The Last Christmas

Nearly every parent dreads the time when Christmas is no longer magical for their children. For me it happened maybe 6-7 years ago. Thanks largely to the Internet that Al Gore created by the tween years there was a fairly high degree of skepticism about Santa. By age 13 or 14 it was assumed that they knew that Santa Claus was indeed much different than the man in the red suit they saw at the malls or the Santa I played for the Cub Scouts and for his classmates in elementary school using an incredible Santa suit my ex made for me (neither son knew it was me either- that’s how good the suit was). The suit still fits, but now I don’t need quite as much padding as I did then…

This is the last year I will have my kids as kids. While they will always be my kids I could never get over my mom and dad calling my brother and I "kids" well into our 30’s- but it’s different. Nick will be home one more year attending community college, maybe longer depending on where he finishes his last two years of college, and Matt can pretty much go anywhere he wants. His first choice college is in Tennessee but he is also being pragmatic and looking at a school in Tampa as well. With Bright Futures, the Florida Pre-Paid College Fund I’ve been paying into since they were both 6, and scholarships he will no doubt get, he will be like his brother actually getting paid to go to college instead of owing the equivalent of a small town’s annual income when he gets out. But where he goes is his choice, not mine. Both young men are just that- young men- and have good heads on their shoulders. They are super smart, practical, and handsome to boot. Basically they have the world by the balls.

Nick works at the Holy Grail for Mac-aholics as an Apple store employee and did very well his first quarter in college, unlike his father whose 0.923 his first quarter in college was reflective of a belief that college was about women and alcohol and not academics. Going to an all boys Catholic High school tends to do that to you though so…That said, I’ve forgiven myself after so many years….And Matt- my IB student with a 4.3 GPA and 33 on the ACT- he has the entire world pursuing him and rightfully so….I am incredible proud of both boys…

So it’s Christmas Day. I looked over at the clock 6 a.m., 7 a.m. Not a creature was stirring, not even a mouse (or Elvis the Wonder Beagle either but all he does is sleep anyway so…). I miss the days when the kids would tip toe into our rooms at 5 a.m. and ask if we were up (we were now) and then proclaim that Santa had come while they were sleeping…of cursing the translator of instructions from Chinese to what they thought resembled Ing-rish at 3 a.m...of figuring out how something went together…of finding bigger and better hiding spots…of wrapping and wrapping and wrapping… and of course of last minute gifts that were impossible to find a day or two before Christmas- the ones you go to the ends of the Earth to find…like a streetlight….yes, a streetlight… Don’t ask, but I still have it in my closet…

This year I have to realize that my babies aren’t babies anymore but young men who are well on their well to becoming productive members of society, albeit capitalists for sure. Yes, giving them cash is so much easier and practical than finding exactly what they wanted ....but there was also a special joy in finding that one special gift they wanted…I smile every time I see the movie “A Christmas Story” where Ralphie gets his Red Ryder carbine-action, 200-shot, range model air rifle with the compass in the stock. Yes, Ralphie is finally happy but the pride his father had watching him open it resonates much more with me than anything else.

We had so many Christmases like that. After my ex and I divorced Christmas were still special but held at two houses not just one…and we always had dinner together as a family just like we will again tonight even though she has been remarried now for a few years. Thankfully her husband has welcomed me with open arms realizing it’s not about us- it never was about us- but about the kids…. and that we really do have some really great kids…

So tonight we’ll have dinner, maybe watch Billy Murray in “Scrooged” or the “Jeff Dunham Very Christmas Special” or maybe even “A Christmas Story” again and then I’ll hug them both goodnight. But this year’s hug will be more than just saying goodnight. Instead it’s saying goodbye to the end of an era that was as important for me as it was them.

Next year Matt hits 18 and technically my work is done….or so I’m told. Hopefully I’ll have the same relationship with Matt as an independent adult that I now enjoy with Nick- letting his make his own decisions for sure but still pinging the old man every now and then for his opinion. And once, maybe once, just for old times sake, I’ll be lucky enough to have them ask me for something truly unique and different- that one Christmas gift that is so hard to find- so I can search high and low, find it for them and rekindle the joy I had when my babies were still babies and Christmas was a magical time for all.

Merry Christmas to you and yours…His love never ends….

Aunt Mary

Today was Aunt Mary’s birthday. She would have been…well….old….91 to be exact…but alas she went home to her Savior three and a half years ago. Now most of you are thinking what’s the big deal about an aunt who is dead whose birthday was today but my Aunt Mary was a special aunt. She hated the fact that her birthday was so close to Christmas. God help you if you wrapped her birthday gift in Christmas wrapping paper although truth be known Aunt Mary was much better at giving gifts than receiving them.

Aunt Mary never EVER forgot a birthday. She probably had 100 or more relatives in her little black book and each and every one of them always got a card from Aunt Mary on their birthday. Always. And the card always contained $1 in it. If you were 5 years old or 50 you got a crisp $1 bill. That was tradition. And that was what we all looked forward to. Her cards were never ever late either, using nothing but a tattered old date book to keep it all straight. No computer, just her date book.

The date book is long gone, thrown out along with too many irreplaceable family photos and so much more by a cousin who appreciated nothing other than the money that remained in the family bank account. Oh, what I wouldn’t pay to have the single page with my birthday on it as a reminder of an aunt who never forgot me. Once I got older I never forgot her either, always sending her flowers, candy, or something else always wrapped in birthday paper to let her know how much she meant to me. She would always call me up after then too - I was always Michael, never Mike- and thank me. Sadly, the woman who never forgot anyone was all too often forgotten by those closest to her, even her own daughter, yet how could you forget a woman like this?

I was asked to give the eulogy at Aunt Mary’s funeral. The funeral was held at St. Anthony’s Roman Catholic Church in Red Bank, New Jersey, the church where I served as an altar boy from age 7 to age 13. I had only been in that church twice since I left New Jersey back in 1973- once for my mother’s funeral in 1990 and then again for my father’s funeral in 2004. Both times I sat in the front pew. This time though I had to go up to the altar.

When I was younger the altar was a place of mystery. Sadly the church decided it needed to be “modernized” and in the process had changed so much of it that a lot of the mystery and magic was gone. Looking around the only things I remembered were the Stations of the Cross where I had walked to many times during high mass carrying the incense, but the stained glass windows might have been there. I looked up and my heart sank- the choir loft was gone. This was the very same loft where Aunt Mary’s voice would join the voices of the other woman in the choir singing “Oh Bombino” and other songs in Italian at midnight mass every Christmas Eve right after the feast we all had that never had meat because good Catholics never ate meat on Christmas Eve….

I walked up and looked around the church. Poor Uncle Lou was beyond distraught at losing his wife of nearly 50 years, at Aunt Katie who just lost her husband (Uncle Bill) the year before, and Uncle Joe and Aunt Marnie thinking to myself “This is all that is left.” Sadly Aunt Katie passed away a few short months after Aunt Mary did and Uncle Lou went home in 2009, leaving just Uncle Joe and Aunt Marnie- two out of 16 aunts and uncles my brother Frank and I had- remaining.

I gathered my thoughts and began the eulogy. It was good….very good….and I got three quarters of the way through it and then choked up when I got to the words “This year there will be no birthday card from Aunt Mary….” For 51 years I had faithfully gotten a card from Aunt Mary and this year….the reality hit me. It wasn’t about the card. It was about the woman. You would walk in her house and before you had your jacket off she was making you a cup of tea and breaking out homemade cookies. “Sit down, Michael. I’ll make you a cup of tea” she would say… God, I can close my eyes and hear her now…So I stood there, my heart in my throat, trying to talk yet saying nothing, tears flowing down my cheeks, thinking about Aunt Mary…and then I made history….I tried to talk and got one word out then had to stop….another word…then stopped…and then a single word that probably never has and probably never will be uttered from the altar of Saint Anthony’s again. “Shit”. There I am miked up with probably 60 people in attendance and the only word that comes out of my mouth at the time is “Shit.” I heard a few laughs and realized what had happened and caught myself, laughing a bit, saying “Sorry Aunt Mary, sorry Monsignor” before I continued with the balance of the eulogy. Had Monsignor been there I know he would have smacked me upside the head big time for that and required me to say 12 Hail Marys, 7 Our Fathers and 3 Glory Be’s for my offense, but then Monsignor probably already was rolling over in his grave having the Diocese allow girls on the altar who wore sneakers at Mass AND got paid to boot- $10 each. For all I know the choir got paid as well- all 6 of them. When we were growing up there were at least 30 choir members and no one ever got paid…at least not monetarily...and only boys were allowed on the altar. It was a privilege…it was special…..it was a different time and place.

The funeral ended and we all went back to Chiafulio's afterwards for the obligatory feast (although I knew the place as Red Bank Pizza growing up) and later that night I flew home….All went well until my birthday a month later and no card from Aunt Mary..and then the emotions came welling back….And again today, three and a half years later, on her birthday, as I wrapped Christmas presents I saw the birthday wrap too and remembered the woman who never forgot.

