You Can't Fix Stupid

I was on a conference call the other day with a client who hired me to evaluate their marginally performing PACS and RIS and to look at options for replacement as well as options relating to a VNA. My first step before initiating vendor divorce proceedings is to always to see if this marriage can be saved, so I went to the vendor and asked if we could have someone come and look at the systems. The answer I got was:

“Support will complete an analysis of (the client’s) current stability issues to include looking at the database and a possible re-org if needed or required. We will provide a summary of findings on Tuesday's ...conference call with (the client). We will then prepare to send someone onsite relative to our findings. Resources are aware of the possibility of onsite time, but we first need to know and understand the issues at hand. “

Huh? Understand the issues at hand? What has my client been documenting for the past several years? What kind of ‘splainin’ do you need there, Lucy? Again keep in mind that the problems they have had have been documented out the ying yang and evaluated, masticated, desecrated, flatulated and every other “-ated” including probably masturbated to for months, if not years, so my response to the vendor was:

While I appreciate the efforts taken here I have a hard time understanding why it will take so long to schedule someone to come on site… (My client) have been documenting the problems….since day one and have been paying (a whole lotta money) per month in service for that privilege. Is it too much to ask to send someone on site NOW instead of waiting until your "resources" "know and understand the issues at hand" and delay this further with yet more calls and more discussions? Quite frankly if (you, the vendor) doesn't understand the issues at hand by now- after all the documentation provided by (my client) to (the vendor) over the past several years- talking about it further isn't going to do anything but delay this further. From my discussions with (my client) as well further delays and excuses are not what they want or need further nor is it what they are willing to accept.
I will be suggesting to my client that all further service payments be placed in escrow until the problems they have experienced have at the very least been addressed if not properly fixed by (the vendor). Paying (a whole lotta money) per month for service to experience the type of problems they have had is simple unacceptable. This has gone on for way too long and has been very well documented as well. I have at least two trees work of documentation here- I'm sure, or at least hope- you have the same there. I would respectfully request you have your service department provide copies of all the records and documentation that (my client) has provided (the vendor) over the past several years to the stated resources, have them review this, and then set up a time to make at least a two day on-site visit ASAP. Decisions need to be made by (my client) ASAP whether to stick with (the vendor) or look for a replacement source for their RIS, PACS, (and other clinical information systems). Merely talking about it will NOT get the job done. They need someone on site NOW.
Until such time as you can provide us with a time and date for someone to come on site and discuss this I feel that the calls (with executive management on the future of our relationship)….. to provide us with a summary of findings and ...to discuss product and business related issues will not be necessary. That said, I will defer this to my client to have the final say in this.”

Lo and behold late that same day we get notification that someone from the vendor’s service department would be out to my client's site within a week. When he did come out he found a number of issues that had could only be dealt at the vendor service level, not by the client’s IT department or PACS Systems Administrator. That was good. The changes to the system were made and the system performed better and was much more stable.

“Can you look at our RIS and other systems too?” we asked him. "I’m sorry, I only can address PACS.” Now I learned long ago to never shoot the messenger, having been the messenger way too many times myself, plus he was much too nice a guy and did fix the problems he came to fix so….we thanked him and went back to the well.

“We greatly appreciate.(your rep’s) visit last week and his ability to work closely with (my clients) staff to understand and improve the PACS performance. From what I understand (your rep) made some changes….that resulted in much improved system performance and stability. That is a great start. There still remain several issues that need to be addressed so we all look forward to reviewing a copy of (your rep's report) and the plan(s) of action that will be outlined as well as the associated timeline(s) to address these issues from (the vendors) support organization.
As (your rep) was only able to address the PACS, (you, the vendor) needs to set up a time to send someone else out to address the ongoing RIS and (other) issues as well. Optimally this can be one person but nominally two can come out as well, so let us know when this can be set up so we can have the right people from (my client) available.”

