Straight Talk From the PACSman: The Swiffer approach to RSNA

2013 10 08 10 52 12 712 Cannavo Mike 2013 200

To the uninitiated, attending RSNA can be as overwhelming as a teenager going on his or her first date. You have hopes and dreams about where things might go, but you really have no idea how to get there.

Those who have attended the show in the past are more like the newly divorced: You recall how the game is played, but you realize things have changed considerably since the disco ball glittered and you last danced to Donna Summer.

Most of the folks heading to Chicago in a few weeks aren't looking for a first date or a new suitor. They have been married to their vendor for a while, as comfortable as Morty and Lee Kaufman in the Swiffer TV ad.

Michael J. Cannavo aka the PACSman.Michael J. Cannavo aka the PACSman.
Michael J. Cannavo aka the PACSman.

Sadly, in many cases, the vendor-client relationship works about as well as the interaction between Morty and Lee: "Morty, are you listening to me?!" Morty, head back, eyes closed, responds, "Yes, dear," reflexively providing his conditioned response to Lee's query without so much as awakening from his stupor. Both parties hear what the other is saying ... but not really.

After so many years together, the "Yes, dear" response becomes automatic and listening skills need improvement. While Morty and Lee have had 44 years to sort things out, most vendor-client relationships have a fraction of that. They are beyond the honeymoon phase but not quite so comfortable as to be able to read minds.

The relationship can be improved, but it has to be done in such a way that it doesn't affect what attracted you to each other in the beginning -- and at a price that won't break the bank, either.

While the RSNA meeting offers you virtually every vendor you care to see (and many you don't, with hucksters who will try to reel you in from the aisles like a circus hawker), if you don't plan your trip, you'll become as disappointed as two kids with braces trying to figure out how to unlock after their first passionate kiss.

Here are some tips to make your PACS evaluations go better.

No. 1: Know your requirements

This goes well beyond "We want a PACS," "We want a replacement PACS," or "We need XYZ software." This doesn't mean you should come in with predefined notions or with singular solutions, but you should understand the problem, how it's affecting your department, and what your goal(s) are to solve it. Let the vendors explain how their product can solve your issue, then listen to their spiel. Understand that RSNA is merely a first date -- not a marriage commitment -- and that there needs to be follow-on webinars, onsite demos, quotes, and requotes, as well as detailed discussions with all stakeholders including IT on how this fits into the big picture.

No. 2: Set your priorities

The rock band Queen sang a great song that starts with the lyrics "I want it all, I want it all, I want it all ... and I want it now." The reality in today's budget-constrained world is that you are lucky to get anything at all, let alone what you want right now. That said, you need to clearly set and define your priorities based on the importance of the problems you are trying to solve. Don't be averse to being creative, employing leasing or volume-based licensing, repurposing hardware, or bundling PACS deals with other purchases. Another great way to get what you want is to deal with someone at a regional VP level or higher. If it makes overall sense for the company, they won't let a deal walk and can be very creative.

No. 3: Work from a script

If you are evaluating two or three PACS, make sure you do apples-to-apples comparisons. The best way to do this is to work from a script. Ask the key stakeholders what is and is not important to them, prioritize these items, and then rate what you saw in each area. Take notes on what you liked or didn't like about the product, then bring everything back to the stakeholders for discussion. This way, when you do onsite demos, you can make the most effective use of everyone's time, honing in on what's important and not wasting time on fluff that has little or no relevance to your facility.

No. 4: Consider if it will work with what you have, plus any trade-offs

One of the biggest mistakes people make is assuming. Vendors assume you'll ask the right questions to determine if and how a product will work for you, and buyers assume the vendor will tell them what they need. The best answer here is breaking down the word assume into three parts: making an "ass" out of "u" and "me."

Assume nothing and ask everything, even if you think you know the correct answer. I can't begin to tell you how many times I've gone into accounts that were dissatisfied with an implementation because they assumed the vendors knew their needs, and the vendors assumed they were told all they needed to know.

Who bears the responsibility here? Both parties. If you have a version of software installed now but plan on upgrading in six months, it's crucial for the vendor to know this, because while it may work now it might not after you upgrade. Worse yet, the upgrade might require software qualification that hasn't been done yet and puts you in application limbo. It's not just where babies go before they are baptized (my Catholic upbringing is showing), but worse -- a place where you are in suspended animation because the vendor won't support you until its qualification process is complete. The big downside of this is you never know if, or even when, that process is going to be completed. So even with a service agreement, you may be out of luck if you have a service issue.

No. 5: Make sure you have sufficient internal resources

I have seen many a well-intended project become a source of stress because the resources required weren't available. This often relates more to internal facility-provided resources, specifically IT resources, than external, but it affects both. Vendors plan their resources many months out. Vendor resources also may not always be available, so act before you need it. I tell my sons their chances of winning the lottery are three times better than not getting someone pregnant, so act both responsibility and prophylactically, and plan ahead.

No. 6: Have a contingency plan if it doesn't work

Mistakes happen, but an important step in any change-of-control scenario involves having a contingency plan in case things don't work out. This typically involves running the application in a test server environment before going live and working out any bugs. Don't have a test server? Candles are up to $1 each in church now (they used to be 10¢ when I was an altar boy). Light many. Better yet, buy a test server.

No. 7: Have a budget in mind -- but don't let it define your needs

Money is in short supply, but if you can build a business case for a product, you will be amazed how easily the money materializes (or gets redirected from those other entities who couldn't build their own business case). Vendors are used to selling products, but times have changed to where they now need to be a partner in selling solutions.

