After nearly 27 years as an independent consultant, making the move to the "dark side" and working with a vendor wasn't an easy one. But with the kids grown and gone, I figured it was my time now.
My two years with a major vendor provided me with more experiences and more emotions than I ever thought possible. I learned what I was good at (customer interaction) and not so good at (politics). As much as I enjoyed certain aspects of it, not the least of which was having a steady paycheck, I missed the day-to-day interaction that I got from working with customers in a consultative role.
That was at best 10% of what I did during my time with the vendor, and, frankly, I wanted more. Addressing customers' needs and getting the positive affirmation that came with doing what's right for them made me happy. I realized that consulting is and always will be my first love. So now I'm back doing what I do best, at least for now. But what I learned on the other side was nothing short of amazing. Here is my top 10 countdown -- or at least the first 10 things -- gleaned from life on the dark side.
No. 10: Don't believe the hype
There is a saying: "If it ain't broke, don't fix it." And so it goes with most information systems, including PACS. There is a big push to get everyone off Windows XP before support from Microsoft ends in April 2014. Does the product die? No. All that happens is future support ends, period. The product still works and will for quite some time.
Michael J. Cannavo aka the PACSman.I find this similar to the hype that surrounded Y2K. "All systems will crash and the world will come to an end!" was the line back then, while the reality was that just a few systems had minor hiccups. If you have a planned upgrade for the end of the 2014 and the system you have is currently running Windows XP, you should be fine.
The same holds true for hardware upgrades. While most hardware is at its end of useful life after five years, it still works. It just might not provide the kind of performance you are looking for, especially if the new software dictates different hardware specifications. Instead of trashing it, repurpose it.
The useful life of monitors often far exceeds that of hardware, and while there may be some slight degradation after a period of time, LED backlit monitors can provide seven to 10 years of useful life or more, especially since autocalibration software is pretty much standard these days. The software should also tell you how much useful life the monitors have left so you don't go replacing them before their time.
No. 9: Not all upgrades are necessary
It's always nice to have the latest and greatest, especially because you are usually paying for upgrades in your service contract price. But if it doesn't offer you anything you want and need, why bother? You don't want to be more than a few versions of software behind, but you don't need each and every new release either.
Most service contracts dictate that you be no more than two versions behind, but the reality is that regardless of how far behind you are, you will still be supported as long as you pay the bill. However, being several versions behind may cause interfacing issues with newer versions of third-party products, including speech recognition systems and the like. The latest versions allow ease of integration; older versions generally not so much.
No. 8: Service is crucial
All PACS ostensibly offer the same basic functionality; how they do it is different. With few exceptions, the base features and functionality that exist in one PACS are pretty much emulated from vendor to vendor. Advanced features and functionality are where the differences lie, as well as being able to address volume and specific needs such as teaching file creation.
That said, nothing distinguishes one vendor from another like service. I knew going into it that the vendor I was with had great service. I just didn't realize how crucial that service was to the overall day-to-day operation of a PACS until I actually spent time with PACS administrators. To me, PACS service was always overpriced and underutilized. Now I realize that service is not an option but a requirement. What's scary is that service is one area where many corporate higher-ups are looking to cut back. I'd rather see people delay purchases, upgrades, or the like than cut back on service.
No. 7: Speech recognition is here to stay
I was never a fan of speech recognition because it took radiologists out of the role of interpreting imaging studies and made them glorified report checkers. A RIS with predefined normals and such could do the job just as efficiently if set up properly. Sadly, RIS for the most part has fallen out of favor lately and been supplanted by speech recognition. Radiologists have also embraced speech recognition, so it's here to stay. It's not cheap, but a properly operating speech recognition system works well and is often worth the price, provided it doesn't interfere with the overall operation of the PACS.
No. 6: Standards offer no guarantees
Virtually every vendor talks a good game about standards adherence. DICOM and HL7 are pretty much de facto standards to which everyone adheres. Integrating the Healthcare Enterprise (IHE) is another story and is still evolving. IHE adherence is crucial for things like vendor-neutral archives (VNAs) and integrating to electronic medical record (EMR) systems.
Connectivity to the EMR is also crucial for achieving meaningful use, so you must find a way to connect to the EMR. This doesn't need to be through IHE adherence -- interface engines work just as well -- but it does make it standards-based and offers a clean and easy interface.
No. 5: Attrition is key
Just like in life, it's often cheaper to keep your spouse than to get a divorce -- unless the situation is so extreme that you just can't stay together anymore. Moving over to another vendor is extremely costly when you factor in data-migration costs, nonrecoverable investments made in software, software customization, training, hardware upgrade requirements, and the like.
Oftentimes you'll find the situation with a new vendor is no better and sometimes is even worse. Vendors will bend over backward to keep a client and will do whatever they can within reason. Price is rarely an issue, and billing can be deferred if/as needed (as long as it doesn't deal with the legal aspects of revenue recognition). Playing hardball will get you nowhere fast. Work with the vendor and you'll get much further.
