Speech Recognition Sucks and It Costs More, Too!

Three articles in the December issue of the Journal of Digital Imaging discuss speech recognition, and only one is complementary. Let's look at that one first.

Mika P. Koivikko, Tomi Kauppinen, and Juhani Ahovuo, all from the HUS Helsinki Medical Imaging Center of the Helsinki University Central Hospital, measured the effect of SR on report turnaround time (RTT). They found an 81% reduction in RTT, and found that "SR was easily adopted and well accepted by radiologists. . .with excellent end-user satisfaction." The Helsinki team compared their old cassette-based transcription to SR using Philips SpeechMagic. They had some additional hurdles:

The Finnish language is challenging for SR because its vocabulary is exceptionally wide allowing many different words to evolve from one word body. HUS Helsinki Medical Imaging Center has actively participated in the development of a Finnish SR context for radiology.

The did improve RTT, as noted, although not uniformly:

During this study, the proportion of reports available within 1 h has rapidly risen from 26% (cassette Q1/2005) to 58% (SR Q1/2006). For nonurgent studies, such as most of our MR imaging procedures, the mean RTT still remained high (Table 2). In contrast, for typical high-priority worklists requiring online reporting (i.e., ICU or orthopedics), we measured an exceptional 53% reduction in RTTs and an increase from 34% to 65% in first-hour reporting. Thus, for our hospital, the increased number of reports available within 1 h from the completion of a study has proven a great improvement.

One has to wonder how much of the improvement came from eliminating the cassettes and going to a digital tank. The authors did appreciate the online editing inherant in SR.

The next article was not quite so kind to SR. Kimberly Voll, Ph. D., Stella Atkins, Ph. D., and Bruce Forster, M. D., from British Columbia, have more realistic observations. They see the potential, but realize the current inadequacies of SR:

The recent improvements of speech recognition (SR) technology have motivated the introduction of automated transcription software in lieu of human transcription. Speech recognition can offer improved patient care and resource management in the form of reduced report turnaround times, reduced staffing needs, and the efficient completion and distribution of reports. As the technology comes of age, however, with vendors claiming accuracy rates as high as 99%, the potential advantages of SR over traditional dictation methods are not being realized, leaving many radiologists frustrated with the technology.

The primary reason behind this apparent failure is accuracy. A 99%-accurate speech recognizer still averages one error out of every hundred words, with no guarantees as to the seriousness of such errors. Furthermore, actual accuracy rates in the reading room often fall short of 99%. Radiologists are instead forced to maintain their transcriptionists as correctionists, or to double as copy editors, painstakingly correcting each case, often for nonsensical or inconspicuous errors. Not only is this frustrating, but it is a poor use of time and resources. To compound matters, problems integrating with the radiology suite and the introduction of delays have further soured many radiologists on the technology. Those choosing to modernize their reading rooms with SR software are often plagued with difficulties, whereas those continuing to use traditional reporting methods have mixed incentives with respect to upgrading. Nonetheless, the potential benefits to radiology reporting from a hospital administration standpoint continue to motivate the adoption of SR technology. Thus, improving SR dictation is of particular importance.

Their solution:

As a partial solution to this problem, we have proposed a post-speech-recognition, statistical error-detection system for radiology. A previously unexplored area of research, this technique shows promise as an effective means to recover from the unacceptable accuracy rates of SR. By flagging potential errors, we can enhance the proofreading process, restoring the benefits of SR in resources saved. The result is a more efficient reading room and an improved experience with SR.

This solution dumps less on the radiologist, helping us in our new-found SR editing duties.

The piece-de-resistance, as far as I'm concerned, is found in the third article, by Pezzulo, et. al., from Brown University. The abstract says it all:

Continuous voice recognition dictation systems for radiology reporting provide a viable alternative to conventional transcription services with the promise of shorter report turnaround times and increased cost savings. While these benefits may be realized in academic institutions, it is unclear how voice recognition dictation impacts the private practice radiologist who is now faced with the additional task of transcription. In this article, we compare conventional transcription services with a commercially available voice recognition system with the following results: 1) Reports dictated with voice recognition took 50% longer to dictate despite being 24% shorter than those conventionally transcribed, 2) There were 5.1 errors per case, and 90% of all voice recognition dictations contained errors prior to report signoff while 10% of transcribed reports contained errors. 3). After signoff, 35% of VR reports still had errors. Additionally, cost savings using voice recognition systems in non academic settings may not be realized. Based on average radiologist and transcription salaries, the additional time spent dictating with voice recognition
costs an additional $6.10 per case or $76,250.00 yearly. The opportunity costs may be higher. Informally surveyed, all radiologists expressed dissatisfaction with voice recognition with feelings of frustration, and increased fatigue. In summary, in non-academic settings, utilizing radiologists as transcriptionists results in more error ridden radiology reports and increased costs compared with conventional transcription services.

Read that summary one more time! SR reports are costlier and have more mistakes! So the only benefit might be from increased RTT, but with an adequate transcription pool, even that falls by the wayside. For what it's worth, the study used Agfa TalkTechnology version 2.1.28.

