Thursday, June 23, 2011

America Thinks It's Got Talent

I avoid many of the "reality" TV shows, as they are generally about as unrealistic as it gets. Of course, Mrs. Dalai is quite absorbed in the Bachelor/Bachelorette series, so I have the joy of watching Ashley make a fool of herself chasing Bently, who isn't interested. Women....

Anyway, I do happen to enjoy NBC's "America's Got Talent"  which is a little different than some of the others.  Basically, it's a throwback to another age, when song and dance ruled the airwaves. The three interpid celebrity judges (Pierce, Sharon, and Howie) travel the nation, looking for the next Million Dollar act, and every so often, actually stumble upon a diamond in the rough. Take Landau, for instance:

Here is a 30-something hair-braided, gum-smacking ex-car wash attendant, who came to the stage on a lark, having no preconceived notion of what would happen next.  But the moment the music started, Landau channeled Frank Sinatra and blew the judges and the audience away with his talent.  And when the judges actually told him just how good he was, he broke down in tears in front of the audience and the world.

Contrast Landau with these clips of the worst of the auditions on the New York City stop:

While NBC does kindly make the clips of the performances available on its website, you had to be watching the show to see the pre-game interviews with some of these folks.  To me, this is the most disturbing part of the story.  Landau was quite humble before he went onstage, which is as you might expect.  However, some of the purveyors of the worst acts ever to be seen on national television were quite convinced that they had tremendous talent, that once they got their national debut, stardom was just days away.

This may not be an ominous sign, but I do think it tells us that there is something wrong with our society, and ourselves.  I occasionally try to sing.  I won't shatter glass, but I'm not too bad.  However, I grasp totally that I am not very good, either, and I would NEVER subject anyone else to my singing. But here we have people literally making fools of themselves, thinking they are far more talented than they really are (a vast understatement if there ever was one.)  There is nothing comparable to the look of utter amazement when they are told in all honesty that their act sucks and they have zero talent.

I wish Dr. Sanity was around to analyze this, but since she has quit blogging, I'll have to wing it.  Basically, this behavior represents a form of narcissism.  The victim (not the audience, the other victim) believes himself or herself to be worthy and deserving of the attention of the masses, not to mention the million bucks.  You'll notice that most of these fools are thirty-somethings and younger, which means that their narcissism was trained into them.  This is the result of decades of discouraging discipline, of telling every kid that they are winners, giving trophies to everyone who even shows up to something resembling a competition.  This is what we get for ditching the rules, for delving into political correctness at every possible turn, for never saying "no".

OK, OK, I understand that a few nut-jobs on a television show don't signal the downfall of society.  But sadly, they are indicative of the way a lot of people think. It borders on delusional, and it has the potential to be dangerous. Especially when these folks vote on the basis of what makes them feel important and powerful.  When they buy into a meaningless feel-good slogan to select leaders.  And so on.  Yup, I think we're in trouble.

By the way, I have no illusions about my writing talent, or lack thereof.  Fortunately, Pierce doesn't judge blogs.

Sunday, June 19, 2011

Doctor "Hunter's" PACS

Thr image previously in this spot, which was properly credited to, has been removed after said website filed a complaint against me. Please feel free to contact and thank them for their vigilance. 

ADDENDUM...I have just purchased the rights to use the photo from iStock did not own exclusive rights!!!!!

I have the joy and educational opportunity to be on call on Father's Day, as I was on Mother's Day, and as I will be on July Fourth. I must be living right.

The good news here is that I got the chance to talk at leisure with one of my partners who has the wonderful fortune to be on IR call this weekend. Dr. "Hunter" as I will call him is a damn good radiologist, although not as computer-savvy as some of the guys. Fortunately, he isn't quite as bad in this regard as another partner, the inspiration for Dalai's Twelfth Law, "The PACS needs to be operable by the least technically-savvy radiologist on staff."  That would be Dr. Bill, who is also an absolutely superb interventionalist, but not so good with computers:

Anyway, as you might guess, Dr. Hunter's favorite hobby is indeed hunting, and he can discuss guns and hunting trips until the cows come home. (He doesn't hunt cows, fortunately.)

