TechNation - July 2014

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VOL.7

EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

JULY 2014

IMPROVEMENTS IN

DISTANCE SUPPORT TECHNOLOGY

A REMOTE HELPER

24 38 70

Biomed Adventures Hot Rods The Roundtable Ultrasound What's on Your Bench?

Highlighting the workbenches of HTM Professionals

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CONTENTS Features

38 48 TECHNATION: EMPOWERING THE BIOMEDICAL / CE PROFESSIONAL

38

THE ROUNDTABLE - Ultrasound This month, TechNation asked experts about purchasing and servicing ultrasound. Our panels weighs in on the latest technology and service options.

Next month’s Roundtable article: Sterilizers

48

Improvements in Distance Support Remote monitoring is a growing trend when it comes to the care and service of medical devices at healthcare facilities.

This high-tech option is often offered by OEMs and can be beneficial when combined with the work of on-site HTM professionals.

Next month’s Feature article: Tackling New Technology

TechNation (Vol. 5, Issue #7) July 2014 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to TechNation at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

TechNation magazine is dedicated to providing medical equipment service professionals with comprehensive, reliable, information concerning medical equipment, parts, service and supplies. It is published monthly by MD Publishing, Inc. Subscriptions are available free of charge to qualified individuals within the United States. Publisher reserves the right to determine qualification for a free subscriptions. Every precaution is taken to ensure accuracy of content; however, the information, opinions, and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher.

JULY 2014

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9

INSIDE

Departments PUBLISHER

John M. Krieg

VICE PRESIDENT

Kristin Leavoy

ACCOUNT EXECUTIVES

Sharon Farley Warren Kaufman Jayme McKelvey

ART DEPARTMENT

Jonathan Riley Yareia Frazier Jessica Laurain

EDITOR

John Wallace

EDITORIAL CONTRIBUTORS

Roger Bowles K. Richard Douglas Myron Hartman Patrick K. Lynch Todd Rogers Manny Roman Cindy Stephens Matt Tomory Karen Waninger

CIRCULATION

Bethany Williams

WEB DEPARTMENT

Nam Bui Michelle McMonigle Taylor Martin

ACCOUNTING

Sue Cinq-Mars

P.14 SPOTLIGHT p.14 p.16 p.19 p.20 p.22

Professional of the Month: Herbie West, CBET Company Showcase: Trisonics New Association Announced Webinar Wednesdays Department Profile: UMC Clinical Engineering Department p.24 Biomed Adventures: Hot Rods and Robots

P.28 THE BENCH p.28 p.30 p.32 p.34 p.36

AAMI Update ECRI Institute Update Tools of the Trade Biomed 101 Shop Talk

P.56 EXPERT ADVICE

p.56 Career Center p.58 Ultrasound Tech Expert Sponsored by Conquest Imaging p.60 The Future p.62 Patrick Lynch p.64 The Roman Review

P.66 BREAKROOM

EDITORIAL BOARD

Manny Roman: manny.roman@me.com Patrick Lynch: Biomed Support Specialist at Global Medical Imaging, patrick@plynch.us Karen Waninger: Director of Clinical Engineering at Community Health Network in Indianapolis KWaninger@ecommunity.com Eddie Acosta: A Clinical Systems Engineer at Kaiser Permanente, Northern California, Fastedy99@yahoo.com John Noblitt: Program Director at Caldwell Community College & Technical Institute in North Carolina jnoblitt@cccti.edu

p.66 p.68 p.70 p.72 p.75

The Vault HTM Webinar Winner What’s on Your Bench?

Scrapbook Parting Shot

p.74 Index Like us on Facebook, www.facebook.com/TechNationMag

Follow us on Twitter, twitter.com/#!/1technation

MD Publishing / TechNation Magazine 18 Eastbrook Bend, Peachtree City, GA 30269 800.906.3373 • Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com

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PROFESSIONAL OF THE MONTH Herbie West, CBET

By K. Richard Douglas

A

n interest in how medical equipment is used to treat newborns helped motivate Herbie West, CBET, to leave the automotive service field and explore a career in Healthcare Technology Management. West, the clinical engineering manager at Roper Saint Francis Healthcare, recalls that some time spent in the hospital combined with his wife’s work as a neonatal nurse piqued his interest further.

“I found the human interface with electronics and the imaging world fascinating, and I was very curious as to how it functioned,” he says. “I had a lot of conversations with my wife about how she used medical equipment on a daily basis to care for newborns. The care of all levels of neonates, critical to normal, made it even more fascinating in how medical equipment is used to sustain life from the beginning.

Hence, I had a high interest in getting involved and turned down other options until I was accepted, at an entry level, in the biomed department at Roper hospital.”

An electronics degree from Trident Technical College along with years of experience in automotive mechanics combined to give West the initial building blocks he needed.

“Once I entered the field, I pushed hard to learn as much as I could through self-education, working with peers and some formal training through the OEM companies,” he says. “I found reviews of operational theory in service manuals a great help, along with articles available in magazines covering the biomed field. I actively participated in the on-site vendor training in-services offered through our

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in-house biomed department.”

“These in-services covered topics from vital signs to MRI. Most importantly, I spent as much of my free time as possible with my teammates in multiple disciplines just to learn more about their systems,” he adds. “I have always been a person who seeks opportunities for advancing my skills and expanding my knowledge base.”

West says that those early days, as an entry-level biomed, were spent replacing IV pole wheels. He was initially assigned to the endoscopy department, which ended up providing a wealth of opportunities in video and networking. In his “Tech I” years, he also spent as much time as possible learning about hospital operations and all the specialty areas.

The “Tech II” years allowed West to focus on imaging, working on C-arms and portable X-ray units.

“I continued to work through all other areas of general care, building my knowledge and skill sets, and before I knew it, I was moved into CT and MRI services,” he remembers. “In my ‘Tech III’ years, I was privileged to have multiple OEM training classes in many of the imaging modalities. I worked hard on building my leadership

Herbie West, CBET, is always looking to advance his skills.

skills at the same time. I greatly enjoyed the challenges of working with my teammates, vendors and customers in all aspects of the day-to-day activities.”

At the time, the department at Roper hospital had several managers and the organization had merged with Bon Secours Saint Francis, which had its own in-house biomed department. West was proud of the in-house team at Roper and was concerned about outsourcing, so he applied for the position of supervisor when it became available.

“After a few years of sharing the biomed services with the St. Francis team supervisor, we reorganized and I was

equipment. We have a high level of connectivity from EMR to physiological monitors; telemetry, wireless infusion pumps, PACS throughout imaging, networks within endoscopy, echo, EEG and a host of other specialty areas.”

He says that keeping his staff up on integrations, and the understanding of networking to support these areas, has been a big challenge as well.

“We are separate from IT but we work closely together to ensure the full infrastructure is maintained, which can be a challenge,” he adds.

FAMILY AND LEISURE

Herbie West, enjoys playing the guitar and is a beekeeper in his spare time.

promoted to biomed manager for Roper Saint Francis Healthcare,” he says. “It has now been 21 years in the biomed profession with 13 of those in management of the biomed department. And what an adventure it has been.”

Time away from work includes honey, livestock, woodworking and fishing. “I enjoy my little homestead where I raise cows, chickens and a host of other birds,” West says.

“I garden as much as I can for food and the beauty of flowers. The flowers are mostly for the other girls in my life, my honeybees. I raise honeybees and harvest their golden nectar to share with friends — and for a few coins. I also enjoy playing the

“Timothy Blake West resides in Charleston with his wife, Jen, and our first lovely grandchild — Olivia Wren West. She has become the sparkle in our eyes at just a month old,” West says. “I can only say when it comes to family, everything else is set aside.”

What is important to know about West?

“I think first you have to understand that I greatly appreciate and love the biomed world,” he says. “When I get into anything, I strive to give my all to produce positive results. I love nothing more than to analyze and resolve problems. These problems seem to come more often and get larger each day, but they build character.”

He says that he takes nothing for granted and appreciates every opportunity.

“Most importantly, I do not look for what I can gain, but for what I can provide to others, to help them to grow and enjoy life and work in any way they can,” West says.

