Saturday, August 20, 2011

Tax Envy

Warren Buffett, the Oracle of Omaha, came out recently with a rather controversial statement:
But for those making more than $1 million — there were 236,883 such households in 2009 — I would raise rates immediately on taxable income in excess of $1 million, including, of course, dividends and capital gains. And for those who make $10 million or more — there were 8,274 in 2009 — I would suggest an additional increase in rate.

My friends and I have been coddled long enough by a billionaire-friendly Congress. It’s time for our government to get serious about shared sacrifice.
Ummm, OK. That's nice of you to offer, Warren. I wonder how many of your millionaire/billionaire friends are on the same page with you on this.

Sadly, Warren doesn't put his money where his mouth is, making him a very rich hypocrite with wonderful-sounding but ultimately empty rhetoric. David S. Logan, writing on the Tax Foundation's Tax Blog, notes:
Mr. Buffett chose to leave most of his fortune to the Bill & Melinda Gates Foundation and, thus, avoided an estate tax that could potentially give 55 percent of his wealth to Uncle Sam. Moreover, keeping that wealth actively working in the private sector would generate deficit reducing tax revenues indefinitely.
Logan goes on to deconstruct the faulty thinking behind Warren's generous offer:
  • Mr. Buffett seems to forget that capital gains and dividends taxes are a double tax on corporate income. Before it gives out a dollar in dividends, Berkshire Hathaway - like all U.S. corporations - must first pay a 35 percent federal corporate income tax, one of the highest in the world. Then, shareholders pay the individual tax rate of 15 percent on their dividend income or the gains from appreciated stock. As a result, the combined tax rate of 50 percent is the 4th highest combined dividend rate in the industrialized world. Ironically, we had the 8th highest combined rate under Bill Clinton.
  • In his op-ed, Mr. Buffett suggests that increasing taxes on the rich ensures that they pay their fair share. Perhaps, but while the top 1 percent of taxpayers earn 20 percent of the nation's income, they currently pay nearly 40 percent of the income taxes. That's a greater share of the burden than the bottom 90 percent combined (that's everyone earning under $100,000 by the way). 
  • Let's not forget that when the top marginal income tax rate was 70 percent in 1980, the rich paid 20 percent of all income taxes. Yet now, when the top marginal rate is 35 percent they pay twice that. 
  • Finally, while the tax burden on the rich has been growing, the burden on low and middle-income Americans has been shrinking. By most accounts, roughly 50 percent of American households pay no income tax at all. Indeed, the IRS will give out roughly $110 billion in "refundable" tax credits this year to households that pay no income taxes.
  • Contrary to Mr. Buffett's and President Obama's perceptions, America's wealthiest taxpayers are paying a disproportionate share of the income tax burden. Before we ask the rich to pay more, perhaps we should ask those who are paying nothing to contribute at least something to the basic cost of government.

Scott Hodge, also writing for the Tax Foundation, elaborates on the notion that the "wealthy" aren't paying enough:

  • Recently released IRS data for 2009, shows that taxpayers earning over $200,000 paid 50 percent of the $866 billion in total income taxes paid that year, or $434 billion. Skeptics will say, "That's because they earn the majority of the income in America. Not so. These taxpayers earned 25 percent of the $7.6 trillion in total adjusted gross income in the country that year.

  • The 2009 IRS data also shows that a record 58.6 million tax filers had no income tax liability that year. This means that 42 percent of the 140 million Americans who filed tax returns that year contributed nothing to the basic cost of government.
  • I have to believe the "rich" are doing more than their fair share. In fact, they are covering the nearly half of the country that pays nothing at all. How much more should they pay? Review the facts above before you answer that.

    But the nation is in dire straights, with horrendous debt, and the "rich" are holding out on us need to do their fair share to help the nation. Sadly, the United States has hemorrhaged so much money so quickly, the "rich" could not even begin to bail her out. Again from the Tax Foundation's Logan:
    So taking half of the yearly income from every person making between one and ten million dollars would only decrease the nation's debt by 1%. Even taking every last penny from every individual making more than $10 million per year would only reduce the nation's deficit by 12 percent and the debt by 2 percent. There's simply not enough wealth in the community of the rich to erase this country's problems by waving some magic tax wand.

    Finally, to put everything in perspective, think about what would need to be done to erase the federal deficit this year: After everyone making more than $200,000/year has paid taxes, the IRS would need to takeevery single penny of disposable income they have left. Such an act would raise approximately $1.53 trillion. It may be economically ruinous, but at least this proposal would actually solve the problem.
    But, we're missing something. Those to the Left of center, whose numbers include hypocritical billionaires, it seems, aren't interested in fixing anything, such as paying off the debt. Just what do they want?

    Here's one possibility:
    . . . First place aversion arises from progressives’ moral view that requires them to help everyone– you can never reduce carbon emissions enough, donate to the poor enough, elevate support minorities enough, etc– and holding themselves accountable for failing their moral obligations. And they fail all the time because progressives like nice, expensive cars, clothes, food, yoga studios, Martha’s Vineyard, etc, much too much to abide their moral world view. That moral deficiency causes them to:
    1. Appoint others who force [others to pay taxes] and contribute to ending every harm; forgiven and made worthy, they ignore that their appointees often harm the poor and force others not afflicted by First Place Aversion to pay; and 
    1. Steal and sully the poor’s lack of culpability for all the wrongs that rich progressives can’t fix by paying them off with other people’s money.