Their answer:

“On Friday, we can also discuss the need for additional support to address any RIS and (other) related issues and concerns. “

I love it. Let’s talk some more. So back I come again with this statement:

“One of the first priorities that needs to be addressed is getting someone on-site to (my client) to handle the RIS and (other) issues next as has already been done with (your rep) and the PACS. We will need a date and person(s) for that addressed ASAP.”

Their answer:

“We will discuss additional onsite needs tomorrow on our call.”

I love it again. Let’s talk some more…and more and more So back I come again with this more direct statement that left little room for interpretive error:

“It's fine to discuss this all tomorrow- just know there is an expectation on the part of (my client) that an on-site visit to address the RIS and (other) issues will be made. Just as with PACS, attempts to fix issues with these systems remotely to date have been unsuccessful so (my client) feels an on-site visit is dictated for these systems as well.”

I followed this up with yet another e-mail reiterating the same thing so there were absolutely no Cool Hand Luke moments. The vendor knew our expectations so….let's fast forward to the conference call. There were at least seven people from the vendor side on the call (that we knew of) including four stuffed suits pulling in six figure salaries, five from my client, and me. Lotsa lotsa bodies.

So we start out recapping what the rep did to fix the problems with the PACS. So far so good. Then we move on to the RIS. I ask “When can we have someone on site to review the RIS (and other) problems? “ No answer. I ask the same question again. No answer. A third time. Again, silence. By now I am waiting for the cock to crow like it did with Peter’s denial of Christ, yet the more I asked the more we were met with silence. Can someone- ANYONE- please tell me that you will have a warm body out here within the next 3 weeks? Silence. Madness. Now in Mark 14:67-72 it says the cock crowed each time after Peter’s denial but in Matthew, Luke, and John it said it crowed only after the third time. I would have been happy if it crowed after any time but the while there were a lot of vendor cocks on the call, not a single one dared crow at all. Finally the regional rep spoke up and said “We’ll get back to you by the end of the day with a decision.“ OK, that’s some progress, I thought. And low and behold, 25 minutes before the end of the work day, we get this very detailed e-mail:

We will send someone onsite to (the client site) before 4/15 and are targeting 4/11 and 4/12 specifically. We will be back in touch with further details.
Have a nice weekend!

THAT is what took seven people including four "management types" an entire day to get back to us on- that “someone” will be on-site? No wonder why this company is so "challenged" in the marketplace. They suffer from analysis paralysis with no one there making ANY decision let alone an executive decision. Without going into details this is a seven figure install and the customer has nearly paid as much again in service as they have for the system in the 5 years or so they have had it. That said is asking the vendor to spend $1,000, or even $2,000, to send “someone” out to assess a problem with one of the systems really too much to ask? Not in my book or in most companies books either but obviously it is in this companies book. Hell if this were a larGE-er company there would be 6 people on site- 4 watching the one person doing all the work and the other taking notes to insure that Sick Sigma is being followed properly.

Knowing that “someone” would be finally coming here’s what I wrote back:

We would prefer (the rep we know) to be (the vendors) on site person if/as possible given he has both a positive existing relationship with (my client) and knows many of the problems they have faced intimately, but in his absence "someone" else will do...I'm also sure (my clients administrator) will also make sure all the parties at (my client) are made aware of these tentative dates and will have them free up their schedules accordingly.
Have a great weekend!!

Do we really need to go through all this? No. Does the vendor really care about losing this account? No. Can the vendor afford to lose this high visibility account? No. Can you fix stupid? No.

To be continued…..

Gypsies, Tramps and Thieves

I was listening to the radio this morning and up pops an oldie but goodie that Cher did way back in 1971.....

I was born in the wagon of a travelin' show
My mama used to dance for the money they'd throw
Papa would do whatever he could
Preach a little gospel
Sell a couple bottles of Doctor Good

As the song went on I got to thinking- gee, that sounds a lot like my industry.

Gypsies, tramps and thieves
We'd hear it from the people of the town
They'd call us gypsies, tramps and thieves
But every night all the men would come around
And lay their money down

Even the vendors were represented well..