“Most importantly, I do not look for what I can gain, but for what I can provide to others, to help them to grow and enjoy life and work in any way they can.”

– Herbie West

Today, West manages three full-service hospitals in Charleston, S.C., several diagnostic, ER and urgent care centers and many physician practices.

“Our biomed team handles all services from general floors, to labs and OR, as well as all the imaging services,” he says.

KEEPING CURRENT Asked about challenges, West responds with a bit of humor; “I would like to say the big Y2K bang, but maybe not.”

“Because we own services on all the equipment within our organization, my big challenge is keeping up with all the new technology associated with each area,” he says. “Over the years, we have grown in the integration of medical

guitar and building with wood — barns, sheds, houses.”

When he finds any extra time, West can be found on the river casting his fly rod, using his homemade flies. He is on the lookout for that special trophy fish.

“Of course I catch and release, so that trophy fish would only be seen in pictures,” he jokes.

On the home front, West gives credit to his wife of 38 years, Deborah, for the support and encouragement he has received over the years.

“We have two wonderful sons,” West says proudly. “My oldest, Justin Ramsey West, is a nurse at Mission Hospital in North Carolina — so healthcare and service runs in the family.”

FAVORITE BOOK “The Worst Hard Times – The Dust Bowl” by Timothy Egan. “This should be a mandatory read for our culture today. Talk about survival.”

FAVORITE MOVIE “Fly Boys” FAVORITE FOOD Shrimp and fish – hey, I live on the coast!

HIDDEN TALENT Song writing WHAT’S ON MY DESK/BENCH? “Phone, computer, pen and pad but most importantly a cup of coffee and a picture of my granddaughter; Olivia Wren West.”

SPOTLIGHT

COMPANY SHOWCASE Trisonics

T

en years ago Stuart Latimer, Bryan Hoffman, and Alan Pettenati realized that there was something important missing in the ultrasound industry: exceptional customer service provided in a cost-effective manner. This realization led to the partnership and formation of Trisonics, Inc.

In 2003, the three men purchased a warehouse in central Pennsylvania, and took their toolbags out to provide their customers with a new solution to ultrasound service. They have built Trisonics to where it stands today with more than 25 employees while still holding true to the belief that success comes from making your customers happy.

“The success of Trisonics comes because our staff and engineers believe in the core values upon which Trisonics was built: excellence, integrity, and experience. It is our top priority to treat each customer with respect and integrity, and to ensure complete satisfaction with the services we provide. In order to provide this high level of service, the right people have to be in place. Trisonics owes a lot of its success to hiring great people who are dedicated to what they do,” Latimer explained.

The quality of every Trisonics employee adds to the company’s expert knowledge in the ultrasound industry and continues the legacy of outstanding service.

The old saying goes, “It’s hard to find good help these days.” While it can be difficult to find the right people, Trisonics did not shy away from the challenge during a recent expansion.

“A challenge that we faced last year was a lack of personnel to support the growing demands of the company. Trisonics needed to find the right people to put in place who were not only experts in their current roles, but could also be diversified enough to help

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Technical Service Coordinator John Steffen works on a medical device.

out when needed in other areas,” Latimer explained. “We were fortunate enough to bring on some A-list talent over the past year. This expansion will truly help Trisonics grow to the next level.”

The growth of the company has been exciting for everyone involved.

“Everything Trisonics is offering right now is exciting,” Latimer said when asked what product or service he is the most excited about in 2014. “Whether it is a service contract offered by one of our Senior Territory Engineers or training biomeds

on-site at their facility or helping a hospital find the right system to fit their needs … everything we offer is exciting. We just hope we can bring our level of excitement to the customers as well.”

One way Trisonics provides this high level of customer service is through the unparalleled expertise of their staff and engineers.

“One advantage that Trisonics has over the competition is that we know ultrasound. We have over 200 years of combined experience in ultrasound service and sales,” Latimer said. “Our engineers are

“One advantage that Trisonics has over the competition is that we know ultrasound. We have over 200 years of combined experience in ultrasound service and sales.”

– Stuart Latimer

The Trisonic headquarters is in Highspire, Pa.

able to adjust and adapt to this changing marketplace and they always make sure to go above and beyond for our customer. We pride ourselves on making long-term relationships versus short-term fixes.”

At Trisonics, they are willing to work the extra hours, make one more phone call, and drive even further to make sure their customers’ ultrasound needs are met each and every day.

“Trisonics hopes to continue to grow and expand. We want to make sure that we have the best people in place to meet the needs of our customers. Right now, Trisonics is busting at the seams in our current facility. Because of our recent growth, not only with personnel but acquiring thousands of pieces of new parts and equipment, we have outgrown our current building,” Latimer said. “We are in the process of looking for a new place to call home.”

Currently, the Trisonics facility houses 12 in-house staff and 13 field engineers with more on the horizon. They are constantly adding to their inventory, and look to continue this level of growth for many years to come.

“The three owners of Trisonics would like to take this opportunity to recognize all of our employees. They are the best at what they do and have made Trisonics into the success that it is today,” Latimer stressed.

“We absolutely feel that we have the leaders in this industry working for us and are proud of what they do day-in and day-out for our customers. It is an exciting time for Trisonics and we cannot wait to see what tomorrow holds.”

When asked if there is a specific message that he would like to share, Latimer said, “Yes, that if you have not used Trisonics in the past, give us a call and experience firsthand the customer service and expertise that you will not find anywhere else in this industry. I want your readers to find out for themselves what they can expect from Trisonics and get to know us personally.”

FOR MORE INFORMATION about Trisonics, visit www.Trisonics.com.

The founders of Trisonics are Vice President Bryan Hoffman, Vice President Alan Pettenati and President Stuart Latimer.

SPOTLIGHT

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NEW HTM ASSOCIATION Takes Root in Nashville

N

ashville was the site for MD Expo last fall and the community response was amazing. So, it is no surprise that healthcare professionals are coming together in the Music City to form a Healthcare Technology Management organization.

John Krieg, founder and president of MD Publishing, heard about the meeting to form a HTM association in middle Tennessee and quickly decided to attend.

He said the meeting was well attended by individuals from hospitals and vendors.

“MD Publishing and TechNation magazine are excited to be a part of this new organization and to lend support,” Krieg said.

“The former Middle Tennessee Biomedical Association was resurrected,” Krieg said. “It has a new name, a new focus and

is taking a new direction.”

He said the group is following in the footsteps of KAMI (Kentucky Association for Medical Instrumentation) and HTMA-SC (Healthcare Technology Management Association of South Carolina).

Pat Lynch with GMI also attended the meeting. He said that a group of 17 interested people met at St. Thomas Midtown Hospital in Nashville, Tenn., during the first week of June to begin the HTMA-MidTn (Healthcare Technology

Management Association of Middle Tennessee).

Several hospitals were represented, along with some industry companies.

“We selected 12 people to serve on the board of directors and began work on bylaws,” Lynch said. “For the present, membership is free.”

“Please visit the website at www.htma-MidTN.org to register and begin receiving emails about our activities,” Lynch said.

JULY 2014

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WEBINAR WEDNESDAYS

Webinar

Wednesday

Are a Hit!

H

TM professionals from around the world are registering for and attending these free informative sessions that often include CE credits. Among the countries from which biomeds have viewed the webinars include the United States, Puerto Rico, Bahamas, Bahrain, Canada, Italy, Greece, Mexico, Saudi Arabia, Qatar and the United Kingdom.

The webinars have been so successful that MD Publishing has doubled the number of sessions offered each month to keep up with demand!

In July, the two webinars include “A Look Inside X-ray Measurement Systems” on July 9. It will be presented in the popular roundtable discussion format. The April webinar on test equipment was the first to be offered in this format and the positive feedback left no alterative than to present another webinar with a panel of experts. The second webinar of the month will be held on July 30 and focuses on time management and how it can lead to a more successful career.

THE WEBINARS FOR JULY ARE AS FOLLOWS: WHAT’S NEW IN X-RAY TEST EQUIPMENT WHO: Presented by: Panel Discussion featuring Radcal, RaySafe, RTI Electronics and Fluke Biomedical DATE: Wednesday, July 9, 2014, at 2 p.m. EDT X-ray equipment is an important tool in the healthcare industry. It helps healthcare professionals diagnose and treat patients. The importance of these devices makes the X-ray test equipment

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used to analyze this equipment a vital tool in providing quality healthcare.

