Saturday, March 24, 2007

Let's Contain the Giddiness...

Image courtesy of:

I try to be sensitive to the whims of my readers, and, believe it or not, I really don't like upsetting anyone. It has come to my attention that there was much intestinal disruption caused by my recent article discussing a certain piece of software. While I regret any distress I may have caused, I will stand by every word in that article. Now, those who know me well realize that I don't want any false information disseminated under my signature, and I am always responsive to documented corrections. So, if there is any factual error on that post, please let me know via the comment field below. The grapevine connection will eventually get the message to me, but it will likely be something other than what was meant to be said. (Anyone ever play Post Office?) But rest assured that when someone tells me that my product, in this case my blog, is impairing their work., I listen, and I do something about it.

Monday, March 19, 2007

Dalai's Laws of PACS

I. PACS IS the Radiology Department.

II. PACS exists to improve patient care. Its users are the radiologists and radiologic technologists. The entire goal of the PACS team is to optimize PACS function for its users.

III. Once PACS, never back.

IV. Workflow is inversely proportional to the number of buttons on the PACS desktop.

V. PACS should not get in your way.

VI. Speech recognition will be feasible when the CEO, the CFO, and the CIO use it for their correspondence.

VII. The degree of understanding of radiologist workflow is inversely proportional to the size of the PACS company.

VIII. An average PACS consultant will take 6 months to tell you what you already know.

IX. PACS should be the shared responsibility of the Radiology and IT Departments.

X. The time of delivery of a patch for a malfunction is directly proportional to the square of the severity of the problem.

XI. A true PACS Guru is worth his/her weight in gold.

XII. The PACS needs to be operable by the least technically-savvy radiologist on staff.

Tuesday, March 13, 2007

Some Thoughts About Marketing
...and Complaints

Abercrombie and Fitch T-shirts, short-lived designs

Images courtesy of: and

My daughter is home from college for Spring Break, so naturally, we had to go clothes shopping. (Why couldn't DRA-2005 have slashed retail prices, too?) We went to the regional hoity-toity fashion mall, and commenced charging. My poor AMEX card will never be the same.

We had one mildly disheartening experience at Abercrombie and Fitch, you know, the place with the suggestive photos of young people almost wearing their wares? Well, today, the mannequin was wearing the shirt that took my daughter's fancy. We looked all over the store--no other such shirts. We collared a sales-droid who checked in the back and--no other such shirts. We asked if we could buy the shirt off the mannequin's back--Oh no, those belong to the Visual Department, and we can't sell them. We asked a manager, and, in a tribute to consistency, we received the same story, with considerably more attitude. This made no sense to us, as the shirt had a proper price tag, and appeared ready to be set free from its bondage. So, I asked if there was someone in Corporate I could call, and I was given the number for Customer Service.

I stepped out into the mall, and called, and eventually I was connected with a supervisor named Curtis. Curtis was very pleasant and patient, and explained that yes, the displays are indeed owned by Abercrombie Central, and moreover, they are not saleable as they have been cut, re-sewn, and otherwise disfigured to look good on the mannequin. This is why they cannot be sold, not simply the ownership issue the sales kids were trying to cite. He offered to order the item and send it to us with no shipping charge, which I declined, but I did thank him for it. He asked if I would like to file a complaint, and I did. Here it is, petty though it is: Putting an item on display when there is no such item for sale within the store is really bad advertising. If I had wanted to order from the catalogue, or from their web-site, I could have done that without driving several hours to the big hoity-toity regional fashion mall. It makes more sense to remove such a display until such time as the item is actually available within the store. Curtis promised to pass along my complaint to the national office.

There are good and bad ways to market your products and your name, and there are good and bad ways to handle complaints. The shirts seen above are examples of really bad marketing. Curtis, on the other hand, properly dealt with my complaint, although I have very low expectations of my advice being followed. Still, I may someday set foot again into an Abercrombie store, and possibly even buy something, which I might not have considered without his ministrations. On the other hand, simply repeating a programmed mantra ("Corporate owns the display", "Our other customers want it that way") is not a good practice. Demeaning and discrediting the complainer, especially without dealing with the complaint, is definitely on the bad list, and can have very serious consequences such as losing the customer permanently.

