Big Scanner In The Big Apple

Following our recent visit to Ann Arbor, we went to New York to see a Philips Precedence SPECT/CT in action. We had a long look at the scanner and the computer, and spent an incredible time with Dr. S., whose Nuclear Medicine knowledge I could only hope to faintly imitate. I'm thinking of submitting the time as CME; that's how much I learned.  

The Precedence itself is HUGE, although it would probably fit the room where it needs to be placed. The SPECT part of the machine consists of two heads on articulating arms, as you can see above, basically a stationary version of the SKYLight, of which we already have two. The CT is a nice 16 slice unit. The computer system is the Extended Brilliance Workspace (EBW), which is unified across the Philips line, more or less, anyway, and it is fairly powerful. We will probably mostly use our Segami Oasis and TeraRecon (if it ever arrives) for most of the processing, though.

Now, if all decisions were made by how much fun one has on the site visit, well, it's hard to top The Big Apple. (Elscint once took me and a former partner to Israel and Germany, after the company was bought by GE, and the stuff we went to see was never put into production.) 

Having a few hours to kill before our flight back to the boonies, we went down to Ground Zero to see the new Freedom Tower:

Then it was off to Times Square, where we encountered the Naked Cowboy:

He was not really naked, as he was wearing a pair of Fruit of the Loom's, but a guitar hides a multitude. I texted the photo to Mrs. Dalai, who, miffed that I was having fun in NYC, responded, "Looks like you're working hard." I responded, "So is ...." ummm...never mind.

Here is Kathi, our Department Director, and Gerald, the Philips rep, enjoying the sites of Times Square. Notice that the camera is pointed up, and not at Naked Cowboy. 

Kathi was quite traumatized by our various cab rides. After my trip to Peru, nothing they can do bothers me, although had one of the drivers actually struck the two pedestrians he was aiming for, that might have reached my threshold of attention.

When you have only a few hours in New York, you have to make them count. We had a great lunch at the Atlantic Grill, but for me the absolute highlight of a trip to Manhattan is a stop at the Carnegie Deli:

You won't find these matzoh balls in a jar!

Despite the cabbies' best efforts, we did make it back home safely. Time to make some decisions...

Medicine And Capitalism

In response to my last post, Anonymous (he sure does get around!) eructated forth the following:

You, my dear sir, are a hypocrite,

As you admit yourself, and what anyone who have come across your blog before knows, you are a staunch defender of the free market and capitalism. The most basic part of *that* is a well-functioning market where the price of goods and services are determined by supply and demand.

As my old friend and foil "eradicator" once posted on AuntMinnie, much of what we see happening in health care today is anything BUT capitalistic, and bypasses any semblance of a "well-functioning market". Prices of goods and services are NOT determined, at least not properly, by supply and demand.

Let me explain.

In healthcare, at least in our particular, peculiar version of it, the consumer has few choices. Basically, one goes to a physician on an approved list, has tests at facilities that have negotiated contracts with the third party payer, Medicare, or whatever, and has little knowledge overall of what he or she has bought. Or rather, what has been bought on the patient's behalf. The only decision the patient can make is which insurance to buy and how much, and usually even that is out of their hands, having been preordained by their employer anyway.

My socialist friend Anonymous (why else would he get so snarky, unless perhaps he wallows in this unsavory stuff?) makes a fundamental mistake in his (get over it, pronoun-pc'ers) analysis. What BadRay is doing is NOT offering the consumer the opportunity to CHOOSE for themselves to pay less for ummm, an unknown level of care (yes, for the lawyers I shall say unknown). Rather, it targets institutions interested in skimming profit, and this is very clear from the teaser on the website. Said institutions are choosing on behalf of the consumer, and the patients haven't a clue that their child's scans are being read by  the lowest bidder for the job. Like Enron, BadRay does nothing at all to promote choice, nor does it add any particular real value to the system. If anything, it restricts choice, deciding more or less by itself who should read, and pocketing a middle-man fee for insinuating itself where it doesn't belong.  This is not capitalism, it is manipulation, pure and simple.

Can health care operate on a purely free-market basis? I'm not sure, frankly. The only example I can see on first blush is that of patients going to other countries to have expensive procedures done at a lower price. Those who do so, those who are able to do so, that is, do indeed exercise choice in an international free-market. I don't have the figures, but I suppose most do OK, assuming their surgeons are well-trained, and the facilities are up to snuff. But with the lower price tag comes some strings, mainly the lack of recourse should something go wrong. It's sort of like buying something on eBay, but maybe not even as secure. Caveat Emptor.