Hunter is based at our smaller, AMICAS hospital. He has been exposed to the new AMICAS PACS more than the rest of us, and has had some problems with it. When this morning's conversation rolled around to the topic of PACS, I was expecting the worst, a tongue-lashing about "my" PACS. Surprisingly, I found Dr. Hunter to be quite insightful on the current and future state of our enterprise. Let me elaborate.

AMICAS PACS, or AMICAS 6, or Merge PACS 1.0, is a considerably more powerful product than its predecessor. With power comes more buttons and settings, most of which are in the background. Sometimes, those settings don't get set right, or at all, for that matter, and that has been our problem. The hospital in question has had some transitions, and in fact just let go the PACS admin who had been trained up on AMICAS 6, but never had time to go through and customize it for us. The formerly junior PACS admin, who is now the Senior PACS admin, as well as a bunch of other things, has not been to training. Fortunately, he is wise enough to know what he doesn't know, and gave me super-user access. Thus, I've been able to do some fine tuning and improve the experience for my mates at work.

I'm not going to diss AMICAS 6, as I had a little to do with its creation. I can (mostly) honestly say that the parts of the program my partners dislike are those which were "inspired" by other systems, and which some other members of the now-defunct Advisory Board insisted be included. One particularly despised function is a more elaborate history listing that superimposes itself above the Real-Time Worklist, and basically takes up space that would be better devoted to the worklist itself. This, I believe, was modeled after Stentor/iSite. I didn't like it there, and I don't like it here. I've asked Merge to put in a control that will let us big-time super-dooper-pooper-scooper-users turn it off. The drive to appeal to a minority user (not a racist statement, I promise) illustrates the situation described in Dalai's Fifth Law: "Workflow is inversely proportional to the number of buttons on the PACS desktop." The desire to please everyone can ultimately lead to the Lego-PACS syndrome of hyperconfigurability.  Even Dr. Hunter gave in to this rationale, wondering if the PACS shouldn't just start out as a plain vanilla framework, to which one could add various modules.  He used the example of a white Ford pickup, of all things.  "Some want bucket seats, some want flame decals on the side, some want brush guards.  Let 'em build it the way they want it." Personally, I would never buy a Ford anything, but you get the point.

Dr. Hunter bemoaned the loss of simplicity (if not innocence) we had with AMICAS 5. But I can tell you that the advantages of the new program compensate for this, once the program is configured properly. Still, I hear what he's saying, loud and clear. I used the example of Hunter's new iPhone to illustrate. Apple takes the old AMICAS approach. The iPhone has some configurability, but not so much as, say, an Android phone. But the iOS works really, really well for the vast majority of people, and they flock to Apple so as to have something that works, and work well, right out of the box. Android requires a significantly greater degree of fiddling to get to where you want to be, and I understand that Blackberry's are sheer drudgery in this regard, which probably explains why RIM sales are plummeting. Most of my partners who suffered through various Blackberries now have either iPhones or some Android variant. AMICAS 6 tends to resemble the Android end of the phone spectrum. It works quite well, don't get me wrong, but it isn't as simple as it used to be. There is always a trade-off between usability and power.

Hunter then shocked me with the his home-grown ideas for where we need to go with PACS. In his own way, he has figured out a few things that took me quite a while to realize. He has some inkling of how an enterprise-wide system might work, inspired by the fact that some of our partners never seem to get around to helping with the lists at other sites. "Why not have some sort of window on your computer, or even something you could pull up on the iPhone," says Hunter, "so everyone can see which sites need help?  And make 'em link to the PACS programs so I can go right to where I need to be!" Good idea, although my personal thought is to simply (not really) connect all sites to one single unified worklist.  Let everyone chip away at everything.  Frankly, though, Hunter's idea would probably be easier to implement, requiring fewer permissions from IT and security types.  He had a similar idea for report sign-out amongst the various RISes we use.  Not a bad thought, really.

The lesson to be learned this Father's Day is of course not to be on call if you can avoid it. Seriously, though, my chat this morning illustrates what I've been saying for a very long time on this blog and elsewhere: PACS designers need to listen to how bread-and-butter, front line, out-in-the-boonies radiologists do things.  We use the stuff every day, day in and day out, and we have a reasonably-good idea of what we need the PACS to do and how we want it done.  Unfortunately, every PACS vendor feels the need to appease outliers sometimes, adding stuff that only a few really want, or even building something just to please the IT folks who hold the purse strings, and not the radiologists who actually use the damn thing. The disconnect is just something that has emerged over time, but doesn't have to be the way things are done forever more.