I never had schoolin' but he taught me well
With his smooth southern style
Three months later, I'm a gal in trouble
And I haven't seen him for a while
I haven't seen him for a while

So why do I think we are an industry of Gypsies Tramps and Thieves? Look at the definitions:

Gypsy: a laborer who moves from place to place as demanded by employment.

Tramp: a person who engages freely in promiscuous sex; or as the Urban Dictionary defines it “ Any woman who will open her legs for anyone, except for me.”

Thief: a person who steals, especially secretly or without open force.

Every year when I go to RSNA, HIMSS, and other trade shows I am amazed at the number of individuals who have moved from one company to the next…IMHO half of them should be collecting unemployment checks but instead their incompetence is often rewarded by them securing a better job with a different company at twice the pay. Does this make sense? Of course it does….That is one of the reasons I don’t have a “real” job in this industry.

The Peter Principle is stated in chapter 1 of the book with the same title: "In a hierarchy every employee tends to rise to his level of incompetence." In the 30 years I’ve been in this industry I’ve seen the Peter Principle applied time and again. This often affects people who lost their jobs due to attrition in a half hearted attempt to show profitability for the company’s quarterly or year end statement. “Look, we made money!! Of course we have no R&D or sales force left but we made money by reducing our overhead!!” The fact that sales wasn’t selling and leadership wasn’t leading that largely contributed to getting you into this fine mess to begin was somehow overlooked…. but these are minor details. Give them a nice farewell package and let them move on to screw up yet another company. This does not apply to all individuals- there are some very good people in our industry who have done exceptionally well and deserve an upward move- but there are some "moves" that I've seen that just completely defy logic.

At times it seems like no one is minding the castle or even cares. I recall several years back when I was asked to come join the sales force of a major PACS company who were holding their annual sales meeting down here at Disney- at the Grand Floridian no less. This week long foray had to have easily set the company back $1M with airfares, hotel charges, luxury meals, etc.- for a sales force that hit all of 74% of its quota. I laugh when comparing this to my times working for Motorola in the late 70’s where we ended up having our sales meeting at a divey Best Western in Cordele, Georgia. We all wondered what we did wrong to deserve this locale- the land of Stuckey’s pecans and shelled peanuts- and the answer came quickly- “You were at 96.7% of quota- close, but we don’t pay you for getting close. When you hit quota you get rewarded, when you don’t you count your blessings you still have a job. You have 90 days to get the numbers up- let us know what we need to do to help you..“ That was it- short, sweet and direct. And you know what? We never missed our quota again.

The contrast between the two companies was stark and is one of the reasons why “big spender company” still hasn’t turned a profit in many many years…and probably won’t for a while either. While “leadership” is finally taking steps to bring spending into control they are doing it the wrong way- by cutting areas that don’t need to be cut, not hiring as many people as they need while burning those they do have out and….but that’s a big company for ya…That’s why I love the little companies…..they think small…and even a few medium size companies who still think like a small company. They see it paying dividends in big ways.

While I'm at it because you hold the title of Senior VP, President, or CEO of the company doesn’t mean you need a limo to take you to McCormick Place or that your require a suite at the Fairmont with fresh fruit platters delivered daily and plenty of space for your handlers to roam about. Get a regular room, meet in the restaurant and take the bus- you might actually learn something about your company as well.

So how does mediocrity continue to thrive in our industry? I guess no one read Ephesians 4:25 “Therefore each of you must put off falsehood and speak truthfully to his neighbor, for we are all members of one body.” If anyone did speak truthfully about the people who were up for various jobs most wouldn’t be in positions they are in now, but the threat of lawsuits is so prevalent that no one dare say anything negative about anyone. There are also always seemingly valid excuses for not making quota, for the company not growing etc. It’s like dealing with my kids when they were younger- it was NEVER their fault and always related to circumstances beyond their control. Thankfully my sons have matured and they now accept responsibility for their actions- most times .