    In other words, rich progressives need to feel good about themselves, perhaps to assuage their guilt over being wealthy in the first place.  But instead of getting down and dirty themselves, they do their "good" by forcing others to cough it up.  In the meantime, they totally ignore what makes the poor, ummm, poor.

    It is beyond the scope of this post to discuss the latter issue.  Suffice it to say, in many cases (but certainly not all), those in poverty have landed there by making incredibly bad decisions.  Alcohol and drugs are big players in this, but simple lack of discipline is right up there, too. You've seen people in line at the grocery paying for food with their WIC card, while chatting away on their iPhones, wearing $200 sneakers, and draped in gold.  These people can be white, black, Hispanic, or whatever, so don't accuse me of racism. And don't accuse me of lying, either, as you've seen this, too.  These people are "poor" because they can't stop spending money on the non-necessities of life, and they have been trained by the sympathetic, hypocritical Left to expect the rest of us to cover their chit in life.

    I believe strongly in charity, in helping those who NEED help.  I tried to cast my views in the light of the Jewish approach to charity relative to the Health Care Abomination in THIS post, and my feelings haven't changed.  The approach of the Left has nothing to do with helping anyone.  It is simply a drive for power and control. It pits rich against rich and rich against poor in hopes of confiscating from the former and buying off the latter. There is no thought of raising the poor out of poverty, but rather keeping them just happy enough that they don't realize what has been done to them.

    I've heard angry Leftists rail against the "rich", with the implication that the rich got that way off the backs of the poor, and that they owe it to the poor to take care of them.  Perhaps this is true in a few situations, but these are few and far between.  Buffett himself became very wealthy by making shrewd investment decisions, evaluating the companies he bought with data available to anyone who can read, especially in this day and age of universal information brought to you via the Internet.  Who did he steal from?  No one. Why is he wailing about the low tax rates of the ultra-rich?  I guess it makes him feel better.  Old Warren may not have been the most moral fellow in his younger days, and he might think he has to make things right with God. Whatever floats his boat. But it's very hard to get around his hypocrisy. He bleats from his bully pulpit, all the while avoiding every last bit of tax possible.  If he feels so strongly about this, he could make a much more powerful statement by writing a very large check to the IRS. (If you are so inclined, go straight to Pay.gov, and give until it hurts.  Hurts YOU, that is.)

    I've noticed that Warren's Berkshire Hathaway hasn't done so well lately:


    Maybe Warren is worried about joining the ranks of the poor himself?

    Friday, August 19, 2011

    Captain Kirk Sings Cee-Lo's Song...



    Yes, that IS William Shatner's voice (mostly):




    If you haven't heard it yet, here is the incredibly talented Cee Lo Green with the original (WARNING---EXPLICIT LYRICS NOT INCLUDED! THIS IS A FAMILY BLOG!!):



    I had to get one last shot at Xtranormal's "Totally Trekkie SciFi Movie Contest" and you'll note mine is indeed the final entry. Wish me luck!

    ADDENDUM

    Well, this cartoon received an honorable mention from Xtranormal, but didn't win the contest.  It went a few seconds over the two minute limit, and "rules are rules"!  I'll do better next time.  This is what happens when you slap something together five minutes before the contest ends!!!

    Wednesday, August 17, 2011

    TabCo...er...Grid Tablets Launched!

    I recently posted about some stealthy company named Tabco with some new take on tablet computing. Like every other new product, this was supposed to be the NEXT BIG THING, rendering iPads, Galaxy Tabs, and so on to the garbage heap (as well as their lemming-like owners, according to the ad.)

    Well, as reported in Techie Buzz, it turns out that TabCo is REALLY FusionGarage, based in Singapore, and their new product line includes the Grid 10 tablet, and the Grid 4 phone. Yes, phone! These little gems utilize the new Grid OS:
    GridOS is a groundbreaking operating system that features many first-of-its-kind functionalities. It reinvents touch computing from the ground up. Its user interface is unlike anything out there. It’s a groundbreaking, visceral experience. GridOS is stunning, smart, social and transportable. It features a groundbreaking animations engine. Every feature had been rethought and made better. Web Surfing, Email, Video, Music, Photos, Home Screen Navigation and more. It’s like nothing you have experienced before and it’s what makes Grid10 an exhilarating experience.

    GridOS user interface is fresh and intuitive. Its grid layout is fluid, easy to use and unique compared to any other device. User interface innovations extend across all its functionalities. Even the way you interact with a volume dial has been rethought and delivered.

    GridOS was built leveraging an android kernel. It was built on top of Android. Similar to how Apple built Mac from Unix BSD. GridOS is highly secure and scalable.

    GridOS supports Android Apps. Android Apps runs on GridOS without requiring and redevelopment or new code. With thousands of apps available, you with never be bored with GridOS.
    One key to GridOS appears to be the reinvented wheel:
    This is no vanilla UI. It fundamentally changes the way you will experience a tablet. Completely gesture-based and button-free, Grid10 lets you navigate naturally, easier and without restriction. We’ve even eliminated the boring slide bar to access Grid10. You sign on – literally – with your signature. Sounds like we have reinvented the wheel, doesn’t it? Well, we have with our wheel-based interaction. A finger tap brings up the wheel and its spokes offer a multitude of functions. Just slide your finger around the wheel and choose the desired function.