This 90-minute webinar will highlight some of the latest and greatest advances from leading manufacturers. The webinar will feature a distinguished panel of representatives who will discuss the fast-evolving world of X-ray test equipment. Also, attendees will be able to submit questions to the expert panel to gain valuable insight regarding X-ray test equipment.

EFFECTIVE TIME MANAGEMENT = CAREER SUCCESS WHO: Tim Shaver WHEN: Wednesday, July 30, 2014, at 2 p.m. EDT Tim Shaver, of Tim Shaver and Associates LLC, obtained a bachelor’s of science in Engineering from the United States Military Academy. He has five years of U.S. military experience, 18 years of experience with a family-owned business and has spent 17 years as a business owner. Some of his credentials include Vitage Chair, Sandler Trainer and Certified Behavior Analysist. He will share tips and advice on time management and the positive impacts that can have on a person’s career.

Tim Shaver will be presenting a webinar on effective time management on July 30.

REGISTER FOR THESE WEBINARS at IAmTechNation.com/webinars/. Also be sure to check out the webinars coming up in August.

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DEPARTMENT PROFILE University Medical Center Clinical Engineering Department

By K. Richard Douglas

W

hen you think of Vegas, you think of the public relations campaign that says what happens there, stays there. There are certainly some exceptions to that rule, and one of them, is the good work done in the Clinical Engineering department at the University Medical Center (UMC). The medical center is the state-designated Level 1 Trauma Center for Southern Nevada. The center is also home to the Lions Burn Care Center.

UMC’s clinical engineering team is an ARAMARK shop and is headed up by technology manager; Jorge Ramos.

“ARAMARK assumed responsibility at UMC in 2001 through an acquisition,” Ramos recalls. “The majority of our talented and tenured management group has been with UMC for approximately 20 years.”

In addition to Ramos, who is director of clinical engineering within UMC, the team consists of a supervisor, five BMETs and an ISE II. There is also another supervisor for their equipment distribution department. That department has seven general utility technicians.

The department uses the ARAMARK iDesk product for data collection. The department members troubleshoot down to the component level, according to Ramos.

“Five of the techs in the department had received their BMET certification in 2013. Eight are members of the Nevada Healthcare Technology Association (NHTA),” says Mike Lane, clinical engineering supervisor, who is also the NHTA’s president. He points out that Frankie Ebiya, another member of the clinical engineering department, is vice president of the association.

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“ The customer satisfaction and feedback, on this program from the nurses, is just night and day from where the program was before. The nurses no longer have to get on the phone asking about where’s their equipment, it hasn’t been delivered or they have something that’s broken.”

– Jorge Ramos

PROJECTS IN EHR With CE/IT integration an ever-growing reality, the department has set the standard that reflects their name.

“The clinical engineering field is fast becoming integrated with information technology in many aspects,” Ramos says. “Our team currently operates over 15 homogeneous local area networks.

From the installation, implementation, and support; the clinical engineering department has placed a priority on patient monitoring.”

Ramos says that since the implementation of their electronic health records project, the CE department has worked closely with IT to diagnose and prevent issues with data capture.

“One of our BMETs, Zachary Brown, completed a degree in CIT-Networking to help bridge the gap between the two worlds on current and future projects,” he says. “Other key CE/IT projects include wireless networking of our infusion devices, wireless adaptation of portable imaging equipment and assessment of future telemetry architecture.”

The UMC Clinical Engineering Department includes Jorge Ramos, Frankie Ebiya (back), Corie Springer, Mike Lane, Zach Brown (back), Princess Sayas, WIllie Dela Cruz, Larry Robinson, Jim Clark (kneeling), and Remnan Lopez (kneeling).

UMC was one of the first in the country to pioneer an equipment distribution program, according to Ramos.

“That traditionally was, and still is, handled by central stores group or sterile processing group,” Ramos explains. “We took a program that should have been in the hands of equipment experts, out of those hands, and really maximized the efficiency and effectiveness of that program.”

“We have a computerized tracking system, much like our CMMS, that this equipment is on, and we have a 24/7 crew, so we know and monitor at all times the flow of that equipment,” he adds. “We’re also on top of it when that equipment is broken and funnel that straight to our repair shop. Plus, that helps us in identifying problems with par levels and we’ve maximized that in order to decrease rental costs to virtually, and I’m not exaggerating, down to nothing at this account.”

“By really dialing in and drilling down on those numbers, and establishing true par levels, we’ve also perfected that program. It took it to another level when

we began forward stocking,” Ramos says. “The customer satisfaction and feedback, on this program from the nurses, is just night and day from where the program was before. The nurses no longer have to get on the phone asking about where’s their equipment, it hasn’t been delivered or they have something that’s broken. They get something that is a top-notch quality product delivered to them clean. We’re also integral to the infection control process there. It’s just an outstanding program.”

MOVING TO SMART PUMP TECHNOLOGY “Whenever you talk about a transition of a fleet of equipment within a hospital, such as infusion pumps, and it also involved a fleet of pulse oximeters, that is a huge undertaking,” Ramos says.

The clinical engineering team was instrumental in the request for proposal. It took over two years to work out the deal.

“Now we have integrated that fleet of smart pumps, working closely with the pharmacy, as far as the guardrails on there, working closely with IT and the

wireless system, to make sure that we have that working properly. The tagging of all the pieces; now we have a modular system as opposed to before, where you had a pump, you had one unit. Now you have a PCU,” Ramos says.

“We went from 650 pumps; roughly 1,300 channels,” Ramos explains. “We now have over 2,000 pieces that have to be tracked (and) tagged.”

Those pumps are spread out over the five buildings on the UMC campus.

The team also provides service to 12 satellite specialty care and clinic locations. One clinic location is 80 miles from the hospital.

The department was also involved in projects to relocate monitoring for telemetry and a chest pain center. They relocated old monitoring systems to areas that didn’t have monitors. Ramos says that the team goes above and beyond with telemetry.

One example he shared is when they were doing a hardware refresh on an old system in telemetry. There was also an asbestos abatement project being done on a floor where a new cardiovascular center was being created. The telemetry room, where 188 channels are monitored by four full-time techs, had to move.

The CE department moved them and transitioned them along with the installation of the new equipment. The department made it seem seamless, despite the construction going on at the time.

“I have to give kudos to my crew, that they have the abilities and skills to do this kind of thing,” Ramos says proudly.

SPOTLIGHT

BIOMED ADVENTURES Hot Rods and Robots

By K. Richard Douglas

T

he actor Robert Duvall was once asked by a young actor; “What do you do between jobs?”

Duvall responded; “Hobbies, hobbies and more hobbies.”

We spend a third of our lives working and a third sleeping, so in that remaining third, a distraction like a hobby helps us relax and stay focused on something we enjoy. For many biomeds, who are already technologically and mechanically savvy, the lure of restoring an old car or truck just makes sense. From a full ground-up restoration to some simple customizing, the joys of seeing the finished product is always rewarding.

One HTM professional in St. Paul, Minn., didn’t stop with his auto restoration project. He also built a functioning robot; a Dalek to be exact.

Chris Cheney, CBET, a field service biomed for Penlon, has found a rewarding hobby in doing both.

“I am the MERA (Medical Equipment Repair Association) Tech, which means I represent the manufacturer as a factory-trained tech to the end user,” Cheney says of his job. “I am trained on more than 50 different machines plus general biomed. I travel mostly Minnesota, Iowa, North and South Dakota and Wisconsin, but I can be

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Chris Cheney, CBET, is currently working on a 1950 Chevrolet pickup.

sent all over the country to back up other techs.”

Cheney has been a biomed for about eight years. He attended tech school and thought he would repair computers. He did electronics with the phone company originally, and when that ended a friend who teaches X-ray technicians, suggested the biomed profession.

RUST BUCKET TO HOT ROD Cheney isn’t new to the street rod scene. He recently sold a 1929 Model A

coupe hot rod to a buyer in Sweden, and used some of the money to take his wife on a trip to Italy, when the urge to start a new project hit.