If anyone is in heaven it is my Aunt Mary so happy birthday Aunt Mary- take care of everyone until I get there. Know you never have been and never ever will be forgotten.

The Lighter Side of RSNA

There is a side of RSNA that few see- the lighter side. The PACSMan Awards are a blast to write and post on AuntMinnie.com and nearly all are done tongue-in-cheek with a lighthearted attempt at humor. Inevitably someone will think I am vindictive and have a vendetta against their company but that simply is not the case. This year as in years past they were the top read story from RSNA so someone must be enjoying it. If you missed it you missed out, but something tells me if you are reading this blog that you have no doubt already read them in some case many times trying to figure out who won what award. I'll never tell..

Many know of my relationship with Merge- a love/hate one if there ever was one. We should get married but one walk down that aisle is enough for anyone or at least for me. But I’m still friends with many who still work there, including Paul Merrild, Merge’s Senior Vice President of Marketing & Corporate Strategy. Paul introduced me to Justin Dearborn and Jeff Sturges, their President and CEO respectively (even though Dearborn was their CEO before he became President. Talk about Abbott and Costello’s "Who’s on First") but alas Mr Ferro remained as elusive as ever talking only with my good friend the Dalai. Maybe if I had accepted their offer of a glass of Kool Aid I would have gotten to see him, but I limited myself to just a lil candy from their voluminous candy rack (another Merrild trademark) and a cocktail or two at their party. Everyone was cordial to me as well and there was no animosity as well. Paul even allowed me to play on the video games and personally handed me the gun as seen below. You can feel the love can’t you?

Everywhere I went on the floor I knew I was safe from bitchy attitudes because there was chocolate in nearly every booth. ThinAir Data took this a step further and put a packet of Ken’s Salad Dressing in with their Hershey’s kisses as a joke.

But the joke was on them as several overseas members got all excited over the dressing to take back with them and brought many of their friends of their friends others back home which left the vendor scrambling to find more…Hey, whatever it takes to get customers into the booth. It provided a good belly laugh for sure.

I wish every vendor could be as clear and concise in their messaging as this vendor was.

Most marketing managers would be scratching their heads wondering what Revana Health was thinking by having absolutely nothing in their booth besides their corporate logo, but in the 5 minutes I was there at least 5 people came up and asked the same question- “What do you do?” (answer: provides medical imaging centers with a suite of software and services to increase business performance).
Would a booth with all sorts of signs and diagrams and hardware have had the same impact? No- not even close. Brilliant marketing on their part. The fact the two gals who manned it were very cordial and easy on the eyes also helped as well (laugh).

Being a Floridian for the past 30+ years I smiled when I saw the gator sitting on the DR vet table in Canon’s booth. I smiled even more broader still when I saw the kitty cat sitting there as well looking sound asleep. Now I am not exactly a fan of cats- they are much too aloof like many a woman I have dated in life- so the juxtaposition of the gator and kitty was just too good to pass up. I would make a few other comments but I am trying to be politically correct in my old age so those of you who know me can read between the lines.

Having fun is the name of the game and IDS (Integrated Document Solutions) found a great way to get people into their booth with Shan the Candyman (yes, that is the name he goes by). He is only 1 of 3 people in the country who do candy art and he brings it to a level I have never seen before. For this one gal he did a dinosaur eating a dinosaur but could do just about anything for anyone and did. As I left he was doing a football team logo and did a killer Luigi from Ninetendo’s Mario Brothers and a cute pink pony for the owners daughter. This guy has talent with a capital T…



I have talked about the El Grande diner many times but here is the only shot you will ever see from it. The rest is top secret. As the night drew on and margaritas flowed the PACSMan Awards you’ll never ever hear about came out (affectionately known by our group as FC’s). I know you are thinking why are they called the FC’s. We’ll save that explanation for another time and place (laugh). Just know though that it is incredibly hard to find a divey Mexican joint that makes decent margaritas once Salvadors closed finally but we found one.

The guys you see here (a few gals were invited but were no shows BTW) are mostly from AuntMinnie.com and have known each other for years and in many cases decades. We all share a passion for imaging and a respect for each other. I can think of no better group of individuals to be with than these guys. From left to right are Eric, Dr Dalai, Brian, Wayne, Me, Jim, and Erik.

And last but not least, this Cher lookalike is the daughter-in-law of the guy who was behind the Timeo booth.

We chatted a bit about my Italian heritage and he was so much fun to talk to and proud- God was he ever proud “Atsa my daughter-in-law. You takea her picture and put it in the paper, yes?” So from one proud Italian to another here ya go my friend… Hei!! Pay attention. Do Not Hesitate!! Look at her will you…Now I don’t do Musculoskeletal Ultrasound- hell, I don’t even know what it is- but I’d but the book just because she’s in the photo.

You want to get your heart racing even more? Do a Google image search under Cannavo- yes, atsa my name. I used to be on page one, now I’m on like page 6 but do I care with someone as gorgeous as mio cugino Rosaria? Nope. Momma mia, check it out.

She hails from the same area in Sicily as my grandparents and while I’m not 100% sure if she is my cousin or not Ima gonna say atsa my cousin because all us it makes for good press (laugh). I always tell my sons to make sure you know who you are dating because she could be related to you but if she looks like that…who cares? I’ll just sit back and smile and say “Atsa my boy!!”

If Merge Covered Lincoln’s Assassination

I have often said that Merge Healthcare has the very best marketing and PR department in the entire medical imaging marketplace. No one even comes close especially when it deals with handling what is affectionately known in the journalism industry as “spin”.

The most recent third quarter results from Merge speak volumes to this. I’m one of the few who reads the entire story so I was intrigued when I read the headline ”Merge Healthcare Reports Record Sales in the Third Quarter”. Hmmmm, interesting I thought. Then I read the subhead “Revenues grew to $45.2 million in the third quarter, compared with $16.9 million in the third quarter of 2009.” Very interesting…Then I read the rest….until I got to the statement “The company posted a net loss of $5 million in the quarter, compared with a net loss of $936,000 in the same quarter of 2009.” and then look at the rest of the financials. I laughed but wanted to cry. The spin doctors worked their magic. While nothing was hidden and all was very legit, most of the “bad news” was buried deep beneath the marching bands and ticker tape. Fortunately for them most of the investment community never looks far beyond the headlines which allowed the stock to climb almost 29% to over $4.00 per share last week alone.

I got to thinking- how Merge might cover President Lincoln’s Assassination and came up with this, with thanks to Wikipedia:

Sold Out Crowd Enjoys “Our American Cousin”
at Ford’s Theatre
Minor disturbance interrupts an otherwise enjoyable evening
Mrs. Lincoln unhurt in assassination attempt

Washington D.C. April 15, 1865- The Washington elite enjoyed a sold out performance of Tom Taylor’s three-act play “Our American Cousin” which played at Ford’s Theatre last night. The play is a farce whose plot is based on the introduction of an awkward, boorish American to his aristocratic English relatives. It premiered at Laura Keene’s Theatre in New York City on October 15, 1858 and recently moved to the D.C. area. The play concerns the adventures of an American, Asa Trenchard, played by Harry Hawk, who comes to England to claim the family estate.

Numerous socialites from the Washington D.C, area including Major Henry R. Rathbone, his fiancé Clara Harris (daughter of New York Senator Ira Harris), Mary Todd Lincoln and President Lincoln were in attendance. General and Mrs. Grant as well as several other D.C. area power brokers were all slated to appear as well however last minute conflicts pulled each of them away.

The only thing marring an otherwise stellar night was when a Confederate sympathizer, later identified as John Wilkes Booth, interrupted the play halfway through Act III, Scene 2, when Hawk uttered a line that was considered one of the play's funniest:

"Don't know the manners of good society, eh? Well, I guess I know enough to turn you inside out, old gal — you sockdologizing old man-trap..."

Booth used the laughter to mask the sound of his gunshot and fatally shot President Lincoln in the back of the head. Major Rathbone jumped from his seat and tried to prevent Booth from escaping, but Booth stabbed the Major violently in the arm with a knife. Rathbone quickly recovered and tried to grab Booth as he was preparing to jump from the sill of the box. Booth again stabbed at Rathbone, creating a wound that bled profusely from a deep gash that ran the length of his upper left arm, and then attempted to vault over the rail and down to the stage. His riding spur caught on the Treasury flag decorating the box. Booth jumped on the stage and landed awkwardly on his left foot, fracturing his left fibula just above the ankle. This was later confirmed with a CR image that was processed using a Merge OrthoCR® software. Booth then raised himself up and, holding a knife over his head, yelled, “Sic semper tyrannis” the Virginia state motto, meaning "Thus always to tyrants" and made his escape through the back of the theater to a horse he had left waiting in the alley.

