The 2010 PACSman Awards: Much ado about ...

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CHICAGO - Anyone going to RSNA this year looking at PACS knew not to look for anything earth-shattering. Sure, there were lots of advances, but most dealt with new features and functions such as 3D PACS and upgrades to existing software more than anything else.

Meaningful use (MU) of healthcare IT -- required to receive stimulus funding from the U.S. government -- was talked about in no fewer than three educational presentations, but only more than a handful of the 400+ companies showing PACS and RIS actually addressed meaningful use in their booths, and it was mostly on a superficial level.

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Michael J. Cannavo

Interestingly, while the presentations talked at length about how radiologists can qualify for American Recovery and Reinvestment Act (ARRA) dollars, certification is just starting to take place in the radiology space, with only one vendor that I saw on the show floor showing that their technology has been certified.

Most vendors are looking at mid-2011, at the earliest, before they will become certified, and even then the systems will probably not come close to meeting the full criteria and measures for MU. This really requires a full electronic medical record (EMR) system that most radiologists are hesitant to invest in unless they belong to a larger practice or they own several outpatient imaging centers.

ARRA doesn't pay for systems -- it pays for compliance, and how you comply is up to you. Most RIS products will eventually be certified, but most won't do all that is required by stage 1 of meaningful use, and both radiology and cardiology PACS aren't slotted to be included in MU until stage 2 in 2013.

Nearly every PACS vendor at this year's RSNA show had different iPhone and iPad apps running -- some radiology-centric, some expanded out to include EMR-like features as well. All displayed various levels of success in porting their software to the mobile devices, with the biggest challenges occurring in getting over speed reductions that occurred when way too many wireless applications were running in McCormick Place simultaneously.

It should have been raining in the exhibit halls with the number of references to clouds this year, with no fewer than 30 vendors promoting their solutions that ran in "the cloud." A handful really got it, though -- mostly storage providers who leverage the cloud to address remote storage -- while the rest hung on the coattails of an industry that has yet to define itself.

The same could be said of vendor-neutral archive (VNA) providers. Interest was exceptionally high in establishing not just VNAs for PACS but archives that can be expanded out across a facility or even an enterprise. Data migration was mentioned here and there but not extensively addressed. That said, nearly all the majors recognize that they need to embrace VNAs or face significant market backlash.

The number of teleradiology services providers remained fairly constant, but teleradiology software developers themselves have all but evaporated, instead becoming incorporated into PACS. The same can be said of peripheral manufacturers. There were just a handful of CD burning companies, digitizer providers, and the like showing product, most of these the market leaders.

Computed radiography (CR) and digital radiography (DR) systems were all over the floor, with advances to that technology shown as well. Wireless CR was a big hit, as were some of the advances shown with DR. Some of it bordered on the downright ridiculous -- more might be better, but do we really need a 48-megapixel DR system? -- while others were just intriguing, like the combined CR/DR offering shown.

The speech recognition market is heating up some with competition to the industry leader being offered, but adoption rates are still fairly slow and steady.

There wasn't the heavy-duty promotion of RIS that I expected, despite the push for MU and ARRA dollars; however, structured reporting and decision support were both being looked at very closely.

Few vendors talked about Integrating the Healthcare Enterprise (IHE), although there was a very good IHE connectivity demo running. Fewer still talked about the XDS standard -- just one vendor directly addressed this -- and everyone just assumed we'd get there eventually.

Integration wasn't that big a deal this year. Again, it was assumed that integration would just magically happen. More frightening were reports like the one that came out this week that said 92% of all respondents to a KLAS survey said they did not plan on replacing their PACS next year. That means you are going to see dogfights (and pricing discounts) that would make the Red Baron look like student pilot.

One interesting trend was the number of PACS vendors who have elected to develop their own advanced visualization software versus the third-party solutions that have been the trend for years. I'm glad to see reinventing the wheel isn't dead.

There were -- thankfully -- very few new PACS vendors, yet several vendors that play in this market were conspicuously absent from the show.

Overall, it was an intriguing year for healthcare IT, but not one that would have justified the trip to Chicago in and of itself. The number of postshow parties was down significantly. Several of the big parties were tabled for various reasons -- but on the plus side, the AuntMinnie crew found a suitable replacement for our annual El Grande dinner, replete with orange walls, a PiPi room, and even line-dancing lessons, so life is good again. Thank God for small miracles.

And with that all behind us, here are the 2010 PACSman awards:

The St. Francis of Assisi Award to the company whose 20 x 30-ft booth consisted of nothing but a white carpet, a congruence symbol, and a desk with two gals manning it. They took to a new level the saying "Preach the gospel at all times; if necessary, use words" that was attributed to St. Francis (but really wasn't said by him).

The Jackson 5 Award to the company that had the words "As simple as A, B, See" to describe their PACS.

A, B, C,
It's easy, it's like counting up to three
Sing a simple melody
That's how easy PACS can be
(That's how easy PACS can be)
One, two, three, baby, you and me!

The Ah Choo Award to the company whose handouts were -- drumroll please -- facial tissues.

The Georgia on My Mind Award to the company whose products were named Ray this and Ray that -- and all I could think about was Ray Charles or Sweet Baby Ray's Barbeque sauce.

