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The 2009 PACSman Awards: Red, black ... or both?
By Michael J. Cannavo
December 3, 2009

CHICAGO - There is nothing like taking a six-day, five-night Caribbean cruise with two teenagers three days before the RSNA conference to prepare you for the show. I plan on justifying the expense to my accountant by saying I needed practice with all-you-can-eat food and wonderfully stiff drinks on the Love Boat to help me get ready for this year's marathon event at McCormick Place.

Little did I know the number of cocktail parties this year would decline as much as attendance did (despite official protestations to the contrary), but I still got enough party invites to make it worthwhile, even if just a few still offered a full open bar. Having three exhibit halls instead of two contributed to my feet aching more than normal, requiring me to break down and spend $14 after day one on a set of Dr. Scholl's tricomfort orthotics because I could no longer feel my legs by 6 p.m.

Michael J. Cannavo

Those who know me know that my spending that much money is as much of a travesty as Elin using one of Tiger's clubs that he made $100 million with last year to smash out the window on his Escalade to "rescue" him. But but sometimes ya just gotta do what ya gotta do.

A closer look at official show statistics won't be available until January, but of the 700-plus exhibitors this year, a number that was equal to last year, more than 100 were first-time exhibitors. And those choosing to be identified as Integrating the Healthcare Enterprise (IHE) companies constituted just four.

Square footage in the technical exhibition was also stated as "well above current industry forecasts," whatever that means, but in booths of the major vendors, you could pretty much dance due to the openness. Less equipment means less staffing, which in turn reduces show costs.

So what was PACS like at this year's show? The best I can relate is to the television ad for Enterprise Rent-A-Car, where the wife (girlfriend) holds up red and black negligees and asks her husband (boyfriend), "red or black?" to which he answers "both."

Ladies, go ahead and say it now -- he's a typical male. The truth is, he knows what is underneath it and he knows what's (probably) in store for them both later that night (if he doesn't fall asleep first), but he gets to pick out the negligee while she finds a way to tease him once again. Hopefully he'll get to enjoy it while the lights are still on, as well, even though statistically more than half of all couples make whoopee with the lights off (go figure).

And so it was with PACS this year: lights on, lights off, it was PACS in a new wrapper once again, but it's the same PACS underneath. That's not necessarily a bad thing and can even be exciting if you're in the right mindset. Lots of PACS were repackaged, re-engineered, re-energized, and re- this and re- that, but underneath it's the same old PACS.

I also found it fascinating that companies seem to be distancing themselves from IHE and, instead, are using the XDS moniker to make it look like they are doing something different. With adoption of IHE painfully slow and limited to just a few of the majors -- and even then in a very limited fashion -- vendors need to do something to take advantage of the trend toward establishing an electronic health record (EHR) and possibly accessing available American Reinvestment and Recovery Act dollars. XDS support seems to be it, even though few even discussed this.

Teleradiology services were all over the place, with telemammography the big deal this year. With quoted prices like $35 for a final CT read, most rads are like my good friend the Dalai who have to choose between fighting them or surrendering. The Dalai used to have his countdown to retirement clock on his Web site before he realized that with declining reimbursement, he'll probably be 96 (or dead) before he can retire.

Integrated radiology and cardiology systems were shown by most of the major vendors, not just blurring the line about what a PACS is but setting up the battleground of who owns PACS, as well, and who makes the final PACS decision. So far it seems like IT is winning ...

The Big Six PACS vendors are also fighting back against the Goliaths who are trying to gain a foothold in the marketplace by establishing vendor neutral archives (VNAs), but so far the battle has been uphill, with the Goliaths winning. The majors are trying to expand what has been a radiology-centric archive to a fully deployable VNA, but the IT community is skeptical given the fact that so many radiology archives still have proprietary elements within them.

Probably the biggest new trend was the promotion of cloud computing. Simply put, a cloud-based system allows multiple disparate systems to upload images and reports to a central data repository, or "cloud," and then resend them out to various clients from a single site.

The cloud is responsible for consistently formatting everything in a singular fashion, so that it can be read by the Web-based viewing software on the receiver's PC. This is typically aimed at the primary care physicians as opposed to radiologists but can be used by both. The upside is that a primary care doc only has to get information from a single source instead of querying multiple disparate systems. The downside is that the hospitals that own those multiple disparate PACS and RIS have to pay what amounts to a fairly significant sum for cloud usage.

It was a fun year, so here are the 2009 PACSman Awards:

The Paris Hilton Award

To the bimbette who snuck her Chihuahua into one of the bigger parties at a prominent Chicago museum, and somehow it got loose. Word was that the facility's security force was not amused.

The Turn the Other Cheek Award

To the company that showed sumo wrestling in its booth. Sumo wrestling has a very high relevance to radiology -- and as soon as I figure it out I'll let you know what it is.

The Frank Sinatra Award

To the company who did it "my way." Of course, these guys have been marching to the beat of a different drummer ever since Wilhelm was around.

The Feng Sui Award

To the powers that be who decided that two halls weren't enough, and we needed balance by moving to three. Word has it Dr. Scholl's contributed $150,000 to the RSNA Educational Fund this year for making this change

The Big Brother Award

To the vendor who decided to embed RFID in the tags its people wore to determine how much staff it needed this year. By using the information gleaned from the RFID tags last year, this vendor found out that nearly one in five of the people it brought to RSNA spent less than 15 minutes TOTAL time in the booth -- and they brought a LOT of people, as well. This year they cut staffing by almost half. Now that's what I call smart. I see every exhibitor attendee turning over their badges now, looking for an embedded RFID chip and saying, "What the #@%$!??!"

