they are used to using over the newer, much more powerful, but more complex newcomer. Of course, in discussing the situation, it becomes clear that the rest of the gang really wasn't all that familiar with the older program, and really didn't realize that the smooth functionality they craved was in large part due to hundreds of hours of work by one of my technologists, who created maps by which the program knew which images to place where in the great scheme of things. But that's all under the hood, and no one really is concerned with how it works, just so long as it does work. 

So the big question is this: Do I insist on the program I think is best, or do I practice what I preach, and go with what works best for the crowd? Actually, that misstates the situation somewhat, as I have asked the vendor in question to create a pablumized pared-down profile that should make everyone happy. It remains to be seen if they can do so. 

I am a Bioengineer by training, which is a branch of Electrical Engineering. I have managed to make the two persona live in internal harmony, but for most physicians, Star Trek's Dr. McCoy said it best:

"I know engineers, they LOVE to change things."  And so they do. And sometimes for the better. I've whined for years and years that engineers don't design usable PACS interfaces, but that isn't always the problem. Sometimes, PBKAC.

Hoist by my own petard. We'll see what happens. 

1 comment :

Phil said...

To answer your question - do you stick with what you have chosen, or stay with the old familiar - one thought comes to mind. Have them all read an edited version of this. You might also enumerate the features the new software has that eliminates annoying problems with the current system, then let them choose. Then get the group together to discuss it (if possible) and let them jointly make the decision.