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| Mohannad Hussain, Medical Imaging |
Q. Let’s start by telling us a little bit about how you got into medical imaging?
In 2010, I stumbled upon a local company here in Waterloo, Ontario that is into medical imaging and of course, PACS people would know it as Agfa. So that was kind of my introduction to medical imaging.
It’s funny because as someone who has created software in multiple domains, you come to medical imaging you're a little surprised by how complicated medical imaging can be at times when it comes to certain things. I remember when I was being interviewed at Agfa, in 2009 before I actually started at Agfa in 2010 and the interviewer was telling me about this super secret project, which was a web-based medical imaging viewer, and at that time I was just thinking to myself what's the big deal of being able to view images in a web browser like every other industry has been doing for years?
It was only until I actually started at Agfa that I realized all the nuances behind the scenes to displaying those medical images. They're not just your typical picture. There's a lot more to it, you know with DICOM and all that stuff. I always joke with people that when you get into medical imaging there are two life-changing events that you look forward to in that career. Well, I guess you don't really look forward to because you kind of just get hit with those events and your life is never the same.
The first life-changing event is the first time you see a DICOM header, you know, the actual metadata inside DICOM and then the other life changing event is the first time you see an HL7 v2 message. So that's basically how I got into this so I started with PACS and you know initially when I started, it was essentially just another job but it didn't take long for it to actually be a lot more meaningful and purposeful, and a couple years into it, I decided that medical imaging was my purpose. I decided to stay in it and as my career progressed I became more focused on medical imaging. Nowadays, software development is still a big part of my life and I do a lot of that in medical imaging but again, I do it with a focus on medical imaging.
I always tell people, especially when I talk to software developers in training, that medical imaging is not a field that you choose for the money. If you are looking for money go to financial services or things like that. That's where the money is. You choose medical imaging because there's this noble purpose behind medical imaging, you feel like you're leaving a good legacy, you're contributing to making people's lives better. Actually shouldn't say people I should say patients’ lives. Patients can be our “countrymen”, our family, or our friends, even ourselves at times.
Q. So as a developer, where did you work first and then how long did you work at Agfa? And what was your position there?
I was at Agfa for nine years or so total. For six years I spent doing pure, what they call R&D development. R&D is when you're creating new products and or new features for existing products. So most of my time there was actually spent working on a universal web viewer the web-based viewer. Then afterwards my last three years were with the service department at Agfa but within that there's a team that did customization. So this is not a customization where they change the configuration of the product, these customizations were developed as what we call last-mile products. So, you sell a PAC system or a viewer that is solving 99 percent of the problem for the customer but there's one percent left. So that was the team I was part of, we developed a solution for that last one or two percent.
Q. As you went through all of that 10 years at Agfa, what did you feel was the strongest assets or skills that you developed over that time?
A number of them. So one of them is generally you develop an appreciation for medical imaging. You see how medical imaging is a weird mix between forward thinking and kind of being stuck with some older technologies because you know when medical imaging had things like interoperability in the early 90s when DICOM came out, that was pretty cutting edge at the time and when radiology went digital that was very advanced at the time.
But you know somewhere along the line things kind of fell behind and the innovation pace slowed down considerably. So that's good news and bad news. The bad news is innovation can be a little bogged down, but the good news is that it's ripe ground for innovation and you're certainly seeing that. For example with this new wave of excitement and the hype over artificial intelligence you can see how radiology is ripe for Innovation. It (AI) has got its kinks but there is some really cool stuff emerging. So that was one thing an appreciation for where medical imaging is. Then there are a number of skills that are also very interesting as you know, when you get into medical imaging you kind of have to get involved in things that are specific to medical imaging like DICOM and HL7, that you probably wouldn’t use anywhere else.
Q. Was there a specific event or a project that kind of tipped the scales for you and convinced you that you should go out on your own as a consultant.
That's a good question. So a little background on being on my own. I actually have run my own consulting business on the side for the past 13 maybe even 14 years now. So what I did is I actually ran it on the side with three different employers and my employers always knew that I was doing this but to avoid conflict of interest, I always had my side business running in different domains. For example, when I was working for Agfa, I built a product for a supplier of technology for the mining industry, which was very different from what I was doing for Agfa.
