Tuesday, December 15, 2009

On The Twelfth Day Of PACS-mas, My Vendor Gave To Me...

A friend of mine is part of a large group in a large city, and they are none too happy with their Fuji Synapse PACS. As his (unaltered by Doctor Dalai) wish-list below nicely outlines, there are a number of features that are not found on their Fuji system (but are available from Amicas!) Without further ado...

1. I should be able to make custom window level settings so when I hit "7" I get MY bone settings.

2. I should be able to customize my right-click generated side bar. When I right click, there are probably 25 options and I only ever use 3 of them.

3. When I reserve a case from the list I should be able to see I've done so.

4. I should be able to pre-select cases on a list I do NOT want displayed if I start F8-ing through a list.

5. Synapse is very unstable. I've never worked with another program that spontaneously crashes at a rate near Synapse. It is unacceptable.

6. In the notes window there should be a single click button to add the word "dictated" without typing that also removes the case from the list and displays my next case.

7. We need a PACS that can support cine for ultrasound, especially vascular.

8. We need a PACS that has full Nucs and PET/CT capability to read on the fly as one reads all other cases.

9. I expect a customized worklist that populates every case I am responsible for covering and none that I am not, so I can access ALL of my cases from a single worklist (as Amicas does). I want a separate worklist also visible that shows any other cases I could read when my list is clean (as Amicas does).

10. I expect a smart worklist that allows me to move from one case to the next without ever returning to the list to look. A smart list needs to manage the order cases appear based on acuity and chronology (as Amicas does).

11. I want to perform MIP and 3D reformats on the fly, when needed, without having to request the study is sent to Terarecon. I expect to be able to SAVE those images (which Fuji can not do with its limited MPR function--Amicas can).

12. I expect images to pre-cache to my PC without me moving a finger. I want every case on my list to have every image loaded before I open it (as Amicas does).

13. I expect a single button click to send my case to OPS with notification to call ordering physician and transfer them to me (as Amicas does). I should never have to open multiple folders and drag a case.

14. I expect a separate single button click to send case to OPS for OPS to call the report (as Amicas does).

15. I expect a single click on my worklist to display all cases I've read that day so I can quickly go back to a case for a clinician (as Amicas does).

16. I want a completely customized hanging protocol that puts every series of my exam and the comparison exactly where I want them every time (as Amicas does).

17. I want to send a email or text link to the ordering doctor that takes them straight to my report and includes annotated images (as Amicas does).

18. When I open a report from Synapse in a new window, I should not have to resize that window EVERY time. It should remember the size I made it last time.

19. I want a way to see a case is cached on my PC before I open it (as Amicas does).

20. I should not have to tolerate sending suggestions like this for 2 years without any being addressed or getting concrete responses from my PACS vendor (as Fuji has).

21. I expect a PACS that mines all databases we access for relevant priors without the extra fee Fuji charges, I want it free like it is with Amicas.

22. I expect to be able to open extra comparison exams in new side windows so I don't have to give up my primary reading space on my layout for another old series (as Amicas does).

23. I want a side annotation that is visible but not distracting to indicate what studies are comparisons so I never have mis-arranged series and read the wrong date's exam as current (which I've done with Synapse). As you've guessed, Amicas has this feature.

24. A PACS system updating a list or exam in the back-ground should not disable our ability to continue scrolling through the exam we are reading, as it true for Synapse.

The interface with our exams is a critical component of our practice. We need to demand excellence. It is currently available.

Just not from Fuji, eh?

My friend went on to speculate that even beyond the above list, what we really need is " a bowling alley order button analog- push the button and help comes." This is probably one of the best ideas I have ever heard. Think about it... a help button that actually helps, either accessing the proper page of the manual based on the state of the PACS GUI at the moment, or alternatively patching one through to the vendor's (or hospital's) help desk, letting them see the problem at hand. This would be simple to implement, but incredibly powerful, much more user-friendly and downright useful than anything out there right now.

Once again, all the vendors have to do to make their customers happy is to listen to them! Simple? Apparently not for some of the larger companies.

On the First Day of PACS-mas, my vendor gave to me. . . a PACS that will work as guaranteed.


Jared said...

Unless he has some serious pull with Fuji development, then it's time to budget for the Amicas machine. It was probably time 2 years ago.

Anonymous said...

Is your friend referring to the current Amicas PACS, or the "old" Emageon PACS. We have Emageon and it can do most of what is on the list, but the Amicas system I saw did not allow for customized hanging protocols (#16).


Dalai said...

JW, you need to have another look at Amicas. They have had one of the better customized hanging protocol setups for many, many years. Version 6 has been further enhanced, allowing for staged protocols (such as all the T1's, then all the T2's on an MRI).

aycandigital said...

I would recommend OsiriX PRO combined with aycan store, which will fulfil most of the wishlist for a fraction of the price of "normal" PACS solutions.


Stephan Popp
aycan Medical Systems

Anonymous said...

Taking into account that you're with Aycan, I'm sure that recommendation will carry a lot of weight.

aycandigital said...

Dear anonymous,

yes I'm with aycan and I doesn't make sense to me to make a secret about it. I recommend to read the article at apple.com. Consider that Apple wouldn't promote it, if it wasn't reality.
Search the web for websites mentioning OsiriX and you will get more trustworthy information from independent resources.

I was posting this comment, because Dr. Dalai seems to be open for all comments at his blog (even from vendors).

Our customers tell us, that we are providing solutions, which are a lot more practical and flexible than PACS of the big industry players.

OsiriX - the free Open Source software - already has 40.000 users worldwide. OsiriX PRO is the FDA-cleared and CE-labeled version of it. Combined with aycan store - the vendor neutral DICOM PACS archive - we are offering a fast and versatile solution which can provide most of the missing features mentioned in the wishlist.

Stephan Popp
aycan Medical Systems

Anonymous said...

Hey I have no issue that you're a vendor - it just sounds kind of pompous (or maybe just misguided) to say "I recommend" when you are selling the product.

Anonymous said...

Mr. Aycan,

If using your solution, when I open my Osirix workstation and see my worklist (assuming worklists exist) and double click that study does it open right away? Or, does it have to do a Query/Retrieve? I always thought of osirix has a standalone workstation and something that doesnt allow streaming of images from a server on-demand. If it is option A (stand alone requiring Query / Retrieve), then you are foolish to compare it to Amicas or anything else.

aycandigital said...

Dear anonymous,

I didn't compare OsiriX PRO / aycan store with Amicas. I even don't know the system.

I said that most of the Fuji user wishlist can be done with our solution.

OsiriX PRO has a technology where it can load studies directly over the network without Q/R. It also offers a RIS interface, which allows RIS clients to trigger the display of certain studies (of course out of a worklist).

Stephan Popp
aycan Medical Systems