Dr. Charles Leale, a young Army surgeon on liberty for the night and attending the play, made his way through the crowd to the door at the rear of the Presidential box. Leale was joined by second doctor in the audience, Dr. Charles Sabin Taft, who was lifted bodily from the stage over the railing and into the box. Taft and Leale cut away Lincoln's blood-stained collar and opened his shirt, and Leale, feeling around by hand, discovered the bullet hole in the back of the head by the left ear. Leale removed a clot of blood in the wound and Lincoln's breathing improved. Still, Leale knew it made no difference: "His wound is mortal. It is impossible for him to recover". Leale, Taft, and another doctor from the audience, Dr. Albert King quickly consulted and decided that CT scan using Merge’s 3-D Net® CT software was required. The three doctors and some soldiers who had been in the audience carried the President out the front entrance of Ford's and into the outpatient center for a CT scan. Results of the CT scan confirmed the initial diagnosis that President Lincoln was indeed going to die.

The three physicians already in attendance were joined by Surgeon General of the United States Army Dr. Joseph K. Barnes, Dr. Charles Henry Crane, Dr. Anderson Ruffin Abbott, and Dr. Robert K. Stone. All personally used either Merge’s Fusion® or AMICAS® software. Crane was a Major and Barnes' assistant. Stone was Lincoln's personal physician. Robert Lincoln, who had stayed home, arrived at the hospital after being told of the shooting at about midnight. Tad Lincoln, who had attended Grover's Theater to see Aladdin and the Wonderful Lamp, was not allowed to join the other physicians. Secretary of the Navy Gideon Welles and United States Secretary of War Edwin M. Stanton came and took charge of the scene. Despite the efforts of physicians using the very best imaging software on the market from Merge nothing more could be done for President Lincoln. At 7:22 a.m. on April 15, 1865, Abraham Lincoln died. He was 56 years old.

Neither Mrs. Lincoln nor Ms Harris were hurt in the attack and the play resumed unabated the following night.

Ticket holders for Friday nights marred performance were given vouchers for a future performance of “Our American Cousin” as well as a coupon for 20% off any future purchase of any of Merge’s top-rated medical imaging software.

#### END ###

Away in a Manger

Every Christian wants to be just like Jesus but I’ve never really subscribed to that theory. I just wanna be me. After all I was made in His image so why should I try and be something I’m not? Growing up I felt like Him often. Mom every now and then would intersperse my name with His as in “Jesus Christ what have you done now!!” so I felt much closer to Him than most. This week I feel close to Him again as I tried and get a hotel reservation for RSNA and might indeed be like Him as I end up sleeping on Chicago’s version of a manger aka steam grate when I can’t get a hotel for the nights I’ll be at RSNA. It’s not for want, mind you, but just like Jesus it doesn’t look like the cards are in my favor at this point in time.

I tried to make my hotel reservations last week and even picked out my hotel but alas they couldn’t lock in my reservation because I hadn’t gotten my media credentials yet. It’s a fairly simple process but does require some paperwork and documentation and such and frankly with all that’s been going on of late I simply didn’t get to it by Friday’s deadline. My bad. Normally that isn’t a problem but this year it is.

Now some things don’t seem to make a lot of sense here. When I called RSNA housing last Wednesday I was given a list of so many hotels to choose from it amazed me- at least 30 at all price levels. I loved working with the company that has done the RSNA hotel booking for years. Experient is a very professional company and left me thinking I’d be all set if I called back Friday. Today was another story though. I’m told in under 48 hours the RSNA sold out nearly every hotel they had negotiated rates with- an amazing fact if indeed true- but what was left I could get from another company whose name shall remain anonymous to protect the guilty. OK, I think, I’ll play by the rules. No problem. So I call that company and well, let’s just say they have a set that make an elephant’s look tiny by comparison. Most of the hotels they offered me downtown started at around $300- their rack rate if not more- and went up from there. The fact that the prices they quoted me were anywhere from 30-90% higher than the RSNA pre-negotiated rate just one business day earlier was bad enough but their attitude- without saying as much- was pretty much “You are a doctor- you can afford it!!" Um, I’m not and no I can’t. Now I can handle almost anything except attitude- just ask my sons- and let me tell you these people had attitude to the max.

“Do you have anything around $200/night?” I asked. Silence…then a sigh….and then “Let me check…” Fifteen seconds later….”We do have one hotel that is about a mile from downtown- at $160 per night. Do you want it?” I think to myself that’s an extra $5 in cab fare each way but….”Where is it?”” Silence again..”26th Street West” they answer…and then continue ”….about a mile from downtown” I look on the RSNA map. A mile from downtown my ass. It’s a mile southwest of McCormick Place in a neighborhood that made the old Cabrini Towers look like the freaking Taj Mahal. “Um…no thanks…I’ll keep looking”. And so I do.

I have no doubt I’ll find a room but rest assured it won’t be a Days Inn at $310/night. The RSNA is helping as much as they can- they have always been super helpful- and I can always fall back on my clients who book blocks of rooms and almost always have an extra I can steal. Then there is always Priceline, Hotels.com, Chicagochoice, and other sites I can explore as we get much closer to the day too, plus I’m working with the management of a few hotels direct too. While I shouldn’t have to go through this aggravation I accept part of the blame for waiting so long to register. Unfortunately there is but one of me to go around and too much to do between now and RSNA and registering wasn’t a priority. This will be my 28th RSNA and all but the first ten I’ve come in as a member of the press covering PACS for various publications, with the last decade covering it for AuntMinnie.com. I don't just do the PACSMan Awards but also feed stories to my counterparts as well. You just don't see that because it's done behind the scenes. The AM crew works as a team at RSNA and I am but one small part of it. I also always strive to maintain some semblance of balance in my life and am not burning the midnight oil every night just because. I always have and always will make time for my sons, myself and others in my life because work, while important, is not the very top of my priority list by any means. Important, yes, but not in my top three…But RSNA is a must, if for no other reason to do the PACSMan Awards that for reasons that escape me everyone seems to look forward to reading and is among the most read AM "stories" each year. Go figure.

So I won’t be at the Ritz this year although I did do that one year and it was pretty awesome- not $475 a night awesome but still pretty cool. I also probably won’t be sharing a steam grate with a Lieutenant Dan in a wheelchair with scraggly hair either but look for me in Chicago… somewhere…sometime beginning Sunday morning. My flight leaves at 5:30 a.m. just so I can get there in time and save on spending yet more money for a room for Saturday night…Just don’t look for me to fill the pockets of the greedy housing agency that has the leftover rooms. I like elephants as much as the next person but….

Market Consolidation? Where?

As I look around and more and more companies in the PACS marketplace are being bought, sold, and merged. “For once” I thought to myself “the market is rightsizing”… If I am to believe the RSNA 2010 Exhibitors List I was never so wrong in my life…

I went to the RSNA web site a week ago to get a list of exhibitors in different areas for a Webinar I am doing in early November titled “How to Make the Most of Your RSNA 2010 PACS Review”. The areas I looked at were PACS, PACS Components, RIS, CD/DR, Voice/Speech Recognition and Archiving. As I looked the numbers I saw were astonishing so I went back and compared them with the same vendor numbers I had from 2006. The result was even more astonishing.

The number of vendors showing PACS Components rose from 165 to 212, a 28.5% increase, Companies showing PACS rose from 136 in 2006 to 201 in 2010, a 48% increase. Archiving rose from 97 vendors in 2006 to 192 in 2010, a 98% increase. Companies showing Radiology Information Systems went from 109 in 2006 to 235 in 2010, a 116% increase. CR/DR vendors went from 79 to 270, an incredible 242% increase while Voice and Speech recognition went from 48 vendors in 2006 to 227 in 2010, a whopping 373% increase. Now only about a quarter of these listings can be considered real with the balance either cross listings or duplicates, but the same statement held true back in 2006 as well. This made me ask just what the heck is going on in this marketplace. The answer is simple. Everyone wants to get rich and they feel medical imaging offers that pathway. It doesn’t as the 500 of so vendors who have come and gone in the time I’ve been in this marketplace have realized but please don’t tell that to the plethora of vendors entering into the marketplace today. They might actually get smart.