So I've kind of always had what you might say is an entrepreneurial side of me in a sense. A couple of things that tipped the scale where I decided to quit my job and go full time, I've always kind of imagined myself going on my own full-time at some point. I didn't realize it would be this soon in my life. I kind of assumed it would be when my kids were bigger and they had little to do with me at some point and I had a lot more time on my hands. Two things came about that tipped the scale. Number one there was an opportunity I was presented with to work with a local hospital, but it was a contract based opportunity. That was one thing, and then the other one was that just generally over the past couple of years I've had a lot of people come to me and say hey, we've got work that we need your help with, and I've had to turn them down because I wanted to avoid conflict of interest with my employment. So in order to avoid that conflict I decided to just go out on my own to be able to accept such opportunities.
Q. It sounds like you had things kind of rolling already. You had a client and you had prospective business coming to you, so you didn't need any financing or funding to get started?
I was luckier than most people in that sense. Most people who go out on their own may not have the same safety nets I was very lucky to have, so in my case, you know being able to plan for this for a few months in advance actually allowed me to put together a little bit of savings on the side as a safety net. Also the last event that kind of triggered me going out on my own was the contract with the local hospital was actually a year long. So that actually gave me a runway until the end of the year. Additionally, the other safety net is being married and my wife actually works full time. So we figured if worse comes to worst we could survive on one salary for a little while.
Q. You mentioned planning, and I looked at your website and it looks like you're a very big believer in thorough planning. What was your own plan for going into this business?
That's a really good question. You're absolutely right. I'm generally a big planner but believe it or not going out on my own wasn't actually one of those things that I planned. I actually got asked that a lot, people would ask me ‘you're on your own now what are you going to do? And I always tell people I don't know, I'm going to see what I can do with anything where I can apply my skills and interest. That was really the big plunge. It's not really very specific, it is very general.
Q. So you had clients you had a one-year contract to keep you going, and you've been doing this for a while as you said, 13 or 14 years what do you know now that you wish you had known when you first started?
I haven't actually had a moment to pause and reflect on that, so I don't really have an answer but off the top of my head, it's probably a number of things. I might blabber here a little bit, so stop me if I go on for too long, but I'll try and answer the question.
Probably the top one is the positive side of stepping out on your own. It is actually a lot of fun. I really am enjoying myself. That's not to say that I didn’t like my jobs when I was employed full time. I definitely liked them, but being on your own is just different, you know, there's a bit of satisfaction that when you're on your own and being your own boss is satisfying.
But there are also negatives not everything is of course straightforward from a financial point of view. It takes a little bit of discipline as your income is not as predictable as being employed. You've got your salaries being deposited into your bank account, you know twice a month or every two weeks, right? With consulting your payments are kind of sporadic in that sense so you have to be pretty good with financial planning.
Also all those years when I ran the business on the side, I ran it as a sole proprietorship and now I realized the need to be an incorporated business and I underestimated just how much work was actually involved in incorporating and getting all these requirements done. Now the good news is a lot of this work is foundational work you do it once and it's done, but nonetheless there was definitely a chunk of time getting a business Incorporated, having to find an accountant, find a lawyer, getting things like liability insurance.
The contrast is interesting, as a consumer, I've always just bought consumer Insurance, like car or house you basically give the insurance company your money and boom, you're done! Getting liability insurance for an incorporated business was definitely not straightforward. I've actually talked to a number insurance companies that flat out refused to give me a quote because they didn't want to touch anything with healthcare. They thought it was too risky to begin with and the ones that did give me a quote had me fill out forms that were like 10 or 11 pages long.
Q. Where do you want to go with your business say in the next five years or so?
A really good question. And again another question that I get but I haven't fully figured out yet. It goes along the same lines of you know, what is my plan now that I'm on my own? The obvious answer is of course I want to grow the business, and I hope that the business will become stable enough and sustainable. It's still very early stages. So nothing is guaranteed at this point. I've had people asking me if I’m going to have employees, and my answer is let me see if I have enough work to keep me busy and then we'll worry about having employees but that's definitely on the table.