Here's my own humble opinion: The whole mess needs to be scrapped. Every last facet. Medicare and Medicaid must go. They are bloated, corrupt bureaucracies, and for the most part have created the tangled quagmire that now drags us down. Overpayments and underpayments are the rule, not the exception. A lot of docs have made a lot of money off of both by gaming the system, and that is not acceptable.

I'm not going to go into much detail, because I don't have time or energy or intelligence enough to do it, but I think my friend Bart was on the right track with his idea that I published years ago. Basically, let the government buy the most basic of catastrophic insurance for everyone, and then the individual fills in the gaps. Remove interstate restrictions, etc. This is not the insurance exchange envisioned by Obamacare, by the way. I'll add to Bart's plan the thought of removing Medicare and Medicaid from the equation, or at the very least, revamping them from top to bottom.

But I digress...

I have no problem with profit. I think profit is a better and more benign motivation than power. I DO have a problem with cheating, with gaming the system, with manipulating people's lives and health to make a buck. But that sort of garbage isn't really capitalistic anyway.

The Future Of Radiology? Seriously??

As you know, I do occasionally follow the internet trails that lead my readers to this information sink called DoctorDalai.com. It sends a thrill up my leg to know that anyone actually reads this drivel, and I just have to know how you may have stumbled upon this particular intellectual wasteland.

Someone from Rome (Italy, not Georgia) found me by Googling the phrase, "when radiology pacs don't work."  We can only wonder which system they might be using...anyone have a GEneric Answer I can Give For thAt?

Anyway, coming before this blog on the search was an entry for RadBay, The American Radiology Exchange, LLC, "The Future of Radiology" or so they say. Now, I think this company has been discussed on AuntMinnie, but I can't find the thread, so we'll pursue this as a new topic.

What is BadRay, I mean RadBay, and what did they do to earn my sarcastic derision? Simply put, they reduce the radiology business to an auction:

RadBay is an internet based auction site that matches up hospitals, imaging centers, and physician offices (including other radiology groups in the case of night reads) with radiologists through an online bidding process.

After a radiologist has signed up and installed our PACS partner’s viewer, his/her account is activated on RadBay. Imaging centers send studies to the RadBay PACS which sends the study info to RadBay to be auctioned to qualified radiologists for competitive bidding. You can bid on single or multiple studies at once. Once a study is auctioned, the radiologist will interpret it and sign off on the report in a specified time. The time is different based on the priority (stat, ASAP, routine) of each study. Once you interpret a study, it will be transcribed by the imaging center’s transcriptionist. After you sign your report on the PACS, RadBay bills the imaging center for the interpretation. RadBay then pays you after receiving payment from the imaging center.

As for the imaging center...

After you have signed up and been connected by our PACS partner, completed studies are auctioned to qualified radiologists for competitive bidding. When you sign up, you have the option of setting a maximum price for each type of study to ensure costs are controlled. The auction process allows qualified radiologists to bid competitively to drive down the price you’ll have to pay to have your study interpreted. You can allow any qualified radiologist in your state to bid on a study or restrict bidding to your preferred or sub-specialized radiologists. RadBay only lets radiologist that are caught up on their work to bid. Once a study is auctioned, the radiologist is required to interpret it and sign off on the report in a pre-specified time. The time is different based on the priority (stat, ASAP, routine) of each study. You may use your own transcriptionist or allow us to connect you to a preferred transcription service. You are then billed by RadBay and the radiologist is paid by RadBay, thus completing the transaction. With a vast pool of radiologists and the ability to add and remove radiologist with ease, quality can be maintained to the highest standard and the fastest report turnaround can be achieved. In addition, radiologist have the opportunity to give technologist feedback on every study. You can get reports from this feedback, allowing you to see how you can improve the quality of your studies.

Why a radiologist would want to work as the low-bidder is beyond me, although I guess you gotta do what you gotta do, right? For the imaging center, the attraction is clearly spelled out by our friends at BadRay RadBay (and this is on their website, mind you...I'm not making this up!):

Summary Of RadBay Benefits

Profit
The auction process allows the hospital or imaging center to pay the lowest rate for interpretations on each study, keeping more of the global charge.

Quality

Imaging centers and hospitals can pick from a list of all licenced radiologist in their state, regardless of geographic location. If they experience problems with the reports of a radiologist, they just remove him/her from their list. There is no longstanding contract with a radiologist, politics, or privilege issues to prevent removal from the list.
Every study can be read by a radiology sub-specialist, giving even the smallest communities the level of radiology care previously only achievable at large academic centers.
Radiologists can easily give electronic feedback on every study, so radiology directors can get hard data on what can be improved in their department.
With or without a local PACS, our cloud PACS can act as a backup PACS for your facility (without additional charge).

Rapid Delivery Of Care

RadBay monitors the workload of each radiologist and does not let them bid on new work until they are caught up, insuring rapid report turnaround.