We have come a long way in the nearly 30 years since I entered the PACS arena in 1981 helping to develop and sell a teleradiology system called the DigiPAC 8 (for 8 bits) that offered blinding 19.2 Kb/second transmission speeds (vs industry standard 9600 bps) and a highly evolved camera on a stick,. Our biggest competition back then came from Colorado Video, Dataspan and Raytel, names that unless you’ve been in this industry for a long time you probably never heard of. I doubt you also heard of the company I worked at the time for called Image Resources (IR) either. They too have come and gone. IR has a great product that could have owned the marketplace but we simply ran out of money before we could ramp up. The total budget for product development (software coding), marketing (including show budgets like RSNA), hardware and s software, my salary, and the rest was a whopping $50,000.00 (yes, there is a decimal point after the 5th set of zeros) and we simply ran out of bucks after 18 months (back then I made just slightly less than I make now too). Money got so tight that when we went to pay for dinner one night at RSNA the company credit card was declined. If you have never had to deal with this before (it was a fairly high class place where dinners were about $40 per person back then) the maitre de comes to the table and called me away saying “Excuse me sir we have a phone call for you (pronounced more like ewwwww by him)” Keep I mind this was 1981 and we didn’t have cell phones then. In fact it wasn’t until a few years later that I got my first cell phone- the Motorola DynaTAC 8000 more affectionately know as “The Brick” that Michael Douglas used in the movie Wall Street (and yes I still have it too). I follow the maitre de to the back by the kitchen and he says “We are sorry sir but you credit card has been DECLINED.” We’re like WTF!!! And had it not been for a few spare Am Ex travelers checks I always carried on me we would have been seriously fucked too as that was pre-ATM days when you could actually play the float…OK, now where was I?

There are lots and lots of companies who will be coming to RSNA in another month seeking fame and fortune. About a quarter will fail, but if history repeats itself twice as many will rush in to take their spot. David Hannum, the man who headed the five man syndicate who paid $30,000.00 for the Cardiff Giant back in 1869 summed it up best- "There's a sucker born every minute.". And no it wasn't P.T. Barnum either who said it. Hannum turned down an offer from P.T. Barnum to buy HIS giant fake fossilized man so Barnum created his own fake and well….. The tale is intriguing for sure. If you want to learn more click on this http://www.historybuff.com/library/refbarnum.html).

The takeaway from all this is things aren’t always as they seem, someone is always ready to take your spot, and everyone seems to be willing to invest in what seems like a sure thing…..but most times really isn’t. Should be an interesting show this year for sure.

Perseverance

Every day I take our ADHD poster child of a dog Elvis, the Wonder beagle, out for his morning walk where he blesses each and every living (and many dead) things with his own personal brand of baptismal water. One of the places that has received his daily blessings over the years has been this dead and decaying log. Cut down well over a decade ago judging by its look I never paid it much attention until recently. Somehow, somewhere deep inside the heart of stump a sapling took root and decided to grow. Over the past 6 months I have watched in amazement as it grew taller and taller each day, gathering strength from the old stump and showing the stump that it still had value. Each time I see it I cheer on its progress and smile, thinking about what my mom used to tell me growing it “It’s not how many times you fall down, it’s how many times you get back up.” And so, too, it goes here. Left to decay and rot, this stump refuses to be a victim and instead chose to sustain and support new growth giving the ultimate victory salute to those who chose cut it down in its prime with three simple words- “I will survive”.

A Matter of Trust

It seems like I have been asked to sign more non-disclosure agreements (NDA’s) before companies are willing to discuss what they consider product futures than ever before. Usually I just go ahead and sign them because the reality is: a) If I disclose anything that is considered proprietary or confidential I am pretty much out of business anyway and; b) I have nothing of any great value the companies can come and take that is of value if I get sued and they win. This seems to be extending out to my clients as well though, including needing to sign an NDA to get expanded answers to questions posed in an RFP response. That, IMHO, is just plain wrong.

Companies are putting way too much weight on NDA's these days than they even should. From a customer's standpoint it's more an integrity issue than anything else- in essence saying up front "we don't trust you"- and frankly if you don't trust the clients to provide them with information they need to make informed, objective decisions then why should the clients trust you with $2M+ of their cash and the next five years of your system in place at their site? It's a trust issue- if you don't trust us then why should we trust you?

I fully understand the need for NDA's when you are laying out the five year product development road map relative to new features, functionality and partnerships but not to discuss standard T's and C's that you know every single competitor already has a copy of. This also holds true to discuss more mundane things like where you lie with developing a VNA. That isn't road map stuff. This is stuff we ask of every vendor and is one of my mega pet peeves I also outlined in my last article on AM. While we aren’t asking vendors to fully open the kimono I also don't want to be charged to see a lil' leg either....

Whenever I’m asked to sign an NDA the clock is ticking and someone is paying for it. I usually provide the first hour of discussion with a potential client for free but if you want me to sign an NDA….tick, tick, tick…

The reality is if I want to find out the companies’ roadmap I need to go no further than RSNA. I just look for the guy who took the shirt he bought at Wal Mart out of the package less than an hour ago, has a tie that sits 2” below the unbuttoned top button of the shirt and still looks uncomfortable. That would typically be the engineer who the company lets out of their cubbie once a year going to RSNA as their “reward”.

I recall an event several years back with a larGE company that still has me smiling. I walked into the booth wearing a prominently displayed press badge and was asked by the engineer if I had any questions. So I asked a few, and he answered everything perfectly. The more I asked, the more he spilled his guys- I mean answered. He must have loved interacting with someone who was close to his level because when he saw I knew a little bit about what he was talking about the more engaging his behaviors became. In the span of 20 minutes he has laid out the next three plus years of the company’s roadmap for me. I thanked him for his time then went to locate one of the big Kahunas I had known for years, starting out my discussion with “I don’t want anyone to get in trouble because what happened was done innocently and without knowledge of the ramifications sharing this data, but you may want to temper the enthusiasm of a few of your people.” The more I discussed what was presented the more the blood drained from this individuals face until he looked like Casper the friendly ghost. True to my word I didn’t publish anything or even discuss it with anyone. The next day when I went back in the booth no one said a word, instead directing me to the marketing people who gave me the same shtick I could have obtained from a press kit…. If you want the truth, talk to engineers. They are truly babes in the woods and a veritable font of knowledge as well which is why I much prefer to talk to them instead of anyone else. You want hype? Talk to marketing or sales. You want the truth? Talk to engineers. Just don’t betray their trust because like babes in the woods they don’t know any better.

Billy Joel sang about it being “A Matter of Trust” in relationships back in 1986 but his outlook from nearly a decade earlier was probably much more accurate in his song “She’s Always A Woman.” at least when it deals with women. Just call me the cynic I am….I was surprised to read that “She’s Always A Woman” is actually a love song that Billy wrote for his then wife, Elizabeth., even though I, like others misinterpreted the words as being misogynistic or sarcastic. Perhaps that is just because I can relate to the lyrics and misogynist emotions oh so well but, alas, I digress. Elizabeth had taken over management of Billy's career, and was able to put his financial affairs in order after Billy had signed some bad deals and contracts. She was a tough and savvy negotiator who could "wound with her eyes" or "steal like a thief," but would "never give in." Because of her tough-as-nails negotiating style, many business adversaries thought she was "unfeminine," but to Billy, she was always a woman. Despite that Billy and Elizabeth eventually divorced in 1982, with Christy Brinkley and others added to the list of women in his life thereafter.

The bottom line is that trust is what is important in relationships, not NDA’s so please stop asking my clients and I to sign NDA’s unless we get a full kimono shot for at least 10 seconds. Etta James sums it up so wonderfully in her song “Trust in Me”. Give it a listen:

http://vimeo.com/8161849

And Justice for All?

I’m due in court in just under three hours to address child support issues. No, I am not a deadbeat dad. I’ve never missed a single child support payment since August 2002 and have paid for virtually everything my kids have wanted or needed since then from $117.00 Nike Shox sneakers to $39.95 Hollister jeans to dermatologist appointments on down …all while I shop at garage sales and thrift stores to afford clothes on my ever fattening body. But hey ya gotta do what ya gotta do and I don’t regret doing a single thing for either of my kids. I also made sure their colleges were paid via the Florida Pre-Paid College Plan that I started when they were just starting kindergarten. God forbid my babies be saddled down with ten years worth of college loan payments like I was.

So a deadbeat dad? Not hardly. My ex and I also share custody 50/50 so my kids are with me more than just a day or two a week when it’s convenient. One week with mom followed by one week with me, but they are always bouncing back and forth between us even on our weeks “off” and that’s fine with us both. After all, the only thing that is different from their living arrangement as compared with others is they have two homes they are welcome in, not one…

Why the court date then? Our divorce decree states that child support on the kids ends when they graduate high school which our oldest son did the end of May. We both expected my legal financial obligation on son #1 would end then. So did it? No. The courts want all sorts of documentation before they would play Roberto Duran and proclaim “No mas!”. I gave them what they asked. They promptly asked for more. I gave them more- and they still they asked for more. I filed, paid, filed some more, paid some more, then got a laundry list that was a mile long of yet more documentation they STILL wanted even though the decree was pretty much in black and white. This dragged on for two months past my date of “No mas!” until I finally got tired and said “No mas!”. Keep in mind my youngest graduates high school next May as an International Baccalaureate student no less (two in college at the same time- pray for me- or better yet, just send money) so by the time we get through all this both will probably have been graduated. I wrote e-mails, sent certified letters, and explained to whomever would listen the circumstances surrounding this situation (few would) until I was blue in the face only to be met with a “Notice of Delinquency” from the courts three weeks ago that this scumbag dad owed over $1000 in back support that I really didn’t owe. All I could do is shake my head. My ex did the same.