The article made a very profound discovery: "Our results suggest that radiologists are not good transcriptionists." Duh.

Once again, when you look below the surface, SR just isn't a good idea. It may improve turnaround time, but generally only when RTT was dismal to begin with. It just doesn't work well, and in the private-practice setting at least, it is costly and error-prone. Of course, the hospital bean-counters don't care about the added cost of a radiologist-transcribed report because....they don't pay the radiologist! But outside of that, SR just doesn't make sense. Not yet, anyway.

AMICAS To Buy Emageon!

Wonders in the PACS business never cease. I've been reporting on the merger/acquisition debacle concerning Emageon and HSS, which was scuttled by the imminent demise of Stanford Financial. But like the Phoenix, coincidentally, the code-name for AMICAS' revolutionary Version 6 software, Emageon will rise from the ashes to be purchased by...AMICAS!

I just received an e-mail from Dr. Stephen Kahane, President of AMICAS (I'm sure I wasn't the only recipient) which included the following paragraphs:

Emageon is an organization with a mission and goals that are very similar to AMICAS'. While AMICAS and Emageon have approached the market with different strategies, we believe that our strategies and our businesses are highly complementary.

Together, we believe that AMICAS and Emageon will be the undisputed independent leader in image and information management with over 1,000 customers. As one organization, we'll bring together the best employees, customers, and solutions in image and information management - including radiology PACS, radiology information systems, cardiology PACS, cardiovascular information systems, referring physician tools, business intelligence tools, enterprise content management systems, and revenue cycle management systems.

From the Frequently Asked Questions:

• Our combined business will have over 1,000 customers!
• Our combined business will span the entire continuum of imaging customers – from large radiology practices, like Radiology Limited (Tucson, AZ), all the way to prestigious institutions such as The Johns Hopkins Hospital (Baltimore, MD).
• Our combined business will have a comprehensive portfolio of image and information management solutions for both radiology and cardiology.

And:

We‘ll move quickly to bring Emageon and AMICAS together. There won’t be an "Emageon" division of AMICAS. There will be ONE AMICAS: one team, one plan, one mission. This acquisition is a fairly significant acquisition for a business of our size, so it will take time and a lot of hard work. We expect the integration to be substantially complete in the weeks following the closing and fully complete within 180 days.

What about product overlap?

There is remarkably little product overlap between the companies. The core products at AMICAS include radiology PACS, radiology information systems, revenue cycle management solutions, referring physician solutions, and business intelligence solutions. The core products at Emageon include radiology PACS, cardiology PACS, cardiovascular information systems, and enterprise content management systems. The only product overlap is with radiology PACS – the other solutions are already highly complementary to one another.

The radiology PACS solutions from both AMICAS and Emageon will continue to be sold, deployed, supported, and maintained – both solutions are robust offerings with very happy customers!

Given the slaughter of Emageon's stock price, it was a bargain waiting to be plucked, and AMICAS apparently had the cash on hand to take advantage.

Here's my personal assessment, neither reviewed or endorsed by AMICAS: This move bought AMICAS a significant increase in its customer base. That alone was probably worth the expenditure. AMICAS now (finally) will own its own cardiac package. You might recall that Emageon bought Camtronics, and their cardiac software and EMR, in November, 2005, for $40.4 million.

As for PACS, I would expect AMICAS to support the Emageon product as they promised, but. . . I haven't played with Emageon PACS in quite a while. The last I heard about it was from Dr. Elliot Fishman during a Johns Hopkins lecture in 2007. He wasn't terribly complementary, saying that it choked if they tried to load anything larger than a 100-slice CT, forcing him to use the Siemens InSpace/Leonardo station. Now, Elliot loves InSpace, so maybe there was a little hyperbole involved. Still, I think we can probably label Emageon PACS as "End of Life". Knowing the principals (and the principles) of AMICAS, I expect them to keep Emageon PACS sites up and running for several years, as they have promised. Ultimately, I would expect those sites to be moved to AMICAS PACS (Version 6), although I have no idea how much they will or won't charge for this privilege. Again, this is only my personal speculation, with absolutely no confirmation from AMICAS whatsoever.

I have heard that the Emageon "back end" may have some advantages, although I don't know much about that at this time.

To me, the most important thing to come out of this deal is an unsaid message. Amicas loses deals here and there because they are "too small" or "likely to be taken over". With the Emageon purchase, they have made a loud statement: They are solvent, they are stable, and they are the big company buying the smaller one, the pursuer and not the prey, so to speak. At worst, they got Camtronics for less than what Emageon paid for it in 2005, and they significantly increased their customer base.

I can promise, though, that some folks made some money today. Emageon stock (EMAG) went from $0.80 to $1.68 at 1:10 PM today, right around the time of the press release. I wasn't one of them, by the way. The stated purchase price is $1.82 per share, for a total of about $39 million. I wonder if AMICAS could have negotiated it down a bit further.

Any chance of AMICAS headquarters moving down to Birmingham? The weather is so much better there than in Boston. . .

The Doctor Dalai Show Goes To New York City

How Some Out There See Dr. Dalai

The PACS of Your Life (Good Riddance?)