Budgets are good for establishing a baseline estimate of what a product should cost, but actual costs can be higher or lower. Many companies also offer a "light" version of software that doesn't have all the bells and whistles but may still meet your needs just fine. Bundling also works, where the cost of one or two additional applications you want increases the overall cost just a small percentage, not double or triple as you might expect. Bottom line: If it will increase productivity and save time and save money, you can have just about anything you want if you can make the business case for the purchase.

No. 8: Understand the difference between a data move and a data migration

If you have data somewhere and do not want to store it in a vendor-specific format, you need to choose a vendor-neutral archive (VNA). That also means you need to understand the difference between a data move and a data migration. Data moves typically involve moving data from your existing vendor's archive schema to your existing vendor's VNA. Isn't where the data are stored (the archive) the same? In a word, no.

An archive archives data; a VNA manages data. A VNA allows you to do purges and other tasks using intelligent (or image) lifecycle management (ILM) software, whereby most vendor archive software only archives data. Data migration typically involves moving data from the existing vendor's archive, be it network- or direct-attached storage (NAS/DAS), a tape jukebox, or other device, to a third-party archive (a VNA, for example).

VNAs are great, but migrating archived data to a VNA is neither fast nor cheap. Plus, if it's done incorrectly, it can affect your workflow. With a data move, you typically lose little, if any, data. With a data migration, you can lose the data stored in private tags and possibly other data as well. A data migration can also take up to 10 times longer to perform than a data move, due to the need to reconcile the data being migrated and a host of other issues, including the need to archive current data concomitantly.

No. 9: Understand time and cost -- what you'll gain and lose

Whether raising kids, buying a Swiffer, or buying add-on software, the initial costs pale in comparison to the long-term costs. Kids are a given -- the initial costs of "birthin' babies" pales in comparison to the actual costs of raising them, and the older they get, the more they cost, especially the cost of their toys.

I still miss my fourth-generation iPad that I had for a whopping 10 days until my youngest son home from college "appropriated" it. (The reasoning: "You are old and don't need this and it really will help me in school.") Now my used first-generation iPad and I visit the new one in Memphis because we old folks don't need anything new.

I also love my Swiffer WetJet, but when you factor in the four AA batteries it takes and the cost of pads, it's not cheap. It's worth it, nonetheless. Morty had a point when he asked, "How much dirt can two people make?" But even though it's just me and Elvis the Wonder Beagle, I can tell you, the answer is a lot.

Software costs goes far beyond the initial cost. If you spend $50,000 on software but get a 70% discount off list, you may think the cost is cheap at $15,000. Service costs are almost always based on a percentage of list price, usually around 15%, so service on your $15,000 software is $7,500 per year. This equates to 50% of the net price. Do you need service? Absolutely, so factor this in, along with training, implementation costs, internal costs (IT and department resources), etc.

No. 10: Don't forget the big picture

Administration and IT are both going to want to know how what radiology is doing fits into the big picture. This includes integration into an electronic health record (EHR), how it will help the facility achieve meaningful use stage 2 (and beyond), how what you have proposed buying meets new regulatory and other guidelines, and so on. Find out where the PACS vendor has integrated with your EHR vendor, what worked and what didn't, integration requirements, time to integrate, costs, etc. Have the answers ready, because the questions will be coming.

No. 11: Use consultants properly

Yes, I am a consultant, and yes, I earn my living helping clients through the very tasks I have outlined here. That said, I also sleep very well at night knowing I provide a fair value for my services. Do you need someone to hold your hand and walk you through RSNA? Not even Stevie Wonder needs that.

Save the money and plan your trip to maximize your time spent there alone and leave the consultants behind. Both you and the vendor will appreciate that. You should also figure out what you need before engaging third-party help. Do you need reports by the pound with bar graphs, pie charts, and a host of other graphics that few understand? I've seen some incredibly expensive bookends that are never looked at again once they are read and put on a shelf.

I would venture to say that 95% of all facilities can and should get some form of help, but make sure you properly identify the need for the services you are buying. PACS optimization is one crucial area to examine. So is workflow analysis and even staff augmentation. RSNA appointment setting and rep introductions are not one of these.

No. 12: Have fun

Like the Blues Brothers, you too are on a mission from God, but the RSNA can be a blast. Sadly, while the days of the mega parties are officially gone, most vendors will still take you out to dinner, so enjoy the "free" meal while you can. Don't be too serious. You should learn about the product, but it's equally important to learn about the company and also your account executive.

With any luck you will be working with them both for a while, and it's all about relationships. Wear comfy shoes -- sneakers, if you feel you can get away with it -- and don't worry about being a style king. RSNA is business casual; leave the ties and suits at home.

When you look at the cavernous entrance to the show floor at McCormick Place, with more than 800 vendors, you might feel like Lee trying to wring out her old mop: "I'm not big enough or strong enough for this."

If you plan ahead, though, and do it right, you and Morty can waltz your way through RSNA with a smile, saying, "It's almost like dancing."

Keep it clean, folks.

Michael J. Cannavo is known industry-wide as the PACSman. After several decades as an independent PACS consultant, he spent two years working as a strategic accounts manager with a major PACS vendor. He has now made it back safely from the dark side and is sharing his observations in this Straight Talk From the PACSman series. He can be reached at [email protected] or by phone at 407-359-0191.

The comments and observations expressed herein are those of the author and do not necessarily reflect the opinions of

Page 1 of 775
Next Page