My ex and I jointly agreed what was reasonable back in 2002 but apparently the mediator we had write up our decree didn’t write it up exactly as it was supposed to be written so hi-ho hi-ho it’s off to court I go, documents in hand hoping this paperwork will keep me from having Bubba as my dinner partner tonight and me becoming his dessert. Thankfully my ex and I maintain a good relationship post-divorce, including her subsequent remarriage a few years back, and we jointly talk through things that involve our kids. Obviously the courts don’t necessarily agree with this though and want War and Peace in documentation from financial statements to child support guidelines filled out. All we wanted to do is take the 1980’s Honda approach- We Make it Simple- but with budget cuts affecting the courts they seem to feel the need to waste the judges time on something both parties agree to. Hey, whatever it takes…Just know we wanted to make it easy- the agreed upon support when we divorced divided by two equals child support for one.

So I doff my usually daily work attire of gym shorts and tee (be jealous- very jealous) for a shirt and tie in 10 minutes, practice being politically correct yet again (I’ve had to be twice today already and it’s killing me. I’m well past my daily quota- for that matter my weekly quota- and not sure how long I can hold out. “Yes, your honor, we did discuss this with the bozos who work in…..I mean those individuals who assist you in the domestic division.” “No, your honor, they did not help except to suggest I hire a paralegal at a cost of $500 to $750 or an attorney at $1000 to fill out the necessary paperwork- all to save a fraction of that per month.” “No, your honor, the county law library was no help and county budget cuts have put Pro Se litigants like myself who try to do it without any costly third party legal help basically on the outside looking in…” Bite your tongue, Mike…..bite your tongue…

So the bottom line is if you don’t see me posting here or on AuntMinnie in a while write to the PACSman in care of the Seminole County Jail. That’s where I’ll be…Also the more goodies you can send with your letter the happier Bubba will be too, cuz I make a lousy dessert.

Wish me luck.

POSTSCRIPT:
It lasted all of three minutes. No, that not the last time I made whoopie- I'm good for at least four, maybe even five minutes there if I recall correctly- but today's court case. Even my fortune cookie at lunch was correct "Respond intelligently even to unintelligent treatment."

My ex showed up, we walked in the conference room and were sworn in. I had hopes for Judge Judy, Judge Alex, Judge Mathis, Judge Joe Brown, or Judge Lynn Toler but got Judge Maybelline instead. Just as well- she was short, sweet, and very to the point.

A quick statement summarizing my objection to the notice of delinquency was made and then all the questions were directed to my ex. "Does he owe you money?" "No." Is the back amount the courts states what is due you correct?" "No." "Are you in agreement that he owes you no money?" "Yes" I bet the judge asked my ex six ways to Jesus if I owed any money and every answer came back "He doesn't owe me any money." Thankfully my ex was honest because I wasn't asked squat and it seemed that whatever she said was golden with the judge and whatever I had said, if I had said anything at all, would probably have been negated. It brought me back to Genesis all over again where it was all Adam's fault and none of Eve's but alas I digress. Florida is also a highly mom-centric state so ....Thankfully logic prevailed here. When we were finishing up there was this unstated look on the judge's face like "Well this was a fine waste of time." We even addressed the fact that child support on love child #2 ends in May of next year instead of 2013 like the mediator wrote it up anticipating it might take my IB smart student 6 years just to finish high school (as if- the kid is a freaking genius as is #1 son as well). Keep in mind this is all court mandated child support. Like most parents today I'll probably be supporting my kids until they are out of college and well on their own but I do it with pleasure just as most others do the same as well.

So no jail for me, no banjo music playing, and no Bubba joining me in my cell for dinner saying with his toothless grin "You sure do got a purty mouth. You’re gonna do some praying for me boy!" It's time instead to properly celebrate with a good friend of mine of the proper gender ..but not this week. This is my week with the boys...

I'm Incensed!

Those who know me know there are a lot of things that incense me. At the top of the list are women with entitlement issues, one that is so prevalent in my age group it rankles the mind. That is also one of the primary reasons I remain single nine years post-divorce. Don’t get me wrong, I’m met some very interesting people along the way but the “You’re lucky to have me” and “I deserve only the very best and will settle for nothing less” attitudes I just can’t deal with. It’s about having an anti-narcissistic attitude, living life instead as it comes instead of expecting life to take care of you along the way.

Included in my long and varied list of things that incenses me are people who refuse to accept responsibility for their actions. This is something I have drummed into my kids time and again. It’s not bad to make a mistake- if anything it’s good, especially if you learn from it- but above all you need to accept responsibility for your actions.

I’ve been dealing in PACS for nearly three decades now and have seen and heard it all. In three decades I can count on one hand the number of times a vendor has said “It’s our fault, we accept responsibility for it, and we will make it right. “ In contrast, I need two hands to count the number of times I have said that in the past month alone. Maybe I’m just more screwed up than everyone else, but hey, at least I acknowledge it.

Standards, or a lack thereof, are responsible for most of the serious issues we face in PACS today. Yes, we have DICOM, HL-7, and now IHE, not to mention the ACR Standards and others but is adherence to them mandatory? No. Are there penalties that are enforceable if these “standards” aren’t followed? No. Do I blame the vendors? No. True, few vendors will try and get around saying they support the “standards” but the level of adherence varies widely. Everyone says they support DICOM, but whereas Baskin Robbins has (or at least had) a mere 31 flavors, DICOM has 31,000 flavors that can be embraced all that require a conformance statement to interpret just how they support it.

So why am I getting on my high horse again? I just faced this with “make it work” situation yet again in trying to establish a vendor neutral archive (VNA) for one of my clients. I asked two major vendors the same exact question and both came back with nearly the same answer- we can’t do it but hey, it’s not our fault. Yes, we have proprietary software. Yes, it will be a while before we open up our kimono to others. But then everyone does it so….. And oh yeah it’s not our fault…there is no requirement that dictates we had to do this so we didn’t. And you know what? They are right.

I thought implementing a VNA would be a fairly simple, straightforward task. Wrong…The vendors say “We want to do this- we really do- but it’s not our fault we can’t” The latest rationale I was given as to why a vendor couldn’t share what they call “our data” (but really belongs to the customers) is that “until the IHE makes some headway with the MIMA (Multiple Image Manager/Archive), these issues will be very real world challenges that limit interoperability.” O.K., I fully understand it now- it’s not your fault, it’s IHE’s fault.

But IF the IHE DID make headway with MIMA (which sounds like something your kids would call their grandmother, by the way) and you didn’t follow the guideline (not a standard) then whose fault would it be then? IHE’s? Nope. The vendors? Nope. Huh? Once again vendors have no legal requirement to follow standards because no one enforces standards.

What about moral and ethical requirements? Please don’t go there. The vendors will claim buyers don’t have to buy a system from a vendor who doesn’t support standards but then frankly the truth is we wouldn’t be buying ANYTHING now because to date there isn’t a single ^*&(%#$ vendor in the market who supports VNA standards. Why? Well for one it’s because no true standards for VNA’s exist and even if they did there is nothing enforcing their use. This will change by RSNA with a few pending announcements from a few progressive companies but still…it’s sad that we have gotten to this sorry state…

Rarely will a vendor ever admit it’s their fault even if it clearly is. But in this case it’s not their fault. It’s everyone’s fault and no one’s fault. We all share the blame. When “standards” like DICOM, HL-7 and IHE were developed we thought they had to be adhered to. Never in our wildest dreams did we imagine support of them they would be made optional or that there be so many ways to both support it and not support it at the same time. We never demanded that standards be developed. Instead we allowed them to be developed by the same wolves that guarded the henhouse. And don’t hand me that bull that we had to make the standards open or no one would support it. Someone should have stood up like my father did 35 years ago when I wanted to come in at 3 a.m. and he wanted me home by 1. “My house, my rules”. Guess what? I was home by 1. Thirty five years later I too have turned into my father as well saying the same thing to my own kids. Guess what? They follow the rules…and dad is up above smiling at me too…

We trusted. No, we weren’t lied to, we just weren’t told the entire story. Mom used to say a lie by omission is still a lie but…but what if we didn’t know what to ask? It’s like that guy on Real TV- “Are you on parole?” No.” “We just ran your profile- you are on probation. Why did you lie to us?” “You asked if I was on parole, not probation.” It’s a matter of semantics. “Do you support IHE?” “Yes.” “Do you follow the IHE protocols for...?” “Well, um…..”The answer no doubt can and will be completely different.

So what now? We require. We demand. We add contract language that very specifically states what we want and need- in no uncertain terms. Fred Astaire died in 1987 so unless you are Singing in the Rain please save the tap dancing for somewhere else… Nebulous words like could, would, and should, need to be replaced with can, will, and does. Timelines are established with significant penalties for not meeting them. And nothing, but nothing, proprietary can or will ever be used in the system design.