Another breaking point;
An upgrade redesigned.

Techs grab you by the wrist;
And ask why you’re behind.

So do the best beta test
And don’t dare whine.

You mustn’t question
How the vendor wastes your time.

It’s never quite predictable
Just when the PACS will die.
You know it's going to mess with your mind.

So take the cine loops
And CT’s in your mind.

Hanging protocols
Might work some other time.

Worklists that never run
And buttons galore;

For all they’re worth,
No one knows what they’re for.

It’s never quite predictable
Just when the PACS will die.
You know it's going to mess with your mind.

(music break)

It’s never quite predictable
Just when the PACS will die.
You know it's going to mess with your mind.

It’s never quite predictable
Just when the PACS will die.
You know it's going to mess with your mind.

This Just In: Stanford Charged With 'Massive Fraud'

Thanks to an anonymous tipster, who sent me the link to this piece from pMSNBC:

Federal regulators on Tuesday charged Texas financier R. Allen Stanford and three of his companies with a "massive" fraud that centered around high-interest-rate certificate of deposits.

In a complaint filed in federal court in Dallas, the Securities and Exchange Commission alleged Stanford orchestrated a fraudulent investment scheme centered on an $8 billion CD program that promised "improbable and unsubstantiated high interest rates."

Stanford's assets, along with those of the three companies, were frozen. Stanford's companies include Antigua-based Stanford International Bank and broker-dealer Stanford Group Co. and investment adviser Stanford Capital Management, which are both based in Houston.

Looks like Emageon dodged a bullet. I still wonder if the $9 Million check from HSS cleared....

Emageon's Suitor's Financier's Tangled Troubles

Sir R. Allen Stanford, Stanford Financial Group, probably waving, not thumbing his nose at Emageon.

Photo courtesy of http://online.wsj.com

Three Wall Street Journal articles have appeared in the past two days, outlining a probe into the Stanford Financial Group, which owns the bank that reneged on financing HSS's purchase of Emageon.

The story from Friday, February 13, notes that Stanford is being examined by the SEC, the Financial Industry Regulatory Authority (FINRA), and the Florida Office of Financial Regulation.

The focus of the probe isn't clear. Mr. Stanford's firm offers many financial services, chief among them wealth-management services, and markets certificates of deposit through his offshore bank, Stanford International Bank Ltd., in Antigua. The CDs offer unusually high and consistent returns. Mr. Stanford controls both the bank and the financial group that markets the CDs the bank issues.

By Valentine's Day, yesterday, WSJ reported that the FBI had entered the probe. It seems that Stanford Financial Group had recently been telling its depositors that they couldn't redeem their CD's for two months. Sir Allen emailed his customers, telling them that he had been "infusing cash" into the Antigua-based Stanford International Bank, Ltd. How did Stanford reach the FBI's radar? It seems that like our old pal Bernie Madoff, some of Stanford's returns are too good to be true given the investments he claims to have made:

Stanford Financial Group previously has been in the sights of various regulatory and law-enforcement agencies, according to the people familiar with the matter. Those people say the agencies now are focusing on certificates of deposit, which are marketed by the financial group's wealth-management arm and sold by Mr. Stanford's Antiguan bank. The CDs offer unusually high returns; for example, as of Nov. 28, a one-year, $100,000 CD paid 4.5%.

"The first thing that grabs your eye is the business model," says Alex Dalmady, an analyst who unveiled concerns about Stanford International Bank in the magazine VenEconomy Monthly but isn't involved in the investigation. "Taking deposits and playing the stock market -- this is way too risky. "

Stanford's Web site says that the bank has invested in a diversified portfolio including stocks, while banks generally make money by lending. A memo on Stanford's Web site says that the bank has never made a structured loan or a commercial loan. . .

"We want our depositors to know that SIBL had no direct or indirect exposure to any of Madoff's investments...Also, SIBL has never made a structured loan or a commercial loan. All loans are cash secured and to SIBL clients only at a maximum 80% loan to 100% cash collateral ratio."

Now here is where it gets interesting. A second WSJ article from February 14, 2009, tells us:

An offshore bank at the center of two U.S. federal investigations recently curtailed financing commitments to two small American companies, regulatory filings show.

Stanford International Bank Ltd. of Antigua recently failed to provide some $16 million in funding to a small Florida telecommunications firm, while a small Alabama health-care firm said it was unable to complete a roughly $62 million merger after funding fell through. Stanford International had previously planned to provide funding to complete the deal, according to the health-care firm.

It was understood that Stanford was funding Health Systems Solutions' bid for Emageon. But the true relationship appears to be a little deeper:

Stanford also owns a majority of the shares of Health Systems Solutions Inc. of New York City, which is traded on the OTC Bulletin Board. In October the firm agreed to acquire Emageon Inc. of Birmingham, Ala, but the deal was terminated Friday with Emageon attributing the development to Health Systems' inability to obtain funding on or before the closing deadline of Feb. 11. Executives of Emageon couldn't be reached for comment and Health Systems executives didn't respond to requests for comment.

