In the latest installment of our ongoing series, PACS consultant Michael J. Cannavo addresses the current state of confusion with PACS marketing and sales, and describes his solution -- using good old common sense.
One of the most fun exercises I've had in working with vendors over the years happened a little over a year ago. After discussing the company's products and services with various management types for about an hour, it became very apparent that each individual was either talking about different products or there was a serious disconnect in what I was asking them.
I did a simple test with the group, asking them to put on paper the top five benefits their PACS product offers. This they did, submitting their answers to me. From five different people in management, I got 18 different answers to five questions. On the plus side, seven of their answers overlapped. On the minus side, 18 didn't.
The exercise reinforced something I've known all along: PACS companies may think they know their products well, but most really don't. While they were singing what they thought was the same song in the same key off the same sheet of music, many were singing different songs in different keys. This cacophony adds to the challenges faced by a marketplace that is already confused about PACS.
The last thing a potential buyer needs is a PACS vendor that is lost about its own product. Worse than that, many PACS vendors don't seem to have a very good grasp about their products as they relate to market needs.
The last part of this is critical. Even those companies that do "get it" relative to their specific advantages and benefits often fail to relate these to particular markets or individual customer needs. Instead they tend to fall back on competitive selling, saying "We do this that they don't do," regardless of how or even if it impacts the customer's needs.
I loved getting a 13-page "cover letter" from a vendor that responded to an RFP my client had sent out that had things like "legacy system goes here" left blank and the customer's name misspelled at least twice. What's even more amazing is that all the sites in the "customized document" referred to mid-sized hospitals. This wouldn't be so bad if my customer hadn't been a multisite imaging center, yet as they were they could relate to almost none of it.
Blanket statements like DICOM conformance, or better yet 100% DICOM conformance, mean little or nothing. That's like Juan Valdez selling 98.9% pure Colombian coffee -- OK, Juan, where does the rest come from?
The same holds true for generalized statements that include words like "no," "anytime," "all," or even "flexible" -- they are just too broad and inaccurate to even be considered "reasonable." I've seen so many confusing diagrams, storyboard messages, and the like that I've just wanted to scream.
Just do it
Less is also more when it comes to marketing materials. Relate the marketing materials to the customer. Vendors keep forgetting that it's not why or even how they do it that's so important but simply that they do it. Stating advantages and benefits is also fine, but it has to relate to a customer's needs. Specificity is key.
If vendors are selling to a radiology manager or radiology group, as in the case of imaging centers, they need to tailor their message to them. Conversely, if they are selling to a hospital the message needs to be tailored to many individuals, not just one or two. The needs of larger hospitals also vary dramatically from those of smaller hospitals, so these need to be addressed in different manners as well. And in Europe, the vendor's PACS message needs to focus on the C-suite individuals (CEO, CIO, CFO, etc.) because they make the ultimate buying decisions.
So what's the answer? First, marketing needs to make sure everyone is singing the same song in the same key. Start with sales and product management, research and development, and other key areas. Marketing needs to get its act together and focus on product advantages and benefits relative to market needs, not their competitors. If you have a few vocalists who require "additional voice training," remove them from the chorus lest the song suffer.
Next, get rid of the way-too-expensive $2 to $4 each "say nothing, do nothing" brochures that are pervasive throughout our marketplace (and for that matter our entire industry) and rife with doublespeak and technical mumbo jumbo. Instead go to "stepped inserts." Stepped inserts are cost-effective single-sheet summary pages that provide focused detailed information about a vendor's products and services. The key words here are single-sheet and focused, allowing literature to be customized based on the audience you are talking to and changed on the fly as needed or as the product gets updated.
Finally, be short, sweet, and direct. That says it all.
PACS logic
Understanding a PACS quotation is more challenging than raising kids, because when the kids get older at least you stand some chance of understanding them even if you don't now. And although you don't know why they do what they do, you do understand "logic" from their perspective, however illogical their actions might seem.
