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.