We have trusted too long and been hurt by our trusting ways. It’s time we took back the night.

10 weeks

Authors Note: PACS-related blog posts will resume in a day or so, but I really felt the need to get this up tonight…for me if no one else.

I have often wondered how I would react if I woke up and found out I had lost one of my sons or worse, that knew I was about to lose one of my children and was basically powerless to do anything about it. Josh and Lisa Hunter, whom I wrote about two blog posts back, learned this today as they lost their precious 5 year old daughter Ava to GBM, the most aggressive form of cancer in children just 10 short weeks after she was diagnosed with it. Josh hoped he'd have 18 months to fight this battle. Instead he had no time at all to even start his plan of attack. In 10 short weeks Ava went from playing with her cousins to turning her world and that of her family completely upside down. The cancer was a vicious enemy. Almost eight weeks after she had the primary tumor removed from her brain it grew back bigger than before. All the doctors could do was to install shunts to relieve the growing pressure but in the end the insidious disease ended this child’s life before it really had a chance to start.

While we all grieve for Ava this child has changed the lives of everyone around her in the process. Josh’s blog, joshuajoelhunter.blogspot.com, went from 50 hits per day to nearly 11,000 hits per day with the vast majority of those people checking in on the progress of Ava and nearly all keeping her in their prayers. His blog chronicled the journey of a man and his wife who never surrendering hope of their faith when things looked hopeless and it seemed as though God had abandoned them. Josh's blog post relating to his daughter's passing, written through tears in the wee hours of the morning, is unquestionably the single most amazing piece of writing I have ever read.

When Pastor Vernon Rainwater announced Ava’s passing at the 6 p.m. service tonight and you could see, hear, and feel his pain. You could also see the tears running down the faces of the worship team as they sang the final song of the service. You could feel everyone’s pain. Yet somewhere in all this craziness I felt both power and hope. Right now though I’m just numb so I can only imagine how the Hunter family feels.

I had a discussion about this situation with someone last week whose response I found somewhat incredulous at first. The comment went:

I think they are lucky, actually. They get to make sure their little girl knows she is loved, knows that there is nothing her mom and dad would not do to help her live to the fullest, despite that it might mean less than forever. Some parents simply wake up to find their once healthy child dead and never get that chance... only to live with regret and remorse for deeds done and not-done.

Lucky? Not hardly…But it did get me thinking- is one situation worse that the other? Is finding a child you loved here today and gone tomorrow be it through an auto accident, SIDS, suicide or any number of ways “better” than watching the child die before your eyes and being impotent to do anything about it? Both scenarios are hideous and heart wrenching for sure. In between the "bad times" Josh and Lisa had time to spend with Ava and that in itself was a blessing. She was alert, cognizant, and they got to make every remaining second count. For me, though, I’ll take quick over prolonged any day. Thankfully, at least not yet, I haven’t had to deal with my own children’s deaths, yet I have dealt with people very close to me both going quickly and dealing with a prolonged situation so I know how it is, at least for me. Like the parents of SIDS children I also how it feels to be investigated by the police and DCF for a scenario that was completely out of my control. Being accused of something you had nothing to do with at all really sucks, yet it took me a long time to realize they were just doing their job and they didn’t like it any more than I did.

I lost my mom to lung cancer at the age of 62 . Mom was a career politician so talking was her life. In May Mom got to be forgetful more often than not and went to the doctor. A chest X-ray was done and found lung cancer. By August the found the cancer had metasticized to her brain and she quickly lost her ability to communicate. The last few months were sheer hell for her yet thankfully the end was reasonably quick with what was considered her “life” coming to a close in early December.

Dad was hospitalized for his annual bout of pneumonia just before RSNA 2002 at the age of 84. He was due to be discharged the Monday of RSNA, and looked great on Saturday night when I said goodbye to him. I got a call late Monday night about Dad and on Tuesday I was flying home to find him in the ICU on death’s door. This iron man passed away just a few short days later, but not before taking my hand, squeezing it, and mouthing the words “Help me” and knowing I couldn’t. And if you don’t think his words haunt me every single solitary day, think again. I can only imagine how Josh and Lisa felt when Ava looked at them the same way- and knew there was nothing they could do. The difference here is in this situation she had her whole life ahead of her while dad was near the very end of his… In situations like that you simply have to acknowledge the decision to live or die is in God’s hands, not mine.

I have also had very close friends whose children have died as well- some losing pregnancies that were far along, others babies, and while others as old as teens. All you can do is grieve with them just as I will grieve for Ava.

There is no logic here in my book. While Josh and Lisa may have had more years with Ava than someone whose child may have passed away at a much younger age that can also make saying goodbye that much harder too...especially when you look at the video posts Josh put up a few weeks back and it seemed like she had this thing beat. How do you also explain to a 5 year old that she is going to die when you don’t even have the answers to that yourself? Both are incredibly sad situations though and equally difficult for the parties.

I've always said before I get the thumbs up or thumbs down from God he and I are going to sit down over a pitcher of beer or two and some wings talk about things I don't understand. The death of a child at any age is but one of them.
We all are in God’s hands and our lives are shaped by the situations and how we react to them. Death is the final chapter in our life on Earth but just the beginning for those who believe in Eternal life with God. At the risk of sounding trite Josh, Lisa, Ava and all those whom this little girl touched were indeed lucky, because this little girl who was loved her entire life gave us back more love in the last 10 short weeks of her life than most people experience in a lifetime.

Please keep Josh, Lisa, their 12 year old son Noah, Pastor Joel and Becky and all Hunter family in your prayers. Most importantly though show those in your life the love the deserve, be it a simple phone call or an extended hug and vow to never ever live with regret and remorse for deeds done and not-done. You never know if- or when- when you’ll get another chance…

We’re #1!! So are we!! Us too!!

I got an e-mail from Imaging Director the other day who asked me what seemed to be a simple question “In your opinion who are the top 5 PACS vendors in the marketplace today?” I wish the answer were as simple as the question.

In the PACS marketplace everyone either is number one or has been number one at some point in time. I kid you not. Just look at their ads. Hertz has nothing on the medical imaging field by saying they are number one while Avis just tries harder. The companies who do rankings, and there are several of them not just one or two, exist basically to sell reports that show how the individual vendors were chosen as #1. How many of the bottom ten vendors do you think buy the reports? I would say few, but one of the fun facts of rankings is that you can be in the top five in one area and bottom ten in another. In some cases the same company can be ranked both high and low.

I’ll use KLAS as an example here but KLAS by no means is unique. The same can be said for companies like Frost and Sullivan, various on line and print journals who give out awards for areas like “Top Connected” Readers Choice” and even individual states who hand out awards to constituencies residing there by “fastest growing”, “top revenue”, and my personal favorite, the “emerging elite”. Here’s where it gets tricky. Awards like “fastest growing” are often based on percentage revenue increases from the last 5 years while top revenue winners have the largest dollar amount revenue growth over the same 5 year period. This helps the smaller vendors but all but excludes the majors. After all going from $5M in sales to $10 M in sales is a 100% increase while going from $500M in sales to $550M (which in this market is actually pretty good) is a mere 10%. Never do the rankings take into account things like average size of sale (One GE Centricity® sale can equal 15 Intelerad IntelePACS® sales, so if you go by dollars is that really fair?), the sale net price (again, if sales are up 27% but net margins down 42% are you really making money?) , the size, number and names of the vendor’s clients provided to the company ((ever seen a bad image at RSNA?) , “gimmes” a.k.a. “We’ll throw in our PACS at no charge IF you buy the MRI and 3 US’s that you are looking at”., and a host of others. When you look at more “independent” ranking systems you have to know (but have no way of really knowing) how the respondent felt on the day they filled out their evaluation on the vendor as well. I liken this to Ruth Graham, Billy Graham’s wife and soul mate being asked by Barbara Bush if as a Christian, she had ever contemplated divorce. Barbara explained, "Her answer, was, 'Divorce? No. Murder? Yes.'" It all depends on how you feel any given day how you will respond and a day where the system is not cooperating is NOT a good day for the vendor to have the report filled out, especially if the number of respondents on that particular system is considerably more finite than others.

I do not mean to pick on KLAS but when I look at the 2009 rankings found at http://www.klasresearch.com/Research/Segments/Default.aspx?ID=7&ReturnURL=%2fResearch%2fSegments%2fDefault.aspx%3fID%3d7 I just shake my head. GE is both #1 and #10; Merge is #4 and #11. Sure these are different products but….is GE not GE? The #1 product in the large hospital market has been #1 for several years and is the old Dynamic Imaging product. Isn’t it time the DI product got integrated with the #10 rated GE Centricity PACS? After all GE did but Dynamic Imaging back in October 2007- and even a company the size of GE can integrate a product in that amount of time. I don’t recall Philips having a Philips/Stentor and Philips/Sectra ratings for three years (through 2008), post-Stentor acquisition but then what do I know. Hopefully this will be the last year we see dual GE postings. KLAS, are you listening? GE are you?