Credentialing/ Governmental

You can do your own credentialing from the information that we collect from radiologist when they sign up, or pick from a list of radiologists that are credentialed through a Joint Commission Certified process. With patient studies archived in the cloud PACS, if a patient goes to a different center or even a different state, their images are readily available, moving toward the federal government’s goal of easy access to electronic medical records.

Community

The American Radiology Exchange, LLC believes in supporting local communities and seeks to donate a portion of every dollar earned on RadBay to support local nonprofits. Imaging centers are encouraged to recommend a local non-profit for RadBay to support.

The first entry is of course the most important, of course. And why deny it?

Somehow, it isn't surprising that BadRay RadBay uses Viztek PACS, which is certainly adequate to the job, but definitely not the most expensive product out there.

This is how low we've sunk, folks. Medicine by low-bid. Would you want your scan read on this basis? Not to denigrate those fine radiologists who find themselves in need of employment by these means, but come on, folks. This is ridiculous.  I'm a capitalist, and proud of it, but I have to think that medicine is somehow different than making widgets. So, what's next? Surgery by the lowest bidder?

Excuse me, but I've got to go bid on some widgets on eBay.

It's Here...

In case you missed it, the NEW iPad (that's its name, not iPad 3 or iPad HD, or the SJM (Steve Jobs Memorial) iPad) has arrived. Debuted by Tim Cook, Apple CEO, the New iPad does indeed have a 3MP display with 2048 by 1536 pixel resolution. That's Barco territory, folks. It also boasts a new A5x quad-core processor, and the same price points as its predecessor, the iPad 2.

OK, PACS vendors. It's your turn. Go out and write the killer PACS iPad app for this thing. I'll be the first to volunteer to test it out for you. Well, as long as someone supplies me with a NEW iPad. The 64 Gb version with 4G would be just fine, thank you.

Great ExSPECTations

I'm on my way back home from frigid Ann Arbor, having just spent the morning in an amazing Nuclear Medicine department. It's embarrassing, really. Our entire Radiology and Nuc Med divisions would have fit easily within the confines of the U of Michigan Nuclear Cardiology Department alone! I lost count of the number of scanners I saw, and we never even ventured into non-Nuclear territory. Maybe there is something to this academic stuff after all.

I am very grateful to the folks whose schedules we disrupted, in particular Jeff M., and Dr. B., who gave very generously of their time to show us the Siemens Symbia SPECT/CT scanners (several of them...LOTS of them!), discuss their operation and go over images and protocols.

The Symbia series has been around for a few years, which means two things: the bugs have been worked out of the platform, and it may not be at the bleeding edge of technology. At this point in my career, a proven track record tends to trump all else. The CT component is a little long in the tooth, basically the older Emotion platform, but its images are fine. Really, the only thing it really lacks for my purposes is the ability to utilize iterative reconstruction. This could perhaps be added in software, but apparently that is not a likely event. I'm still satisfied with the dose in the setting of a SPECT/CT acquisition.

Symbia does offer IQ-SPECT for cardiac studies, which will allow either a reduction of injected tracer dose, or a significant time-savings. How about acquiring a cardiac scan in 4 minutes instead of 20? Or double the counts with a 6-minute study? Or cut the dose back with a longer scan? I'll let you read the brochure for yourself, but in viewing live studies, I can tell you that the IQ-SPECT scans look about the same as those from the conventional protocol. Key to the process is a focused collimator, the successor if you will of Siemens' old CardioFocal collimators we used to have on our Orbiters from 1990. Everything old is new again, as they say...

The physician (a cardiologist, actually) who had done much of the research for IQ-SPECT was not available today, but I did have a great conversation with Dr. B, a private-practice rad who had returned to academia, and two of the residents. It seems they were not familiar with me and the blog, but I gave them my card, containing my URL. Hope you guys aren't too disappointed in what you find here!

Dr. B and I commiserated on the joys and perils of Private Practice Radiology, not the least of which is having decisions about equipment often made by administrators and vendors, and having no recourse for bad equipment.  I sheepishly mentioned that I have on rare occasions used this blog to hold a vendor accountable (I believe I might have said something like "hold their feet to the fire" but that wouldn't be like me) for bad products. He nodded approvingly, and said, "I think you would fit right in with Academic Medicine." Which I take as an incredible complement.

The two residents were quite impressive themselves, and I wish we were hiring so I could rescue them from the horrendous weather up there in Michigan.

Due to various machinations, we won't be looking at the Discovery 670 NM/CT 670 this time around. However, I will say this now: we will never again buy a conventional gamma camera without integrated CT.  (I can act like a big-shot with other people's money, but it makes perfect sense.) I do believe we are to have a peek at the Philips Precedence before the final decision is made. I hope we have a room big enough for it! 