I know I sound like the consumer from Hell, and I try not to be. I realize that this is an imperfect world with imperfect products built by imperfect people, and I am far from a perfect radiologist, believe me. But I have this old-fashioned Nordstrom-like belief that the customer is paramount, and at the very least deserves to be heard. He or she might actually have a valid point that could save someone some money. Or time. Or maybe save someone's life. From the Restaurant Doctor:

Stamp out inconveniences before they become irritations.

Stamp out irritations before they become complaints.

Stamp out complaints before they become problems.

Stamp out problems before they become crises.

Notice that there is no mention of stamping out the complainer!

Remember, the "C" in PACS stands for "Communication". I think this has become a lost art in the 21st Century. There is much talk, but little listening, and even less hearing, not to mention a desire to shift blame anywhere possible. That is how complaints turn to crises.

ScImage Unites The VA
...and validates Dalai's idea

I have made a number of disparaging comments about ScImage over the years, based on my very unsatisfactory experience with their older products. I have agreed to bury the hatchet, given a very eloquent post on a rather unusual AuntMinnie thread by Rob Tinker, ScI's National Operations Manager:

.....Of course, Dr. Dalai, I encourage you to continue to broadcast your valued opinions to the professionals that browse Aunt Minnie’s forums but we would ask that instead of continuously bashing ScImage based on your experience with a 3 or 4 year old product, come take a look at what we are doing today, so that you will at least be providing an opinion that is relevant. I would welcome the opportunity to speak with you regarding all this, at your convenience of course.

That nicely closed a rather contentious series of posts, and set the tone for a truce if not a total reconciliation. (I still don't know who started the nasty thread, by the way, but in the end, the true nature of several AM regulars became quite clear, and that is satisfaction in and of itself.)

I remain on ScImage's e-mail list, and today I received this notice:

Los Altos, CA – March 12, 2007 – ScImage, an award winning enterprise imaging and information management company, based in Los Altos, California, announced today that the Veteran’s Health Administration (VHA) has awarded ScImage the contract for the VHA’s nationwide teleradiology program serving more than 150 Veteran’s Health Administration Medical Centers.

The ScImage solution will be deployed as a web layer on top of disparate PACS at various facilities to route exams along with prior images and reports based on dynamic business rules and will be used exclusively in the VHA’s Teleradiology Center to provide a virtual reading environment for reading radiologists and/or radiology groups. Deploying the solution in this manner will enable the VHA to surmount the shortage of qualified staff in certain geographies and provide faster turnaround. The result will be a more unified and consistent collaborative reading workflow that VHA program directors can watch and manage very closely from anywhere.

At its core, PicomEnterprise boasts one database and a shared infrastructure that simplifies workflow for multiple facilities. The solution features several time saving and innovative clinical applications for TelePACS over broadband infrastructure. “ScImage is proud to be a part of such an important project. Providing the VHA with a unified approach to medical image and information management will lead to improved clinical workflow, patient care and a lower total cost of ownership,” stated ScImage Founder and CEO, Sai P. Raya, Ph.D.

Overall, ScImage will provide an extremely comprehensive solution that is ideal for the VHA’s objective of a centralized workflow model that will enable them to have full 24x7 coverage across the United States. ScImage’s solution will be placed in VHA datacenters to provide a virtual reading environment for radiologists from anywhere while administrators can monitor reading progress, exam volumes and workflow efficiencies.

That would probably explain why this blog received so many hits from VA headquarters in DC in recent months. I would, of course wonder what other companies were competing for this contract, but in the end, that is unimportant. What is critical is what ScImage will do for the VA: unite its "disparate PACS" systems into one enterprise. Now my idea was to unite regional centers' PACS systems to accommodate the "portable patient", which in the end is similar to what ScI will accomplish. There are, of course, rather significant differences. The VA is a more homogeneous group of hospitals than even the handful in my neighborhood. They are all under the same umbrella and administration, and their patients generally migrate only within the system. Thus, what the VA (or VHA...I'm of the old school) is doing is not only desireable, but really is mandatory given their circumstance and organization. But the lesson to the rest of the health care system is quite obvious. Here we have on a national scale a project validating the idea that small hospitals won't consider.

Obviously the technology exists to connect one PACS to another, and let me see Mrs. Jones' CT from St. Elsewhere done 48 hours ago. The only thing preventing this from happening is petty hospital and IT politics, and I do mean petty. But, don't worry, when Hillary is elected, we'll have some sort of National Health Care system, and no doubt the order to connect will come from Washington itself. That might be the only good to come of it, but....

Congratulations to ScImage. This is a big one for you guys.