My mom was one of those stay-at-home moms in the 50s and 60s. Think June Cleaver from Leave It to Beaver, Harriet Nelson from Ozzie and Harriet, or even Morticia Addams from the Addams Family (although Mom never dressed in black unless there was a funeral to attend.) She was always there, apron on, with home-cooked meals, and someone to answer when I yelled out “Mom, I’m home!!” when walking through the door after school.
Mom was not only an amazing cook and good nurturer but had a brilliant mind as well. She easily could have been a lawyer at a time when less than 3% of all women were attorneys. Since going to law school with two kids and a husband was not an option, Mom elected to go into politics. For anyone else, that would have been a great choice. For Mom, it was not so great.
Mom was a tell-it-like-it-is person who believed the 11th commandment should have been, “Thou shall not lie.” She ran for political office in our town twice and lost, not just because she was a Democrat running in a predominantly Republican town, but because she said the things that people didn’t want to hear. They needed to hear it but they didn’t want to hear it.
With many things she was ultimately proven correct, but few remembered what she said when she said it. Those who were voted into office tap-danced around why their decisions weren’t proven to be correct and everyone just accepted that as truth. Mom went on to be a congressional secretary and took on various positions locally like Chairman of the Planning Board where she could do and say things that were in the best interest of everyone. I inherited many of her traits, even though some might say most of what I say isn’t in everyone’s best interest.
Lies of omission
Cutting through the vendor bullshit isn’t easy and frankly there is a lot out there with PACS and especially AI. People are pretty much told what they want to hear, not what they need to hear. While few companies actually tell lies, outright lies of omission sadly are many. This is especially prevalent when dealing with AI. You never asked me, therefore I have no obligation to volunteer that information. That is blatantly wrong.
I have been in this market since the early 80s and have seen more companies come and go that you can shake a stick at -- many, many hundreds. Surprisingly, most didn’t fail because their product sucked. Well, a few did, but they weren’t the majority. Truth be known, if you took every PACS and every AI product out there they all basically do the same thing.
The differentiators are the advanced features one company may have that another doesn’t. Just having those features isn’t enough, though. It’s explaining -- no, showing -- how the features can improve day-to-day operations and in return show a return on investment. Most companies have the same basic message or rely on studies to show that their product is better than a competitor’s.
The right choice?
But is it 1% or 2% better to choose them over their closest competitor? If their competitor has been in the market for three years longer, have a few dozen sites fully operational, and have $50 million in the bank to fund them long-term are they a better choice … unless of course you get to use the newer system for six to nine months for free to evaluate it? Most of what you see in terms of references are also far from transparent. Take them all with a grain of salt. It’s like seeing a bad image at the RSNA meeting. You see some now and then, but for the most part they are all picture-perfect.
More often that not a radiology group wants a new PACS or AI offering but simply can’t justify it. That is where I come in. Simply saying, “I want it because it’s too old or doesn’t do this or that,” just doesn’t cut it. The boys upstairs who control the money will ask two questions. Number one, does the system you have currently work? All will say yes. Number two, why then do you want a new system?
There may be logical reasons like having the PACS support the latest operating system or hardware that reached its end of life and is obsolescent, but there usually still needs to be more. PACS isn’t a car that has 200K miles on it that will cost more to keep then replace it. If so, why has it taken you so long to come to the decision that you need a new one?
Kia or BMW?
My car has 144,000 miles on it and is in great shape. No way would I trade it even for a new one. If it’s drivable, then drive it. If it won’t drive, then we evaluate if it is cost-effective to fix it or get a new one. But don’t choose a BMW, Audi, or Lexus when you have done well with a 10-year old Kia that gets you from point A to B. Can you have those? Yes, but you need to justify any added cost and think it through carefully.