    I might have chosen another example than Lady Gag Gag, but you get the idea.

    The Grid10 is a nice-looking monolithic slab with a 10-inch screen:

    Under the hood, or screen, or whatever, it's pretty advanced for a tablet (from Techie Buzz):
    Some other technical aspects of note is that it packs a Nvidia Tegra II 1.2Ghz Dual Core processor, 512MB RAM, and 16GB of storage. It runs on the GridOS. It is Wi-Fi and 3G capable. It has a front facing camera that will work with its video calling feature that boasts one to one, and one to many, video calls. It also allows for HDMI connectivity.
    More specs here. The WiFi version is $499, and the 3G (no 4G, I guess) is $599.

    The Grid4 phone looks like a squared off version of the iPhone 4, but with no home-button:

    FusionGarage is rather proud of the minimalist design:
    It will be hard to look away from a Grid4. It’s amazingly sexy. It’s amazingly sleek. There are no buttons. There are no curves. Its just 4 inches of all screen. The straight edges scream simplicity. It’s a triumph of honest design. The all-aluminum back is a nice touch. It’s shaped around the function with no artificial design. You will turn heads with a Grid4 in your hands.
    The 4 inch screen has resolution of 800x480 pixels, as compared to the iPhone 4's 960x640 pixels on its 3.6 inch diagonal screen. Sorry, Verizon-lovers; the Grid4 has a quadband GSM chipset.

    In rather amusing fashion, all the accessories, such as the adapter plug below, are done up in Grid Red:


    Are the Grids iPad/iPhone killers? Hard to say at this point. Frankly, based on the very limited views on the FusionGarage website, they have more potential to be Android killers. They seem to build nicely upon the Android kernel, with what seems to be a far more pleasing interface. But the market will decide.

    If this all sounds a bit familiar, you may be remembering the last production from FusionGarage, the rather unfortunately-named Joo-Joo, which was formerly known as the Crunchpad. It ran Linux, and barely saw the light of day. I expect FusionGarage will have significantly more success with the Grids. Seems to me they will appeal to those who don't want to give Apple (and Steve Jobs) their due, but are looking for something beyond the Androids.

    I would love to hear from any bleeding edgers who've actually purchased one of these things...

    Tuesday, August 16, 2011

    My Big Fat Greek Vacation



    My loyal readers have no doubt noticed a paucity of postings here on the blog. There are several reasons for this:

    1. I'm tired and lazy
    2. I was in Greece with my family for part of July
    3. It's hot here (and in Greece)
    4. We're trying to get Dalai, Jr., to work on his college applications, and the daily whippings take a lot out of me
    Most of these are self-explanatory. The trip to Greece had been planned for the better part of a year, but was almost scuttled by the troubles reported over there, mainly in Athens. However, we never saw a hint of riots or other nastiness, although most of the shopkeepers, and the captain of our little boat, were rather disheartened by the whole economic situation, and blamed Germany for charging Greece 7% interest when everyone else gets 3%. Apparently the concept of being a bad risk doesn't translate well. But life goes on over there, and the Greeks seem proud and happy none-the-less. Personally, I would be depressed at paying over $10 for a gallon of gas, but they seem to be used to such things. 

    I would post more photos, but our group had five cameras going more or less simultaneously, which produced well over 3,500 images, so it will take a good while to pare all that down to a usable level. 

    Anyway, be prepared for more PACS news. If there's a topic you feel deserves attention, or if you've heard something especially juicy, please drop me a line at doctordalai(AT)gmail.com.

    Ευχαριστώ!!

    Sunday, August 07, 2011

    Thursday, August 04, 2011

    TabCo?


    Attention tablet users!  Apparently, you are all a bunch of lemmings, satisfied with the mediocre performance of the available devices, iPads, Galaxy Tabs, and so on.

    Enter TabCo.  Here's what I know about them:  NOTHING.

    Here's what All Things D knows about them:  (Hint:  not much...):
    The big reveal for TabCo is set for Aug. 15, but AllThingsD has managed to gather a few facts on the company’s forthcoming product.

    On the hardware side, TabCo’s product will have many of the usual features, including Wi-Fi and optional 3G connectivity, support for Bluetooth and USB, as well as its own suite of apps for editing and viewing documents, photos and videos.

    The big thing that sets it apart, I’m told, is its software and what insiders call a “predictive user interface.” The design is said to anticipate user needs to help perform tasks such as Web searches, buying products or getting directions.
    OK, I'm intrigued, but we've all been disappointed before, as ATD notes:
    I can say that the company is playing a high-risk game with all of its antics. Such activities can — and have — built buzz for new technologies even before anything is known about the actual product. That said, such pitches often spin out of hand, with the hype building so much that the eventual product can hardly help but fail to meet expectations.

    Microsoft tried such an approach in the middle of last decade with Project Origami, which was later revealed to be a pricey handheld touch computer. Though in many ways aprecursor to the iPad, the initial batch of Origami devices were too expensive, hard to manipulate via only one’s fingers, and had embarrassingly short battery life.

    Perhaps because the Origami devices were so far short of expectations, Microsoft essentially dropped the project rather than continue to iterate and plug away — a decision that the company might be regretting after seeing Apple enjoy the riches from a tablet market that Microsoft spent years working to create.