I bet I've looked at over 1,000 PACS quotes in the past 22 years, and most of them made little sense to the untrained eye. Even to someone like me who spends most of his time going over PACS quotations day after day, I keep muttering that there needs to be a better way. I know what the vendor is trying to say, but just can't say it easily.
Everyone who has read my writings knows I'm a proponent of line-item pricing, with costs broken out wherever possible by hardware and software. Let's carry this a step further. Few, if any, vendors are willing to give up their proprietary names for what are basically generic terms -- file server, Web server, display workstation, etc. -- even if the vendor elects to argue that they do so much more.
Let's compromise then. If 51% of the functionality of your SDFSAM3 (Super Duper File Server and Much Much More) unit is to perform tasks generally associated with a file server, then how about for discussion purposes we just call it a file server?
The same goes for archive components, workstations, interfaces, and more. Break out hardware costs and software costs separately, not bundled. Now, next to each item in the cost summary, put a picture up relating to what the component is. If it's a server, put a thumbnail-sized picture of a server up. If it's a diagnostic workstation, put up a thumbnail-sized photo of a diagnostic workstation. The same goes for archives, Web components, etc.
Surely we can agree on generic photos for quotes, although knowing this marketplace there will need to be a committee to appoint the committee to establish a working group to develop the committee to appoint the photo utilization committee.
Get all the vendors to pick a single photo representing a server -- Dell, HP, they all basically look the same -- but we need to be politically correct and offer vendors choices, just as we did with DICOM. Let's just hope we don't mess up the photo selection process like we did with DICOM by being politically correct.
A hospital, imaging center, or others looking to do an apples-to-apples comparison of the vendor's quotes can then evaluate vendors much more easily and closely compare costs for hardware, software, installation, training, and service, as well as the total system costs, by using the photos to identify what goes in what column.
Some vendors may say that a breakout like that doesn't adequately reflect their product offerings, but frankly that's what sales reps' jobs are about -- to explain the particular advantages and benefits of their product relative to the customer's needs. I'm just trying to make the customer's job easier by understanding what the quote is about.
There also needs to be detailed breakouts for installation and training -- how many hours are provided for each and what tasks are done for the monies being quoted; these too can use icons. Again, this just makes sense.
PACS contracts
So much has already been written about PACS contracts (including an article I won an award for in 2002 that can be found in the American Healthcare Radiology Administrator's journal, Radiology Management, titled "Trust Your Mother, but Get It in Writing," but one thing is clear over four years since the writing of that article -- PACS contracts remain abysmal.
Last year, over 50% of the work my firm took on dealt with helping clients get a contract that protects their best interests. While I don't want to shoot myself in the foot by taking business from myself or others here, it really doesn't need to be this way. Some vendors, mostly the smaller independent players, have two- or three-page contracts that do nothing to protect either buyer or seller. Others, most notably the major PACS players, have contracts full of pages upon pages of legalese.
Who is protected by these monstrosities? Take a guess. What's funny (but not) is that people have been signing these contracts for years without even knowing what they are signing. With due respect to both inside and outside legal counsel, unless you've seen a PACS network in operation and know what a PACS can and cannot do, and what the vendor will and will not do contractually, you can't adequately review a PACS contract.
I recently finished an engagement with a client who spent eight long and trying months trying to negotiate a contract with one of the majors before they finally gave up and went to another PACS vendor. Within two weeks of being engaged by my client, the PACS vendor and I had a contract pretty much fleshed out and ready to be signed. This is not meant to sound boastful, but I knew what the vendor was and was not willing to give on and what could and could not be a part of the contract.
A large part of this delay was also due to the client hiring a boutique law firm that indicated they had done PACS contracts before. That said, no legal counsel I know of would ever try to include a clause as inane as "what we saw demonstrated by this person on this day at this location will be exactly what we get."
Site-specific customization notwithstanding, this precludes any updates, upgrades, etc. from ever being a part of the system, and does not factor in a facility's own site-specific customization. We got around this by including both a functional and operational specifications clause relating to the current commercially deliverable software, but not without a fight from outside counsel. In this case, billable hours seemed to take precedence over common sense, which we nipped in the bud fairly quickly, but not without spending tens of thousands of dollars and countless man-hours going through an exercise in futility.