“A friend of mine was cleaning up his property and had a couple of these trucks, so I asked to buy one, which he only asked $300 for,” he says.

Cheney ended up with a 1950 Chevrolet pickup truck.

“Well my plan was to hot rod this truck, and when I got it home, (I) took it apart to see what I would need, which was a lot,” he says.

“ A friend of mine was cleaning up his property and had a couple of these trucks, so I asked to buy one, which he only asked $300 for.”

– Chris Cheney

“The only parts I kept were the cab and doors, hood, and frame,” Cheney adds. “The rest was too beat up and rusty. I started on the frame and stripped it down and added independent front suspension and ‘truck arm’ suspension in the rear, all on (an) adjustable air ride suspension. Then (I) added a 354 cubic inch HEMI from a 1956 Chrysler New Yorker, (and a) rear end from a 1960 Ford.”

The next step in the project was to put together a pickup box and rear fenders.

Cheney painted them 1969 Chevy green.

Last year, he had the cab stripped and sandblasted so he could start the bodywork on both. The cab then got a coat of primer. He got a 1984 pickup seat and removed the center portion to accommodate the cab size of the older truck cab.

The new upholstery will be tuck and roll with green piping.

“I found a set of front fenders that were in really great shape for cheap, and was able to sell the extra parts, so they only cost me about $20,” he says.

When the truck is done, it will get to be seen by a lot of people before Cheney starts on his next restoration project.

“I will be taking this truck to the ‘Back to the 50s’ show here in St Paul, Minn.

About 12,000 cars show up every year; it is the big show in Minnesota, but I also hope to attend many others also,” Cheney says.

“And when this truck is done, I will be doing some repairs and updating to my 1965 Rambler Classic, that was my first car. I also restored a 1971 Moto Guzzi motorcycle, which I have rode to Sturgis about six times,” Cheney says.

A SLICE OF ‘DOCTOR WHO’ From building a hot rod to building a robot may seem like a stretch, but fabricating is fabricating. It was an introduction to the mysterious “Doctor Who” that led to the Dalek project.

“I first saw the show on public television here in Minnesota. I enjoyed the show a lot, as it had great stories and characters,” Cheney says. “The sets were a bit cheesy and all, but I was hooked.

When I moved in with my friends, I found they too liked the show and we would always try to watch (it). When they brought back the show, they had really put a lot into the sets and everything and now I think it is more popular than ever.”

After he decided to start building the Dalek, he starting attending some science fiction conferences. He had visited the BritCon, the Minneapolis Comic Con and some smaller shows.

“Well first, I have to give credit to the web forum I joined call Project Dalek.

Without their help, I would have never attempted this. It is a 2005 — new style Dalek (NSD).”

Cheney used mainly plywood, MDF, fiberglass and resin to construct the robot, or for purists, the cyborg. He constructed the dome and shoulder section from fiberglass. He used 4-inch stainless steel gazing balls to make the arm and gun pivots.

Some creative jerry-rigging allowed for construction of the rest of the Dalek.

“The hemispheres on the skirt are half of a 4-inch plastic Christmas ball, the plunger on the arm is a plunger, the detail around the hemispheres are a resin cast of

a

Chris Cheney constructed a Dalek.

truck oil seal,” Cheney explains. “Things like that.”

“The insides of the wood parts are reinforced with fiberglass, and the lower fender will be painted in truck bed coating,” he adds.

When the Dalek is completed, will it actually work?

“Yes this will be very functional, I will be able to ‘trundle’ in it and turn the head dome and use the arm and gun, and speak like one, with the lights on the dome lighting up also,” Cheney says.

“Right now I am looking for a cheap old electric wheelchair to power it so I won’t have to use my feet.”

The truck is about 50 percent complete and the Dalek is about 75 percent done.

Cheney hopes to put the finishing touches on the truck by summer of next year.

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AAMI UPDATE

New Publications to Offer Support to Dialysis Facilities

W

ith the number of patients requiring dialysis growing worldwide, up-to-date guidance for facilities offering this treatment is urgently needed. Recognizing the need for standards and guidance in this area, AAMI plans to release seven publications to help dialysis professionals.

The recently published Dialysis Water and Dialysate Recommendations: A User’s Guide was developed by a member of the AAMI Renal Disease and Detoxification Committee. It is intended as a tool for those who oversee and operate hemodialysis facilities, providing clarification on regulatory requirements and current AAMI guidance. It provides a side-by-side comparison of Centers for Medicare & Medicaid Services (CMS) regulations and interpretive guidance for the Condition of Water and Dialysate Quality Rule with the suite of standards that have been adopted by AAMI as replacements for ANSI/AAMI RD52:2004, Dialysate for Hemodialysis.

Later this year, the AAMI Renal Disease and Detoxification Committee plans to publish a new technical information report (TIR) to provide dialysis practitioners with more information related to recommendations made in certain recognized standards. AAMI TIR58, Water Testing Methodologies, will address contaminants in dialysis water, as well as available testing methodologies to meet the requirements of these standards.

Although the documents emphasize known toxicities, other contaminants

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that may interfere with dialysis treatment also are discussed. The TIR will provide information in an accessible chart format to allow for quick reference and help readers understand the reasoning behind the requirements.

Other forthcoming standards include AAMI versions of: • ISO 11663:2014, Quality of dialysis fluid for hemodialysis and related therapies • ISO 13958:2014, Concentrates for hemodialysis and related therapies • ISO 13959:2014, Water for hemodialysis and related therapies • ISO 23500:2014, Guidance for the preparation and quality management of fluids for hemodialysis and related therapies • ISO 26722:2014, Water treatment equipment for hemodialysis applications and related therapies

AAMI JOURNAL OPTIMIZED FOR MOBILE DEVICES Members and subscribers now have mobile access to AAMI’s peer-reviewed journal, BI&T (Biomedical Instrumentation & Technology), and its supplement, Horizons.

The move reflects AAMI’s commitment to expanding members’ options for

reading and sharing articles from the association’s award-winning publications.

“We hope the mobile feature will enhance the value of BI&T and Horizons,” said Sean Loughlin, AAMI’s senior director of communications. “Today’s busy professionals no longer restrict their reading to print copies of publications or even to what’s on their desktops. They are on the go, and we intend to be on the go with them. We are determined to meet the needs of our members.”

Published bimonthly, BI&T is a widely respected journal dedicated to the interest of those who develop, maintain, and use healthcare technology. Each issue of BI&T contains case studies, cutting-edge research, interviews with healthcare technology leaders and medical device manufacturers, career advice, and many articles that offer practical tips to clinical engineers, biomedical equipment technicians, and other professionals in the field. Recent cover stories have included a look at the challenges associated with battery-powered medical devices, an in-depth analysis of the promise offered by 3D technology, and a sobering examination of the possible dangers posed by the use of opioids and PCA pumps.

Horizons is published twice a year. Each issue focuses on a specific topic, such as home healthcare technology or medical device alarm systems. The just-released spring issue of Horizons tackles the subject of cybersecurity in healthcare.

For more information about AAMI’s publications, visit www.aami.org/ publications.

AAMI RELEASES FAQ RESOURCE ON WIRELESS CHALLENGE IN HEALTHCARE Wireless support has been added to my responsibilities, and I don’t know anything about it. Where can I go to learn?

That is the first question in a new document of FAQs dealing with the wireless challenge in healthcare.

Released by AAMI, the project is the work of AAMI’s Wireless Strategy Task Force, which was created in the fall of 2012 to dig deeper into the wireless challenges that many healthcare facilities now face.

The free resource, FAQs for the Wireless Challenge in Healthcare, contains a total of 70 questions, covering a wide array of topics, including regulatory matters, architecture and network design, prepurchase and preinstallation information, security, and management of the wireless network.

“The more ubiquitous the use of wireless solutions, the more challenges there are,” said Steve Baker, senior principal engineer at Welch Allyn. “To aid in understanding those challenges in health delivery organizations where the number of different devices with wireless is staggering, we developed this document to help healthcare technology and IT experts, as well as facilities management professionals, get a handle on the issues and gain an understanding of some of the fundamental precepts of wireless networks.”

