CHICAGO - It's been two years since I've written about PACS at the RSNA show, and frankly I've missed it big time. Everything about it -- and more. So without further ado, here's my take on the latest offerings in PACS and imaging informatics at RSNA 2013.
I'm used to seeing a number of overseas visitors at the RSNA show, but this year was more like a Vonage commercial, with 60 different languages being spoken. This year's RSNA set a new record for international participation, with 38% of attendees coming from outside the U.S., while overall registration ostensibly was flat (official numbers aren't in yet).
The same record no doubt will also be set with the number of international exhibitors. Now, "crazy generous" is a good thing, but many of the U.S. companies that exhibit have either no international presence or a very weak one, so the changing face of the RSNA meeting affects them on many fronts.
There were several other changes this year. Belt tightening was obvious all around. The megaparties from the major OEMs have all been canceled, ostensibly due to new "Sunshine" regulations designed to cut back on corporate gifts to physicians. Interestingly, several of the smaller vendors must not have gotten the same memo, as many had their own parties and radiologists were still being taken out to dinner.
PACS consultant Michael J. Cannavo returns with this year's PACSman Awards.Outside bus advertising was gone, and even the chocolates being handed out were cheaper this year (Hershey's outnumbered Dove or Ghirardelli by at least 10:1, with Godiva apparently a no show). In an event that has always stressed technology, old-fashioned ballpoint pens were the popular handout this year, although in a nod to technology, a few vendors gave out pens that worked with tablets as well.
The RFID badges of recent years were gone as well, a nod to either the success or failure of the RSNA's attendee-tracking program, depending on whose position you took. Sometimes having too much data isn't a good thing.
Having the exhibit hall reduced to two halls instead of three was a welcome sight (the Lakeside Center was converted to poster displays). While the total number of vendor booths was fairly comparable to previous years, many of the exhibitors downsized their booths from prior years.
RSNA has gone from a show that highlighted "big iron" imaging technology (CT, MR, ultrasound, nuclear medicine, etc.) to one that is 60% or more dominated by PACS and imaging informatics. The delineation between healthcare IT and radiology also seems to be blurring more and more each day.
While radiology (and radiologists) still call the shots relative to PACS vendor selection -- specifically as it relates to radiologist productivity -- hospital IT staff is becoming more and more involved in the decision-making process, especially in relation to vendor-neutral archives (VNAs), the use of the cloud, and universal viewers.
References to VNAs were up dramatically, cloud references were down slightly, universal viewers were everywhere, and too many vendors were living in the land of make believe, where everything happens easily and quickly.
I should have brought a button I got 20 years ago that a display vendor gave me -- it simply said, "We can do that." It reminded me of situations I've been in time and again where sales commits to deliver a feature to a customer, and engineering plays their "Diff'rent Strokes" card, asking "What'chu talking 'bout Willis?" when presented with both the feature and customer delivery timeframe.
Breast imaging was a hot topic at RSNA as well, with RIS making a resurgence. Let's hope we can avoid the RIS-driven PACS versus PACS-driven debacle that we saw in years past. A lot of what was shown was integrated RIS/PACS, which thankfully takes away arguments over who is in the driver's seat.
Technology vs. solutions
The biggest challenge I saw had to do with understanding technology. We, as an industry, have completely confused end users by promoting technology over solutions. People don't buy technology; they buy solutions to problems.
You can go to eight VNA vendors and get 10 definitions of what a VNA is (because two of them no doubt are schizophrenic and have different opinions within themselves). We need a single definition.
The same can be said about the role of the cloud, RIS, and other technologies. Walking around the RSNA show, I was amazed by the lack of information that companies gave about their products. Most presented their products so broadly that I just walked on by, oblivious to any understanding about what they have that makes me want to look closer.
If RSNA is to continue to succeed as a show, vendors need to explain how things work, not just in solving a single problem, but in creating solutions that help show a return on investment.
Our industry has been great at talking about improved patient care as the be-all, end-all and forgetting that the bottom line is still the bottom line. Healthcare always has been and always will be a business. Capital dollars are hard to come by, and competition for dollars is fierce. Modalities have to last longer because the money just isn't there to replace or upgrade them.
Because more than 90% of all hospitals and imaging centers in the U.S. already have PACS, end users (and vendors) really only care about four things: add-ons, upgrades, optimization, and integration. Add-ons and upgrades were largely what was shown at RSNA 2013.
Rarely was the business case made for the product, though, and that may hurt its chances in the market if the return on investment can't be shown. Integration needs to be a part of the solution as well: What role is the PACS, VNA, etc., going to have in either saving money, creating additional revenue streams (meaningful use dollars, etc.), or meeting state or federally mandated requirements (dose management, critical results reporting, etc.)? Very little else matters.
Competition for dollars is steep, and time to review products is limited. The combination of these two issues makes the RSNA show that much more important, providing end users with a venue to evaluate everything under a single roof.
But enough doom and gloom. There's also a fun side to the RSNA show, so after a two-year hiatus, here are the 2013 PACSman Awards.
The Optimus Prime Award
To the companies using the words transform, transforming, transformational, and variants thereof: How many transformations do we need before we are transformed? That reminds me of a guest preacher we had one Sunday morning, who said that most people who watch religious broadcasting were already saved, and asked the obvious question, "How often do you need to be saved to be truly saved?" The same holds true for transformation.
