Sunday, March 26, 2017

The Best Designs Of (For) Mice And Men

Of all the things you didn't know about me, perhaps the most irrelevant is the fact that I'm a frustrated inventor. Periodically, I come up with ideas of things that should exist but don't, and in general they don't for some very good reason. I did once go so far as to retain a patent attorney to research one of my brilliant intellectual offspring. He found the same thing had been "discovered" and patented four times before. That knowledge cost me $500. Of course, one would search the U.S. Patent Database today with Google. How times have changed.

The Agfa Daily Blog Update recently linked to an article celebrating some of the best designed products of all time.  It's a good read, although I found the selection a little, well, optimistic for that particular blog. Still, it prompts some interesting discussion. Five design professors were interviewed, and asked for their choice of the best-designed product of all time. I won't go through the entire list, but the one that took my fancy was the lowly old dial telephone, as described by Professor Kalle Lyytinen of Case Western Reserve University:

American industrial designer Henry Dreyfuss’ AT&T Model 500 phone is one of the most iconic and recognizable products of the 20th century. The phone – together with its design process – was a harbinger of many design principles used today.

Rotary phones – which feature a round dial with finger holes – first emerged in the early 20th century. But many of these were bolted to the walls or required two separate devices for speaking and listening.

In addition, early telephone users would call into operators, who would use a switchboard to connect callers. When this process became automated, designers needed to figure out a way to offer an intuitive interface, since callers would be dialing more complicated number sequences (essentially doing the “switching” on their own).

Though earlier models came close to addressing these needs, the 500 model elevated the design, adding several functions that forever changed the way phones would be used.

AT&T’s first rotary phone in 1927 (dubbed “the French Phone”) had an integrated handset for both the loudspeaker and the microphone, but it was cumbersome to use. Meanwhile, Dreyfuss’ earlier model from 1936, the 302, was made out of metal and also had an awkwardly shaped handset.

Then, in 1949, his Model 500 came along.

Employing new plastic technology, the phone’s handset was smooth, rounded and proportional, an improvement on unwieldy earlier versions. It was the first to use letters below the numbers in the rotary – a boon for businesses, since phone numbers could now be advertised (and remembered) as mnemonic phrases (think American Express’ “1-800-THE-CARD”).

The 500 phone was also the first to undergo a design process that used ergonomic (comfort) and cognitive experts. AT&T and Dreyfuss hired John Karlin, the first industrial psychologist in the world, to conduct experiments to evaluate aspects of the design. Through extensive consumer testing, the designers were able to tweak all minutiae of the product – even minor details like placing white dots beneath the holes in the finger wheel and the length of the cord.

Including its later incarnations, the phone would go on to sell nearly 162 million units – around one per American household – and become a presence in living rooms, kitchens and offices for decades to come.
Italics mine.

It should be intuitive that a well-designed product does what it is supposed to do, does it well, and is easy to use. Compared to this old phone, the 500 was quite an advancement in each of those criteria:

As I've said on numerous occasions, Apple (whose products were curiously not mentioned among the top five) has mastered this concept. The late, great Steve Jobs quite literally used Zen philosophy in his product design. As Drake Baer writes in Business Insider:

When you look back at Jobs' career, it's easy to spot the influence of Zen. For 1300 years, Zen has instilled in its practitioners a commitment to courage, resoluteness, and austerity — as well as rigorous simplicity.

Or, to put it into Apple argot, insane simplicity.

Zen is everywhere in the company's design...

It's the industrial design equivalent of the enso, or hand-drawn circle, the most fundamental form of Zen visual art.

But Zen didn't just inform the aesthetic that Jobs had an intense commitment to, it shaped the way he understood his customers. He famously said that his task wasn't to give people what they said they wanted; it was to give them what they didn't know they needed.

"Instead of relying on market research, [Jobs] honed his version of empathy — an intimate intuition about the desires of his customers," Isaacson said.
It is rather ironic that Agfa itself attempted to develop a PACS interface in a vaguely similar manner using Alan Cooper's Persona approach with limited success, depending upon whom you ask. We still use IMPAX 6.x, which is the one of the later descendant of Agfa and Cooper's Odyssey PACS prototype. It does work, but takes approaches I would not, as a practicing radiologist, have recommended, and I continue to despise. As usual, the bottom line is this: those who design products MUST get into the heads of those who will USE those products. It really is that simple. Steve Jobs got it. Tim Cook, maybe not so much. Some PACS companies, well, not much. Maybe not at all.

I've been blogging about PACS for over 12 years now, and I'm not seeing a whole lot of improvement in this regard. Here's a good example. I've spoken previously about our Centricity Universal Viewer, which is not universal in any real sense, although as the heir to Dynamic Imaging's IntegradWeb, it had great potential. We have been able to come to terms with it, and GE has actually fixed many of the problems we've had with it. But as my senior-most partner puts it, the enemy of good is better. Exhibiting the faith of those who walk on hot coals and handle snakes, we agreed to have the embedded version of the Advantage Workstation placed on the system. It seemed like a good idea...we would be able to view PET/CT's and do high-level imaging things on any workstation. The number-crunching is done on a separate AW server with server-side rendering, so there should be no ill-effect upon PACS. Right.