I've had people ask me if I’m going to launch products and I tell them. Well, I don't really have anything right now, but if I come up with something I'd be open to that. So yeah, the plans are a bit in flux. You know, I like I said, I generally tend to plan things. This one thing wasn't so well planned.
Q. You’ve been doing this a while. You have clients. You've kept them on your roster, what is the key to sustaining your client base?
Yes, there are a number of things. First of all, I've been very lucky that I've rubbed shoulders with amazing people, who opened up doors for me throughout my career, starting with my very first boss at Agfa and my boss's boss also at Agfa (Bill Wallace and Don Dennsion) who are downright amazing people.
Secondly, one of the very first things that got me involved in the (medical imaging) community was being sent to the SIIM conference, the Society for Imaging Informatics in Medicine. That opened up a lot of doors for me and it wasn't like, you know going for the purpose of rubbing shoulders to get work and sell products and services. Honestly it wasn't, it was just that I was told to go to SIIM because it was “interesting” and that was pretty much all the context I was given. I did go and it was an eye-opening experience because at the time having worked for a vendor, you're basically in a bubble. There's a lot you don't know about the general workflow the general challenges within the domain and so on and so forth.
So I went to SIIM and I learned a lot that first year and then when I came back that first time there was no plan for going back again, because as a developer it was understood that I would only be sent once in a lifetime kind of thing, but it just so happened that there was a need for someone to conduct some technical training at SIIM the next year, or it may have been a couple of years later, and I got volunteered to do that and that actually put me on a path that I'm still on.
So I went again to SIIM and I have never missed a meeting since then. Again, it's not that I go with the purpose of marketing myself or my services, absolutely not. I go in with a purpose of just meeting up with amazing people, learning from them, rubbing shoulders talking about problems thinking about solutions together and the rest is a byproduct. Finding work out of the community or making connections, that kind of stuff that is all a byproduct.
Q. In terms of the medical imaging would you say that you became a PACS expert or a DICOM expert or what's your field of strength?
I get asked that question a lot, especially now being on my own, as far as services go, the question is what's your major area of expertise? My answer usually is that I am a jack of all trades and master of none. I actually like being a generalist. I love being able to dabble around, that being said, there are definitely areas where I think I know quite well. I know PACS systems very well, I'm pretty good with DICOM, I know that stuff pretty well. I have done a lot of work in integrations, especially front-end integrations, so like connecting two applications on the desktop rather than just connecting them on the server side, some people call that desktop integration. That's another area. I know very well. I've also done back-end integration.
Another area of expertise, I don't know if I called myself an expert, but I think I know enough about newer standards, that also is an area of interest for me. So, you know, everyone talks about DICOM but there's DICOMweb, which is amazing. It's a major development and works really well in terms of making things easier. On the HL7 side, you have things like FHIR and the FHIR standard. Other standards keep coming out of IHE. There's a brand new standard that just came out. I think it was last year on AI workflow and AI results. These are all very interesting and you know important for someone to be sort of the evangelist for a lot of these standards.
Q. Is that primarily what you're doing now in consulting is working on those technologies or those standards or are you involved in other things as well?
I'm involved in a plethora of things. I can tell you as an example, my contract with the local hospital here is actually got me working on essentially two things, an innovation and research project as number one and number two is helping to improve operational efficiency, such as helping them with improving workflows, integrating systems that kind of stuff is taking the bulk of my time and working on those, but that's my focus for now. Among my other hats, I've done work on these new standards, and one of the other things I do is I also work as the technical project manager for the SIIM hackathon and have been for the last six years.
Q. I was going to ask you about that so yes this is a good time to talk about that.
You know the SIIM hackathon is essentially a place where we evangelize these new standards and the development of these standards because of course these standards are living things in a sense. They're always being iterated and always improving and adding new features. So that's a major area of work for me. I also volunteer and have done training on some of these standards both at SIIM and other conferences. If you look me up on YouTube you're going to find a bunch of sessions that are recorded from as an example, the FHIR DevDays conference.