The Soup and Sandwich Award
To the two major vendors that are moving healthcare together -- one transforming healthcare, the other advancing healthcare. The burning question is did they use the same ad agency?
The Independence Day Award
To the vendor that had the monstrous 20-ft iPad look-alikes highlighting their booth. Even though it was a sleight of hand using high-resolution projectors instead of a single LCD panel, all I could think of is Will Smith saying the words, "I gotta get me one a these."
The Good, Better, Bester Award
The AT&T kids could teach this company a lesson. While good is better and bester is better than best, bestest trumps them all. Change the product name to bestest -- or better yet betterbestest -- and you'll have a winner.
The Ogden Nash Award
While candy is dandy, the candy is gone this year and so is the Tesla. The way the year has gone, they probably figured liquor is quicker anyway ...
The Rainy Days and Mondays Award
To the vendor that gave a full product demonstration -- to 30 empty seats. Sing it, Karen. "Talking to myself and feelin' low ..."
The Captain America Award
To the company that had a photo of three kids playing Captain America. I love companies that don't take themselves too seriously, but have a good product. That's called confidence. Beats the jackhammer and the pretty woman side-by-side video any day.
The Niagara Award
Or is that Viagra? Something about the falls ... This company's product sounds like a new wonder drug -- something to make the ladies happy; combine extend and suite and you have the name.
The Meat Loaf Award
Once again we have "Paradise by the Dashboard Light" scenarios with several companies promoting their dashboards. It's time to ask definitively, "What's it gonna be boy, yes or no?"
The Green Eggs and Ham Award
To the company that came up with a Dr. Seuss-based marketing theme, but thankfully revived themselves by keeping Tux the penguin in the booth and playing "Where's Waldo" with him on Twitter. Bummer. I was all set to say, "I do not like to see your spam, I do not like green eggs and ham."
The Ted Kaczynski Award
To all the vendors that used the word "UniViewer." Every time I hear that word I think of a workstation wearing a gray hooded sweatshirt. Kaczynski raged on about the erosion of human freedom necessitated by modern technologies. His methodology was all wrong, but certain aspects of his manifesto do ring true.
The John Gray Award
Men may be from Mars and women from Venus, but the Venus PACS product this year was from Korea and the Marz VNA was from the U.S. Of all of Gray's books, I can relate best to Venus on Fire, Mars on Ice: Hormonal Balance -- The Key to Life, Love, and Energy. I'm not sure about life, love, and energy, but I have lived through hormone hell and Venus being both fire and ice ...
The Log Cabin Award
To the New Hampshire company that gave out samples of locally produced maple syrup. Log Cabin can't hold a candle to this stuff -- it's that good -- and it sure beats pens and breath mints. Oh yeah, the company has some interesting products as well.
The 'Time for a New Booth' Award
Most facilities upgrade their modalities every five to six years. This company's booth is long past that expiration date. Now, I believe in fiscal responsibility, but enough already. With all the companies being bought and sold, please buy a used booth from someone else.
The Elephant Award
This one is a tie between the hotel that wanted to charge me a $29 early check-in fee for checking in one hour early at my $200+ per night hotel, and the two gals who accosted me outside McDonalds asking for a few bucks so they could get breakfast. They followed me as I walked toward my hotel, so I asked them why they didn't get the $1 sausage McMuffin I often get. "We want a real breakfast," was the answer. That's understandable. Go back to the underpass, change into your evening gowns, and then I'll take you to the Four Seasons. Sheesh.
The Epcot Award
I appreciate feeling like I'm back home, but globalism reached an all-time high at RSNA 2013, with Germany, China, Japan, Korea, France, and others all showcasing 10 to 12 vendors each in their booths. All that's missing is that obnoxious "It's a Small World After All" song; then I'll feel right at home. No wait, that's Disney -- Epcot is next door. Never mind.
The Sea World Award
Speaking of obnoxious, the theme from "Jaws" being played every 20 minutes has to grind on you -- or so those vendors who have booths around this company told me. Cute theme but ... And why would you ever name a company after Shamu (or a person who contributes a lot to the church)? Between the two, I once again felt right back at home.
The Fe, Fi, Fo, Fum Award
Usually when I hear the word Semper, it's teamed up with Fi and I look for a stylin' Marine in dress blues. Using a Latin name like Semper in conjunction with the word data just doesn't have the same ring or connotation. Now, using the Latin version sure beats using the English version of "Always," which is typically found in aisle 4 of the supermarket next to the hair care products, but still.
The Wizard of Oz Award
It wasn't a yellow brick road, but an orange one -- still, I couldn't help but want to skip through this company's booth with Toto, Scarecrow, and the Tin Man at my side. "We'rrrrrrre off to see the wizard, the wonderful wizard of Oz."
The Sherlock Award
To the company that made the brilliant statement "Girls are different than boys" and had me invoking Sherlock's name. I know the context in which it was said was relative to CT findings, but what I found most interesting is that the No. 1 imaging procedure performed on boys is CT head without contrast. Maybe that's from guys beating their heads against the wall trying to understand girls; we could have told you that without the study.
The Both Sides Against the Middle Award
Gotta love the acronyms. If we pronounce this company's VNA phonetically, you get the Egyptian goddess who was worshipped as the ideal mother and wife, as well as the patroness of nature and magic. She was a friend of slaves, sinners, artisans, and the downtrodden, but one who also listened to the prayers of the wealthy, maidens, aristocrats, and rulers. Sounds like the typical PACS vendor to me ... end user, too.