Doctor Dalai's Ultimate PACS Fix

Confirmed! iPad 3 WILL Have Retina Display!

The folks over at MacRumors were able to get hold of a display module for the upcoming iPad 3, and literally examined it under a microscope.

From the MacRumors story:

Clearly, there are four times the number of pixels on the new display, and this all adds up to a resolution of 2048x1536, as compared to 1024x763 for the old model. The screen is still about 9.7" diagonally.

The Barco 3MP monitor sitting on my desk shows the very same numbers as the new iPad display.

You realize what this means, of course. The iPad has the potential to become the de facto mobile PACS platform. Of course, there are a lot of hoops to jump through before that happens, but trust me, it will happen.

I do have to add my own personal slant. I've got an iPad 1, and I'm not all that fond of it. There are a number of things it just does NOT do well, not the least being the simple writing of a simple blog by a simple radiologist. However, I did get a case with a Bluetooth keyboard, and this may help things. As far as graphic tasks, however, the iPad/iOS approach does seem to work well, and with the new Retina screen, there can be no worries about resolution. Now, contrast will be another story...will we have to only use PACS apps in the dark? Only the Shadow readers know for sure...

And The Winner Is....

I know there is a lot of pent-up desire out there to know which advanced visualization solution we chose. Now, the decision was far from easy, as any of the five contenders would have done the job. Most likely, anyway.

In the end, we gathered everyone's notes and tally sheets, spoke to as many of the attendees as possible, and tried to synthesize their opinions.

All five products have some things they do well, and some they don't. There are actually few glaring deficiencies, such as the one product that won't be able to create AVI movies until the next release. Another requires an add-on bit of software for certain functions supplied by another vendor, and I am told said add-on won't work as a thin-client, and thus must be installed on every reading station.

At the host of this little party, I have been hearing lots of interesting tales... Did I know, for example, that one company did this, another didn't do that, and by the way, this company just got thrown out of a big-name academic center in favor of that company?  Sheesh.

Now, don't bombard me with queries such as, "but why didn't you like X?" It's not that we didn't like X, but we felt that one product would satisfy our needs in a manner better than the rest. Your mileage may vary, and I urge all potential customers to check out the software for themselves.

Many thanks to all of the vendors and all of those who attended our little shoot out.

And now, the winner is....

Wait for it.....

TeraRecon

I'm looking forward to having it up and running ASAP, so I can report on how well we did with our choice. More to come!

PeerVue Purchased By.....

McKesson!

http://www.businesswire.com/news/home/20120208006474/en/McKesson-Acquires-peerVue-Leader-Radiology-Workflow-Solutions

Today McKesson announced that it has acquired peerVue Inc., an innovative provider of solutions that simplify diagnostic medical imaging workflow, expedite communications for improved quality and efficiency, and support customer efforts to improve patient safety. The acquisition extends McKesson’s portfolio of enterprise imaging and information management systems with highly flexible workflow capabilities that address site-specific needs such as critical results management, peer review and emergency department communication for multiple disciplines.
“We can bring together new care coordination capabilities to close the gaps in workflow for clinicians and enable better health in this generation and beyond.”
“peerVue brings world-class capabilities that facilitate care coordination, which is essential for better care and better business as part of our Better Health 2020 strategy,” said Kevan Torgerson, president, Enterprise Medical Imaging group, McKesson. “By addressing critical imaging workflow needs, particularly for radiologists, our combined capabilities empower care teams to more effectively engage with one another and to make better informed decisions throughout the diagnostic workflow.”

Even McKesson folks didn't know. Good security, people!

The Merge PACS Roadmap

When Merge bought AMICAS last year, many of us were quite worried about the path our PACS would follow, especially with the loss of the main developers and programmers. As a customer, I'm happy to say that promises made at the time are being kept, and the future looks pretty good, at least for the next few years.

I had the chance to visit Merge HQ in mid 2010, and I filed this report:

But what I really came to Chicago to discover was the future of AMICAS PACS, and I think the answer here is satisfactory. The Merge people feel that Merge and AMICAS were more complementary than competitive, except in the realm of RIS/PACS. Everyone agrees that AMICAS had a great PACS, and Merge had a good RIS. These two programs, respectively, will be the go-forward products. Everyone at the table wanted to be certain I deliver this message clearly, so I will quote verbatim: "The approach to RIS/PACS will be the consolidation of the best practices of all of the applications into a single platform workflow and viewing solution." Well, there you have it. All Merge RIS/PACS customers, including those using AMICAS PACS, Fusion PACS, or RadStream (from Emageon) WILL BE SUPPORTED, and will have an upgrade path. How much the upgrades will be wasn't mentioned. What I will call AMICAS 7 will ultimately include the best of all worlds, blending the best of the legacy products, and using the ECM as the back-end.