The Ogden Nash Award to the company that covered all the bases shared by the limerick "Candy is dandy but liquor is quicker" by offering a huge variety of candy in their booth and an equally huge variety of drinks at their party.

The Wife and Lover Award to the Chicago nightclub that scheduled two competing company parties on the exact same night at their location. Nice move -- not!

The Hebrew National Award to the company whose legal department put the kibosh on their customer party for the first time in more than a decade due to concerns over running afoul of the National Electrical Manufacturers Association (NEMA) code of ethics for vendors. This despite the fact that many other NEMA members didn't see it that way. "We answer to a higher authority," indeed.

The Grace Under Fire Award to the major PACS vendor whose Sunday night party started out under the cloud of Murphy's Law, with buses being delayed due to Da Bears and incredibly long registration lines for those wanting to register onsite. But they once again pulled off a wonderful party in grand fashion.

The Hot Air Award to the company that has changed product direction three times in as many years (we're an MSP provider -- no, a VNA provider, no, a cloud provider) and consistently bad-mouthed its competitors, yet didn't even bother to show up at the RSNA conference themselves. Actions speak much louder than words.

The Don Rickles Award to the company that had hockey pucks with its logo on them as giveaways. I can see the excitement now -- "Look what I brought you from RSNA, dear -- a hockey puck!" Next year, stick to chocolates.

The Viagra Award to the structured reporting company whose product makes it sound like when you use it, you'll get bigger and better -- sorta like half the 431 e-mails I had waiting for me when I got back from the show. OK, who's been talking?

The Scarecrow Award to the two companies that handed out stress balls in the shape of brains. Are they trying to tell me something?

The Harvest Moon Award to the company that offered free shoe shines to anyone who would sit down ... and while you were captive gave you their extended elevator pitch. "Shine on, shine on harvest moon. ..."

The Both Sides Now Award to the plethora of companies -- with a few exceptions -- that had references to cloud this and cloud that, but really couldn't relate completely how clouds affected their company. Judy Collins sang it best:

I've looked at clouds from both sides now
From up and down and still somehow
It's cloud's illusions I recall
I really don't know clouds at all

The Listerine Award to all the companies that showed blown-up photos of faces on their booths and didn't at least airbrush the plaque from around their teeth.

The Full-Circle Award to the companies that used 360 in their marketing messages. While I'm sure their intended message is to show that they provide their customers with complete coverage, I can't help but interpret it as spending good money to bring you right back where you started from.

The Doublemint Award to the company whose product combined CR and DR together to create two, two, two imagers in one ... also known as the Certs Award.

And finally ...

Two years ago, I broke with tradition and gave an award for good marketing to women's imaging vendor Hologic of Bedford, MA. Not unexpectedly, they still seem to have their act together relative to product messaging.

Then last year, the annual PACSman Award went to the divey little Mexican restaurant the AuntMinnie staff and I had been going to for more than a decade, but which unexpectedly went out of business after 25 years. After a long second day, we would kick back, relax, and laugh over great drinks and lousy food. I guess our once-a-year dinner wasn't enough to sustain them.

This year, as I looked at these massive booths with huge staffs and millions spent on marketing, one company's 10 x 10-ft booth along the perimeter of the McCormick Place floor stood head and shoulders above the rest. I had seen them here in years past and always wondered what they were doing here, but somehow this year I finally checked them out.

Their product was about as far from sexy and exciting as it gets -- making and installing MRI quench lines -- yet the excitement they held for their product and -- dare I say it, pride -- in the services they offered were unequaled anywhere. They were knowledgeable without being arrogant, confident without being cocky, unpretentious, and truly cared to hear what your needs were.

This was the one constant that prevailed as I listened to the company's owner talking with one customer after the next. You could tell he wasn't exactly supercomfortable in the monkey suit he felt he had to wear here, but that's to be expected when your nickname is "Sonny" and you spend most of your day on the shop floor with people your daddy hired when he founded the company in 1972.

The various marketing experts who visited him at the RSNA show had gently suggested that he consider changing the company name to something fancier and more suitable for the medical imaging community, but he told me he'd hear nothing of it. This was his daddy's company and his daddy took pride in what he did. So does he and his staff. And because he and his daddy shared the same name, it made the company transition that much easier when Sonny took over the firm in 1986.

On the home page of their no-frills website, their core values are prominently listed -- integrity, quality, satisfaction, and concern. He's a "No Bull" kinda guy in a marketplace well known for bull. I like that. So should you.

So, the 2010 PACSman Award goes to Ernie Chonko, president of Ernie's Welding and Fabricating of Largo, FL. That's Ernie's with a capital E.

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Sonny, your daddy would be very proud of you.

By Michael J. Cannavo contributing writer
December 2, 2010

Michael J. Cannavo is a leading PACS consultant and has authored nearly 300 articles on PACS technology in the past 16 years. He can be reached via e-mail at [email protected].

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group. Rather, they should be taken as the personal observations of a guy who has, by his own account, been in this industry way too long.

Related Reading

Building a Better PACS: Part 6 -- Data migration lessons, August 16, 2010

Building a Better PACS: Part 5 -- Vendor-neutral archives, February 8, 2010

The 2009 PACSman Awards: Red, black ... or both? December 3, 2009

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

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