Hmmmm. Interesting. As an aside, Stanford had a similar relationship, and a similar deal-retraction with Elandia International, a communications firm:

The Florida firm losing $16 million in financing from Stanford International is called Elandia International Inc. of Coral Gables, which trades over-the-counter on the so-called pink sheets. Elandia says it controls a collection of small telecommunications firms in Latin America and the South Pacific. Regulatory filings show that the Elandia's chief financial officer is James M. Davis, who is also chief financial officer of both Stanford International Bank and Stanford Financial Group.

Efforts to contact Elandia executives by phone and e-mail were unsuccessful.

In a new SEC filing, Elandia also said Stanford International Bank had also agreed to convert an outstanding $12 million loan it had made to Elandia into shares of Elandia equity. Such debt-equity swaps often take place when borrowers lack the cash to pay loans back.

Since Emageon got their $9 Million payoff for the deal's collapse (I assume the check cleared), they came out of this "merger" better than they might have had it actually gone through. I have just two words of advice, though: due diligence..... Someone should have had a deeper look into the inner workings of HSS and Stanford. But I guess it's rather rare for people about to get married to look deeply into anything but the eyes of their beloved.

Sony Releases New POS Device (Warning: Excessive Profanity!)

Hat-tip to The Samurai Radiologist for finding this clip. He is apparently having some problems with his RIS/PACS system, and advises mentally inserting the name of said vendor when we hear "Sony" on the video.

For more family-oriented protests, feel free to sing the Belgian Rhapsody instead.

Emageon Deal Off

The Tampa Bay Business Journal reports that the HSS/Emageon merger is a no-go.

A proposed merger between Health Systems Solutions Inc. and Emageon Inc. fell through after Health Systems could not provide the money needed to close the deal.

Emageon (NASDAQ: EMAG), a health care information technology firm headquartered in Birmingham, Ala., said in a release that it terminated its merger agreement with Health Systems due to the company’s failure to receive all necessary financing on or before the designated closing date of Feb. 11.

Emageon said it received $9 million that had been placed in escrow with The Bank of New York Mellon by Health Systems in connection with the proposed merger.

Emageon said it terminated the agreement one day after Health Systems announced in its own release that funding from Stanford International Bank Limited for the acquisition would not be available and that no other funding for the acquisition was available.

At least Emageon got the $9 mil. There was some speculation that the money hadn't even been properly escrowed, but that's apparently not the case.

So who wants to buy a PACS company?

Belgian Rhapsody

Is PACS online today-
Is that just fantasy?
Still caught in downtime
With no functionality-
Open your files
Look up from the dials and see
I’m just a poor rad, trying to get through the day
‘Cause PACS is easy come easy go
Why it glitches, I don’t know
Any way the circuits blow doesn’t really matter to me
To me…..

Mama, just read a scan
Had a CT of the head
Clicked it off, now PACS is dead
Mama, it had just come up
But now I’ve gone and crashed it all again
Mama, Oooo, ooo ee ooo
Didn’t mean to make it die
If it’s not online again this time tomorrow
Back to film, Back to film, as if PACS doesn’t matter

Too late, my PACS won’t scroll
Couldn’t label any spine
Lovely software past its prime
Goodbye to my worklist, it won’t update now
Gotta reboot yet again and hope it works
Mama, Ooo Ooo Ooo Ooo,
I can’t have it die
I wish sometimes I wasn’t a rad at all

I see a little problem getting back online
Waterloo, Waterloo, Can you make the damn PACS work?
Shorting out and sparking, keeping me remarking: OY!
Mike Cannavo, Mike Cannavo
Mike Cannavo, Mike Cannavo
Mike Cannavo make it work, oh make it work Ooo, Oooo,Ooo
But I’m just a poor rad and my PACS hates me-
He’s just a poor rad from a bad residency
Spare him the joy from this monstrosity
Easy on easy off, will you let me work
Just fix it! No we will not make it work-Make it work!
Just fix it! We will not let you work-let it work!
Just fix it! We will not let you work-let me work!
Will not let you work-let me work
Will not let you work-let me work
No,no,no,no,no,no,no,no
Mama mia, mama mia, mama mia let it work
The Psycho ward has a nice cell set aside for me, for me, for ME!
So you think you can patch me and tell me I’m fine
So you think that an upgrade will keep me online
Oh, baby, can’t do this to me baby
Just gotta hang on, just gotta stay online right here
Nothing ever matters
Anyone can see
Nothing ever matters-nothing really matters for me
Any way the circuits blow….

Obam-A-gfa?

From Reuters comes word of Agfa's optimism over President Obama's health plans and the part Agfa might play:

Shares in Belgian imaging technology company Agfa-Gevaert (AGFB.BR) jump after saying a U.S. healthcare group has deployed the company's new diagnostic image technology.

The stock rises as much as 12.8 percent to 2.7 euros, outperforming the DJ Stoxx European Technology Index .SX8P, which is up about 0.7 percent.

ING analyst Arnaud Goossens says a nearly $900 billion stimulus package announced by U.S. President Barack Obama that included about $20 billion to help doctors and hospitals upgrade medical technology.