Baker led the FAQ project for AAMI, writing much of the content. He was assisted by Rick Hampton, wireless communications manager at Partners HealthCare Systems; Scott Coleman, network technologies manager at Welch Allyn; and Paul Sherman, a consultant who is retired from the Veterans Affairs.

All are members of the task force.

YOU CAN DOWNLOAD a free copy of the FAQs at www.aami.org/hottopics/ wireless/AAMI/042514_WirelessFAQ.pdf AAMI HAS ADDITIONAL RESOURCES focusing on wireless technology on one of its “Hot Topics” pages at www.aami.org/hottopics/wireless/index.html.

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CT SCANNERS

Making the Premium Choice

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s CT technology advances, the new premium scanners now provide more detailed information in cardiac, oncology, and emergency imaging, while reducing the radiation dose delivered to the patient. Learn about the latest premium features, explained in the article below.

In the upper echelon of the CT market are scanners packed with the newest, most advanced technology available. Most of the recent innovations in CT focus on improving image quality by making acquisition times as short as possible. The goal is to capture a true snapshot of the patient’s anatomy — specifically, moving anatomy. This capability has paved the way for new features such as dynamic cardiac and cerebral imaging that are designed to widen CT’s range of clinical applications. Another key focus is on features to improve workflow by integrating the scanner with peripheral systems such as IT systems and contrast injectors.

Manufacturers also continue their efforts to reduce and control X-ray radiation, which is associated with cancer.

CT is the largest single contributor to radiation dose from a man-made source.

While the magnitude of the cancer risk is uncertain, it is widely accepted that more could be done to control the dose. Over the last few years, all manufacturers have taken major steps in this direction. In most cases, the latest developments have first been introduced on premium systems.

The main drivers of CT technology advances are demand for: • New clinical applications: o Dual-energy CT and spectral CT o Dynamic imaging • Further dose optimization • Workflow integration

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NEW CLINICAL APPLICATIONS Dual-Energy CT and Spectral CT Dual-energy CT (DECT) and spectral CT are two advanced image acquisition techniques that, while they go about it differently, both aim to achieve the same result: to allow radiologists to more accurately distinguish between different types of tissue and thereby help provide more definitive diagnoses. In most respects, the two technologies are

Each manufacturer has a different DECT or spectral technique available or in development, and differences should be expected in how these techniques perform.

Dynamic Imaging Dynamic imaging (also known as 4-D imaging) refers to the ability to obtain a series of snapshots of anatomy over a few seconds to a minute in order to show organ function. The resulting images can be quantitatively analyzed to help clinicians determine an accurate diagnosis when, for example, blood flow through an organ (perfusion) is clinically relevant.

Dynamic imaging capabilities are particularly useful in emergency imaging, where the top indications for CT use are suspected stroke and trauma.

Manufacturers also continue their efforts to reduce and control X-ray radiation, which is associated with cancer. equivalent — what you can do with DECT you can do with spectral CT. Currently, only DECT is commercially available; however, spectral CT is expected to become available in the near future.

Although DECT imaging was introduced a few years ago and has known clinical benefits, it is not yet widely used in clinical settings due to some technical challenges. However, interest in the technology is growing. This is evidenced by the fact that today all the commercially available premium systems are capable of DECT imaging and it is an option on some lower-cost systems.

Any CT scanner can provide a series of static images. The advantage of premium CT systems is that they all provide extensive anatomical coverage, which allows serial images of entire organs to be acquired easily. All the major vendors offer very similar 4-D imaging capability.

Dynamic CT imaging has a wide range of applications; for example: • In cardiology, research has shown that dynamic CT angiography could reveal conditions that are not found by conventional techniques.

• In dynamic joint studies, preliminary research has shown that dynamic CT technique can generate images of high temporal and spatial resolution without requiring repeated joint motion, which is used for assessment of joint instabilities.

• Perfusion CT imaging can provide diagnostic information in diagnosis of cancers, vascular malformations, etc.

FURTHER DOSE OPTIMIZATION As CT’s high patient radiation dose continues to receive attention, CT manufacturers continue to take steps to control and reduce dose without affecting image quality.

Detection System The goal of CT designers is to develop detectors that provide the highest spatial resolution with the lowest noise. As detector performance improves, it is possible to reduce the radiation dose.

Incremental refinements are being made by improving the scintillation detector material or solid-state detector material and the electronics.

Dose Reporting To gain the full benefits of the dose information, it may be necessary to install dose monitoring systems. The main benefit of dose reporting is that the dose data can be more easily tracked and audited. All new CT systems have dose reporting features as standard, and older systems should be upgradable to include this feature.

WORKFLOW INTEGRATION Currently, most CT scanners have tools designed to improve workflow efficiency, as well as patient management and safety.

User interfaces have been designed to

automate as many steps as possible and, therefore, reduce the number of mouse clicks and user errors in routine workflows. Such features include automated preprocessing/launch, auto 3-D generation, and automated scan settings based on patient information.

Also, all major CT manufacturers have introduced new technologies that aim to enhance integration with peripheral systems such as contrast injectors and IT systems, the latter including conformance to IHE (Integrating the Healthcare Enterprise) profiles.

Recently, manufacturers have paid more attention to integration with CT injection systems. Seamless integration between the injector and scanner improves the workflow, since approximately 50 percent of CT studies require injection of contrast media. In contrast-enhanced studies, the contrast is injected first, then after a short delay, the scan starts; the length of the delay depends on the time it takes for the contrast medium to reach the organ of interest, which, in turn, depends on the patient. Traditionally, the user would need to start both devices, with a delay between start times. The contrast injection parameters are manually set on the injector’s control console, which is usually adjacent to the CT scanner’s console. The optimal injection parameters depend on the type of scan and the patient’s characteristics.

Basic scanner-injector integration, which only allows the scanner and injector to communicate their status with each other, is widely available. In basic integrations, the interface simply ensures

that the injector will only start the injection when the CT scanner is ready, using the Controller Area Network (CAN) class 1 or 4 message-based protocols. Such an interface does not endow any significant workflow benefits.

Integration beyond CAN class 4 is now becoming available between some CT scanners and injectors (advanced integration). This level of integration enables the scanner to control the injector.

This means that the injector’s control console is no longer needed, the contrast parameters can be automatically set based on the CT parameters, and the injector is started from the CT control console.

Also, the electronic injection report can be included in the exam summary and sent to a PACS automatically. This has several potential advantages in addition to those already noted: • Patient-specific characteristics can be shared between systems to help optimize the scan.

• If a problem emerges with one device, the other can be automatically stopped, thereby improving safety.

• Automatic documentation of all relevant parameters is available in one place.

THIS ARTICLE is an excerpt from a Health Devices article posted on ECRI Institute’s Health Devices System, Health Devices Gold, and SELECTplus membership websites on March 18, 2014. The full article includes more guidance on CT technology advances process, several supplements, and corresponding graphs.

To purchase this article and its supplementary materials or to learn more about membership programs, visit www.ecri.org, contact clientservices@ecri.org, or call (610) 825-6000, ext. 5891.

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33

BIOMED 101

Don’t believe everything you read about Windows XP

By Derek Brost

B

y now, you’ve probably heard a growing choir of consultants and industry professionals harping on the perils of running Windows XP on devices that carry patient data. The argument goes that since Microsoft is ending its support for that operating system, data stored on XP-powered devices is at serious risk for breaches, hackers, and other cyber dangers. “Hurry up and upgrade your Windows or else!” goes the warning. Don’t believe everything you read.

THE REAL CHALLENGE We don’t mean to diminish the importance of addressing XP as an unsupported platform. Yes, it’s a problem. But the real challenge is that Windows XP is just one of many unsupported, unpatched platforms operating life-saving devices today.

Removing all XP platforms from your hospital will do little to improve your risk profile.

In reality, many medical devices (including major diagnostic and therapeutic devices like CT scanners, MRIs and lab machines) carry at least eight versions of Windows that predate XP as well as several versions of DOS, the iconic black screen of the 1980s.

Remember when you used to play Atari? Hospitals still use devices with operating systems from that era to diagnose and treat patients, as well as capture and maintain their data today. (You’ll likely find one just down the hall from you as you read this.) As for devices running on more current versions of Windows, most of them haven’t been patched either.