    The Segway, too, was built up to legendary proportions before it was revealed, with leaks suggesting that luminaries like Jeff Bezos and Steve Jobs believed the product could change the world and cause cities to be designed differently. In the end, the Segway proved to be a niche success, at best, as a platform for security guards, mail carriers and tourists looking for a unique way to see the sights.

    So, TabCo — or whoever you are — you’ve got our attention. Now it’s up to you to deliver something that keeps it.
    We'll be watching.  8.15.11.  At least it's not set for 4.1.12....

    Tuesday, August 02, 2011

    The End Of An Era


    Everyone who is anyone in the PACS business knows Mike Cannavo, the One and Only PACSMan.  I'm very sorry to report that the PACSMan is no longer with us.  But don't grieve...Mike is still alive and well.  He simply had to move on to greener pastures, given the current economic troubles with PACS and everything else, leaving the PACSMan entity behind.  Mike posted this message to AuntMinnie's PACS forum:

    After 28 wonderful years it’s time for the PACSMan to finally hang up his shingle and just become just plain Mike again. It’s been a blast but change is necessary for growth and my life is changing in so many ways.

    My sons have grown into wonderful young men, men I am exceptionally proud of, and my role as a dad has slowly evolved over the past few years. I am now more of a confidant and mentor than taskmaster and taxi driver. Soon, all too soon, my house will be emptier as my baby heads to Rhodes College in Memphis to start college. My oldest attends college locally and still lives at home but between school and work (both at the Apple store and as a top notch web-site developer) I don’t see him nearly as often as I used to either. So it’s really just me and Elvis, the world’s wackiest beagle, and sadly soon he too will no doubt be headed down the road to a new home since my new job requires a bit of travel.

    New job? Yes, after years of being on my own I have indeed elected to join the racks of the steadily employed and it’s not heading up Merge or Iron Mountain either . I have loved being a PACS consultant- no position could have been better given the requirements I had when my kids were growing up- but the position I was recently offered allows me to help more than just a handful of clients a year. That is very important to me- sharing the knowledge- just as it has been over the past several decades in the 350+ articles I’ve written and in the countless presentations and Webinars I’ve given. I have been given the chance to take on a phenomenal position in a phenomenal company with a phenomenal leadership team and frankly it’s just too good to turn down. So it’s my turn now.

    Know I am really going nowhere and will still be very actively involved in the radiology community, just not as the PACSMan. . . I’ll probably change the blog title to something like “Confessions of an Ex-Altar Boy” or something equally reverent. You will also see my comments in the PDF now and then but under a different moniker. And who knows, someday the PACSMan might indeed make his triumphant return, probably doing it just like Jesus did by riding in on a donkey to Jerusalem, but instead my riding onto the floor of the RSNA on one instead . We’ll just have to see what the future brings.

    To Brian Casey, Erik Ridley and rest of the AuntMinnie staff, thank you for giving me to the chance to share what I have learned over the years with our readers. To the AM readers, thank you for making my articles number one each time they were published, and especially the ever politically-correct PACSMan Awards® which I will miss writing more than anything else I’ve ever done. To my clients, end-users and vendors alike, you are the very best and your kindness and support will never ever be forgotten.

    When my son graduated high school a month or so back (Summa Cum Laude no less) it was a bittersweet moment for me. It signaled that my role as a dad was pretty much over. I’m still not sure how to deal with that- empty nest is hitting me a lot harder than I ever expected- but Matt’s class motto put things in its proper perspective for me. The saying is attributed to Dr Seuss and goes “Don’t cry because it’s over, smile because it happened.” And so that is what I will do and hope you will as well.

    Thanks for 28 years of smiles. Until we meet again I remain.

    Mike Cannavo- The One and ONLY PACSMan
    Well, there you have it.

    I've been in communication with Mike since 2003, when I first started dabbling heavily in the PACS field as a semi-educated consumer.  Our corresponding friendship started with my wondering how to handle some nasty trolls who were attacking me on the PACS forum.  Mike responded:
    A lot of these folks making the postings suffer from a disease known as LDS, and I'm not talking about the The Church of Jesus Christ of the Latter Day Saints either. It's Little D*ck Syndrome- where you have to make up for your "shortcomings" somehow so you mock on the first person who seems to know what the hell they are talking about. I live it every day.
    Classic Mike.

    I'm expecting him to keep his promise, and appear to us in unexpected ways, be it on a new blog or in some clever new persona on AuntMinnie.  In the meantime, if you want to know the Mike I know, head to his blogsite before it goes away- http://thepacsmanpontificates.blogspot.com/. We share a lot more in common than most would imagine. Mainly our warped sense of humor and love of filet.

    But maybe, just MAYBE, the annual PACSMan awards can morph into the DoctorDalai awards?  Would anyone mind very much?

    Godspeed in your new career, Mike!

    Friday, July 15, 2011

    A Challenge to GE and AGFA



    Yes, GE, and AGFA, I'm throwing down the gauntlet. It's time. It's really way past time I do this. 

    Here's some background. My group covers a number of hospitals. The two largest in our system use AGFA IMPAX 6.5. We also cover a very busy oncology clinic that uses Centricity 3.1. As you might imagine (and one of you claims to have a Healthymagination) patients bounce back and forth between the clinic and the hospital. Mr. Jones might have had is last three CT's at the clinic, but now presents the the ED with intractable pain, and must of course be scanned STAT! Mrs. Smith's tumor was discovered on scans at the hospital several months ago, and now is a patient at the clinic where her followup imaging will take place.