"It could be a coincidence, but it could be that people are already speculating that Agfa could get business from this stimulus plan," Goossens says, reiterating his "buy" rating and 3.10 euro target price for Agfa-Gevaert.

I hate to break it to the Europeans, but just because there is money to be spent on healthcare IT doesn't mean Agfa is going to get any. But hey, since we're throwing away billions and billions on pork, another few million won't make any difference, now will it? We might as well join in with Ontario's government, eh?

Expressive Tax-Funded Art

Fox News reports on a publically-funded art project in Berkeley, California:

Dogs do the darndest things.They poop, they hump and they sniff in all the wrong places.

And now you can see them do all of the above every time you cross the pedestrian bridge over Interstate 80 in Berkeley, Calif., thanks to the largesse of the taxpayers.

Artist Scott Donahue of Emeryville, Calif., was paid $196,000 by Berkeley's public arts program to create two large statues, which feature small, artistic medallions that show dogs doing what dogs do best.

"Various things," Donahue said. "Biting each other, chasing each other…. One dog is defecating, two dogs are fornicating."

But with the country in a deep recession and California on the verge of bankruptcy, some taxpayers are questioning the money Donahue got for his work. His total budget was $196,000 — 1.5 percent of the total budget for building the pedestrian bridge. And all of it came from taxpayers.

At least it doesn't take an Art-History major to interpret what the dogs in this particular piece are doing. Or what Berkeley did to its taxpayers.

Life Imitates Art

A year or so back, I wrote a post about a hypothetical hybrid ultrasound/CT scanner, which was intended to tweak a nose here and there.

Imagine my amusement when I discovered that someone out there was merging cardiac echo with SPECT scanning, an even less-likely combination. But it's true. An article in the Journal of Nuclear Medicine by Walimbe, et. al., describes the process:

Early experience is described in implementing a new multimodality stress test for accurate correlation of complementary functional and perfusion information from real-time 3-dimensional (3D) echocardiography and SPECT, respectively. The proposed new multimodality stress test has the potential for simultaneously improving sensitivity and specificity in the detection of early coronary artery disease (CAD).

Methods: Pre- and poststress real-time 3D echocardiography and SPECT images were acquired in 20 patients referred for CAD evaluation and processed using previously developed algorithms for automatic fusion and quantitative analysis of myocardial function and perfusion. All cases of CAD were diagnosed by reviewing quantitatively analyzed fused images, using newly developed software.

Results: Real-time 3D echocardiography, SPECT, advance
processing, and image review were successfully performed in all 20 patients. Compared with the angiographic findings in 12 patients, diagnosis based on fused images correctly identified 13 of 13 diseased arteries, compared with 11 of 13 identified by SPECT and 6 of 13 identified by echocardiography-based analysis.

Conclusion: The results suggest the feasibility and potential effectiveness of novel multimodality stress testing.

OK, so it isn't in one box. Yet. Here's the protocol and the results page:

Hybrid strength wins again. Maybe the Squawkie and the Cymbal aren't too far off, after all?!

Emageon Waits Still

It looks like Emageon is still waiting at the altar. From HealthImaging.com:

Emageon, a developer of enterprise medical IT systems for hospitals and health care networks, reported that it has been informed by Health Systems Solutions (HSS) that it does not expect that Stanford International Bank will provide the funding necessary to consummate the parties' planned merger transaction.

The deal was scheduled to close today, Feb. 11, in accordance with the terms of the parties' amended merger agreement.

The Birmingham, Ala.-based Emageon said it "is evaluating its options in response to this development."

At the time the Feb. 11 extension was established as the new closing date, Stan Vashovsky, CEO and board chairman of the New York City-based HSS, said the extension would "allow us additional time to complete our integration plan for our technologies. As a result, we will be in a better position to immediately serve the market upon closing."

In October 2008, HHS signed a definitive agreement to acquire 100 percent of Emageon's stock in an all cash transaction of approximately $62 million.

So we wait, I guess. For what it's worth, Forbes has this to say about Mr. Vashovsky:

Stanley Vashovsky

Chairman of the Board/Director/CEO
Health Systems Solutions, Inc.
NY
Sector: TECHNOLOGY / Healthcare Information Services
Officer since September 2007

35 Years Old
Stan Vashovsky has been Chairman of the Board of Directors and Chief Executive Officer since September 2007. Mr. Vashovsky began his career as the founder of Medcare Corporation, a medical instrument business, in 1991 and Medcare Software Company, a provider of health care maintenance management software, in 1992. In 2001, Philips Electronics North America Corporation ("Philips") acquired both companies and Mr. Vashovsky remained as President of the newly formed Philips Medcare. From January 2003 through June 2007, Mr. Vashovsky led Philips" Services Innovations Group which was responsible for developing technologies to supporting Philips Medical Systems Services Group.

Compensation for 2007
Salary $98,748.00
Bonus $0.00
Restricted stock awards $0.00
All other compensation $4,000.00
Option awards $1,826,660.00
Non-equity incentive plan compensation $0.00
Change in pension value and nonqualified deferred compensation earnings $0.00

Total Compensation
$1,929,408.00

Not bad. He could almost afford to buy Emageon all by himself.