The Buzz Lightyear Award

This former PACSman Award winner just can't lose by stepping all over itself once again. I can hear old Buzz now: "To PACS ... and beyoonndd." Gimme a break, will ya. Next year maybe they'll get a Woodie award ... but I doubt it.

The Reverend Jim Jones Award

This vendor doesn't typically sell PACS outside its core constituency, yet keeps drinking its own Kool Aid by hyping itself as the next Great White Hope. I've never been a huge proponent of KLAS rankings, but when you get a D ranking for large PACS and an F ranking in Community PACS and don't even compete in the Ambulatory market, typically you don't tell the imaging world you have it all together ... but we'll just have to see what next year brings.

The Deliverance Award

"Paddle faster -- I hear banjo music." Gotta love the full-sized photo of Carl holding a banjo -- and you, too, can have your photo taken next to him as well. Soieeee soieeee ...

The Wizard of Oz Award

To the company that helped show everyone that unlike the scarecrow, I do indeed have a brain -- even if it was superimposed over the empty shell of my cranium and had a key embedded in it.

The Three Dog Night Award

To vendors that once again overused the word "one" in their marketing collateral. Don't they know that one is the loneliest number that you'll ever know? Their concept marketing was only exceeded by those that used the word "any" ...

The Mac Daddy Award

The Dalai would love these guys -- all Mac radiology solutions, all the time.

The Home on the Range Award

To all the companies that are promoting cloud computing ... where the buffalo roam and the skies are (not) cloudy all day.

The Little Jack Horner Award

I had to wonder if I was at a cosmetology show or a radiology show, but my right thumb got polished very nicely by this nail company -- and for a mere $49.95, the other nine digits could look equally shiny. Ah, no thanks.

The Secret Service Award

To those companies that still held parties this year but kept the guest list tighter than ... well, I won't go there. It was easier to get into a White House state dinner than it was an RSNA party this year -- but thankfully my charismatic ways helped me wrangle a few of the more sought-after invites. Has anyone seen a little doggie out there among the diamonds and dinosaurs lately?

The Man in the Mirror Award

To the company that best provided a definition of the PACSman -- Realist, Rebel, Visionary, Protector, Fighter, Survivor. And yes, I am all those things and more. And we won't go into the "more" either ...

The Tim the Toolman Award

To the company that offered a software suite that consisted of two words -- Power Tools. Ya gotta love 'em ...

The Jackson Browne Award

This OEM software provider's name has nothing to do with its product, but when I look at it, all I can do is think about Jackson Browne's song "Rosie" that is an eloquent tribute to life on the road.

The Bob in Bangladesh Award

To all the teleradiology companies who say it's better in Bangladesh ... or, at the very least, cheaper.

The TV Award

Growing up, we had a Zenith TV set where I was the remote control ("Would you change the channel for me, please"), and that is all I could think about when I read this overseas company's goal of "pursuing the zenith of accuracy in medical diagnostic" (and yes, that is exactly how it reads).

The Tadpole Award

This company took the concept of being at the right place and right time to a new level by having a four-foot square photo of them there lil' baby tadpoles fertilizing an egg. I keep hearing that Dr. J song in my head. Ah, no thanks. My kids are 16 and 18 now, and I'm on the downward side of life. Sit on a bag of peas for a day as I did 15 years ago and you, too, can enjoy life as it's supposed to be.

And this years PACSman Award goes to a place you never ever heard of:

RIP Barro Mexican Cuisine, aka Salvador's, at 73 E. Lake St., ranked 2,974 out of 4,517 Chicago restaurants for quality, with zero five-star ratings, three four stars, one three star, one two stars, and two one-star rankings from seven total reviewers. For the past decade, this hallowed haunt has been the hangout of the AuntMinnie editorial crew for our annual El Grande dinner, where we skewered vendors and attendees alike over wonderfully strong drinks and lousy Mexican food.

Upon arrival for this year's dinner, we were greeted with a dark, vacant storefront and a sign that said "Thank You, Chicago, for 25 Great Years." Most times we were the only ones in the restaurant, which made the ambiance even better (and, unfortunately, probably contributed to their untimely demise as a Chicago hallmark as well), but nothing can ever compare to Barro. I'll miss the 24-oz El Grande margarita that few could finish, but if you did, no one -- not even your mother -- was safe; the great fried ice cream; and of course the infamous Pipi Room.

If you know of a Mexican restaurant in Chicago that has strong drinks, mediocre ambiance, and lousy food where we can be totally incognito, please let us know because the El Grande dinner just isn't the same without it.

Until next year -- olé!

By Michael J. Cannavo
AuntMinnie.com contributing writer
December 3, 2009

The PACSman Awards are intended to provide a light-hearted approach to the RSNA show. Unbeknownst to many, the PACSman is indeed a real journalist, having received his BA in communications from the University of Central Florida in 1977. He has authored more than 350 articles about medical imaging, including the PACS Secrets and Building a Better PACS series on AuntMinnie.com, so to reward him for his efforts over the course of the year, we give him free reign to do the PACSman Awards. The last time we checked, Mike has not won a Pulitzer Prize for the Awards, although a few companies have taken out contracts on him for what he says about them. That said, the PACSman Awards are not meant to be anything other than an alternative to mainstream RSNA press coverage, something that we hope makes you smile from a guy who, by his own admission, has been in this industry way too long.

Related Reading

Building a Better PACS: Part 4 -- Warranties and liability, September 15, 2009

Building a Better PACS: Part 3 -- Look before you leap, July 2, 2009

The DRA and PACS: One hospital's story, April 14, 2009

Building a Better PACS: Part 2 -- Standards, guarantees, and flat-rate pricing, February 19, 2009

Building a Better PACS: Part 1 -- Making it work for end users, February 2, 2009

Copyright 2009 AuntMinnie.com



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