Amigas, Mac's, and IBM's and the Medical Environment

by

Michael Tobin, M.D., Ph.D.

Introduction

Everyone with an Amiga has an opinion and I am no exception. What else would you expect? If we were not unusual and creative -- and yes, visionary -- people, we'd be drones using clones (even rhymes, doesn't it?).

Please keep in mind that I am a medico and not a banditto. I have no special inside information. I wrote my first computer program on punch cards in Fortran in 1965 for an IBM 340 mainframe but am no computer expert. I am in medicine and know many people with all different kinds of computer systems. I've taken no surveys but I have done alot of listening, reading and thinking. I thought I would share with you my perspective. I represent no one other than myself.

IBM and the clones

It is my opinion that IBM in joining forces with Apple to produce an operating system (Taligent) is now perceived as conceding failure to be able to develop a viable one on its own. There may be no long term future to PC DOS software as we know it.

Plain vanilla DOS with its command line structure and arcane limitations is widely accepted as having been out-of-date for years. Hiding Microsoft DOS with Microsoft Windows I regard as akin to putting wallpaper on top of a rhinoceros. The result one gets is very bumpy, uneven, and hard to handle. And, because the rhino is never far from the surface, there is always the possibility that he will poke his head through the paper at the least convenient moment, and mess everything up.

OS/2, the latest IBM operating system, seems to get good reviews from its users. However, they get uncommonly upset when you remind them of the more than 30 megs of disk space the operating system eats up versus the nice little ROM chips we have in the Amiga. Naturally, they are concerned about IBM's commitment to OS/2 with Taligent in the wings. No one I know is getting rid of MS DOS for OS/2. While this should make MS DOS supporters breathe easier, they do not because they have their own reasons to feel uneasy. With so many multi-billion dollar companies organizing to sink Microsoft, who knows what will happen to MS DOS?

And those low prices for clones? Don't count on that forever. People are writing that the tight profit margins will so squeeze the industry that many smaller companies will be forced out. Fewer companies usually means less competition, less pressure to innovate and fewer choices for the consumer in addition to higher prices from those larger manufacturers which are expected to ride out the crisis. The profits and happiness of these larger companies may in turn be short lived if the software and hardware developed by IBM and Apple is as proprietary as what Apple has now. The net effect might be the total extinction of the clone makers as we know them with even higher prices and less selection.

In the medical area, the feeling seems to be that MS DOS will be around for quite a while because of the large number of clones, which continue to be popular for word processing and billing. Networks are typically Novell-based but in my department, seem to require a full time person to keep everything up and running. The secretaries constantly complain how slow the system is and detest the awkwardness of the wordprocessing and other network software.

Although unpopular at the Society of Nuclear Medicine annual meeting, PC's have acceptance by their sheer numbers alone. Whether or not they are truly loved, it is clearly possible to develop educational and commercial applications for the IBM and the clones, many of which were shown at the Radiological Society annual meeting. New applications are described each month in established medical journals which never accepted such material previously. A new organization called the Society for Computer Applications in Radiology which publishes a journal while more popular accounts with more immediate application are to be found in magazines such as Physicians and Computers.

The World of Mac's

The Mac has been the temporary beneficiary of this chaos. Having in essence received an endorsement of its operating system by IBM, the worry nonetheless exists that Apple may lose its individuality in the long run by uniting with IBM. Remembering the dangers in making love to an elephant, some fear that Apple will be crushed by IBM.

Macs are popular in nuclear medicine because of their graphics. There are at least two companies using Macs with their own proprietary boards both to capture and to process images from nuclear medicine gamma cameras (so-called because they detect gamma rays). Several other companies -- and I mean big multi-nationals - - use the Mac for off-line image display and limited image manipulation. Typically, these companies develop their own image handling software in-house.

Mac applications are easy to use and if they are somewhat boring, they are that way because they are so uniform. They seem neither easy to create or to modify, but many users seem to have no great interest in doing so anyway. The base number of colors and non-interlaced display combined with decent monitors make the Mac output look very good indeed.

The issue of Mac prices didn't seem to concern the attendees too much. The presence of some low end Mac models seemed to make some people think that the pricing structure is in fact rather reasonable. However, when they realize that these models are black and white only and non-expandable or limited in expandability, they begin to understand that these low end units may not be the great bargains they initially seemed. Also, the prices of Mac software are still in many cases outrageously high. A program equivalent to Gold Disk's HyperBook might cost $1000 or more on the Mac (and wouldn't have an AREXX interface, of course). Prices don't seem to bother Mac advocates partly, I suspect, because they can get the hospital or their foundation grants to cover their software expenses, which (I guess) all agree should costs lots of money and which we, the public, will pay for in one way or another.