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We worry about keeping financial systems up to date, so why wouldn’t we take the same care toward medical devices that can be corrupted just as easily, jeopardizing the health of patients and their data?

WHY NOT UPGRADE ALL SYSTEMS? The primary obstacle to upgrading all systems, in three letters, is the FDA. Because medical devices are FDA-

regulated machines, we can’t treat them as conventional computers, updating their software, patching operating systems, slapping anti-virus or encryption capabilities as we wish. By doing so, we would be altering their FDA-approved state, potentially corrupting the device’s function or the data stored in it.

Rather, the FDA requires that any modifications to a medical device must

be validated, regression-tested and cleared by the manufacturer fi rst. No one is implying that this requirement is a bad thing; just a necessary safeguard designed to ensure data accuracy and patient safety.

WHAT TO DO Outside of working with manufacturers to update medical device software, what’s a healthcare provider to do? Below are four steps for greater security and compliance: 1. When conducting your HIPAAmandated risk assessment, be sure to include every place where ePHI resides in your facility. Think beyond traditional computers and tablets. A typical hospital averages two medical devices per bed that capture, store or transmit ePHI. That includes behemoth devices like MRIs all the way down to more ordinary patient care tools like pulse oximeters or IV pumps that regulate medicine dosages. If it has patient data in it, it’s subject to HIPAA.

device, then uploading it to the network where or when needed? Not all devices need to “talk” to each other, the Internet, or your network.

Limit those capabilities where no real need exists.

3. Determine if you need to keep information on a medical device once you’ve put it in the patient’s chart. Why leave test results on a laptop-based medical device when they are so easy to steal? If nothing else, remove old exams on a regular schedule — daily, weekly or monthly — ensuring that they are appropriately transferred to your EHR.

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4. Because Windows is such a common operating system, many hospital employees use it to check email, download personal fi les, access their Facebook profi le or surf the Internet on medical equipment between patient studies. Defi ne acceptable use policies for medical devices, then educate staff and ensure they don’t misuse those devices in your facility.

Evaluate if legacy systems connected to your network really need to be connected. Are there more secure ways to get the data from a device to the network?

If you do nothing else, please observe the fi rst recommendation: complete a risk assessment that captures all places where ePHI is stored in your organization. Not only does that assessment fulfi ll a vital HIPAA requirement, but it’s also the foundation for identifying your true risk level and steps necessary for greater ePHI security and compliance.

Armed with those fi ndings, you’ll be able to identify high-impact steps that don’t waste your resources on shortsighted Band-Aids like a Windows XP witch-hunt, which only addresses a small part of the problem.

2. Evaluate if legacy systems connected to your network really need to be connected. Are there more secure ways to get the data from a device to the network, such as downloading information to an encrypted USB

DEREK BROST is the Chief Security Officer for eProtex. He spearheads the development and implementation of solutions to health IT security and HIPAA compliance demands.

As such, he oversees risk assessment and mitigation efforts for more than 100 healthcare facilities nationwide.

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SHOP TALK

Conversations From the TechNation Community Q A

Looking for tips on benchmarking.

What are the pros and cons?

Many HTM departments use COSR as a benchmarking tool. You should be benchmarking yourself annually to your previous years and also against other hospitals inside and outside your organization. A successful department can use this information to share with your C-Suite. Benchmarking helps departments justify budgets and will show if you are on track or if there are opportunities. Your CMMS system must be accurate, this is the primary tool for benchmarking, budgeting, meeting regulatory requirements and showing all the savings you provide or show those opportunities to spend money on training to bring costs down.

Telling your story to the C-Suite or those you report to will be more difficult. Dollars are very important in healthcare and showing you are benchmarking against yourself and others is important. Almost every department in a hospital uses some type of benchmarking to prove they are keeping costs down.

A

There are several external benchmark solutions in the industry.

Larger organizations can benchmark internally quite effectively. The accuracy of your CMMS system cannot be overstated here. When using external benchmarking sources it is difficult to know the accuracy of “others”

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1TECHNATION.COM

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in the comparison pool. How are devices inventoried? Are all expenses captured (i.e. imaging oncology, lab including contracts)? How is equipment value determined (price paid vs. list price vs. some other data source)?

Are all FTEs accounted for (lab, imaging services)? Are score of services the same? And the list goes on. An apples to apples comparisons is very difficult. Universally, benchmarking is much more effective than comparisons based solely or primarily on FTE counts or productivity metrics.

A

We tried benchmarking here for a while. What a disaster! The questions could be read four or five different ways, and who is to say the way you are reading it is the same way others are.

Years and years ago, the VA had a thing called the BERS survey every year. It used very strict definitions so everyone was answering the same way.

A

We have been benchmarking internally for years. However, when I tried a couple of the benchmarking products the information was basically useless for comparisons. There was not enough standardization across the board to make the information meaningful. I took the information that I was able to mine from the software products to our safety committee and they found it just as meaningless. Benchmarking internally to see where we were doing well or needed improvement has by far been the best

source of useful information. Until someone offers a product that can provide reliable and standardized information for comparing HTM programs, I plan on just doing the internal benchmarking and will keep an eye on where the vendors are going with their products.

A

How about using COSR as the main metric to benchmark? You can then use the high or low COSR to drill down to figure out why the COSR is higher or lower than others. The best thing about COSR is that it allows you to benchmark against any hospital, any size, and services. See the July 2013 article in TechNation for a complete description and explanation.

Q

Is anyone having high failure rates with the CTC VP500DM compression pump?

A

We frequently have them come down for repair and 85 percent of the time no problem is found.

A

We have 25 units and average about one every six months that needs to be sent in for repair.

THESE POSTS are from TechNation’s ListServ. Go to www.1technation.com to find out how you can join and be part of the discussion.

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ROUNDTABLE Ultrasound

U

ltrasound devices are important tools when it comes to delivering quality healthcare. TechNation reached out to experts in the field to find out more about ultrasound devices and probes.

Members of the TechNation panel for this roundtable discussion are Robert Broschart, director of technical services for Axess Ultrasound LLC; G. Wayne Moore, FASE, president and CEO of Acertara Acoustic Laboratories; Hobie Sears, senior sales service manager at Trisonics Inc.; James “Jim” Carr, director of service and international operations at Advanced Ultrasound Electronics; Lawrence Nguyen, CEO of Summit Imaging; Matt Tomory, vice president of sales, marketing and training for Conquest Imaging; and Drew Brown, Director of Operations at GMI. Here is what we found out.

Q

WHAT ARE THE LATEST ADVANCES OR SIGNIFICANT CHANGES IN ULTRASOUND PROBES IN THE PAST FEW YEARS? Broschart: The greatest change has been in the use of single crystal technology. This has increased the bandwidth and number of active “elements” that can be used. A dramatic increase in image quality has resulted from this technology.

Moore: In terms of array materials recent advances made using single crystal arrays, 2D matrix arrays, and the progress being made with cMUT and pMUT technologies are all at the forefront. In terms of electronic advances in ultrasound probes, it would be that more ASICs and other integrated circuit technologies are migrating into the design of the acoustic stack and away from the front-end of the ultrasound system. Additionally, new commercially available wireless probe technology obviates the need for a cabled connection between the probe and the ultrasound unit,

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a major component of probe cost.

Sears: The OEMs all have their own names and new concepts in transducer development over these last few years. The real take-away from this is that transducer design is at the forefront of ultrasound development. It will continue beyond single crystal and matrix technology possibly pushing into CMUT or other yet to be developed technologies. What is important is strategic planning to deal with the higher cost of these transducers and technology as it relates to the cost of ownership.

Carr: The biggest advance in transducer design has been the so-called single crystal probes that are “grown” with thousands of individual elements and are capable of producing volumetric 4D (real-time 3D) images in multiple planes. The essentially perfect homogeneity of the piezoelectric elements can be used to create a significantly better 2D image, as well. These are replacing the mechanical 4D probes that could be seen as a new advance, but are really a rebirth of the old “wobbler” probe technology used before electronic phased array probes were viable.

