The PACSman Pontificates: Pit bull and the PACSman

By Michael J. Cannavo, contributing writer

June 28, 2022 -- My mom raised my brother and me in a two-story 700-sq-ft house built in the late 1800s. I doubt it was even that big. That was her job -- raising the kids. My dad was a civil servant who worked three jobs just to keep a roof over our heads and food in our bellies.

Mike Cannavo
The PACSman, Mike Cannavo.

Ward and June Cleaver they weren’t, or anywhere near it. My brother was the golden child, at times closer to Mary Poppins than a growing boy. In nearly everyone’s eyes, he was perfect in every way. As for me, it seems I was the religious one in the family. My mom would call out “Jesus Christ, what have you done now!!” and for the longest time, I thought that was my real name.

I think I was 7 when mom took on a job as a congressional secretary. She only worked a few years at it before becoming Glen Campbell’s “Everyday Housewife” again. That was a pity because she loved her job and was very good at it. She would have made a wonderful lawyer too. That was her life’s dream. She was attractive, intelligent, and brought rhetoric to a new level. Every day I watched her in awe and learned from her as well.

Mom was also deeply into politics. Sadly, it haunted her most of her life. She was never a success in it because when asked a question she blurted out the answer whether it was the politically correct one or not.

She ran for election for the city council in our town of 8,000 twice and lost twice. The furthest she ever got was chairman of the planning board, but that was enough for her as women didn’t occupy many political spots in the early 1960s.

I often questioned if she lost the elections because she was a woman, a Democrat in a Republican town, or her directness and frankness. I question myself in that regard as well (although FYI politically I am registered as “no party affiliation”.)

In the past six months, I have been not only a bridesmaid but the maid of honor for several potential engagements. It was just me and one other candidate competing for the engagement and each time I lost the election. Was it my political correctness ... or lack thereof? Who knows?

Believe it or not, I can be PC when I need to be. But then requirements for credentials that were never listed on the requirements document suddenly became important. The need for a strong relationship with the electronic medical record (EMR) vendor suddenly took precedence over understanding PACS, long-term enterprise imaging strategies, and artificial intelligence (AI) for a PACS planning engagement. And I’m like, huh? What’s wrong with this picture?

I can reference several others equally insane (or inane) as that one. If it was just me I’d write it off each time as me being me but I was working through recruiters whom the companies had to tell why I wasn’t selected. It’s life but it’s more than a bit frustrating.

I am equally frustrated by so much else that goes on in the industry. Signing contracts has to be number one. The standard vendor contract offers little, if any, protection for the end user and never references how the system is supposed to work (workflow), instead using arcane specifications to somehow describe system performance.

This is like buying a car and the purchase contract says you just put the key in and some gas, start it, and it will go. Not how fast it goes, how comfortable it is, what features it has -- some you want and some you might not want -- what warranty protection you have, etc., -- just that it will go.

And when the radiologists revolt at having to deal with a car they never ordered -- but that others decided was the right car for them -- THAT is when I usually get the call “Help me Obi-Wan Kenobi!”

And I do, mimicking my days as a young child when I saw something that was broken and saying to my mom, “Don’t worry. Mommy Daddy fick it.” And fix it he did. Of course, there were times like when I went behind him with a hammer and helped him “fick” the window with my toy hammer he just ficked.

Now, Dad was a wonderful man and very reserved, but in moments like these, Ward Cleaver he wasn’t. The “teachable moment” contained a lot of words I also hadn’t heard from his mouth before either.

Most times the car doesn’t need to be replaced but just needs a few upgrades. The issue is identifying the upgrades that will help it meet your initial expectations. Again, this is an area that many sites fail to take into consideration. It’s easier to throw out the baby with the bath water instead.

In all my years of helping facilities replace their PACS, over 90% of the systems could have stayed in place if expectations had been better managed on both sides: “This is what it can do, this is what it can’t, and this is how it does it.” But that is so rarely done.

So many end users go through the ridiculously time-consuming and expensive request for information (RFI) and request for proposal (RFP) processes, spending months evaluating vendors -- some they had never even heard of before -- to find out in the end, all are rated pretty much the same. A dart thrown at a dartboard with vendors’ names on the board would have been just about accurate.

Again, without defining workflow, having reasonable performance criteria, acceptance criteria, and above all a good strong contract, a shot in the dark is the best you will get.

If Mom were still here I would have her do the contract review for me even without her having a J.D degree. She would be much better than hospital legal, too. When it came to so many things, she had the tenacity of a pit bull, as well as something so few possess: common sense.

Yes, she would be 98 years old but still as sharp as a tack. Experience is always the best teacher and with my experience working with over 350 end users and her common sense, it would be a win-win for everyone.

Pit Bull and the PACSMan Consulting, LLC. I like the ring to that … and mom gets first billing because, well, she is Mom…

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 developing market-focused messaging as well as sales training programs. He can be reached at 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

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