In practice, well, we've had some trouble. The integration of these two VERY different products could not have been easy, but it could have been done better. As usual, it appears that no radiologists were killed in the making of this product. Or consulted, for that matter. And, those at GE who know the UV well don't have expertise in the eAW (embedded Advantage Workstation) and vice versa. So it is no surprise that the integration of the two is not what it should be. Without going into painful detail, say we are viewing a PET/CT with a comparison conventional CT. I'll have the CT images from both arranged on the left side of the 6MP monitor, and the server-side rendered (but still SLOW) AW windows the right. As originally configured, scrolling through the CT was supposed to synchronize all windows. But that ended up moving images around in an uncontrollable way. I asked for this connection to be severed, and GE tried to do so, but some crosstalk does remain. For example, changing a CT window on UV changes it on eAW as well. Trying to load a different comparison CT restarts the eAW window altogether. And so on.

Had I been called upon to choreograph this dance, I might have been tempted to do some of the synchronization, but I would have limited the depth of the connection. It needs to be kept simple, in my humble (and simplistic) opinion. One side really must not be allowed to interfere with the other. I should think it would have been easier to make the windows totally separate in their operation, so what we see here is a perversion of Job's philosophy. We are given something we didn't know we wanted, and lo and behold, we really don't want it after all!  There are additional problems with hanging protocols, which are completely different entities on the UV and the eAW, but may create overlap. GE has been helpful, but I have the feeling they have not encountered these problems before. Perhaps we are doing something very wrong, or maybe this is one of the first installations of this particular patois of hardware and software. We await further tweaking.

I'll keep you posted.

I was once asked if I planned to create my own PACS. For better or worse, I don't have the resources, the backing, or the expertise to try this, but I am available for consultation (for a very reasonable fee) should anyone with a lot of money and a team of software engineers be interested in making The Best PACS. I'll be waiting by the phone. If contracted for this lofty purpose, I'll certainly do my best to channel the spirit of Steve Jobs. I can try, anyway...

Post Script: My friend Phil sent this comment concerning PACS development, and it is certainly worthy of inclusion into the main post:
When will they ever learn, oh when will they every learn?

Answer - When it affects the bottom line.

Question: When will that happen?

Answer - When radiologists are empowered to decide which product to buy (Oh - and will spend the time to actually evaluate them).

Question: When will that happen?

Answer: ????????????

Sunday, March 19, 2017

Hello, (Friends of Doctor) Dolly!

I know many of you are landing here thanks to my daughter, Dr. Dolly. She was just published on, and my celebratory post on Facebook labeled her a "chip off the old Doctor Dalai". Thus, her friends are now discovering what I do in my spare time. Hopefully this won't reflect badly on Dolly. She is, after all, at the beginning of her career, and I'm at the end of mine. We don't want potential employers, colleagues, administrators, scrub-nurses, or Uber-drivers to think she might turn out like me! (For privacy reasons, I'm not linking back to KevinMD.)

In some ways, I've taken a page from her book. While in medical school, Dolly went on a number of mission trips to such amazing places as Oaxaca (Mexico), Nicaragua, and Uganda. And South Dakota. Having more time available and more training behind me, it occurred to me to do the same while bouncing around the purgatory of quasi-retirement. Once I found RAD-AID, the die was cast. Both of my loyal readers know that I've been to Korle Bu Teaching Hospital in Accra, Ghana, an incredible trip. You can read about it right here on my blog if you haven't already. A medical mission trip is not something you do once; the experience changes you (for the better). The desire to give back, and the growth involved in the process, is addictive. The friends you make, the things you see, the joy of being out of your comfort-zone all necessarily call for an encore performance.

Thanks to a tremendous opportunity provided by RAD-AID and SNMMI, I will be going to Tanzania this summer to provide what little expertise I can muster for the Nuclear Medicine program at the Aga Khan Hospital in Dar es Salaam.

The whole thing comes as a bit of a surprise to me, as I will be the recipient of a Hyman-Ghesani RAD-AID SNMMI Global Health Scholarship, which will cover much of the expense of the trip. The surprise is that this program seemed to be geared more toward academia, and I applied with little hope of success. But I seemed to have impressed the committee to an adequate degree and so off to Tanzania we go. I am truly honored and humbled by the confidence and trust in me. I do have to say that in my 27 years of private practice, I've come to find that experience is the best teacher. Of course, experience and brilliance would have been a better combination, but we can't have everything.

The mission has only one downside. I'm committed to present a report at the subsequent Society of Nuclear Medicine and Molecular Imaging meeting, and in 2018, it's in...Philadelphia. Meh. Oh, well, we have to make some sacrifices here and there.

I've said it before, and I'll repeat...RAD-AID is an incredible operation, worthy of your donations of money, and better, of your time. There is tremendous need out there for your radiological expertise, and yes, your cash. There is a lot of work to be done. Come join me.