So far, this has indeed been the course of events. In particular, AMICAS PACS lives on. I am somewhat distressed that it is now called Merge PACS, but I suppose I'll get over it. To the victor go the spoils, and all that.

A few days ago, some of the Merge folks gave me an update on their PACS roadmap. There were no huge surprises, but a lot of nice features are here or are at least on the way.

Our AMICAS, I mean Merge Hospital is still back on AMICAS 6.0.4, the first maintenance release by Merge, and there we sit for the moment. But we are behind the times.


Version 6.1 was released early in 2011. The most important change was the option to integrate to a Vulture Vendor Neutral Archive (VNA), preferably the Merge iConnect VNA (formerly known as Emageon AMICAS Merge ECM, or Enterprise Content Management.) 6.1 also offers tagging for teaching-file creation:

If you bought Merge PACS today, and everyone was REALLY efficient at getting it up and running, you would receive Version 6.2, which was released in Q3 of 2011. While previous versions would run in a 64-bit environment, 6.2 is a native-64-bit application, which can use more memory for larger studies or more studies viewed simultaneously. Yes, it will run on 32-bit stations, too. There are several fixes as well; our version has a weird glitch involving the display of some of the cursors, and that is now history. 6.2 also includes  instant messaging via Merge Messenger (do you get the impression that they like the name Merge?) which lets users communicate with each other and link to studies in real time.

DICOM SR reports and other such objects can now be viewed. There are some mammo enhancements such as skin-line localization. 6.2 has been more optimized to be launched from an EMR as an embedded viewer.

We will soon see Version 6.3, expected to be released Q2 of this year, and there will be a number of new features available. First in my heart, anyway, will be PET/CT fusion. Actually, any two modalities can be fused, so maybe I can avoid that PET/MRI purchase after all. (It would be nice if we had PET/CT at the AMICAS Merge hospital...)

There will be even more digital mammo enhancements, with linked magnifying glass and linked binoculars view:

Digital tomosynthesis display will also be included:

One of my partners has been whining about requesting user-customized keyboard shortcuts, and his wish is now granted:

6.3 has some back-end improvements, such as LDAP support, and better study-deletion rules. Its code has been streamlined for faster operation, and improved experience on lower-end workstations.

Sometime late in 2012 we will see the next edition of Merge PACS, Version 6.4. In an attempt to consolidate Stryker Ortho customers, Merge will, umm, merge the functions of Stryker PACS into the mothership code. There will also be teaching file worklist access from iConnect. There will be a new option to upload CD-ROM data.

Sometime in Q1 2013, we should see version 7.0, code named Ability (actually, it's not, but I thought it sounded like a nice counterpart to another version 7.0). We will see native DICOM printing (which now requires an add-on such as ePhlegm eFilm to accomplish, global user preference administration, and EMPI (Enterprise Master Patient Index) support, critical for true enterprise systems. There will be some enhancements to the Real Time Worklist (RTWL) as well.

No word yet on Version 8.0.

I'm personally pleased by what I've seen. Merge PACS remains eminently usable, and continues to evolve and improve.  I'll still put it up against anybody else's software. Now, if I could only come out with a new and better version of my abilities...

Today's Best Exam History

Found on an order for an abdominal and pelvic CT:

28 yo s/p GSW to left thigh on Saturday Jan 28, 2012.  Reports evaluation at (outside hospital) showing bullet lodged in muscle.  States this morning, having BM and heard "clink", dug through stool and found bullet.

This is why I went to medical school, folks.

The Best Part Of The Superbowl

I'm not the world's biggest football fan, but I generally do watch the Superbowl. While I don't really have much skin in the game, so to speak, I am very distantly acquainted with the family that owns one of the teams, so I guess I'll root for them.

But the real reason I watch is for the commercials. It has become a tradition for advertisers to put their best efforts into the VERY expensive Superbowl messages.

My all time favorite is still the FedEx Caveman Commercial from 2006:

Time and technology march on, and the offerings from this year are certain to be even more incredible. The productions from several automobile manufacturers have been posted a bit early to YouTube, perhaps to catch that portion of the audience that actually watches the game and goes to the bathroom during the breaks.

First, we have Ferris Honda's Day Off:

Next, a teaser from Acura, starring Jerry Seinfeld and Jay Leno:

Now, a frosty one from Suzuki:

And something a bit more blood-curdling from Audi:

And finally, let this farce from Volkswagen outwit you:

Lexus just barely got the ad out in time for the GS debut on Friday:

I wonder what the good folks at Bud Light will come up with this year....