Nguyen: The latest and most exciting advancement in ultrasound transducer technology is the added capability of live 3-D imaging during Transesophageal Echocardiogram (TEE) studies. These new TEE transducers utilize complex matrix arrays to obtain significantly more data than standard phased arrays. This allows clinicians to scan and view the human heart with live 3D image data to quickly provide more comprehensive data to better diagnose patients.

Tomory: Probe technology has evolved in

Matt Tomory

Vice President of Sales, Marketing and Training for Conquest Imaging

several areas recently. Manufacturers have developed a process to grow transducer crystals that are homogenous at the atomic level. These probes allow for greater frequency bandwidth and improve image quality. Another development is the wireless transducer by Siemens. These probes are the beginning of what I see to be remote ultrasound scanning where the scan takes place at one location and is processed at another. The other development is the maturing of the matrix array transducers.

These probes have thousands of elements and are used for 2D, 3D and 4D imaging.

The advantage of these with 3D/4D imaging is they are solid state with no motors, oils and are smaller and lighter than ever.

Brown: The significant increase in the use of multiplexing and sparse array technology.

THE ROUNDTABLE

Q

HOW WILL RECENT ULTRASOUND PROBE ADVANCES IMPACT THE ULTRASOUND MARKET IN THE FUTURE? HOW WILL THEY IMPACT THE MAINTENANCE OF PROBES AND ULTRASOUND DEVICES? Broschart: The probe technology has allowed ultrasound to move into markets previously thought impossible for ultrasound – oncology, podiatry, MSK, etc.

More patients can now be scanned effectively with ultrasound thus increasing patient care. In terms of probe maintenance, with the new technology, it has become paramount that proper and accurate testing be performed. If we cannot test these new probes, then we cannot hope to properly repair them.

Moore: Ultrasound continues to narrow the gap in clinical imaging performance with both CT and standard MRI for several clinical applications and that should keep the ultrasound market growing at a faster pace than the other “heavy-metal” modalities. Lastly, ultrasound is more easily and economically deployed into more clinical environments and is more versatile in both applications and configurability.

Probes are becoming more complex and more expensive, so the number of companies with the technological sophistication to test and repair them will trim down.

Sears: Ultrasound is likely to continue to grow into new areas of imaging with new transducer developments. This may create niche fields with specialized transducer development. It will be up to each facility to decide if those new studies and niche fields are right for them. Specialty transducers are going to be more expensive to maintain and may require specific training, these cost should be part of the discussion for the facility. It is clear that the new developments in transducer technology will require new tools and test devices for major repairs.

Some of these devices have become recently available; others will need to be developed.

However, the best strategy for maintenance is one of education on care and handling of transducers. Experienced ultrasound service engineers are the best ambassadors to get that discussion going in departments that use ultrasound.

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Robert Broschart

Director of Technical Services for Axess Ultrasound LLC

Carr: The matrix array or single crystal designs have provided capability to do faster and earlier diagnosis of many anomalies, and the research on ways to use this exciting technology is still in the infant stages. However, these complex probes are exacerbating an already large problem in the industry; the ability to test a transducer and system to assure the clinical efficacy of the diagnostic results. A white paper published over 10 years ago revealed that just two dead elements or channels next to each other caused the Doppler measurement and results to be incorrect.

There is no test equipment or diagnostics available today that can detect just two dead elements on even a 128-element probe, let alone one that might have 9,600 elements! The manufacturers have taken out or restricted access to any diagnostics that might help us determine if the probe and system are working properly. I believe that regulation may be necessary to protect patients if companies can’t provide tools capable of testing these highly complex systems in order to have confidence in the clinical results.

Nguyen: Multi-dimensional technology enables clinical technicians to accelerate the image capture and improve the diagnosis by utilizing comprehensive 4-dimensional data that reduce anomalies.

Live 3D TEE transducer failures become significantly more difficult to service

because the damage from electrical shorts become more catastrophic due to its higher power and smaller form factor. A quality transducer service provider will be able to yield higher repair success rates from these complex devices which will help lower the total cost of ownership of the device. The alternative is a replacement at a much higher cost. Hospital administrators will want to ensure they are working with a reputable and well-trained team of ultrasound support technicians who can repair beyond the component level. This will provide the highest probability of repair success and lower the total cost of support by up to 97 percent relative to OEM replacements.

Tomory: These new technologies add to the diagnostic quality of ultrasound systems but also the cost initially. Independent organizations are developing repair capabilities for these new generation probes but usually are a few steps behind so the cost of maintenance will be higher than conventional probes. Once a technology has been out for a year or so, the market does catch up and the cost is usually driven down by increased supply.

Brown: Image quality continues to improve, but it is also driving up the cost of maintenance. Many of the new multiplexing and sparse array technologies are designed so that they cannot be repaired completely and they also have a shorter average life span than more traditional transducers.

Q

WHAT TECHNOLOGIES ARE WORTHY OF THE INITIAL INVESTMENT? HOW CAN A FACILITY WITH A LIMITED BUDGET MEET THE ULTRASOUND PROBE NEEDS OF TODAY? Broschart: Again, the best new technologies are in single crystal probes. By adding these probes to your ultrasound inventory you can dramatically improve the quality of scans and increase the number of patients you can effectively scan. These probes do require potentially a newer system or upgrades to existing units. If budget is a concern, you can obviously look into refurbished/used equipment as a way to install the better technologies into your facility.

Moore: It is more a function of the intended clinical use and the results needed by the physician to make a good diagnosis. For example, if you are a cardiologist or a cardiac surgeon you invest in the 2D matrix array technology which provides volumetric 3D images in real-time. By focusing on the level of technology, both for the probes and the ultrasound unit that will be required to accomplish the clinical needs of a given facility – don’t overbuy.

Sears: It is really up to the individual department to define which technology is worthwhile. Where we come in is explaining how that technology may perform in the long run or how it may affect the lifetime cost of ownership. The customer then gets to make an educated decision.

Carr: As a longtime service engineer and manager, I would caution any customer to avoid the bleeding edge of technology unless cost is of no object. Even though there is exhaustive validation required by FDA and other regulatory agencies, new designs almost always are full of bugs. The other big problem with the latest system is that the cost of ownership will be much higher unless and until there are

Lawrence Nguyen

CEO of Summit Imaging

ultrasound technology is escalating in the healthcare system and encroaching into areas where X-ray and CT have been predominantly used. Given the frequency with which ultrasound technologies are being applied, I believe that all ultrasound technologies are worthy of their initial investment. A facility with a limited budget can control equipment service costs with

more expensive technology. Will the newer technology affect patient outcomes? If a probe has additional capabilities, will clinical staff be trained to use it? A perfect example is the fact that many people have a 3D TEE probe but only use it for 2D exams. The difference in cost between a 2D and 3D TEE probe is threefold. The proof of a probe is in a demonstration. Some of these technologies are very cool and the marketing is captivating, but the bottom line is this: Does the technology improve diagnostic outcomes and will it be used to its fullest capabilities? If there are new capabilities, are you able to use and get reimbursement for them?

Brown: You never want to buy Rev 1 of anything. In addition, while the new technology does produce beautiful images, is it really going to improve the quality of care or drive more dollars to the bottom line. Has a C5-1 ever saved a life that a C5-2 would not have? Often the newest technologies are not worth the cost differential.

Q

WHAT ELSE DO YOU THINK TECHNATION READERS NEED TO KNOW ABOUT PURCHASING AND

“Due to its safe, non-invasive method to obtain images, the reliance on ultrasound technology is escalating in the healthcare system and encroaching into areas where X-ray and CT have been predominantly used.”

– Lawrence Nguyen

independent service and parts providers for that system and probes. Buying a used or refurbished system and getting probes and the system repaired by independent service organizations can provide the same diagnostic capabilities at a much lower cost over a typical 7-year period of ownership.

And most of the latest single crystal probes cannot be repaired, which can drive those costs through the roof.

Nguyen: Due to its safe, non-invasive method to obtain images, the reliance on

careful handling and sterilization of its transducers, and should consider partnering with a credible ultrasound support organization that can repair transducers and systems with high-quality refurbished and tested replacement parts. This cost-effective approach can maximize the useful life of equipment and save operators as much as 97 percent relative to OEM replacements.