    We deal with this scenario about ten times per day. The problem is, we don't always know that the patient has had an old study, and more often than not, the oncologists call us, boldly telling us that we didn't go where the patient had gone before, and would we please be so kind as to re-read the rather complex CT's of the head, neck, chest, abdomen, pelvis, spine, and extremities now that we know about the comparison studies. This comparison has to be done on two different systems, which is a pain in the gluteus maximus even if I knew about the old study in the first place. It's enough to make me drink...more than I already do. This is a patient-care issue, and a rather serious one at that.

    Your mission, Vendors, should you decide to accept it (and I'll bet you won't...) is to solve this problem for me. WORK TOGETHER and create a solution. I need some form of Enterprise viewer to link or overlay or somehow mate the two systems, something that will find a patient's exams performed at either site, and let me know, and more importantly, let me read them side by side as if they were done at the same institution.

    I really don't care which viewer ends up doing the job, although if GE wanted to do this right, they would leverage in the Centricity IntegradWeb client somehow. Otherwise, IMPAX 6 would probably be the next best choice. (Don't anyone get a swelled head; I still don't much like IMPAX OR Centricity 3.) 

    This is not rocket science, boys and girls. Smaller companies like Intelerad and eRad, and bigger folk such as Carestream can do this. AGFA advertises their enterprise capability. So. It can be done. Now, figure out the way to do it for me.

    Please?

    Wednesday, July 13, 2011

    RIM-Shot: Lessons From BlackBerry Hill




    RIM, Research-In-Motion, was once THE smartphone company. Anyone who was important, or wanted to look like they were, had a BlackBerry phone. I personally never succumbed, but my brother-in-law, who truly is important, by the way, had one of the early black-and-white models, which he used extensively. Many of my partners dabbled with the various RIM offerings, as I bemoaned in this post.

    But today, RIM is on the road to extinction, a victim of the usual ignorance, arrogance, and hubris I often cite on these pages. The lessons to be learned are simple enough...know who your customers are, and give them what they want and/or need. It really is that simple.

    Jonathan Geller wrote what may prove to be RIM's obituary on BGR.com, dateline today. In his "exclusive look" Geller tells ". . . a story filled with attitude, cockiness, heated arguments among the executive team and Co-CEOs, and paranoia." Sounds familiar.

    Geller interviewed a number of former RIM execs for his piece, and the revelations are multitude:
    Jim Balsillie and Mike Lazaridis are two irreplaceable leaders who were largely responsible for RIM’s success, our source continued. But as time progressed, Mike did not listen to the marketplace. This is obvious from the outside view, though the details surrounding why RIM is no longer a market leader — and why RIM will most likely not be able to regain its leadership position in the near future — are most interesting.

    Let’s rewind a few years. Picture yourself sitting in an executive briefing at Research In Motion. You’d hear Mike Lazaridis unequivocally state time and time again that BlackBerry smartphones would never have MP3 players or cameras in them because it just does not make sense when the company’s primary customers were the government and enterprise. “BlackBerry smartphones will never have cameras because the No. 1 customer of ours is the U.S. government,” Mike Lazaridis would say in meetings. “There will never be a BlackBerry with an MP3 player or camera.”

    The fact is, that RIM didn’t only miss the boat in terms of product features and device trends as we now know, but the underpinnings of the company’s consumer failure began all the way back in 2005 with bold statements like these, combined with a lack of research and development in numerous key areas. . .

    The three-year roadmap for RIM products focused on refining the technology in phones had already been released, rather than looking at where to add major new componentry or trying to identify or even shape future trends.

    “When you hear Mike talk about the latest and greatest, it’s been the same thing for ten years: security, battery performance, and network performance. RIM has positioned battery life and network performance for years. People are not concerned with iPhone battery life,” one source told me. Network performance, to Mike, trumps any innovation a device like the iPhone offers. “Mike is convinced people won’t buy an iPhone because battery life isn’t as good as a BlackBerry,” a different source said. Mike apparently is in disbelief that people can use over 15GB of data on their iPhone and Android devices, and he feels that people will buy smartphones based on network efficiency, even though carriers with tiered data plans in developed markets love customers who use monstrous amounts of data.
    Yup. The surest way to alienate your customers is to tell them what they want, rather than listen. The next-surest mistake is to compound the first mistake by doubling down on a product that no one liked in the first place.

    Of course, you need to identify just whom your customers really are:
    While RIM has always viewed carriers as customers rather than end users, carriers have long been trying to find a different partner that doesn’t charge network fees. 
    RIM saw the gravy-train as hooked to the carriers, and not to the folks like me that would actually have to use their devices and services. Bad move, at least in the end.