DoctorDalai.com Second-Most Read Blog!

I have it on good authority that this blog is the second-most read publication of its kind at some large PACS companies.

I find this very disappointing. Don't you guys have anything better to do?

Seriously, thanks for reading. Your patronage is much appreciated.

(BTW, HISTALK is deservedly number one.)

PeerVue Purchased!!!

Don't know by whom as yet. More to come.

Sono-Roast

Do you own or operate a GE Logiq P6? I don't, although it looks like a very nice machine. But do be careful with yours. It seems there has been a bit of a problem...

From the FDA:

Class 2 Recall GE LOGIQ P6 Ultrasound System

Date Posted January 21, 2012 Recall Number Z-0834-2012 Product GE LOGIQ P6 Ultrasound System. The device is intended for use by a qualified physician for the evaluation of soft tissue and blood flow in the clinical applications of: Fetal; Abdominal; Pediatric; Small Organ (breast, testes, thyroid); Neonatal Cephalic; Adult Cephalic; Cardiac (adult and pediatric); Peripheral Vascular; Musculo-skeletal Conventional and Superficial; Urology (including prostate); Transesophageal (TE); Transrectal (TR); Transvaginal (TV); and intraoperative (abdominal, thoracic, vascular and neurological).

Recalling Firm/ Manufacturer	GE Healthcare, LLC 3000 N Grandview Blvd Waukesha, Wisconsin 53188-1615
Reason for Recall	GE Healthcare has recently become aware of a safety issue associated with the Probe of your LOGIC P6 system that may impact patient safety. GE Logic P6 probe head has a possibility to cause burn injuries to patients or operators.
Action	GE Healthcare sent an "URGENT MEDICAL DEVICE CORRECTION" letter dated December 23, 2011 to all affected customers. The letter identifies the product, problem, and actions to be taken by the customers. The letter instructs customers to discontinue use of the affected product. Contact the GE Support Center at 1-800-321-7937 or your local GE Healthcare service representative for questions regarding this issue.
Quantity in Commerce	2270
Distribution	Worldwide Distribution-USA (nationwide) including the states of AL, AZ, AR, CA, CO, CT, DE, FL, GA, IL, IN, IA, KY, LA, ME, MA, MI, MN, MS, MO, MT, NE, NV, NH, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, and WI. and countries of VENEZUELA, UNITED KINGDOM TURKEY, TUNISIA, THAILAND, TAIWAN, SWITZERLAND, SWEDEN, SPAIN, SOUTH AFRICA, SLOVENIA, SLOVAKIA, SINGAPORE, SAUDI ARAIA, RUSSIAN FEDERATION, ROMANIA, REPUBLIC OF KOREA, QATAR, PROTUGAL, POLAND, PHILIPPINES, PERU, OMAN, NORWAY, MEXICO, MALAYSIA, LITHUANIA, LEBANON, KOSOVO, KENYA, KAZAKHSTAN, JAPAN, JAMAICA, ITALY, ONDONESIA, INDIA, HUNGRY, HONG KONG, GUATEMALA, GERMANY, FRANCE, FINLAND, EGYPT, DENMARK, CZECH REPUBLIC, CROATIA, COLOMBIA, CHINA, CHILE, CANADA, BULGARIA, BRAZIL, BELGIUM, BAHRAIN, AUSTRIA, and ALGERIA.

Whoops. So let me get this straight. The probe which might be used to scan breasts, testes, and other important parts might burn them? Ouch! I'm keeping my small parts away from this particular device for the foreseeable future. Check your serial number against the table published on the FDA page.

I suppose users could double-charge for thermography as well as sonongraphy...

Hat-tip to Dasmah of the Kuwait PACS Club.

Dalai Meets The Next President

Mitt and Ann Romney
Charleston, SC 1/14/2012

Sometimes it's good to be in the right place at the right time, especially when you live in the state that boasts the First in the South Presidential Primary.

Mrs. Dalai, Dalai, Jr., and I were in Charleston for the wedding of a friend's niece, and had the day to wander around. It was a bit chilly, but we took a leisurely stroll through the revamped Market (slaves were never sold there, by the way) and had some rather good seafood for lunch.

As we approached the Charleston Place Hotel, we noticed the Romney-Bus parked outside, with a small crowd gathering, and we proceeded over to check it out. Yes, Governor Romney himself was to appear momentarily, and, indeed, after waiting only briefly, he and his wife walked around the corner. The Governor shook the hands of the twenty or so of us standing on the sidewalk. He got to Junior first, and then to me. He looked me in the eye, and shook my hand quite firmly. I nodded my head gently, greeting him as "Governor." Romney paused a bit, as if to give me a chance to say something else, perhaps something more intelligent. Now here's where you will all think I've lost it, and you may well be right. In that pause, in that hesitation, I sensed...humility. I can't totally tell you why, but I did. In my old age, I've learned to rely on my instincts, and they don't lead me wrong too often. Well, usually they don't.