I could state so many other situations I've worked with relating to contracts, including a whopper in which the executive VP signed a deal paying a vendor based on payment timelines versus actual installation and clinical acceptance, paying the vendor over $750,000 for products that hadn't even been developed yet let alone delivered (gotta love those "futures clauses"). Now I'm not meaning to air anyone's dirty laundry here, but I use these two examples to make a point: there has to be -- and is -- a much better way.
A PACS is a PACS just like a house is a house -- they all perform the same basic functionality. Why, then, not have every deal use a market-wide "uniform standard PACS contract," similar to that which the real estate profession uses when buying a house, and then add to it from there?
If state or local laws require specific terms and conditions, these can easily be included in a contract supplement. If the client requests specific terms and conditions, these can be done as a contract attachment. All the various formulas used by vendors to calculate uptime would be replaced by one that treats the system as just that -- a system -- and not by its individual components.
Penalties would also need to be uniform for both seller and buyer. If a seller is not ready to install when agreed upon, then obviously a penalty needs to be invoked. Conversely, if a vendor is ready to install at the agreed-upon time and has committed the necessary resources to do an installation and the buyer is not ready, then the buyer should bear a financial penalty as well.
It isn't rocket science we're talking about here, but rather common sense. Unfortunately, there is so little of that found in the PACS market that it boggles the mind. I'm sure legal counsel from the majors will say we need this clause or that clause to protect our vested interests. Fine then -- include them as attachments so the customer can at least see what they are getting into. And whenever possible use plain English, not legal gobbledygook that mucks up the waters and that no one but the folks billing at $400 an hour understand. The No. 1 rule in sales is learning to KISS -- Keep It Simple, Stupid. We need to do the same.
When I started the "It's broke" series four articles ago, I wrote about Howard Beale in the movie "Network." He was "mad as hell and not gonna take it anymore," and frankly so am I. And so should you be. Unfortunately, "Network" doesn't end the way Beale expected it to -- instead of committing suicide on air as he had initially planned, he changes his mind. The network, looking to keep its ratings up high since Beale went into his initial rage, instead sends two hit men into the audience to kill him on air anyway.
I wanted the PACS Secrets series to end with a bang, so to speak, although maybe not the way Howard intended it to end. There may be more PACS Secrets articles or this may be it -- that's up to you, the readers. It should all be up to you. That is the point of this entire series and the 10 articles before it. Decisions shouldn't be made for us, but rather with us as active participants, with knowledge your best weapon. You can let us know how you feel by clicking the "Discuss" button at the lower right-hand corner of this article, which will take you to our PACS Discussion Forums.
A quote from the movie "Braveheart" could provide a fitting end for our series: Just don't let 'em get yer kilts up in a bind:
Stephen: Fine speech. Now what do we do?
William Wallace: Just be yourselves.
Hamish: Where are you going?
William Wallace: I'm going to pick a fight.
Hamish: Well, we didn't get dressed up for nothing.
By Michael J. Cannavo
AuntMinnie.com contributing writer
May 29, 2006
Michael J. Cannavo is a leading PACS consultant and has authored nearly 300 articles on PACS technology in the past 15 years. He can be reached via e-mail at [email protected].
The comments and observations expressed herein do not necessarily reflect the opinions of AuntMinnie.com, 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
Part X: Exploring PACS Secrets -- Excuses, excuses, May 19, 2006
Part IX: Exploring PACS Secrets -- How to fix DICOM, April 20, 2006
Part VIII: Exploring PACS Secrets: It's broke -- Fix it, April 6, 2006
The 2005 PACSman Awards: This PACS is your PACS, this PACS is my PACS, November 30, 2005
Part VII: Exploring PACS Secrets -- Pre-RSNA edition, November 28, 2005
Copyright © 2006 AuntMinnie.com