    Speaking of mistakes, it is generally bad form to promise a feature and then renege or require some additional part or fee to make said feature function:
    . . .Jim Balsillie told the carriers at the 11th hour that the PlayBook wouldn’t have native email and would require the Bridge app in order to receive emails and provide calendar functions. “RIM is notorious for dropping these bombshells at the 11th hour on the carriers, and the PlayBook not having native email was a shock to the carriers.” They were all expecting a BlackBerry with a bigger screen. RIM was hoping to blow through the 500,000 units and have carriers take orders for millions of additional PlayBooks, but that has not happened yet. Mike Lazaridis looks at it as, why aren’t people buying this tablet when it has the most powerful engine with respect to multitasking, and supports Flash? But consumers have spoken pretty loudly a number of times, and Mike unfortunately leads the product side and continues to miss the mark with the masses, a former RIM executive told me. “I don’t even see anyone in Waterloo walking around with a PlayBook that doesn’t work for RIM,” another former RIM employee said.
    I think my point is pretty clear. What is happening to RIM is not unexpected, at least by those on the outside. Here was a company that had "lightning in a bottle"; they should have been the premier smart-phone maker on the planet. BUT THEY DIDN'T LISTEN TO THEIR CUSTOMERS. RIM's masters had no clue or care about what the great unwashed masses wanted in a smart-phone. They wanted to dictate what was important and what wasn't. They wanted to tell us...because they thought they knew better than their customers what was needed. Throw in the disconnect between the perceived customer and the actual customer, and you have the recipe for the slow-research-in-motion train-wreck we are now witnessing.

    The lesson is complete when one substitutes the name of a PACS vendor and their product for RIM and BlackBerry, respectively.

    Did someone say Waterloo?

    Friday, July 08, 2011

    It's Heart-Attack Friday

    Dalai's note: A few years ago, our most senior partner was stricken with an MI on a Friday after working a twelve-day shift including weekend call. Today is my 24th day of work with only one day off in the middle, due to some scheduling problems in the front office. Thus, for me, this is a triple "Heart Attack Friday." With some luck, I'll make it past midnight tonight....

    With apologies to Jimmy Buffett and Alan Jackson....



    Dalai:
    My head is hot and my ST segments are depressed

    And so am I

    Angina passes like molasses in wintertime

    But it's July

    Got more pain by the hour and older by the minute

    Damn call days just pushed me over the limit

    I'd like it to be indigestion

    But think I'll just call it MI

    Chorus:

    Draw me up some TPA

    Get that needle parked before my heart infarcts

    I've only been at work for twenty five days

    It's Heart-Attack Friday

    Dalai:

    This cardiac cath is going to take all day

    And half the night

    Tomorrow morning I know there'll be hell to pay

    Hey, but that's all right

    I ain't had much time off in this part of the year

    My cardiac event is gonna start right here

    If the phone's for me

    You can tell 'em I've just gone off call PERMANENTLY

    Chorus:

    Draw me up some TPA

    Get that needle parked before my heart infarcts

    I've only been at work for three weeks and four days

    It's Heart-Attack Friday


    Dalai:

    I could have retired young

    And had some fun, and always be in bed before 2

    At a moment like this, I can't help but wonder

    What would Jimmy Buffett do?

    Jimmy Buffett:

    Funny you should ask, Dalai....

    I'd say,

    "Draw him up some TPA

    Get that needle parked before his heart infarcts

    He's only been at work for three weeks and four days

    It's Heart-Attack Friday

    Yup, Draw him up some TPA

    Get that needle parked before his heart infarcts

    He's only been at work for three weeks and four days

    It's Heart-Attack Friday"

    He don't care

    And I don't care

    It's Heart-Attack Friday

    Hey, how's his EKG?

    What hospital is he in?

    Dalai:

    It doesn't matter

    It's Heart-Attack Friday

    Jimmy:

    It's always Heart-Attack Friday when you're on call

    Dalai:

    I heard that

    Jimmy:

    You've been there haven't you?

    Dalai

    Not yet, Jimmy

    Jimmy:

    I've seen your name on the chart

    Dalai:

    I need to go to Margaritaville, STAT!

    Jimmy:

    All right. That's good



    Monday, July 04, 2011

    Smother Down Under

    I haven't heard much from my friends in Western Australia lately. When I asked about their languishing PACS, I was told, "Not much new. Nothing to see here." This, of course, piqued my curiosity, but no one had much else to say about PACS, or much of anything else beyond the lovely weather there on the coast of the Indian Ocean.

    Nature abhors a vacuum, so it is said, and I sense a vacuum of information. Trolling the internet was not particularly revealing, although I did stumble upon a few tidbits on the official website of the Department of Health from the Government of Western Australia. I have to say that the website is very nicely done, and it is at least a little cleaner and more user-friendly than ours, for example.

    Within the WA site, I found the following passages, which strike me as a bit odd. First, we have the "Policy on Use of Official Information and Public Comment" which was released June 8, 2011:
    PURPOSE

    WA Health employees are not permitted to use official information obtained through the course of their employment to provide public comment or communicate in writing or online without the express authorisation of their Chief Executive Officer. Public comment includes, but is not limited to, verbal comments to the media, written communication such as letters to the media and online communication by email, blogging and posts via social media sites. Unauthorised disclosure of official information is a breach of an employee’s duty of fidelity and good faith which will result in disciplinary action and in some cases termination.

    SCOPE

    This Policy applies to all employees within WA Health entities including:
    • Department of Health
    • Metropolitan Health Service
    • WA Country Health Service
    POLICY

    This Policy covers all verbal, written and online communication by employees using official information obtained through the course of their employment. This Policy applies to communication during and outside of work hours.

