Wednesday, January 28, 2009

Dalai In Paradise

For my BIG birthday, one of those that end in zero, Mrs. Dalai and I had to go somewhere special. I had first heard of Anse Chastanet in St. Lucia many years ago, and had even seen it from the deck of a cruise ship back in 1995. It seemed to be just the place for some rest and relaxation, somewhere to get away from it all. This is a wonderful village of unique and eclectic rooms built up the side of a mountain facing the beach, and overlooking the Piton, the twin peaks of southwest St. Lucia.

In doing my due diligence prior to booking, I discovered that Nick Troubetzkoy, the visionary architect behind Anse Chastanet, had just opened a sister resort above the first, called Jade Mountain. It seemed to be a magical and wonderful place from the description and the reviews (something like 99% positive on, an unheard of validation in this industry.) Figuring that due to the economy and the coming changes in medicine, this would be our last blow-out for a while, we decided to splurge for that big birthday and went for the Jade.

You can read many reviews and descriptions on line, and I won’t bore you with my feeble attempts at describing paradise, but suffice it to say, that’s exactly what we found here: Paradise. The rooms (appropriately titled “sanctuaries”) at Jade Mountain have one completely open wall, and most have infinity pools, which overlook the Piton. This is the view from within our sanctuary:

From the Anse Chastanet beach, you can see the Jade Mountain complex at the top of the hill. There is a restaurant and bar at the very top, with several levels of sanctuaries below. Each sanctuary is completely private, and you can’t see into your neighbor’s. However, because of the generally open design, you can hear them if they make too much noise. This hasn’t been a problem, as the ambient sounds of birds, frogs, and the rush of water through the adjacent fountains covers everything with a soothing backdrop.

A view from the other side, the entry to the Sanctuaries, reveals a spidery network of bridges, each room having its own private walkway. “Sanctuary” as I noted above, is the proper term for the rooms. There is an spiritual air about this place that reminds me of nothing so much as a Buddhist Temple, not that I’ve ever seen one, and the network of bridges brings to mind Hogwarts Castle of Harry Potter fame.

There is open steel rebar coming out of the pillars, apparently a deliberate design touch, looking somewhat like a flare, some decorated with glass sculptures, giving Jade Mountain somewhat of an unfinished look. We have heard that there are plans for expansion, which would build upon these unfinished columns.

My description and these photos do not begin to do the place any level of justice.
We did a few of the touristy things, visiting the volcanic park and viewing the sulfur springs and such in nearby Soufriere, as well as the botanical gardens and Diamond Falls.

St. Lucia has a long history of occupation and colonialism, having been traded back and forth (more accurately captured) between the French and British fourteen times. Marie Antoinette was actually born here, and not on nearby Martinique, or so they say. Sugar plantations formed the major industry for many years, eventually replaced by fruit exportation, and now tourism. We had a fascinating little journey into St. Lucia’s past on a walk through the rainforest and the ruins of a sugar plantation on the resort property. Meno, our guide, was the descendant of the slaves that worked the plantation, and lives today in a one room house in which his grandmother raised him. While touring the remains of the boiler-room in which the cane was rendered down to molasses, and in which many slaves endured a horrible existence, Meno said something quite profound in his heavily-patois-accented English: “It does no good to ignore history, to ignore what happened here. We must remember it and deal with it, and then go on with our lives.” I couldn’t have said it better.

I’ll leave you with one word that sums up Jade Mountain: Paradise. Trust me on this. Save your pennies and come spend some time here. This is one of the most relaxing, restful, spiritual, and romantic places on Earth. I have never, ever, seen anything like it.

Tuesday, January 20, 2009

Agfa Gets Canadian Bailout Grant

Agfa-Gevaert is a Belgian company, but it has a major presence in Canada, specifically in Waterloo and Toronto.

I have reported here and there about Agfa's Imaging Division being for sale, but so far, it remains as it was. I suspect that it will continue for a good while longer, thanks to the Province of Ontario, Canada:

BRUSSELS, Jan 19 (Reuters) - Belgian imaging technology group Agfa-Gevaert (AGFB.BR) said on Monday its healthcare unit had received a grant of 29.6 million Canadian dollars (US$23.6 million) from the Ontario government to aid its growth there.

Agfa Healthcare, which provides hospital imaging systems and other information technology services, said the money would support its research and development and regional operations in Toronto and Waterloo, Canada.

The grant will be part of an increased investment by Agfa Healthcare in its Ontario operations, creating 100 new positions, Agfa Healthcare said.