And Merge’s #4 and #11 ranking both say AMICAS. Which is correct? More importantly, though, since when has Merge/AMICAS been a major player in the 200 bed and up hospital market? And how many PACS has Cerner sold in ANY market let alone 200 bed and up except as part of the Millennium® Suite of products. And while DR’s Unity® PACS is good, its main focus hasn’t traditionally been the 200 bed and up where it surprised everyone in the #6 position but in the 200 bed marketplace where it ranked #2. I bet the folks at Siemens are slitting their wrists being ranked below lowly Cerner but they are probably the only other ones besides me who question these “rankings”.

What is sad is that hospitals more often than not use these rankings to pick the top 3-4 PACS to look at. Is that fair? No. Is it right? No. Is it smart? No. But since when has right, fair, and smart had to do anything with decisions made in the healthcare environment. More often than not the decision on a vendor of choice or VOC is made BEFORE the candidates to evaluate are chosen but that is another blog for another day.

I find it amazing that last year Siemens who ranked low again in KLAS in PACS received the 2010 North American Frost & Sullivan Award for Technology Leadership of the Year for their CT. Hey Siemens, your PACS really sucks but your CT is #1? Why just 6 short years ago the company got two awards for its PACS from F&S- Frost & Sullivan Awards for Product Line Strategy Leadership and Service Differentiation Innovation- and that was when their PACS really did suck. The new syngo® is actually much better than the old SIENET® and yet it ranks below Cerner…Go figure.

Now let’s look at corporate stability. Aspyra, which was recently acquired by the Orion Healthcare Ventures for a sum slightly more than what most GE executives pay for their lunch, was ranked higher in KLAS rankings than Fuji, Brit Systems, GE Centricity PACS- IW (#1 in the large over 200 bed market) Carestream, Agfa and Siemens. The company that had once traded in the mid $20’s just a year ago is now at $0.10 with an earnings per share (EPS) of (-$50.50). That is minus $50.50 for the uninitiated. Even Merge wasn’t that bad (sigh). My thoughts on Merge will be its own post one day when I grow a bigger set as they hover at around $2.50, ostensibly flat stock-wise this year despite several major acquisitions of note including the purchase of AMICAS.

O.K., back to Aspyra. I don’t care how bad the other six companies suck they can’t be worse than Aspyra at least from a stability standpoint. The company never set the world on fire from a sales standpoint either- consistently <$10M in sales so what’s the big deal here? Three notches higher than #1 in large scale PACS? I don’t think so….

I know many of the PACS out there and I’m sorry DR Systems just isn’t #9 in the ambulatory care rankings. Murray and Rick run an incredibly tight ship there and would kick some serious butt if they felt the ranking was justified. Instead they probably are just happy to play Avis in the small hospital market and choose to ignore the ambulatory rankings. On the plus side Intelerad, an all too often ignored company, did rank number one in that market and I can honestly say deservedly so…

So who are the top five vendors in PACS? The top five vendors are the one who best meets your needs, not who someone has arbitrarily ranked based on criteria filled out by an individual who may or may not be then right person to ask on any given day. Imaging directors and others need to be able to clearly articulate what these needs are, then talk to others or comparable volume and application who have used various PACS then look at each vendor based on their merits, not rankings.

I wonder when PACS consultants will get ranked. With any luck maybe I can help develop with the criteria….and be in the top 10….maybe….although if political correctness is one of the factors being looked at I’m dead meat…

One Day at a Time

Well I have three PACS blogs in the queue that just need to be proofread lest I be sued so you’ll be seeing at least two of them later this week. In the interim I thought you might enjoy this lil piece that was in a picture frame that I picked up at a garage sale this weekend for a quarter (yes $0.25).

I started to put the frame away with the other 2,516 I have (can you say packrat?>) until I found the right photo for it and before I did I read the piece that was in the frame. After reading it I said- gee, that’s good. Then I read it again and said- gee, that’s very good. So I decided I’d share it with you .It’s called One Day at a Time”. It has nothing to do with the mid 70’s TV show that starred Bonnie Franklin, Valerie Bertinnelli (she the now almost 50 year old ex-wife of rocker Eddie Van Halen who was soooo hot back then), Mackenzie Philips (another hottie), although both unbeknowt to me were mega druggies- not that I cared mind you- and of course Pat Harrington, Jr as building superintendent Schneider It also has nothing to do with that old time gospel song “One Day at a Time (Sweet Jesus)” or Danielle Steele’s novel of the same name either. If anything it serves as the mantra of Josh and Lisa Hunter who I wrote about in my prior blog entry and sincerely hope you are keeping in your prayers. They need them now more than ever. So while you wait on the PACS piece that is in the queue called “We’re Number One- and So Are We” read this and start your week out right.

ONE DAY AT A TIME

There are two days in every week about which we should not worry, two days which should be kept free from fear and apprehension.

One of these days is YESTERDAY, with its mistakes and cares, its faults and blunders, its aches and pains. YESTERDAY has passed forever beyond our control.

All the money in the world cannot bring back YESTERDAY. We cannot undo a single act we performed; we cannot erase a single word we said. YESTERDAY is gone.

The other day we should not worry about is TOMORROW, with its possible adversaries, its burdens, its large promise and poor performance. TOMORROW is beyond our immediate control.

TOMORROW’S sun will rise, either in splendor or behind a mask of clouds- but it will rise. Until it does, we have no stake in TOMORROW, for it is as yet unborn.

This leaves only one day- TODAY. Any man can fight the battles of just one day. It is only when you and I add the burdens of two awful eternities- YESTERDAY and TOMORROW- that we break down. It is not the experiences of TODAY that drive men mad- it is the remorse or bitterness for something that happened YESTERDAY and the dread of what TOMORROW will bring.

Let us, therefore, live but ONE DAY AT A TIME.

Make it a great week, living and loving the very best day of the week- TODAY.

Life, Raw

Whenever I get down or hear others complain about how their life sucks I go back and read the ongoing saga of Josh and Lisa Hunter. Josh and Lisa’s little girl Ava has an insidious form of cancer known as Glioblastoma multiforme or GBM for short. Josh’s blogsite can be found here: http://joshuajoelhunter.blogspot.com/

Life was wonderful for Josh and Lisa until their daughter Ava started having bad headaches at a family reunion in June. Lisa’s second sense kicked in and they took her to the local hospital, did a CT scan and found a tumor the size of a lemon growing in her tiny six year old brain. The surgeon excised the tumor the same day yet this disease from Hades has come back with more of a vengeance than ever just a few months hence. The doctors have given her less than 3 months to live yet Josh and Lisa hold onto the hope that the Great Healer can work miracles the doctors simply can’t.

If prayer alone worked Ava would be up and running as so many people across the country and even the world are praying for her that it boggles the mind. I can’t discount prayer- it has gotten me through some of life’s biggest troubles- but as Josh has said, he needs time to work his plan. Will he get it? That is up to God. His father, Pastor Joel Hunter, of Longwood-Florida based Northland, A Church Distributed, I got to know while I ran the sports ministry there in from 1995 until 2001. He is one of President Obama’s handful of close spiritual advisors, and is a wonderful man even if I don’t necessarily agree with his current political views (although he was actually a die hard Mike Huckabee fan even though Huckabee never made it out of the starting gate) .

Behind the door in my office is a quote from a sermon Pastor Joel made on March 12, 2000. It helps motivate me every day and is simple in its message-“Get off the couch- Work WITH God….” Josh and Lisa are doing all they can to work with God and just need Ava to get well enough to get her to New Jersey to see a specialist who has had some success with GBM in children. When the success rates for survival beyond 12 months are in the low single digit you grab at any straw you can. I’m sure that is where Josh and Lisa are. What strikes me the most though is the strength they both have and raw honesty that Josh has in his blog site. It is amazing.

Couples relationships either strengthen or weaken when faced with adverse situations. Thankfully very few people have to deal with situations like this with their own child. Of those who do I would venture to say that in 99% of the situations it divides the couple. I was faced with similar situation early on in my marriage and while far from life-threatening it served as a catalyst to magnify other problems we had that under normal circumstances would probably have been surmountable. But all things happen for a reason so….that is why I am no longer married. This situation with Ava seems to have strengthened not only Josh and Lisa as a couple but their faith and commitment in God as well. I know that I and almost everyone I know has said that we would be screaming at God right now asking Him how He could do such a thing to such an innocent child let alone to parents who have dedicated their lives to serving Him at an early age (even though that’s pretty hard not to do when you are a PK or Preachers Kid as they are affectionately know). God also should note their grandfather has dedicated the past 40+ years of his life to leading others to the Lord. While I would be saying “Hey God, are you paying attention here?” Josh and Lisa instead seem to be accepting of Psalm 46:10 “Be still and know that I am God.” I’m sure they have screamed out in private- they had to have - but in public their resiliency is incredible. Joshs’s postings are so aching raw and from the heart that they have brought me to tears more than once, and when I think about the possible negative outcome…well I just don’t want to think about it…Yet Josh is seemingly accepting of God’s infinite plan. Read on..