    Part 2 Division 1 Section 9(b) of the Western Australian Public Sector Management Act 1994 (as amended) (the PSM Act) states that all employees of public sector bodies:

    “Are to act with integrity in the performance of official duties and are to be scrupulous in the use of official information, equipment and facilities.”
    Accordingly, WA Health employees are not to:
    • Release any information made available to them in the course of their duties, or in response to a statutory or legally empowered enquiry, without proper authority.
    • Make use of any information gained in the course of their employment for their personal benefit or gain.
    • Make any statements on official Departmental, Area Health Service or Ministerial letterhead or the internet that conflicts with official policy or legal and administrative precedents.
    Further, the PSM Act, Administrative Instruction 278 – Media & Public Communications states:
    “Selected public servants may be called on, as part of their official duties, to explain or provide information to the media or the general public on their agencies’ policies and activities. Chief Executive Officers will determine which officers shall be authorised to make public comment.
    1. Those public servants who are empowered to make public comment should confine themselves to providing such information as is necessary to explain government policy or to provide factual, explanatory and background material pertinent to the question at hand.
    1. In doing so, they should avoid making any comment which could undermine public confidence or disrupt the everyday administration of either the Public Service or the Government of the day. To this end, they should:
    • Not give their personal views on matters of government policy or administration, or on advice made to government.
    • Not speculate on future policy directions.
    • Not publicly criticise any political party, its actions or its policies.
    • Not prolong discussion or debate on an issue once a decision has been made, or a policy adopted.
    Accordingly, WA Health employees are not permitted to:
    • Disclose official information obtained through the course of their employment to the public through verbal comments to the media, or by written communication such as letters to the media, or online communication by emails, blogging and posts via social media sites, without the express authorisation of the Chief Executive Officer;
    • Disclose official information obtained through the course of their employment to engage in verbal, written or online communication to disparage, discriminate and/or defame WA Health and/or colleagues;
    • Compromise or be perceived to compromise the employee’s ability to carry out his or her duties including the duty of fidelity and good faith.
    In addition:
    • When delivering conference papers or discussing issues related to WA Health or on their professional, scientific or technical findings, it is acceptable for staff to use official information that is not confidential. However, in doing so, employees must issue public disclaimers stating that the views are their own and are not necessarily those of the government of the day or WA Health.
    • Relevant Public Relations / Public Affairs areas within the Department of Health or Area Health Services are to be advised of any conference papers or presentations likely to be contentious or which may attract media attention.

    CONTACT WITH THE MEDIA:
    Generally, public comment to the media is made through the relevant Department of Health or Area Health Service Public Relations / Public Affairs areas. The following should be noted:
    • WA Health employees are not to comment or provide information to the media without proper prior authorisation.
    • Some WA Health employees may be called upon by the Public Relations / Public Affairs area to explain or provide information to the media or to the public on the policies and activities of government.

    OTHER POLICY AND LEGISLATIVE OBLIGATIONS:
    Prohibited Use of Official Information and Public Comment may also be in contravention of:
    • WA Health Code of Conduct;
    • WA Public Sector Code of Ethics;
    • Public Sector Management Act 1994;
    • WA Health policies, including the Prevention of Bullying, Harassment and Discrimination in the Workplace Policy, Use of Social Media; and
    • Health Services policies, including Confidentiality policies.
    .....
    Breaches
    Any staff member who breaches the provisions of this Policy will be committing an act of misconduct and may be subject to the procedures outlined in the WA Health Misconduct and Discipline Policy, the Public Sector Management Act 1994 or to other action or provisions relevant to the management of conduct.
    Kim Snowball
    DIRECTOR GENERALDEPARTMENT OF HEALTH WA
    And here's another, the "Policy on Use of Social Media:"

    PURPOSE

    The purpose of this policy is to ensure that employees do not engage in online communication that is disparaging and/or discriminatory towards the WA Health and/or colleagues. Communication may include, but is not limited to emails, blogging and posts via social media sites such as Facebook, MySpace, Twitter, YouTube and Flickr. Disparaging communication includes negative, adverse, inappropriate, offensive, discriminatory and abusive blogs/posts that criticises WA Health and/or colleagues in a public way.
    The use of online communication via social media to post or blog disparaging comments about WA Health and/or colleagues is a breach of an employee’s duty of fidelity and good faith which will result in disciplinary action and in some cases termination of employment.

    SCOPE

    This policy applies to all staff within WA Health entities including:
    • Department of Health
    • Metropolitan Health Service
    • WA Country Health Service
    POLICY

    This policy covers all online communication via social media sites made by an employee, whether during work hours on a work computer, or during work hours on a personal electronic device, or outside work hours on a personal electronic device. Online communication via social media sites that is prohibited includes, but is not limited to, communication that:
    • Mentions the WA Health by name, its business operations or confidential information;
    • Is defamatory;
    • May be construed as discriminatory or bullying;
    • Bullies, harasses, discriminates or vilifies work colleagues;
    • Includes abusive status updates and/or blogs that criticise work colleagues, offends others and/or breaches their employment obligations in public ways; and
    • Publicises or comments on workplace disputes.
    Prohibited online communication via social media sites may also be in contravention of:
    • WA Health Code of Conduct;
    • WA Public Sector Code of Ethics;
    • Public Sector Management Act 1994;
    • WA Health policies, including the Prevention of Bullying, Harassment and Discrimination in the Workplace Policy, Use of Official Information and Public Comment; and
    • Health Services policies, including Confidentiality policies.
    An employee that engages in online communication to make disparaging comments about the Department, management, colleagues and/or patients will be in breach of their duty of fidelity and good faith. Such conduct will be found to be misconduct which will result in disciplinary proceedings and may lead to termination of employment.
    Any queries regarding this directive can be sent to industrial.relations@health.wa.gov.au.