In the meantime, I'm jealous of Dr. Hunter.  He'll be off duty soon, and I'm sure he's going to go out and kill something.  Sounds pretty good after a weekend of call...

Thursday, June 16, 2011

The Library of the History of Human Imagination

Behold the most unique and amazing 3600 square feet on this planet, the Library of the History of Human Imagination created by Jay Walker.

From the Walker Digital Website:
Jay Walker, one of America’s best-known business inventors and entrepreneurs, has founded multiple successful startup companies that today serve more than 75 million customers in 15 different industries.

Mr. Walker is chairman of Walker Digital, a privately-held R&D lab founded in 1994 and based in Stamford, Connecticut. Walker Digital has invented hundreds of solutions for a wide variety of business problems. Since its founding, the company has funded an R&D budget well in excess of $100 million. The company has specialized in creating innovative applications that work with large-scale networks such as cell phones and the Internet.

Mr. Walker is best known as the founder of, which brought a new level of value to the travel industry. Today, Priceline is a highly profitable, billion-dollar public company with tens of millions of active customers. The business processes that guide Priceline’s success were created in the invention lab of Walker Digital...

The Walker Library of the History of Human Imagination celebrates humanity’s intellectual and emotional adventure of discovery, learning, and creativity by showcasing thousands of rare books, artworks, maps and manuscripts as well as museum-quality artifacts both modern and ancient.

Constructed in 2002, the 3,600 sq. ft. facility features multilevel tiers, “floating” platforms, connecting stairways, glass-paneled bridges, dynamic lighting and music, and specially commissioned artworks that celebrate major achievements in the history of human invention.
Invited guests to the Walker Library range from schoolchildren to business leaders, government officials and scholars, as well as librarians from around the world.

Just a few of the many remarkable artifacts in the Walker Library include:
  • An original 1957 Russian Sputnik, the world’s first space satellite (one of several backups built by the USSR) and the U.S. response, a Vanguard satellite made from surviving parts of the actual American satellite that blew up on the launch pad.
  • One of two known Anastatic Facsimiles of the original 1776 Declaration of Independence (made directly from the original using a wet-copy process).
  • A 1699 atlas containing the first maps to show the sun, not the earth, as the center of the known universe. ("This map, by far the most important map in history, divides the Age of Faith from the Age of Reason,” says Jay.)
When confronted with something this overwhelming, the first question might be, "Why?"  From a interview with Mr. Walker:
"I started an R&D lab and have been an entrepreneur. So I have a big affinity for the human imagination," he says. "About a dozen years ago, my collection got so big that I said, 'It's time to build a room, a library, that would be about human imagination.'"

Walker's house was constructed specifically to accommodate his massive library. To create the space, which was constructed in 2002, Walker and architect Mark Finlay first built a 7-foot-long model. Then they used miniature cameras to help visualize what it would be like to move around inside. In a conscious nod to M. C. Escher (whose graphics are echoed in the wood tiling), the labyrinthine platforms seem to float in space, an illusion amplified by the glass-paneled bridges connecting the platforms. Walker commissioned decorative etched glass, dynamic lighting, and even a custom soundtrack that sets the tone for the cerebral adventures hidden in this cabinet of curiosities. "I said to the architect, 'Think of it as a theater, from a lighting and engineering standpoint,'" Walker says. "But it's not a performance space. It's an engagement space."

Walker shuns the sort of bibliomania that covets first editions for their own sake—many of the volumes that decorate the library's walls are leather-bound Franklin Press reprints. What gets him excited are things that changed the way people think, like Robert Hooke's Micrographia. Published in 1665, it was the first book to contain illustrations made possible by the microscope. He's also drawn to objects that embody a revelatory (or just plain weird) train of thought. "I get offered things that collectors don't," he says. "Nobody else would want a book on dwarfs, with pages beautifully hand-painted in silver and gold, but for me that makes perfect sense."

What excites him even more is using his treasures to make mind-expanding connections. He loves juxtapositions, like placing a 16th-century map that combines experience and guesswork—"the first one showing North and South America," he says—next to a modern map carried by astronauts to the moon. "If this is what can happen in 500 years, nothing is impossible."

Dr. Gene Ovstrovski of recently had the chance to tour the Library and filed this report, which contains several fantastic photographs of the non-collection. (Hat tip to MedGadget, by the way...)