Here is a very wealthy and powerful man, quite likely to be the Republican nominee, and then, God-willing, to be the President of the United States, displacing the accident of fate we have now. Do I think Mr. Romney is perfect? Heavens, no. He has a lot of baggage, just like every other candidate, and most of the rest of us, for that matter. But the man has presence, he has charisma, he has charm, and he does have the air of confidence. But my instinct, my gut-feeling, my sixth-sense, tells me that these characteristics are tempered by humanity, humility if you will. I didn't have the chance to meet any of the other fellows on the trail, so I can't put them through the same test. I'm not sure they would pass.

I can't expect any of you out there to feel what I felt, or to trust my intuition. Frankly, it's pretty much a moot point, as Mr. Romney is expected to win his third victory here in South Carolina, and with that set the tone for the rest of the primary season. Beyond that, I can only hope he learned his lessons about Romney-Care, and will do a little better spinning the Bain story. On various other issues, he says mostly the right things.

They say one casts a vote either for the candidate one likes, or against the fellow one doesn't. Come November, perhaps we'll be able to do both.

Decisions, Decisions...

Dear Vendors:

Yes, we've narrowed it down. No, I'm not going to tell you how just yet.

And while its always nice to see you folks, coming by to chat isn't going to have any effect on anything.

Sincerely,

Dalai

Speech Recognition Doesn't Even Work In Editor Mode!!

Image Courtesy TMONews.com

It seems I was part of an experiment and didn't completely realize it.

One of our in-house transcriptionists as been using speech-recognition in what I call "editor mode".  In other words, my dictation is run through an SR engine (I don't know which one) to provide the first draft of the report. She then edits it while listening to the dictation, and places the final report on the RIS for my review. This should give us the best of both worlds, the speed of SR and the accuracy of a human.

Except it doesn't work.

The particular transcriptionist is really superb at what she does, and before this little experiment, her reports rarely had any mistakes at all. But throw in SR, and all bets are off. Almost every report produced in this manner had at least two or three mistakes.  And these were NOT typos, making them much harder to spot. For example, I dictated something about activity in a stump of an amputee. The SR translated "stump" as "stomach" and this made it by the editor and would have made it by me if I hadn't remembered the case itself. I can cite dozens and dozens of other, similar glitches.

I asked that SR be turned off for this week as an experiment, and wouldn't you know it? Absolutely NO mistakes on our reports. None. Zero. Nada.

Once again, I'll yell it from the hills and the valleys: Speech Recognition is NOT READY FOR PRIMETIME! Period. Maybe in five years.

Even Siri agrees with me on this, although she knows I'll turn her off if she doesn't.

How Much Is An EMR?

MediNote EMR, courtesy Carson Doctors Group

I have to take a moment away from the compilation of the Advanced Visualization results to whine about something else: EMR's.

One of our hospitals is plunging headlong into the EMR quagmire, and I am on the EMR/EHR/EFR Committee (specifically the CPOE Committee) as a representative from radiology and things technical. You would think it a daunting task to upgrade a full hospital system to electronic status, and you would be correct. Fortunately, the IT types and physicians involved are very capable, and really interested in doing a good job, and I have been quite impressed with their efforts to date.

HOWEVER, we have a tremendous stumbling-block, and it relates to the software already in place. While not going into chapter and version (and not naming names, as I think I might have signed something that said I would keep my big mouth shut), years ago, a really bad decision was made to go forward with the version of HIS/RIS (what we used to call EMR/EHR/EFR) that was little more than a port of an old Data General green-screen terminal. In other words, we are stuck with 10-year-old technology emulating 20-year-old technology. It sucks. Period. And we now are charged with making a square CPOE peg, among others, fit in a rather ancient round hole.

You would think that in the process of upgrading, we might simply forklift out the old green-screens and buy something new. Apparently, this won't work. It seems that our small hospital system was told that it would cost $30 MILLION to replace the whole shebang. $30 MILLION. Yes, that would be MILLION with an M. Now, I'm not sure just who set that price, but it was accepted as gospel, and a heck of a lot of work is now predicated on the premise that we must update but not upgrade. Bah Humbug!

I need to poll the audience. Does it REALLY cost $30 MILLION to replace an EMR for a relatively small hospital system? We're talking 300 beds or so, not the Mayo or Man's Best Hospital. Really? Seriously? $30 MILLION!!???

