RSNA 2010: Merge

You might think that the folks at Merge do nothing but play all day.  Their booth here at RSNA has an entire section devoted to a video arcade (see above), and a wall of candy bins.  The major attraction, however, was this fine Tesla electric roadster in Merge Orange. (Yes, that is a stock color for Tesla.) 

Merge actually owns the car, and will use it for advertising purposes.  I certainly got a jolt out of sitting in it, mainly because one has to free-fall into the seat which is about 1cm off the ground.  Getting out is a bit of a production for someone my age as well.  The Tesla's body is designed by Lotus, but mine isn't.

I finally had the opportunity to speak with Michael Ferro, Chairman and CEO of Merrick Ventures, which owns Merge.  I came away from this 5 minute face-to-face meeting exhausted.  This fellow has so much energy he could probably charge up the Tesla just by looking at it.  Once he realized who I was, though, he perked up even more, and (most embarrassingly) made a point to bow in my direction, claiming not to be "worthy" to speak to Doctor Dalai.  The guy knows how to deal with pretentious folks like me!  I just wish I'd had a camera to capture that moment.  And as if I weren't flattered enough by that point, he went on to say that "the only things I read in this space are your blog and AuntMinnie.com, and your blog has a lot more influence!"  From your lips to God's ears, Mr. Ferro.

We spent a few more moments discussing the state of Merge and healthcare.  Michael's dedication to reshaping the landscape is clear, and he noted that he does not draw a salary from Merge.  The company took on a tremendous debt to buy AMICAS, and all possible funds are directed to paying that back, although much is still devoted to R&D.  Mr. Ferro is not so much interested in leveling the healthcare playing field, as in boosting the position of Merge customers on that field.  As a Merge customer, I'm OK with that.  The goal of making Merge a Billion Dollar company is still front and center, and I do think it will happen.

As the boss had to head home for a few moments to see his kid's ballgame (that's the kind of CEO I want to be when I grow up), I was handed off to Justin Dearborn, formerly CEO of Merge, and now President of Merge, as well as Jeff Surges, the new CEO of Merge, and former President of Sales at Allscripts.  I'm not sure if moving from CEO to President is a promotion or a demotion, but both titles sounds rather impressive.  I had met Mr. Dearborn earlier this year on my visit to Merge HQ.  He is as quiet and deliberate as Mr. Ferro is flamboyant. Mr. Surges also seems a bit more restrained than Mr. Ferro, but here everyone is on the same page, and that page is to bring Merge to the forefront of healthcare IT.  We discussed, among other things, how we radiologists could be helped though the maze of Meaningful Ruse, I mean Meaningful Use, and this is something Merge will leverage in its favor, as well as that of its needy customers (like me).  There is a significant amount of reward money to be had (on the order of $44,000 per doc) from the government for implementing a meaningfully usable EMR, and there are penalties for those who don't take the cash.  Only the government could come up with something like that, but I digress.

As a legacy AMICAS customer, the one thing I want even more than a $44,000 handout, or even a Tesla (well, OK, I'd take the Tesla instead, but..) is confirmation that the upgrade roadmap I was given earlier this year will stay in place.  The President and CEO assured me that it would, and I was able to see signs elsewhere in the booth that this is so.  More on this momentarily.

After the meeting with the execs, I had a chance to wander the booth and see what's new.

My first stop was to see my pride and joy, the Halo Viewer in AMICAS 6.0/MR4.  It should be clearly noted that MR4 is the first to be released under the Merge banner, and it shows significant incremental progress as compared to the older version (MR1) that I have on my test server.  To be fair, most of these were present in intervening service releases that came out, or were supposed to come out, before the Merge-r, but they are new to me.  There is 64-bit support for 3D functions, and the whole thing is now Windows 7 compatible.  I would be happier if it was Mac compatible, but I've learned not to ask for that one anymore from most any company, although Intelerad recently took the plunge into Mac-dom.  There are a number of other improvements, such as a nicer interface for the customization of the fast-right-click sequence, and a smoother implementation of the multi-step hanging protocols.  There is a History button that allows rapid access to the last 25 exams (or more if you set it that way).  An outside CD can be loaded in the viewer on the workstation without uploading to PACS.  The latter is possible, although this may need a PACSGear appliance.  The multidimensional RealTime Worklist is much as it was.  Keep in mind, you can have more than one open and visible at the same time.

There was a little hushed talk about what version 6.1 might or might not have, and not much was said because most details are still in flux.  That probably applies to version 7, the, ummmmmm, Merged PACS supposedly blending the best of AMICAS, Emageon, and Fusion/Matrix software.  Of course, no one knows just how that patois might look just yet, and I'm hoping for an invite to the new and improved Advisory Committee so I can offer my biased opinions.  It does appear that 6.1 will use the ECM, or Enterprise Content Management, the old Emageon VNA, as its back-end.  I expect Merge will be able to get this integration accomplished a bit faster than some of their counterparts managed with a similar move.  It helps that there are already 300 ECM's out there, integrated to various other products. 

Interoperability is the name of the game for the future, and Merge wants to be a big player in that arena.  I never understood why until today, when a former Click colleague of Mr. Ferro's told me a story to which many can relate.  It seems that around the time Michael sold off Click, for a very large sum, he began to experience headaches, and the local docs couldn't find the reason.  He carried his jacket of films from place to place, and in many instances, he was told that he had to have a repeat study.  There had to be a better way, and the purchase of Merge was the first step in the quest to find it.  


Ultimately, the idea is not dissimilar to my desire to fix the portable patient mess, and Merge attacks it in a different manner than lifeIMAGE.  By leveraging various items from their acquired toy chests, Merge has assembled iConnect, "The Next Big Thing In Interoperability".  (At least they don't claim it to be a big f'n deal, although it has potential to be just that.)  The concept is simple, really.  All we want to do is access any image on any device at any time.  Simple?  No, it's not, not at all.  But the iConnect portfolio offers one path toward the greater goal.  

• iConnect Access is a web-based platform-agnostic viewer, using AJAX for display.  It works very nicely on the iPad with a limited tool-set, and even better on a PC or a Mac with additional tools.  It has 510K approval for diagnostic reads.
• iConnect Share is a drag-and-drop solution for studies on CD.
• iConnect VNA is the ECM from Emageon as noted above.
• iConnect Exchange is a bundle of the above modules.
• iConnect DR uses the various components to establish a disaster recovery plan.
• iConnect Kiosk is the free-standing registration portal I mentioned earlier.  
• iConnect PHR allows storage of images from the other 'ologies, Pathology, Ophthalmology, etc.

As an aside, another vendor asked me if the Merge Kiosk would accept a patient-entered CD.  At this point, the answer is no.  But I asked my friend Luc, director of that part of the project if that was something they might add.  He considered it for a moment, and thought it might not be a bad idea, but thought the logistics of trying to get a patient to deal with a balky disk would be too hard to overcome.  I tend to agree.

I'm becoming more and more comfortable living under Merge management.  I had my fears, as you all know, but I think they have been proven mostly baseless. This is a somewhat different healthcare journey than I had signed up to take, but it is worthy none the less.

And now, if you'll excuse me, it is time that iConnect with a friend from Perth for dinner here in frigid Chicago.