Only once in my decades in this industry have I found a situation that was outside a person’s control where I said you have to leave. This one company was beyond unreasonable when a friend of mine was given a quota for a relatively small territory in South Florida. His quota was larger than what all companies in the entire state of Florida combined would be able to even come close to hitting if all the planets were properly aligned. He was a top performer too and left soon after. Now is making four times what he would have there with one quarter the pressure and at a much better company. He was the exception though, not the rule. Most just move on and do the same thing for few year until the company gets smart and sends them to more verdant pastures- or other companies.

OK, that’s gypsies. Now on to tramps and thieves. In my business- PACS consulting- tramps and thieves are often one and the same. Our business has taken a financial hit like many have plus we are now being inundated with wannabe consultants who head to Fed Ex/Kinkos, print business cards, and viola- they are an instant PACS consultant until they find the next real job and close up shop leaving their customers hanging. Some- but not all- of my counterparts have also started to compromise their own personal integrity by taking on just about any job that is out there to pay the bills. I understand their rationale but…I’m just not willing to sell out that cheaply- or at all.

I have had many jobs offered to me in recent years but more than half of them I pass on because I couldn’t see the value in them and hate taking money from a company for basically doing nothing- even if they see the value in their own request. With damn few exceptions I’ve been in this industry longer than most and can tell in a New York Minute what a company needs and what it doesn’t.

It’s the same with end users who come to me saying “We want to get rid of our incumbent vendor.” My first question is always “What is wrong with them and what steps have been taken to correct the problem?” In 80% of the cases we can save the marriage and move on. Now this doesn’t benefit me at all- I make a whole lot more money do replacement PACS that includes doing data migration and establishing a VNA- but doing what is right for the customer is what is paramount. As the late Michael Jackson sang:

I'm Starting With
The Man In The Mirror
I'm Asking Him
To Change His Ways
And No Message
Could Have Been Any Clearer
If You Wanna Make The World
A Better Place...
Take A Look At Yourself
And Then Make A Change...
(Na Na Na, Na Na Na, Na Na,Na Nah)

I‘ve only done one project in the past several years I didn’t want to do- a customer survey- but the company was insistent that I do it so I swallowed hard and I did. They hated what I found out (it was less than positive) and they had a hard time believing the results even though I had the e-mails from their clients that documented the findings. I’m sure they will now spend 10x what they paid me to take a more “scientific” approach like they did when they were employed by big boys who had more money than common sense and finally get the results they were looking for. Sounds like the methodology many rankings companies seem to take actually .

Thieves steal but isn’t being paid for something that will not benefit the customer the same as stealing? It is in my book. Is taking money for doing nothing stealing as well? Yes. Now I love retainers and yet hate them for the very same reason. Yes, I can make a company a much better deal work-wise if I know that money is coming in regularly, but please make sure I earn my keep by giving me jobs to do. It’s an integrity issue, pure and simple. You get paid, you do the work. Conversely it annoys me when you do the work and then have to beg to get paid months later too. Thankfully there are only a few companies like that…and most are the bigger companies where you are just a number…and where your invoice that will address next month’s payroll can just sit there because it is so low dollar value-wise relative to the other invoices in the queue.

So- gypsies, tramps and thieves? You bet!! It’s what makes our industry so special.

HIMSS, EHR'S, and ITS

It’s been over a month since I last posted but then it’s been a VERY busy month. I’m going to try and do much better but as I said I don’t make New Years’ resolution’s because I rarely keep them so…here ya go!!