Ontario's Premier, Dalton McGunity, seems to enjoy playing Santa Claus, as he is also behind a $4 Billion (Canadian) loan to Chrysler and GM. The grant (not a loan, apparently) to Agfa will:

. . .help fund the development of new software that allows radiologists to share digital images across a regional network, instead of having to develop X-rays and physically transport them between facilities.
Those types of investments, McGuinty said, are also important to ensure the province's economy bounces back.

"We're doing both at the same time," McGuinty said. "We're lending a hand to Agfa, we're lending a hand to the auto sector as well."

Let's do some math here, shall we? $30 Million (Canadian) for 100 jobs. That would be $300,000 per job, yes? Should I ask my friends up in Waterloo if they're getting $300K at the moment? Probably not. Maybe they would consider hiring only 90 people and working really, really hard on some of my Impax issues?

Oh, Canada! Can I have a grant, too? Please?

Thursday, January 15, 2009

Connectivity Banisher

In the world of Agfa Impax, a "Connectivity Manager" is:

. . . a middleware component in the integration between HIS, RIS, modalities, and PACS systems, linking patient and study data with images. To display the information available from a non-Agfa RIS in the Text area of IMPAX, connect to the Connectivity Manager. . .

The main purpose of the Connectivity Manager main purpose is to take data from one system, such as a HIS, and translate it into a format that another system, such as a modality, can understand. Connectivity Manager accomplishes this translation with mappings. The mappings tell Connectivity Manager how to translate incoming and outgoing messages to external systems. The following mappings must be configured so that Connectivity Manager knows which report source to go to for each study, and how to translate messages sent from IMPAX. . .

Map a reporting name into the Data Store by identifying the sending facility in the Connectivity Manager database. Identifying this value means it will work regardless of whether the sending facility sends their name along with the message or not. Also, if the sending facility changes their name at some point, mapping or configuration changes will not be necessary. The Default Assigning Authority identified in this mapping is the name of the report source entered in the Business Services Configuration Tool.

The sending facility is required to view reports in IMPAX. Connectivity Manager uses the Entering_organization and Requesting_Service mappings to populate the sending facility field. These mappings should include the Default Assigning Authority so that every report contains a sending facility.

Our Connectivity Manager was upgraded last night. And again this morning. From the rad's point of view, this means:
During this time Modality Worklists will not be available and Technologists will have to manually input ALL Patient Information. Studies sent to IMPAX will Fail Verification, and will not update with Reports until the downtime is ended.
I drew the short straw, and experienced the joys of the upgrade. Fortunately, the downtime lasted less than one hour, and not two. Of course, only a few of the techs got around to manually inputting ANY Patient Information. Still, we were OK. Until this morning, when this information (including the accession number by which we dictate) was suddenly absent once again. The culprit was, of course, the Connectivity Manager, which seemed to be confused by "multiple" inputs for the same patient. Now that's a problem, which we hope will be fixed by the experts before too much longer.

As usual, Dalai's Laws of PACS apply. In particular, the First and Third Laws are applicable:

I. PACS IS the Radiology Department.

III. Once PACS, never back.

When PACS malfunctions, the department malfunctions, and don't even consider asking anyone to go back to a manual process. It ain't gonna happen.

So, in the ideal land of Dalai-wood (Hooray for Dalai-wood!), PACS should never break. Since that isn't achievable, these thing need to be created with an eye toward simplicity and functionality. Based on what the "Connectivity Manager" is supposed to accomplish, I'm not really certain why it has to be a separate program or computer or whatever it is. Shouldn't the simple, basic, core PACS be able to talk to others? OK, provide a look-up table (user-configurable, of course), but do we have to have a big, separate, grandiose module that manages to bollux up the works when we upgrade it?

Yes, I know..."simple" and "basic" aren't in the vocabulary of a lot of PACS vendors. Neither is "easy". And "uptime" can be defined to the preferences of those making the definition. But as far as I'm concerned, if it isn't totally "up," then it's "down." (Which happens to be true for many things in life.) So, today, we were "down," courtesy of our dear Connectivity Manager.

Wednesday, January 14, 2009

And Now Khan Is Gone....

Today we lost yet another famous Star Trek actor. Ricardo Montalban passed away in Los Angeles at age 88. Montalban is most famous in the non-Star Trek world for his multi-year stint as Mr. Roark, the host of Fantasy Island. To us Trekkies, however, he will always be Khan Noonian Singh, the genetically-engineered superman seen first the Star Trek TV episode "Space Seed" and reprised in Star Trek II: The Wrath of (who else?) Khan.