I had every intention of retiring December 31, 2025. I planned several day trips including working with elephants near Sarasota, FL, in a few weeks, flying all the way to Maine to see a concert at a 200-seat venue from a guy very few have heard of (unless you are Canadian, that is), hitting a handful of concerts down here at the Orange Blossom Opry, and over the course of this year taking in three major trips -- 10 days in Sicily in May, a 9-day cruise to Alaska in July, and 5 days in New Orleans in October. That’s the plan, at least so far.
What I didn’t look at was what is in between. What I have planned is great but in between is a big fat zero -- nada. I wake up in the morning saying, “O.K., what’s on today’s agenda?” and look at my schedule planner and it's empty. I’m gonna have to start penciling in, “take a shower” so it feels like I got something done. Yes, I could do some volunteer work but I have a personal problem with people who abuse the systems that are trying to help them. A hand up, yes; a hand out, no.
My politically correct side is reflected in a tee shirt the other day that says “You know that little thing inside your head that keeps you from saying things you shouldn’t? Yeah, I don’t have one of those.” My mom would be so proud … It’s not all people who are bad … just like vendors, it’s just a few … but that’s enough to make it out of the question for me to do volunteer work lest I say, actually say, what I am thinking when I run into these folks.
Upsize or downsize
The thrift stores I frequent would love to use my expertise (I am the garage sale and thrift store king) but frankly I would end up taking way too many things home that I feel I just can’t live without. That is why my house looks like a personal storage unit. I should pay myself $250 a month just for storing this crap ... um, excuse me, fine-quality merchandise. I am trying unsuccessfully to downsize versus upsize, but … I’ve had no success so far.
Being a lector at the church is only an hour a week at best. While I have several decades experience as a fallen Catholic starting as an altar boy at age 6, I don’t want to be at the podium reading the Gospel under false pretenses. I am chief of all sinners even though I try my best not to be. It’s all this damn free time I now have, I swear. That has to be it. That said I can’t use serving the church as an excuse for too many decades of sinning before. That’s just not right either.
Still available
I made the decision to stay working a bit here and there and take on a few short-term gigs. Those include helping those looking at PACS and AI focus on getting the answers they need. This also includes helping those in the investment community who have as many questions as they do dollars to invest.
With end users, hospitals, and radiologists, there is actually more of a need for short-term help than consultants who charge you a fortune to hold their hand from hello. Most who still do that are directed by the people upstairs to have someone to take their place against the wall if the decision they make turns out to be wrong.
After over 40 years, I’m convinced you don’t need a consultant to be there during the entire PACS replacement process. If you do, you need to look very closely at your organization. AI is a little different but it’s also a much shorter engagement that starts by looking closely at the TCO (total cost of ownership) or ROI (return on investment) first. Although there are exceptions once again, generally if you can’t justify the purchase you can’t have it. It doesn’t have to be a financial justification, but a justification nonetheless. That said, there are a lot of variables with AI to consider. A consultant can help out there if they know the questions to ask but ONLY if they know the right questions to ask.
Future podcasts
So what’s next on the podcast? Since the market has changed from on-prem systems to cloud solutions I’ll discuss the new kids on the block with PACS vs the established players, and what they need to do to be a success, I’ll also have several discussions on the AI market and AI vendors -- which 100 or so of the 1,400 who have the FDA’s blessing to sell will survive and why, how changes in the European market might help jump start AI, and so much more.
If you have something you want to delve into, email me at [email protected] and I’ll address it in a future podcast. I plan on doing these every other week or so, so there is a lot of ground to cover and all sorts of time to cover it.
Michael J. Cannavo is known industry-wide as the PACSMan. After several decades as an independent PACS consultant, he worked as both a strategic accounts manager and solutions architect with two major PACS vendors. He has now made it back safely from the dark side and is sharing his observations.
His healthcare consulting services for end users include PACS optimization services, system upgrade and proposal reviews, contract reviews, and other areas. The PACSMan is also working with imaging and IT vendors to develop market-focused messaging as well as sales training programs. He can be reached at [email protected] or by phone at 407-359-0191.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