I'm hoping someday to tour the Library myself, should my fame ever reach the notice of Mr. Walker.  I wonder if he has any slide rules in the Library...

Thursday, June 09, 2011

Could This Be Why I Blog?


Nah.  I managed to catch Mrs. Dalai without being a country-music star.  But it could be interesting having William Shatner for a father.  

Hat Tip to Dr. Sanity...

Wednesday, June 01, 2011

Watson, Go Away! I Don't Need You!

Eliot Siegel, M.D., schooling IBM's Watson at the University of Maryland; Image courtesy

Surely you've heard by now of Watson, the IBM conglomeration of 90 servers and 360 microprocessor chips that whupped the pants off the former Jeopardy champion. Watch out, boys and girls, Watson is headed to a hospital near you, and he (it?) may challenge you as much as he did Ken Jennings.

Eliot Siegel, M.D., professor of Diagnostic Radiology and Nuclear Medicine at the University of Maryland is taking the lead in teaching Watson about Medicine. 

From the RSNA News:
Well before Watson's gameshow victory, experts at the University of Maryland (UM) School of Medicine in Baltimore and Columbia University Medical Center began working with IBM to apply Watson's analytics capabilities to healthcare. Specifically, Watson is being developed as an assistant capable of reading electronic health records (EHR) and providing instant feedback to physicians in ways not always available from doctors and nurses.

"This breakthrough in computer science will allow us to explore this technique for medical diagnosis,"
It seems we have achieved a computer that learns heuristically, although 10 years later than Arthur C. Clarke predicted in "2001:  A Space Odyssey."

Earlier attempts at artificial intelligence required every possible question and answer to be hard-coded into the system, a time-consuming process with little value in healthcare, said Martin Kohn, M.D., Chief Medical Scientist, Care Delivery Systems, IBM Research.

"Watson uses a probabilistic, evidence-based approach," Dr. Kohn said. "It generates and scores many hypotheses using an extensible collection of natural language processing, machine learning and reasoning algorithms. Many previous such efforts relied on programmed decision rules. Watson is a self-learning system that does not rely on such rules. It gathers and weighs evidence to refine its hypotheses."
Watch this clip (sorry, I couldn't embed it) of an interview with Dr.Siegel, and you'll get a taste of the future, and perhaps a bit of a chill up your spine as well. Early on in the interview, Dr. Siegel quite matter-of-factly describes how the U of M team will guide Watson through medical school, then internship, and then residency. Say what?
Watson is currently in the testing phase in that learning process, said Dr. Siegel, who pointed out the similarity to real-life students progressing from medical school to residencies.

The first step—acquiring book knowledge—is already under way. Watson's database already includes information from medical journals and textbooks such as the Merck Manual of Diagnosis and Therapy, Harrison's Principles of Internal Medicine, the American College of Physicians Medicine and Stein's Internal Medicine.

Next, experts will work to develop Watson's understanding of the physiology of the human body, followed by the third step: gathering experience.

"Watson not only needs the general knowledge that made him so successful on 'Jeopardy,' but also information from the databases specific to medicine," Dr. Siegel said.
This isn't fair!  If I could just take a text book, stick it up my, ummmm, brain, and have it instantly memorized, I would be whiz, too!

The ultimate goal is for Watson to be a helper to physicians and to serve man:
Radiology stands to benefit tremendously from Watson's capabilities, experts say.
"The technology has the potential to provide decision support on a scale not dreamt of prior to this," said Nancy Knight, Ph.D., the director of Academic and Research Development and a founder of the Maryland Imaging Research Technologies Laboratory at UM.

"Watson can supply the radiologist at the point of care with complete patient information from the electronic health record, including imaging history, allowing the radiologist to mine an often exhaustive number of records to identify the most important points," Dr. Knight said. "It also provides the latest and most extensive scientific knowledge and clinical experience that can be used to inform decisions about diagnosis, additional tests, management and likely prognoses."
Phew.  The damn thing isn't going to read scans.  Yet.

My congratulations to IBM and Dr. Siegel on a huge step into the future.  But I am very, very worried about one facet of this program:
IBM is also working with speech-recognition software developer Nuance Communications to give Watson the analytics capabilities necessary for physician-patient consultations.
I think we humans just got a break.