If this is truly the case, somebody out there (I'm thinking Merge Healthcare has the wherewithal to do so) needs to reinvent this genre. I cannot believe that EMR/EHR/EFR's have to be this expensive, not to mention requiring a two to three year implementation period. It just doesn't make sense to me, and I insist there has to be a better way to do this. Right now, I think the software companies are frankly just fleecing their customers in their frenzy to comply with all the Meaningless Use crap from Washington. Please do feel free to prove me wrong.

$30 MILLION? I'm not buying it. Literally or figuratively.

The Advanced Visualization Caucus

"Glass View" on IntelliSpace, Courtesy of Philips.

(Note...this is NOT an endorsement of any particular product!!!)

The First (and probably Last) Annual Advanced Visualization Shoot-Out (a.k.a. Dalai's Advanced Visualization Caucus, Mini-RSNA) went off with only a few hitches, which I'll outline in a moment.

The vendors all arrived early this morning, and set up their wares in our hospital auditorium. The digs weren't all that fancy, but the cavernous room was nice and warm on an unusually cold day down here in the Deep South. Everyone found a corner with adequate electrical outlets, and within an hour, we had a Technical Exhibit Hall that rivaled some I've seen at relatively large meetings. OK, it wasn't quite RSNA, but this ain't Chicago, and thank God for that!

Pat, the PACS Goddess!

Before I go any further, I must express profuse thanks to Pat, our PACS Goddess. She juggled three dozen variables, kept vendors, docs, and administrators on time and on schedule, and just generally made this thing happen. I'll admit that I came up with the general idea and some of the specifics (mostly stolen from the Stanford PET/CT shoot-out), but Pat deserves the lion's (sorry, Tiger's!) share of the credit for her hard work that brought us all together. And I am extremely grateful to the vendors themselves who came down for this little shindig at no small expense. As proof of their attendance, here are non-Photoshopped images of each vendor team. Note to Corporate: they all actually did show up here to South Carolina, so please pay their expenses. Trust me, NO ONE would visit this particular spot if they didn't have a good reason! Here they are, in no particular order:

Team Siemens

Team Vital

Team Tera

Team Philips

Team GE

A-Team

Team Techs

The last photo, of course, depicts two of our superb CT techs, who will actually have to use whatever we purchase. And I pity the fool who doesn't take their opinions into account. Needless to say, I will!

And that is really the bottom line. This is a decision that affects the way our techs and rads will operate, and so we have to pick the solution that is right for our particular shop. We are quite fortunate in that regard: each of the five contenders would do the job for us, and do it well. The key is to drill down to the one that will work best...for all of us.

Gathering five major companies in a room together is a monumental feat. One vendor suggested that their willingness to do so was related in some way to...me! It seems that the majority of the attendees are devotees of my blog (one poor fellow even used the word "star-struck" which indicates that he needs to get out more) and thus wanted the chance to participate in this event. I'm honored and humbled, and glad that my reputation (good, bad, or otherwise) contributed to the chance to make a good decision for my hospital. 

I suppose you want to know which product won the competition, yes? Sorry...for that, you will have to wait. Pat the PACS Goddess and I will have to compile the questionnaires (and quiz those who didn't bother to fill one out) to see which system will take its place in our place. All of these systems actually work well; each does some things better than others, and better than the rest. 

Each of our participants watched the various programs put through their paces. We had intended to see only our own data run through the processing protocols, but not all of our cases exported properly to disk, which is our own fault and not that of the vendors. Frankly, I wish we had had a week or two more to set this up, but the auditorium was available TODAY, and not again for months, so it was now or never. We were able to view a mixture of our own cases and those from the vendors' stashes, and I think it all turned out well in the end.

I'm not going to go into minute detail about every facet of every system. The post would grow to epic proportions, and you would be bored silly by the end of it. Here are some rather vague tidbits:

• The program I initially thought would be best...wasn't. 
• The program I initially thought would be worst...wasn't.
• The level of automation is quite high with all five. 
• The more raw horsepower, the more complex the interface.
• Several pieces of software are not yet approved (remember, RSNA=Real Software Not Available).
• There are several ways to display transparent/translucent bones.
• No one would give me one of the ubiquitous iPad's. 
• There are vendor-specific iPhone/iPad apps that the vendors don't know about.
• Everyone was anxious to know who won and when the P.O. would be cut, although some were more anxious than others.

So, without further ado, my personal favorite was:...........,,,mjkhgyuftdseaweqTWAYESURIDTOF

Note from Mrs. Dalai:  Hi, everyone. I found Dr. Dalai fast asleep with his head on the keyboard. You must have worn him out today! I'm sure he'll come back and tell you who won, eventually. In the meantime, I'm putting him to bed without his dinner.