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…..

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.

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.

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.