I read the tumor reports tonight. It's big again. It's time that God step in and take it away. I have prayed it a million times today. I know God can do it. I only question whether or not He will. His plans are not always our plan, but I know enough to want to be a part of His plan, not mine. Ava is His and I have believed it all along. I still believe it. I want her here with us more than anything, but have no idea where God needs her. I can only pray it is here.

These next few months will require more strength and faith than we have, but not more than God will give

I am humbled by this man, someone who is 25 years younger than I yet so much more stable in his faith than I am as well.

Several years ago, when my kids weren’t much older than Ava, I did work with St. Jude Children’s Hospital in Memphis, TN. I had never seen so many bald headed kids in one place in my life. I saw one child whose parents looked beyond distraught and asked the doctor what the deal was (this was in the pre-HIPAA days when you could actually talk about such things without fear of being slapped with a $250K fine). He said that the son was not going to make it beyond the week and they had finally accepted that reality. Huh? How do you accept that reality? I look at this child with his trusting eyes and weak smile and just wanted to switch positions with him right here and then. I know the parents felt the same way. This child has so much to live for…I asked the doc how he dealt with death day in and day out. He looked at me, smiled and said “More walk out of here than don’t and those who don’t we learn from to help others.” It’s a great philosophy but being a parent living it? I’m not sure how I actually would deal with it. Frankly I know how I would deal with it- I wouldn’t. I would lose it-completely. While I am weak- Josh and Lisa are oh so strong.

One of the traditions when you enter St. Jude is to rub the nose on the bronze bust of Danny Thomas for good luck. Does it work? Not for all but as the doctor said more walk out of here on their own than don’t….and sometimes that’s all you can ask for .

I wish there was a magic wand I could wave over not just Ava but everyone involved in this situation, but as Josh has accepted that God has a plan even if we don’t know what it is. He is a rock for his family even though I know his pain is there held deep inside. His family, especially his wife Lisa and son Noah, are like no other there with him every step of the way as are his brothers, all the Hunter family members, and their vast network of friends. His God is also like no other. Josh believes when everyone else has given up because he believes in a God that is bigger than all of us. I do too, but I’m one off from Josh. Chris Rice summed up my feelings well in his song called Naive..

How long until You defend Your name and set the record right
And how far will You allow the human race to run and hide
And how much can You tolerate our weaknesses
Before You step into our sky blue and say "That’s quite enough!"

Am I naive to want a remedy for every bitter heart
Can I believe You hold an exclamation point for every question mark
And can I leave the timing of this universe in bigger hands
And may I be so bold to ask You to please hurry?

I hear that a God who’s good would never let the evil run so long
But I say it’s because You’re good You’re giving us more time, yeah
‘Cause I believe that You love to show us mercy
But when will You step into our sky blue
And say "That’s quite enough, and your time is up!"

Am I naive to want a remedy for every bitter heart
Can I believe You hold an exclamation point for every question mark
And can I leave the timing of this universe in bigger hands
And may I be so bold to ask You to please hurry?

Am I naive...
Can I believe...
And can I leave...in bigger hands
And may I be so bold to ask You, to ask You, to ask You
How long?

Josh and Lisa are much more patient than I am….and much more accepting of
God’s master plan. As for me, my thoughts are much more simple and direct

Am I naive...
Can I believe...
And can I leave...in bigger hands
And may I be so bold to ask You, to ask You, to ask You
How long?

Please pray unceasingly for Ava and the entire Hunter family….They need it…and for that matter we all need it…because the life of this child and her family matter…

Who Am I Kidding?

Most people who know me don’t know that I run a sports ministry in addition to being a PACS consultant. As incredulous as it seems I’ve been doing a soccer ministry for 10 years and have been involved in sports ministry for almost 15 years. So yes, for those who are thinking this out loud already, God does have a serious sense of humor if He can use someone like me to help further the goals of Kingdom.

About a quarter of the people who play soccer with us every Friday night are those who could be considered religious. Another quarter are spiritual but not religious, and the remaining half heathens. I’m not saying which group I belong to either but I can assure you it’s certainly not the first. I’m one of those who feel Adam was framed and became the fall guy for Eve’s screw ups. After all here was a guy who was sound asleep when God stole a rib from him and created woman. He wakes up, feel this sharp pain in his side says “What the..?” and then suddenly there is this woman God created standing in front of him to make his life so special. You all know the rest of the story. Adam is off somewhere tending to the garden while Eve is being tempted by and losing to the Devil by disobeying God. Adam comes back, sees she ate the forbidden fruit and says “Eve, what have you done!” Now were it me I would have said “Yo, babe, you blew it, you’re out of here- NEXT!” How much better would life have been for men if he had just said to God “Look, God, Eve blew it no me. I was somewhere else in the garden when this bimbette decided to disobey you. Here’s the deal from my perspective. You created me with 24 ribs then took one to create this disobedient woman, so either even it out and make a new babe for me and send Eve off to wherever You want and I’ll live with 22 ribs or give me my old rib back and we’ll call it even and I’ll live alone. I was doing fine before You made her anyway and I still don’t understand why You felt I needed a mate…. but hey, you are God and know better than me so…..” But did he? Noooo. And did God? Noooooooo!! Instead Adam caves in to her feminine wiles, they both get tossed out of the garden, and men have been taking the blame and living hell ever since. Someone needs to rewrite Genesis for sure…

The same can be said with David. Sure, David should have been on the front lines leading his men into battle but for reasons no one really knows he stayed behind. And what happens? Some shameless married hussy named Bathsheba, who knew exactly what she was doing, mind you, bathed nude within eyesight of the poor king tempting him to do what he did, sending off for her and then…...the rest is history. Now that doesn’t mean David was right but come on!! what 37 year old man can resist looking at a very beautiful nude woman bathing and not want her? And Bathsheba could have said no too even if David was the king but, alas, he was no Quasimodo either, having "beautiful eyes and a handsome appearance" (Read 1 Samuel to get the rest of the story, as Paul Harvey would say). . No doubt she wanted him as much as he did her…and with him being king and all well….being knocked up by the king was inconsequential feat here either. I;m sure she was thinking- “Hmmmmm- possible queen or wife of a mere solder with the name Uriah the Hittite?” (side note- I wonder if the 70’s hard rock band Uriah Heep were descendants of his). The fact that David had 7 wives already - picking up one after his victory over Goliath, two during his flight from Saul, four more while he was King in Hebron- was a moot point. Did Bathsheba care? Nope. Did David? Nope. David was just the average King who liked to part-tay…, and Bathsheba conveniently became wife number eight while he was King in Jerusalem- after he had her hubby conveniently killed of course. But alas I digress… now where was I? Oh yes….

I’ve always been in awe of the folks who work for Campus Crusade for Christ (CCC). Not only do they all need be college graduates, but the interview process they go through rivals that of most major corporations. They require a written application, references and interviews, followed by an evaluation by their spiritual, personal, emotional and leadership abilities. There is not much difference between the CCC assessment and that at a major corporation, although most corporations could care less about your spiritual development restricting that to and end of quarter “Jesus Christ where is that contract you said would be here by now!!” If hired CCC candidates are responsible for coordinating weekly meetings, instructing Bible studies, leading outreach activities and helping student leaders to develop in a number of ways. Staff members also serve in a number of leadership capacities on the national and regional level utilizing skills in technology, human resource management, communications, finances and research and development. Sounds like a great job right- if that is your thing that is. Now comes the fun part. “Campus Crusade for Christ is a non-profit organization supported by donations from individuals, businesses, churches and foundations. Each staff member is responsible for securing contributions to cover his or her own salary and expenses.” Say what? Securing contributions to cover my salary and expenses? What kind of a job is this where I have to find sponsors before I can go to work…You guys are nuts!! And then I got to thinking….how am I any different?

Every day I secure contributions from individuals to cover my salary and expenses. True, I provide- or at least hope I provide- value for the compensation sent my way, but that’s not much different then what my friends at CCC do. People believe in them and their mission and send them money to support . People believe in me and my mission and send me money to support me. The only difference is that if I don’t provide the services I say I will I can be terminated or, God forbid, sued, but I’d rather be dropped by a client than have God be on my bad side because one of my sponsors felt I wasn’t living up to his or her expectations of what they had in mind for me to do- or worse what His expectations were of what He wanted me to do.. They don’t call the man upstairs a Higher Power for nothing you know…

So know that I could leave the PACS consulting world any day now and preach and prostilitze with the best of them at CCC since I have practice raising my own funds and all that. I even have the Pope’s mitre ready as well. Now if I could just pass the spirituality test….. but you have to make it past “In the beginning…..” and well, I’m just not there yet…