HIMSS®- what an interesting show!! 1000+ vendors, 31,000+ people and I asked myself time and again why was I there? It wasn’t to increase press registration although just like RSNA® there were more vendors than attendees (16,586 vendors, 14,639 professional registrants, all willing to pay $3.00 for a 12 ounce Diet Coke® at the Orange Convention Center’s soda machines). Radiology, at least in the form of RIS and PACS, was all but invisible, hidden behind big company facades of products that more clearly addressed the buzzwords of “meaningful use”, EHR/PHR/EMR , and the like and not something as plain Jane or boring as radiology (although there was good representation by VNA and cloud providers.) Why then was I humped like a dog in heat from every advertising and PR agency this side of East Jesus asking me if I could spare “just 30 minutes” to meet with the companies they represented? I kid you not I got 178 e-mails on companies products and services- 178!!!. Of these exactly three (3) represented radiology and radiology-related products and the rest just wasted server space, although it was fascinating to see the way these companies market products for their clients. I loved the “Hi, are you going to HIMSS?” e-mails. Look, dip shit, you got my name from HIMSS as a registered member of the press covering the show but know I’ll be covering it remotely like the Casey Anthony trial….. watching TV and eating bon-bons on the couch but send me your stuff anyway…. just like one major company did by sending me their press kit on CD via Fed Ex overnight one week after I had already submitted my story to the editor. Good move. It would have been much better if you had done what others did having flash drives with your press kit on it in the press room. That would have guaranteed I had at least two copies of your kit were readily available when I needed it- and perhaps even more if you had then on 2GB or 4GB flash drives . Of course it must be pointed out that I was just obtaining these extras for my counterparts who could not make it and wanted their own copies and no other. I do have scruples and integrity you know…and do use the stock photos as well, so thanks.

I covered my thoughts on the show and a few highlights on AuntMinnie.com® (http://www.auntminnie.com/index.aspx?sec=sup&sub=ris&pag=dis&ItemID=94411 if you are interested) but the fun parts were really looking at the vendors and chatting with them. The giveaways here were awesome- check these out- scooters, jet skis, and of course at least 1500 Apple ®iPads.



Of course with the new iPad® coming out this week the ones that were won were already obsolete but still…I have a 6 year old computer that works semi-fine but my kids are still trying to get me over to a Mac.

I did the PACSMan® awards for RSNA on AuntMinnie ®
(http://www.auntminnie.com/index.aspx?sec=sup&sub=pac&pag=dis&itemId=93457 if you are interested) so here’s my version for HIMSS:

“Ich bin ein Berliner!" Some vendors really got screwed with their booth placement but few worse than poor Canadian-based Client Outlook, Inc who got stuck behind ECM Software’s Berlin Wall . Nothing like a 10’ wall in front of you when you are trying to have people see your enterprise viewer product. E-Unity® is a good product too- too bad many never got to see it. At first I thought “Hey, WTF is ECM doing here putting up a wall like this!!” but then I realized it wasn’t ECM’s fault but HIMSS for allowing this. Truth be known most of the radiology companies- at least first or second time exhibitors- were in the very back of the exhibit hall while several non-radiology first time exhibitors happened to be located near the front of the hall. Mere coincidence? You tell me…but considering that radiology was all but ignored by HIMSS…it sure looks highly suspicious to me.

Best Marketing- without a doubt XLR8r. They had it together.

Worst Marketing- No names will be used to protect the guilty, but it deals with infection control and I’ll leave it at that. I wish I could have taken a picture but guys tend to frown on you when you bring a camera in the men’s room so you’ll have to take my word on this one. I’m standing there getting rid of the morning's coffee and look down and there, written on the urinal screen, is the message “Your keyboard is 4 times dirtier that this” (or something like that). I’m like- “Is NOTHING sacred any more?” Now I’ve been in sports bars and such where they had the newspaper sports section posted above the urinal so you can look at the headlines while you take a leak but the urinal screen? And I really didn’t want to argue with the guys but in the absence of a disease condition urine is basically sterile and is greater than 95% water, with the remaining constituents, in order of decreasing concentration urea 9.3 g/L, chloride 1.87 g/L, sodium 1.17 g/L, potassium 0.750 g/L, creatinine 0.670 g/L and other dissolved ions, inorganic and organic compounds so what’s so dirty about a little pee. If it was good enough for Gandhi it’s good enough for me…. But alas I digress lest someone say I’m full of piss and vinegar.