    Kim Snowball
    DIRECTOR GENERAL
    DEPARTMENT OF HEALTH WA
    Well, I think the message is pretty clear, and I have to wonder if my foray into investigative journalism from last year had anything to do with these policy revisions. Anyone taking bets?

    My first thought when reading these policies, which are posted right there on the internet for all to see, was, "What about Free Speech????" As it turns out, Oz has some different rules about that than we do here in the States. From the Wiki:

    Australia does not have explicit freedom of speech in any constitutional or statutory declaration of rights, with the exception of political speech which is protected from criminal prosecution at common law per Australian Capital Television Pty Ltd v Commonwealth.

    In 1992 the High Court of Australia judged in the case of Australian Capital Television Pty Ltd v Commonwealth that the Australian Constitution, by providing for a system of representative and responsible government, implied the protection of political communication as an essential element of that system. This freedom of political communication is not a broad freedom of speech as in other countries, but rather a freedom whose purpose is only to protect political free speech. This freedom of political free speech is a shield against government prosecution, not a shield against private prosecution (civil law). It is also less a causal mechanism in itself, rather than simply a boundary which can be adjudged to be breached. Despite the court's ruling, however, not all political speech appears to be protected in Australia and several laws criminalise forms of speech that would be protected in other democratic countries such as the United States.
    In other words, Western Australia's policies are perfectly legitimate and enforceable, although rather surprising for a nation which prides itself on being cantankerous and disrespecting authority. It therefore seems unlikely that I will ever hear much more about PACS or any other trouble that might possibly disparage the WA government.

    Fortunately, there seems to be no proviso to punish the recipient of such information, especially a foreign national such as myself, so hopefully, I'm still allowed to travel to Australia.  I would be devastated if they took that privilege away.

    In the meantime, I guess it's up to Crikey to find out if anything is going down Down Under.

    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 Destination360.com, has been removed after said website filed a complaint against me. Please feel free to contact Destination360.com and thank them for their vigilance. 

    ADDENDUM...I have just purchased the rights to use the photo from iStock Photos...Destination360.com 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 Priceline.com, 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 Wired.com 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 MedGadget.com 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 RSNA.org

    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.  

    Tuesday, May 10, 2011

    The Need of the Few to Annoy the Many

    My last post was controversial and even provocative, and maybe I made it so deliberately. Obviously, there is a huge gap in attitude between my outlook and that of some in the IT world. I would like to thank the gentleman (or lady?) from Vital Images (read my Privacy Policy...I DO track visitor's IP's) , who added the following comment to the preceding post, quite nicely clarifying the divide:
    "You are assuming that EVERY disk has a virus on it that will bring down your precious system, and I'm assuming that every disk has life-saving information on it. I win. Period."

    I am assuming no such thing. You are simply too narrow-minded to understand that there is a middle ground. It's not black and white. There are solutions that best serve the patient first and foremost, the radiologist second, and IT third without creating undue risk.

    You're arrogant like most doctors. You can't see that there are options out there that accomplish your goals through a different method. If you want to be head of IT, do it. But being an arrogant armchair quarterback who thinks he knows better like a teenager doesn't serve to better patient care, it just serves to inflate your already large ego.
    My dealings with Vital Images have not been stellar over the years, as mentioned in this old entry, but I'm still a bit surprised that this shot across the bow comes from their Minneapolis HQ. Perhaps my favoring of TeraRecon over Vital has earned me a little animosity, but I think VitalMan has a bit more deep-seated resentment. I wonder if Toshiba will embrace and encourage this attitude in their new employees.

    Read the post and my comments. I am in favor of safe-PACSing. I want to use those "solutions that best serve the patient first and foremost, the radiologist second, and IT third without creating undue risk." But where are they? VitalMan, as well as Comrade Stonn, offer only the vaguest suggestion of a fix for this, but they have no shortage of indignation over a the thought of interference with their domain.

    "You're arrogant like most doctors." Here it is in all its glory. THIS is the core of the problem. When some folks don't like what is being said about our current President's policies, they bellow "RACIST"! I suppose the next best epithet would be "ARROGANT". Sadly, VitalMan probably does hold us docs in such low regard. Which is really funny, as those who know me will tell you that I am about the least arrogant doc they've ever met. But I am a fierce advocate for my patients, and a bit of an S.O.B. when it comes to false bravado and empty rhetoric.

    We "arrogant doctors" with "large egos" are responsible for patients' lives. I hate to remind everyone of this, but it is so. The information coming in on foreign CD-ROM's is critical to the health of the patient involved. It MUST be made viewable. Quit carping about how there might possibly be viruses on the disk and therefore we shouldn't load them. And don't demonize me for pointing out the obvious. Rather, acknowledge the necessity of acquiring this data, and work together with us to find a safe way to do so. But as Dr. Sardonicus commented on the last post, many would rather just say, "We don't do that," and go out for coffee.

    The real answer to this particular problem is direct connections between hospitals, and a safe way to import data from foreign PACS, limiting the need to fool with CD's. As an aside, I think LifeImage has a good beginning on the solution. But the problem of IT's resentment of physicians is going to take some stronger medicine to solve.