He had disappeared from the screen for the past many years, save for some voice-overs for animated roles. Sadly, Montalban had been wheelchair-bound for many years following back surgery in the early 1990's.

Montalban also founded Nosotros, which attempted to fairly represent Latinos in the media.

He will be missed. But perhaps one of his last lines from "The Wrath of Khan" is appropriate: "No. . .the game's not over."

Lying Headhunters

I just received a call from "Kristen Scott" who told our receptionist that she "needed a radiologist to look at a plain X-ray." When I picked up, she started into her spiel about a "radiologist who is interested in moving into our area..." I cut her off and told her not to call here again. However, the more I think about this, the angrier I get. She lied to get through to me, and I don't like that at all. Actually, I think this might be the same person that called me a while back and pretended to be a military official with a big federal hospital. Isn't that a felony?

Message to radiology headhunters: Don't even bother to make a cold-call, at least not to anyone in South Carolina. The vast majority of radiologists are NOT going to use your services, and will NOT waste time talking to you. Especially if you call and lie to to us or our staff.

Do I need to make it any clearer than that?

Still Following The Green Brick Road

My friend Brad from Dynamic Imaging, oops, I mean GE Healthcare, noticed my queries about the "hybrid" Centricity offerings, and was kind enough to fill us in on the latest. He attached some brochures that are not yet available online, but perhaps those links will be forthcoming. Here is the new deal:

We’ve heard from the PACSMan at RSNA, and read several recent postings that you’re interested in an update about the “hybrid” Centricity PACS and Centricity PACS-IW technology that GE was showing at this past RSNA. We’re happy to provide you with an update, as well as provide collateral documents (See attached) that go into even greater detail.

Introduced at RSNA 2008, Centricity PACS Web Diagnostic (“Web DX”) provides a Web-based diagnostic viewer for Centricity PACS 3.0 users. Web DX has been developed using groundbreaking technology, leveraging the Centricity PACS trusted backend infrastructure, advanced patented streaming capabilities, and the award winning Centricity PACS-IW viewer. Web DX has received clearance from the FDA (510K) for primary interpretation, and is available for sale worldwide today (English-version).

Web DX delivers the speed and functionality of the PACS-IW viewer through the use of advanced streaming technology connected directly to the Centricity PACS backend. The potential workflow of a Web DX user is multi-fold --- any user who seeks anywhere access to all studies and reports on their Centricity PACS system, a radiologist who seeks to interpret studies from home or at the imaging center away from the main hospital, sophisticated clinicians (oncologist, orthopedist, neurologist) seeking advanced 3D tools wherever they need them (e.g., in the OR, at home, at the office), or for referring physicians simply desiring images and reports wherever they are.

The Web DX Study List is populated directly from the Centricity PACS database, and just like PACS-IW, the Study List is easily customized with a tabbed interface, and imaging studies are viewed on-demand. Quickly loaded with advanced streaming, the studies are hung across the single or multi-monitor screen real estate using comprehensive hanging protocols. All of the feature-rich viewing tools of PACS-IW are available, to include 3D (MIP/MPR) and the innovative (patent-pending) SNAP! Tool for rapid study layouts and series hanging without the need for the traditional drag-n-drop. The user can also display an unlimited number of relevant prior studies and their reports for comparison. Once an unread study is loaded into Web DX, study locking mechanisms are in place so users on Web DX and Centricity PACS cannot both dictate and change the study status to “read” (Note: Centricity PACS v3.0.5 is required to use this exam locking feature). In addition to the above, four (optional) clinical applications are also supported via Web DX today: Orthocrat TraumaCad for orthopedic templating and surgical planning; Barco Voxar 3D and Terarecon AquariusNet integrations for advanced visualization; and peerVue qiVue for peer review, critical results management and ER discrepancy reporting.

We’re truly excited about Web DX and the functionality it can bring to our worldwide Centricity PACS customers. Please encourage your readers to contact their GE Sales Executives for more information.

Translation: GE has grafted IntegradWeb onto Centricity 3.x, theoretically for use as a web viewer. This was certainly an immediate need, because in my humble OPINION, the only viewer worse than Centricity RA-1000 is Centricity Web (the old version). IN MY OPINION, that is.

I, for one, will lobby hard for the use of WebDX as my main reading client, and I'll bet I'm not the only Centricity user who will do so.

Many thanks, Brad!