Addendum:

My friend Mike Cannavo, the One and Only PACSMan, has done a little more research into this. Rather than reinvent the wheel, I'm just going to steal his posts from AuntMinnie. He won't mind.

Re; the Emaegon/HSS merger snag, I find it curious that HSS's stock prices dropped like a log on Friday, 3 days before the announcement that their Emageon merger would be "further delayed" and for all intents and purposes is over.. On 2/2 HSSO stock closed at $0.90. On 2/3 it skyrocketed to $1.95 where it stayed till 2/6 when it tanked again to $.75, close to where it stands today (no change in HSS stock price today either while Emageon lost almost 50% of its value so far). While HSS might say its meteoric stock rise coincided with speculation about its agreement with USIS to develop and implement a multi-phase Production Master Scheduling/Case Load Management system on a desktop/PDA-based application, this announcement was made on 1/30 (after market close) yet had absolutely NO IMPACT on stock prices on 2/2 (Monday), with the stock staying flat until Tuesday. One has to ask the obvious question then- with Emageon stock going from $1.94 on 1/27 to a high of $2.64 on 2/9 on the hopes that the merger was indeed going to happen yet HSSO tanked on the 6th losing more than half its value 3 days BEFORE the merger was officially dead one to ask the obvious question- did someone at HSSO share something they shouldn't have before it was announced to the public? On the surface it sure seems fishy to me and inquiring minds want to know...The SEC also owes it to the investors in both companies to take a closer look at this "deal" as well. There is too much as stake here including the life of a company who has been in the PACS market for way to long to get jerked around like this. If the stock rises and falls are mere coincidence on the part of HSSO then they have nothing to worry about...except the $9M they stand to lose if the deal falls through. And if they do find something fishy, then please say hi to Bernie for me...... Let's hope Emaegon says enough is enough, takes the cash promised (if they can get it that is), and courts another suitor and says adios amigos to HSS for good.....

This story gets weirder still by the minute. An anonymous source provided me with links to stories about the "investment firm" (Stanford International Bank) who was supposedly behind this deal and what I read makes my hair stand on end. Check it out yourself, with the last post (yesterday) referencing the Emageon deal as well:

http://caracasgringo.wordpress.com/2009/02/09/stanford-international-bank-antiguas-bernie-madoff/

http://www.portfolio.com/views/blogs/market-movers/2009/02/10/whats-going-on-at-stanford-international-bank

http://caracasgringo.wordpress.com/2009/02/11/dalmady-to-stanford-international-bank-show-me-the-money/

I can not attest to the veracity and accuracy of these reports and have never heard of the publications, but if they are even 10% true it leads to a host of questions, the biggest one being what was Emageon management thinking letting HSS use SIB to try to put together this deal? From one of these reports: "......the SEC started issuing subpeonas to Stanford Group in July, after two employees quit, saying "that the company gave clients false historical performance data for its securities". If the SEC was investigating the company that should have been fairly easy to discern and were that the case a simple "that's but no thanks" from Emageon to HSS would have sufficed. Instead younow have a lot of people down in Birmingham playing Job and wondering what's next.. I hope the $9M that was supposed to be placed in escrow was indeed in escrow and not just pledged funds....and gets released to Emageon soon. At least that will buy Emageon a little time to figure out what's next... Stay tuned....this thing is more interesting that a Spanish novela ..Ole`

Ole'? Oy Vey would be more like it.....

What's Wrong With This Picture?

History: 30-ish male trauma patient with known parenchymal hematomata.... Notice that only the posterior circulation enhances!

Our neuro-interventionalist was called into the CT suite STAT when the tech saw this. He checked the patient, who was sitting up wondering what all the fuss was about. The scan was quickly repeated with the following representative result:

So what happened?

Tic-Toc-Tic-Toc-Tic-Toc. . .

Give up? So did I. It seems that the patient's IV was placed with great care and gusto. . .into his brachial artery! The pressure of the power-injected contrast was great enough to reverse the normal direction of flow and force contrast back up into the posterior circulation preferentially via the subclavian and vertebral. Sort of a reverse subclavian steal, if you will.

When the scan was repeated through a new, venous IV line, the anterior circulation magically reappeared.

And now you know. . . the rest of the story!

Get a PACS! Centricity IW On eBay, only $45,000!

It had to happen. eBay seller gadgets3001 is offering for your consideration a server loaded with Centricity PACS-IW!

Dynamic Imaging Solutions' Centricity® PACS-IW (formerly Dynamic Imaging IntegradWeb® PACS) number one for the seventh consecutive quarter.

Centricity ® PACS-IW is Ranked The #1 PACS!
Centricity PACS-IW is a standards-based, single user interface, Web-based PACS for new and replacement PACS. Unlimited volume-based licensing with either turnkey or software-only deployment enables users to maximize access using a cost-effective, highly scalable model. Access from any Internet connection is completely portable with a personalized user experience tailored to the user ID without limitation to viewer tools (e.g., 3D, MIP/MPR) or capabilities of the active study list.