Q. So what advice do you have them for PACS administrators or IT professionals that might be considering going out and consulting.
Honestly, this is more generic advice and not specifically about consulting but even if you want to stay current in your job, and you just want to grow, whether you want to grow just because you want to be promoted and get paid more, or you genuinely just want to grow and learn, I think the number one thing is to get out and meet people and talk to people about the challenges they have, the challenges you have, and the solutions to things you've done. That's probably the biggest appreciating factor in my career, just being a part of the community.
SIIM is a near and dear community to my heart. So that's the one I would recommend to most people but of course people may have other interests, or other communities like RSNA or ACR and so on, HRA could be more applicable for some of these people and everybody's a little different. I've been part of the SIIM community, and it's made a major difference in my professional life and I love being part of the community
Previously, being involved in something like SIIM generally meant going to the annual meeting, but there were other things you could do like volunteering as part of a committee and things like that, but generally that's what it boiled down to, is you have to go to the meeting, which wasn't always easy, you know money restraints timing etc.
The silver lining of COVID is now a lot of SIIM meetings have gone virtual, meaning they are usually more accessible, a lot cheaper, but also allows more variety and more selection. You can “go” to the annual SIIM meaning that is now virtual, so it's a lot cheaper. I think the rate this year's $199 or $299 something along those lines, which is very affordable. But even if that's not an option, whether it's for money or timing, there are events happening throughout the year.
SIIM puts on these webinars and that are free for members, quite informative and eye-opening and very low overhead as far as sparing an hour once or twice a month. SIIM recently started a new initiative, which is really cool. It's the SIIM member meet up. So the idea is when you had SIIM events in person, you could run into people in the hallways. Now with everything going virtual you don't have those chance meetings, instead what they're doing is they're having these monthly meetups. It's about an hour long. And usually there will be a theme but not like a specific topic or a hard agenda. So people can just show up and you know talk about things really whatever you want to talk about.
Q. Is there any anything else you'd like to add or talk about that I have missed?
I'm sorry. I rambled on that last point which is the point is to get out and meet people. The second point I do want to make is to always look for ways to upgrade your skills. There are multiple ways to do this. You can go and attend courses, you can pay money for these courses, but there also many free resources that you can also try. So for example SIIM, you know, I'm heavily involved with the SIIM hackathon as I mentioned, and as shameless plug here, the SIIM hackathon is great, but I don't just say that because I'm the technical project manager for the hackathon. I say it because when we created the hackathon, it was created the SIIM way vs. the usual hackathon way. Your average hackathon is for super technical people and usually super competitive.
The SIIM hackathon isn't either of those, the SIIM hackathon is focused on collaboration and education above all. It is not focused on competitiveness and it is also geared for anybody. You don't have to be technical; you don't have to be an expert in coding or for that matter, you don't even have to know how to code to attend the hackathon because it's all about bringing people together and educating people.
So we get people who are technical, we get people who are clinical, and we also get people that PACS administrators and we match everybody into teams so they can actually work together and learn from each other. And of course we have mentors who are happy to help them.
Now, that's the actual hackathon event, but there's also another not so well known aspect of the hackathon, which is the fact that we have our servers running in the cloud 24/7 365 days a year. So these servers along with the documentation we have produced over the years also present a learning opportunity that anybody can use. To use the server's you don't actually have to have a SIIM member, it is completely free. The guides are behind a SIIM membership login, but the reality is the membership isn't actually all that pricey so you can on your own time go in and learn some basics of something like DICOM web or something like FHIR.
The thing is not everyone wants to learn DICOM to be an expert or FHIR to be an expert from day one, some just want to know the basics, e.g. what is available out there and you know what options you have to maybe make your day-to-day life easier is one thing, but also in general just being able to know how to troubleshoot when somebody is stuck on a DICOMweb then can say, yeah, I know what that's like I've done that.
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