Most Fun- Cattail Software’s Karate Choppin’ Buzz Lightyear™ giveaway. When I asked Heather Duffy, the attractive gal in the photo below, what the connection was to their product she said “The future is here.” OK, I get it…”To infinity and beyond!!!” and all that jazz. Next year though they need to get some Woodys so I could say “I got a Woody at Cattail Software!”. That might turn a head or two…

Best Giveaway (outside of the jet skis and scooters and such)- Formfast’s Indiana Jones hats….Must have set them back $15 each but it brought the people in for sure…

Silliest- Gotta love the “Operation” game in Sepaton’s booth

Best Product Name- ebc wayfinding's “Electronic Breadcrumbs”

Best Button- Extormity (aka MIE Medical Informatics Engineering) I love truth in advertising.

Best Double Entendre (and don’t tell me that’s not intentional either). Zebra Technologies.

Most Realistic Representation of How Much Going to HIMSS Costs- KGS/Kforce Government…Their TraumaFX® product was pretty cool although I’m not sure how it ties in to HIMSS outside…Now while I understand why they call the trainer MATT and acronym for Multiple Amputee Trauma Trainer that’s also my son’s name so…

Weirdest- WTF was going on in the Carefx booth with the “Glee” meets “Dancing with the Stars” routine. Three times a &(&^$ day…I though the guys in the Fuji booth were going to smuggle in shotguns by Wednesday morning….and it would have been justifiable homicide at that. Now I am all for corporate enthusiasm but his was carried wayyyyy to far…The decibel level was also ridiculous…..and the tie in? Now I read the company’s tenets- “Benefit of the Doubt”- trusting each other while knowing that all team members have your back while you’re giving your best; “Make It Great,”- the amazing collective energy by striving to improve each and every day and; “Juice.”- solutions, positive attitude, teamwork, and results while under pressure- but come on, this is a trade show, not an audition for America’s Got Talent. I guess I missed it. Maybe if they had a guy dressed as Jesus it would have been better received, playing off their “I Am…” tee shirt giveaway instead.


They’re Tanned They’re Rested, They’re Back!!- …and I loved chatted with them. I smiled hearing the comment “AT&T® is entering the world of healthcare!!” Really now? Ever heard of CommView®? No? Oh wait, that was before you were born my little 22 year old puppy…...my bad…

And last, but not least, from the “I sure hope they paid you a lot for dressing up like this” file, the guys at TeraMedica® who had to endure four days of dressing up like a male version of Betsy Ross to drive home the company’s “Declare Your Vendor Independence ™” message. It’s a great message but…..

Now for those dozen or so people who actually read this blog and wanted a follow on to my prior post here is an update:

I got over the cold from Hades that destroyed my one and only vacation week between Christmas and New Years and now just have to deal with everything blooming down here. Yes it is Florida and yes everything is in bloom. Thank God for Claratin® D and Zyrtec ® D- I’ll live on the stuff for the next 3 weeks or so. Unfortunately wearing contacts is out of the question so I get to embarrass my son by wearing my 1980’s vintage glasses instead. …

Business has picked up to the point where I am about as busy as I need to be (but in typical consultant fashion there is always room for one more engagement. Call NOW!!). With over 25 years experience being on my own I have gotten used to this month to month hand to mouth existence and never once missed a mortgage payment or had to suffer some of the hardships that others have had to endure.

My friend is back from addressing the challenges he faced and has a completely new positive outlook on life. While it cost his insurance $16,800.00 for 30 days treatment (what a racquet!) it was worth ten times that to those of us who have witness this near complete transformation of this train wreck that was waiting to happen.

Things seemed to have worked out on the home front as well. The bump in the road I experienced took all four tires off the road for long enough to have me concerned, but thankfully I’ve been driving long enough to be able to recover and stay on the road instead of hitting a tree. I realized that cruise control can only go so far and that I need to look at the road a little closer to make sure that bumps like this don’t happen again but so far so good.

Overall life is good. Now if I can just get another post up in less than 6 weeks it will be even better. Till next time, enjoy!!