Centricity PACS-IW, which uses native tools for paperless operations (document scanning), print pages (key images), industry-standard IHE Portable Data Imaging (PDI) CD burning, and simple referring physician access for imaging results, is available for outpatient imaging centers, physician offices and hospitals of all sizes. Its Web-based architecture enables rapid implementation, administration and support from anywhere, as well as solutions for high availability and disaster recovery. In addition to core PACS functionality, integrated RIS/PACS solution and clinical integrations to orthopedic templating, advanced visualization, nuclear medicine and digital mammography primary interpretation solutions are also available as optional modules.

I'm assuming the software is included, although the specs on the ad indicate that hard-drives are NOT. This could be a problem. Frankly, I'm wondering just how much of a PACS this does include. You likely would have to add your own RAID, and this doesn't seem to include the $200,000 GE Linux server. I'm guessing this is just the Dynamic Imaging/GE Web server, probably an earlier version than what GE sells today, but I could be wrong.

This could be yours for the Buy-It-Now price of $45,000, or feel free to make an offer!

Additional information from the seller:

Dear Doctor Dalai,

Latest version of Dynamic Imaging Solutions' Centricity® PACS-IW (formerly Dynamic Imaging IntegradWeb® PACS) 3.6.2.0065. Server has been operational only since October of 2007 and been as a production server only for 6 month. Latest upgrade was in August of 2008. The server is on line?.I would be able to give to demo user name and password fill free to explore and view some studies ( DR,US,MG,MR,CR,CT). Please let me know.

IntegradWeb is a comprehensive, flexible and easy-to-use image access and management system. It streamlines image distribution for medical professionals and their staff by eliminating time and distance bottlenecks. IntegradWeb cuts equipment and storage costs for hospitals, imaging centers and medical groups. It allows clinicians to be more mobile and all operations to be more efficient and traceable. IntegradWeb includes all the features you'll need to access and manage studies. It handles Computed Tomography (CT), Magnetic Resonance (MR), ultrasound (US), nuclear medicine (NM), computerized radiography (CR), digital radiography (DR), DEXA (DX), special procedures and Interventional radiography (XA), PET/CT scan (PT), and many other (OT) kinds of exams. A robust toolset allows you to measure, cross-reference, window, synchronize and re-position images, as well as to view them in dynamic motion. You can also print, copy and email images and studies. These are only a few of the features that help you establish and distribute diagnoses. With this comprehensive feature set, you make no sacrifice in flexibility. IntegradWeb can be configured to fit your workflow and preferences, even when those preferences vary from user to user. You can add or remove features, toolbars, menu items and shortcuts and tailor the way certain features work in your instance of the application. IntegradWeb requires no complex programming or coding to make these modifications.

I suspect $45K is a real bargain, but I'm wondering how GE is going to handle licensing and service for whoever buys this.

E.T. Phone Home, or Getting Blackburied

Image courtesy of purplelime

I love my iPhone 3G, far more than any phone, PDA, or essentially any other gadget I have ever owned. It does what it is supposed to do, and does it well. It is simple and intuitive in its operation. The build of the device is military-level, with smooth, clean lines. The screen is great. Adding contacts, phone numbers and other such info is easy, and the App Store makes adding new programs a breeze.

Much as I love the thing, I am still quite cognizant of its deficiencies:

• Cut-and-paste
• Stereo Bluetooth
• MMS
• Video acquisition
• Decent camera (only 2MP, no flash!)
• Removable/replaceable battery
• Removable/replaceable memory
• Hardware Keyboard

Most of these, however, have not proven to be deal-killers by any means, and in day-to-day use, they present no problem at all, at least not to me.

Despite what you might think, my partners do not always follow my advice when purchasing things technical. In this particular case, many didn't want to switch to AT&T from Verizon, feeling that the latter gives them better coverage in our small town in the South. I haven't had any problems with AT&T, but to each his own. Thus, I have had the chance to play with some of the other high-end phones out there, including several flavors of Blackberry's, a few of the Windows Mobile handsets, and some various other touch-screen toys. I won't even try to give you a full review, but what follows is a brief compilation of my musings about these iPhone wannabees.

Research-In-Motion's (RIM's) Blackberry series has captured the hearts of corporate IT folks everywhere. This is primarily due to their proprietary push e-mail, still acknowledged to be the best in the business. One of my partners just got a Storm (left) and one fellow has a Curve. There have been a few Pearls floating around as well.

The Storm was supposed to be RIM's answer to the iPhone, with a touch-screen and no hard-keyboard as found on the Curve. The Storm's touch-screen has another little design-addition; the entire screen clicks when you, um, click it. In practice, the response of the keyboard is poor, and the clicky-screen feels very strange. My partner's machine seemed to have poor build-quality, and the screen had white-spots in it (not on it). To me, the Blackberry OS is unintuitive, and undeveloped. The whole thing seems to have been built as a life-support system for their e-mail client, and everything else added on as an afterthought. Hold the indignity; this is my opinion, and nothing more.