Mac based gamma camera control units are a different issue because they are not competing against PC's or Amigas but rather against the proprietary units sold by the giant manufacturers. Here, even at inflated prices, they are still MUCH less expensive than the proprietary units, whose prices are even more inflated! And, since many physicians already have Macs at home, they can telemodem hospital images to their home as part of a teleradiology system, once again avoiding larger commercial systems.

The lonely Amiga

Where does the Amiga stand in all of this? Here is this very powerful, expandable, easy to use computer system with a wide variety of software and yet I am the only one on the nuclear medicine bulletin board system (called Lunis operating out of Loyola University) using the Amiga. How can it be?

Relatively few people know about the Amiga and even fewer have seen it in operation. Many in the nuclear medicine and radiology community have heard that the Amiga is "great for graphics" but have opted for some other system. Part of this is the herd instinct in which people say: "How bad can it be if everyone has one?" The answer of course is, "Pretty bad!" with more computers sitting in closets than most people would admit. Then, too, people feel that if they get what everyone else has, they can always come to them with questions. This also is fantasy. Most people will politely answer your question by saying, "Check to see that you used com1 instead of com2," but no one is coming down your house to set your DIP switches, install your software, and give you a 200 hour course on how to use WordPerfect. Finally, the number of physcians and technologists who take their computer work home with them is not an overwhelming number. Yes, I make slides for people who use non-Amiga computers, but CrossDos (Consultron) is all I need. I also have no problem with text from other computers. So, this "I want to be able to work at home" is another non-issue for not selecting an Amiga.

So what are the issues? WE NEED APPLICATIONS. We need software companies to develop medical and dental practice management systems. We need billing systems and medical insurance claim form submission systems. We need these aggressively marketed to every physician in the United States.

We need people who will install total packages including word processing, database and spreadsheet programs which MUST read and save files in the formats used by standard PC and Mac programs. Amiga software development companies need to find out what medical and other professional people want in these programs and then put them in and do at least one step better.

Networking is another demand that must be met and now with the Novell link-up possibilities offered by Oxxi is in fact being met. There are just too many other systems out there for Amigas to be isolated from.

Much ink has been spilled on the topic of Amiga graphics. Suffice it to say that 16 color graphics -- and that's what it is for black and white -- just doesn't cut the mustard in this day and age. A 68000 running at 7kHz is also no great shakes. An Amiga 3000 takes care of the speed issue and the interlace flicker issue but not the color display and resolution issue. Everything I read in Amiga magazines published here and in the United Kingdom, seems to indicate that the graphics display will be markedly enhanced by the end of this year -- none too soon, I would say.

But even better graphics display is not enough. Medical image processing applications must be written. These are definitely, in general, NOT the same as what is used in the art world. Careless image processing can both hide true pathology while creating artifacts which look like pathology. My understanding is that image processing programs used in medicine must obtain FDA approval. I have no idea how easy or how complex a process this is. I would strongly recommend physician involvement in the software (and hardware) development.

Teleradiology, the process by which medical images are sent from one hospital to another, is another area where the Amiga could shine and I will be writing an article on this. Suffice it to say that while there are already several companies out there with a wide variety and quality of equipment, the market is still being defined and is very much open.

Medical education is a wide-open area. There are countless opportunities for programs to train medical students, residents, and board certified physicians. If my own experience is an indication, anything you do will be greatly appreciated by those eager to learn.

Conclusions

The medical area is one where the Amiga could do very well with the right applications. The basic triad of word processing, database management, and spreadsheets will have to develop to the quality and power that they are on the IBM and MacIntosh. Stop waiting for the "big boys" on the other platforms to develop on the Amiga -- be glad that they are not thereby giving our guys a great opportunity. These are harsh words but ones from a true friend.

The medical market is large and potentially lucrative but only for those who are willing to put in the effort and develop professional programs with features people need. There is no reason for the Amiga not to be part of the medical area. Aggressive marketing is important because the Amiga isn't the only graphics computer platform out there.

Commodore has a definite role to play in upgrading the graphics display not only the number of displayable colors but also the maximum resolution at which they can all be displayed. It must continue to set standards for new graphics modes and sound. It may even need to encourage developers to go into professional areas like medicine. No one should think that desktop video will be "hot" forever.

January, 1993

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