Sunday, January 11, 2009

Dear Clinician:

Dear Clinician:

I wanted to thank you for letting us know about your recent purchase of a new Computed Radiography/Computed Tomography/MRI/PET/US system. In this time of uncertainty in the medical field, when government is closely scrutinizing such things, I find such an investment for patient convenience very impressive. We really appreciate the opportunity to interpret the images for you.

Your business manager and/or IT guy informed us that your new scanner came with image storage, sort of a PACS, apparently, so you won't be using ours. To facilitate our workflow, we are taking the liberty of having your modality transmit to our full, hospital-level PACS and RIS, at no charge, since you don't want our storage.

I have to pause at this point and point out a few of the capabilities of a full fledged PACS which may not be available on the limited machinery the modality vendor gave/sold/leased to you. To me, the interpreting radiologist, the most important problem is the lack of easy access to prior exams. Yes, you may be able to retrieve a prior on today's patient, and manually send it on to us, but that is inconvenient at best, and at worst it might not happen. Our real PACS has them all available on spinning RAID. And how about reports on that prior exam? We keep those on our RIS. Do you have backups on everything in case of disaster? Where are they stored? (To qualify as a full PACS, we maintain redundant, off-site storage.) And we have our own PACS gurus to take care of everything.

We in radiology appreciate it when you consult us on various issues. We stand ready to assist you in selecting the right scan for your patients. My group also has considerable expertise in PACS, and frankly, it would have been a lot easier in the long run had you consulted us rather than gone ahead with the vendor's recommendations. We might not be able to beat their price, but I guarantee we can provide a better PACS/RIS product, not to mention better service. But don't worry, we'll make it work. . .somehow. We wouldn't leave you (and your patients) out in the cold.


Oh, and a note to the vendors...

I understand that you sell equipment for a living. This is what puts food on your table. I get that. No doubt you are hurting in this day and age, so when you find a clinician who has just stumbled on the idea of placing a scanner in his or her office (for patient convenience, of course), you feel compelled to equip said clinician with as many acoutrements as possible. I would ask you, beg you, cajole you, and even strongly urge you to think long and hard about what you are selling them.

There is more to scanning than the scanner, and a LOT more to image storage than a $1,000 off-brand PC with cheap software. You know that. Just make sure your marks, I mean customers, are made aware of that, too. Ultimately, the patients will suffer if you don't.

Thanks, and have a nice day.

Thursday, January 08, 2009

Emageon Deal Back On

According to Health Data Management, Health Systems Solutions' purchase/merger of Emageon is still going to happen:

Health Systems Solutions Inc.'s pending acquisition of diagnostic imaging software vendor Emageon Inc. remains on track, says Michael Levine, CFO of New York-based Health Systems.

"We've never been in a situation where we said the deal is off," Levine told Health Data Management in a telephone interview. "It's always been a timing situation."

Health Systems in late December was ready to close the $62 million acquisition of Birmingham, Ala.-based Emageon. But Stanford International Bank Ltd.--its financial backer and principle shareholder--wasn't prepared to close and needed additional time, Levine says.

Levine attributes the delay to the financial industry crisis, which he calls "a historic period of time." Stanford International, he adds, has told Health Systems they expect to fund the acquisition on or before the new closing date of Feb. 11.

Stanford is not doing additional due diligence on Emageon before agreeing to the acquisition, Levine says. "They have agreed to our assessment that we were set."

I guess we'll see what happens come February 11. Of 2009, I assume.

Wednesday, January 07, 2009

Madoff, Greed, Gullibility, and Chanukah

[anatomy of gullibility]

The Bernie Madoff affair has both fascinated and disgusted most of us. Here is a old Jewish guy, a scion of the community, former head of NASDAQ, philanthropist extraordinaire, who turns out to be a common thief. To ask why he did it is foolish; like all con-men, he wanted the money, the admiration, and all that went with the illusion he peddled. We can easily understand what he was all about. What puzzles us is how he got away with it, how he conned so many for so long. That answer is a little more complicated.

Writing on, Stephen Greenspan (no relation to the other equally-trusting Greenspan) discusses the human foible of gullibility. The discussion is rather poignant given the fact that Greenspan lost some of his own money in the Madoff mess. Basically, if it looks like someone else is getting the goodies, we all want in on the deal:

The basic mechanism explaining the success of Ponzi schemes is the tendency of humans to model their actions (especially when dealing with matters they don’t fully understand) on the behavior of other humans. This mechanism has been termed “irrational exuberance,” a phrase attributed to former fed chairman Alan Greenspan (no relation), but actually coined by another economist, Robert J. Schiller in a book with that title. Schiller employs a social psychological explanation that he terms the “feedback loop theory of investor bubbles.” Simply stated, the fact that so many people seem to be making big profits on the investment, and telling others about their good fortune, makes the investment seem safe and too good to pass up. In Schiller’s words, the fact “that others have made a lot of money appears to many people as the most persuasive evidence in support of the investment story associated with the Ponzi scheme — evidence that outweighs even the most carefully reasoned argument against the story.”