The other Verizon not-iPhones use varying approaches, some with GUI's layered over the less-graphic Windows Mobile 6, some with LG or Samsung flavors. Many have some great built-in apps, such as voice commands, and vocal turn-by-turn GPS. However, the core functions such as the phone itself, email, and web-browsing still pale in comparison to the iPhone. Symbian, the most popular system overseas, found on the high-end Nokia's and Sony-Ericsson's, just hasn't made much progress on these shores.

While neither I nor any of my partners has yet tried the Google Android OS, as embodied in the G1 below, it may have the potential to be an iPhone killer. Eventually. It has many similarities, including something like the App Store, and of course it has Google behind it. Time will tell.

This was certainly not meant to be a full review of any of the phones mentioned, and you can turn to Google to search for proper write-ups. As usual, I very strongly recommend trying the devices before you buy them, or at least be certain that there is a trial-period, usually 14 days for most carriers. What you see the salesman accomplish in the 2 minute demonstration might have absolutely no connection with the way the machine acts in your hands. You have to try these things in your own production environment to see how they will work.

The whole thing bears an uncanny resemblence to PACS, doesn't it? I wonder if Apple would consider getting into that business? Too bad the name iPACS has already been taken. . .but I'm sure Apple could buy it anyway.

Amicas Focuses With Fovia

Despite what some out there might think, Amicas doesn't tell me everything that's going on with their new software. Sometimes I learn things from the normal sources, such as AuntMinnie.com.

I've been dabbling with a beta version of Amicas PACS, a.k.a. Version 6, a.k.a. Phoenix, which has some rather advanced 3D features on board:

I knew some of the coding had been farmed out to other software shops, as is typical with a huge project of this sort. According to the AuntMinnie teaser, Amicas has just signed with Fovia Medical of Palo Alto, California to integrate Fovia's HDVR (High Definition Volume Rendering) into V6. I'm not certain if my beta-server has Fovia's software on it, but what's on there is pretty powerful already.

So who (or what) is Fovia?

Fovia Medical, Inc., a subsidiary of Fovia, Inc., is headquartered in Palo Alto, California and is an international leader in volume rendering, an advanced technique for visualizing and analyzing large volumes of data in three dimensions. High Definition Volume Rendering® is a proprietary technique, developed by Fovia, which delivers unparalleled image quality and performance.

Fovia appears to have made great strides with software rendering:

Fovia’s HDVR solution overcomes the many limitations of currently available imaging technologies, therefore enabling physicians to take full advantage of 3D imaging as part of everyday patient care. Selected features and benefits of Fovia’s proprietary solution include:

• On-the-fly, interactive deep supersampling with off the-shelf hardware

• Software-only solution that is faster than specialized hardware (ASIC) and video card-based approaches

• Interactive rendering of large datasets without data down/subsampling

• Non-compromised remote rendering over the internet or wireless networks

• Interactive rendering without preprocessing

• Scalability with more users, larger datasets, bigger rendering planes, multiple CPUs and clustering

• On-the-fly modification of all rendering settings

• Instant segmentation

• Multi-classification support

• Native support for embedded polygonal objects

• Selected per tissue lighting control via extended transfer functions

• On-the-fly auto-navigation for fly-through

• Subvoxel precision for 3D measurement

• Compatibility with Windows/Macintosh/Linux platforms

Fovia has designed its HDVR software engine to be easily integrated into various original equipment manufacturers’ offerings, therefore allowing PACS companies, imaging modality manufacturers and other medical imaging OEMs to easily, quickly and cost-effectively integrate a best-of-breed 3D solution.

And no video card is required! Have a look at the HDVR feature set:

• High Definition Volume Rendering®
• Tools for 3D measurement and fusion with polygonal models
• Interactive modification of all rendering parameters
• Instant point-and-click segmentation
• Instant free-hand-cut segmentation
• Classification of voxels with identical scalar values to different transfer functions
• Toggle lighting function for any transfer function segment
• Interactive fly-through auto-navigation
• Interactive arbitrary cut planes
• Unified slab thickness
• User-defined adaptive control of speed vs. quality
• Instant point-and-click measurement with subvoxel precision
• Support of stereoscopic mode
• Gradient modulation control
• Non-blocking/blocking execution
• Network data compression: JPEG lossy/lossless 8/12/16
• Volumetric shadowing

OK, I'm sold. And so was Amicas:

”Fovia’s HDVR technology offers unrivaled 3D functionality to our PACS customers for reviewing large volume data directly within AMICAS PACS,” states Rodney Hawkins, vice president of product management at AMICAS. “With Fovia’s 3D engine as an intrinsic part of AMICAS PACS, radiologists will clearly experience higher productivity gains and more efficient reading workflow as a result.”

Interestingly, there is another PACS company working with Fovia, a company that already does a lot of 3D work, and even has one of the best-selling 3D Workstations with some Advantages. But this particular company likes to find additional talent where it can:

See why GE Healthcare, the world’s largest manufacturer and distributor of medical imaging equipment, has recently licensed our imaging solution.

I guess this is quite a vote of confidence. Let's just hope for Amicas' sake that GE doesn't actually buy Fovia. . .