. . .There are four factors in my explanatory model, which can be used to understand acts of gullibility but also other forms of what I term “foolish action.” A foolish (or stupid) act is one where someone goes ahead with a socially or physically risky behavior in spite of danger signs, or unresolved questions, which should have been a source of concern for the actor. Gullibility is a sub-type of foolish action, which might be termed “induced-social.” It is induced because it always occurs in the presence of pressure or deception by one or more other people. . .The four factors are situation, cognition, personality and emotion. Obviously, individuals differ in the weights affecting any given gullible act. While I believe that all four factors contributed to most decisions to invest in the Madoff scheme, in some cases personality should be given more weight while in other cases emotion should be given more weight, and so on.

Do read the full article to see these factors fleshed out a bit.

It has been well-publicised that Bernie is Jewish, as are many of his investors. This certainly brings scrutiny, if not shame, upon our community. It is interesting therefore to look at the situation from the Jewish point of view.

Rabbi Benjamin Blech, writing on, uses the history of Chanukah to put Madoff in perspective.

Chanukah, unlike Purim, doesn't celebrate the physical survival of Jews in the wake of a genocidal threat. It commemorates our ability to preserve Judaism at a time when the world around us worshiped totally different ideals. . .

When confronted with a culture that worshiped the holiness of beauty, the heroes of Chanukah maintained their allegiance to the beauty of holiness. The Greeks claimed that beauty is truth. The Jews insisted that only truth is beauty. The Greeks glorified the physical. The Jews insisted the spiritual has greater importance. The Greeks sanctified the gymnasium and the marketplace. The Jews worshiped in the Temple and the house of study. The Greeks idolized wealth. The Jews venerated values. . .

To those who ask how could the Bernie Madoff scandal have happened, the answer can only be that for far too many Jews today the Maccabees were wrong and the Greeks were right. Given a choice between assimilating with a conspicuous consumption culture that proclaims "he who dies with the most toys wins," or a more modest lifestyle circumscribed by Torah and mitzvoth (commandments), the tragedy is that so many Jews opted for the former.

Why were (the victims) all willing to assume a level of risk that simply didn't make sense? The answer undoubtedly is because our society was making it clear that it was far more risky not to make outrageous returns on your money, not to have a billion dollars if you only had half a billion, not to be super super wealthy if you are only in the to be pitied category of just the super wealthy.

When being just rich isn't enough, the rich have to risk everything to maintain their social standing.

So where does the real blame lie? Bernie Madoff was taking advantage of a social reality created by us, by our organizations, and yes even by our charities. Honor in Jewish life has all too often been meted out only by the measure of financial, rather than personal, worth. Only the millionaire could become a macher (an important man), and only the close-to-billionaire could dream of becoming a major Jewish leader or honoree.

Rabbi Blech advocates a return to tradition and faith:

The Madoffs of the world must be deprived of their greatest strength -- the power given to them by a Jewish world that has succumbed to values foreign to our faith and antithetical to our tradition. . .we have to identify again with Matisyahu and the Maccabees. It was they who looked at a world tempted by the materialistic visions of Hellenism and warned their fellow Jews that if they traded their holiness for the empty rewards of hedonism, that's what they would look like. And we too, if we make the mistake of choosing gold over God as priority, will be easy victims lying in wait, doomed yet again to Madoff mania.

Strong stuff, obviously, and a bitter pill for most of us to swallow. I, for one, am not quite ready to give up those finer things that I can still afford. However, Rabbi Blech's point needs to be considered by all of us. When our values become totally overwhelmed by the desire for the monetary and the material, we become lesser people indeed. While I don't think that money is the root of all evil, I begin to think that the pursuit of money comes close.

One final, somewhat tangential point to consider. Madoff declared his enterprise a Ponzi scheme just before his sons turned him in to the authorities. Could it be that ol' Bernie has one last trick up his sleeve? Could it be that the money didn't just vanish, but rather was stashed offshore? Will it be waiting for him when he gets out of jail in a few years? If he was smart enough to swindle some very astute people, he might be smart enough to pull off one last scam. We may never know.