Tomory: We always want to examine ROI and patient care when evaluating newer,

SERVICING ULTRASOUND PROBES? Broschart: Only buy from known probe suppliers is one requirement. Anyone can “sell a probe,” but how do you know it has been tested properly? Make sure both your suppliers and repair companies can test, evaluate and repair probes to the correct OEM specs. Too many people say they “repair” probes. Are they using new parts?

Scrap/re-used parts? Make your suppliers provide test results in writing with photos when needed.

THE ROUNDTABLE

Wayne Moore

FASE, president and CEO of Acertara Acoustic Laboratories

Moore: Test the probes before you accept them into service in your hospital. Some OEMs ship brand new probes with dead elements. If you find these on initial inspection, reject them and demand a fully functional probe. If you are going to send probes out for repair, know your vendor, know their testing and repair capabilities, trust but verify and test the probes when they come back from repair to insure quality work Carr: The user of the system is not able to detect defects that can cause clinical results to be incorrect, due to the massive amount of interpolation and post-processing that is done to the image on modern ultrasound systems. I know a clinical engineer whose wife, a nurse at the same hospital, got an unnecessary and potentially deadly angiogram because the probe used had multiple dead elements. There are some test devices capable of objectively testing probes, even those with matrix array or single crystal designs, and TechNation readers should be asking for documented test results when they buy a probe or get one repaired. Otherwise, how does one know if they are using a probe that is clinically efficacious?

Nguyen: It is critical to know the testing protocols performed by the supplier prior to purchasing or servicing any transducer.

The quality of the product is completely

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dependent on testing and quality protocols.

This should include image quality testing on a live ultrasound system conducted by technicians trained to specifically look for image quality. There is no sufficient replacement to a live ultrasound scan as it is the only reliable method to capture intermittent problems experienced by end users.

Tomory: The ultrasound probe is a critical component of image quality on any ultrasound system. They should be cared for as though they are a delicate instrument (they are) and cleaned/disinfected using OEM approved solutions and processes.

When you need a replacement, quality should be your primary concern, not cost.

There are many degrees of quality on the market and when I, or a loved one, is on the exam table, I want to know that the probe is completely up to OEM specs.

When researching probes, it is important to also research companies that sell and repair them to ensure you are getting the highest quality product.

Brown: Visit potential vendors if you can.

That will tell you a lot about where you purchase your probes. If you are going to get a transducer repaired, find out who is really repairing your probes. Are you sending it to a facility that actually does the repair, or are you sending it somewhere that is just “managing the repair”?

Q

WHAT ARE THE MOST IMPORTANT THINGS TO LOOK FOR IN A REPUTABLE THIRD-PARTY ULTRASOUND PROVIDER? Broschart: I believe the obvious things. Do they properly test probes? Do they have the correct test equipment? Are they technically savvy in probe technology? Do they really understand probes? (How they are constructed, how they work, what do test results mean, etc?) What quality metrics do they use? How is their warranty rate?

Moore: Make absolutely sure that the third-party repair company is ISO 9001:2008 and ISO 13485:2005 certified.

Make sure they have the test equipment that can accurately evaluate the probes functionality. A good rule of thumb is: “If you can’t test it, you can’t repair it.” Ask your supplier if they have probe-testing technology.

Sears: Foremost is standing behind their service or product and providing what they say they will. A company that is growing and attracting strong experienced employees is a definite differentiator.

Carr: I believe the most important things to check for when choosing an independent probe repair company are: The test equipment they have and use. Does it provide objective results that demonstrate the key performance specs of the probe? Do they actually repair or do they just sell probes on exchange? Your costs should be lower over time if you institute proper user maintenance of probes and the service company actually repairs what breaks on your probes, instead of selling you a

Hobie Sears

Senior sales service manager at Trisonics Inc.

different probe that they repaired or purchased in the past. Do they have good customer referrals? They should be willing to let you call any of their customers, and you should do it! The company should have a quality system, preferably certified to ISO 13485 by what is called a “notified body,” auditors that are certified by the European Union. If they don’t have that ISO 13485 certification, ask for some referrals for customers that filed a “complaint” against the company so you can get an idea of how they respond when they make a mistake.

Nguyen: When looking for a reputable third-party ultrasound provider, you want to know: Do they fully refurbish and thoroughly test products in-house? Do they use bootleg parts from other countries? Do they farm out their work to another service provider? Do they support products and services with a strong warranty? Do they have the technical expertise to provide in-depth forensic analysis of failures?

Selecting a transducer repair facility that performs all repairs and testing in-house will deliver quick and reliable repairs. A strong warranty provides peace of mind ensuring that repairs performed on the equipment are dependable and will be fully supported. A quality supplier will also provide in-depth forensic analysis to help educate the end users about the likely cause of failures to prevent unnecessary damage in the future.

James “Jim” Carr

Director of Service and International Operations at Advanced Ultrasound

design, but usually all the probes can be upgraded to that technology if or when needed. And some 4D probes can be repaired by reputable third-party companies, although that is limited to just a few models. Since probe repair will be the biggest single component of the cost of ownership for an ultrasound system, it makes sense to buy a system with probes that can be tested and repaired, and to make sure that everyone handling and disinfecting the probes is properly trained and equipped to inspect the probes so they can be repaired as soon as any signs of trouble are found.

Nguyen: It is very easy for any healthcare facility to keep up with the latest technology advances because the independent service providers usually have the capability to obtain the equipment within one year of the launch

“Refurbished transducers are reasonable and a smart business move in obtaining new types of ultrasound transducers. Often these transducers are not actually refurbished; they have just had some use.”

– Hobie Sears

Tomory: Providers should be examined for their quality processes, warranty and reputation. What quality processes do probes go through to ensure they are safe and performing to OEM specifications?

Find a provider that performs computerized, clinical, electrical safety, mechanical and tissue mimicking phantom tests to ensure every probe it provides will produce the highest quality patient outcomes.

Brown: Carefully consider what your needs are and then look at the full spectrum of product offerings from each vendor. Choose a vendor who can meet all of your needs as your primary vendor. In the long run, it will save you time and money.

Q

IS IT POSSIBLE TO KEEP UP WITH THE LATEST ULTRASOUND PROBE TECHNOLOGIES WITHOUT BUYING BRAND NEW?

Broschart: It is possible to purchase used newer technology probes in the aftermarket. Again, just be careful of where you buy them. Make sure they have been tested and proven good.

Moore: In some cases yes, there is a fairly robust after-market for newer probes, provided they have been on the market for at least 12 to 14 months.

Sears: Yes, refurbished transducers are reasonable and a smart business move in obtaining new types of ultrasound transducers. Often these transducers are not actually refurbished; they have just had some use. With testing and verification of performance these transducers perform as well as new transducers.

Carr: It is possible to buy systems that are in current production on the used market. They may be a year or two behind on the latest software or probe

dates from the OEMs. Tomory: Matrix probes and pure crystal probes have been around for some time so they are repairable. As for the wireless, there are limited quantities on the third-party market and only one system utilizing them.

Brown: Absolutely.

Q

HOW CAN PURCHASERS ENSURE THEY ARE MAKING A WISE INVESTMENT WHEN PURCHASING ULTRASOUND PROBES? HOW CAN THEY ENSURE THEY WILL RECEIVE THE NECESSARY LITERATURE AND TRAINING TOOLS TO MAINTAIN THE PROBES? Broschart: In purchasing new probes it still goes back to proper testing and quality control. Can your provider give you all the details on the probe? (Test

THE ROUNDTABLE

results, image photos, etc.) Good repair/ probe suppliers can provide you with the requirements to maintain and test your probes. There is specific probe test equipment available in the market, and new products coming out that will allow facilities to properly test and maintain their probe inventories.

Moore: Test probes before you put them into clinical service, and reject those new probes that have dead elements. If they are using a reputable third-party probe repair company that company should supply them with this.

Sears: This is another area where experience matters and again it comes to proper education.

Carr: The purchaser should either be able to do an objective and comprehensive test of the probe, or get it tested before purchasing one so they know the quality and performance of it and can estimate the remaining useful life. The manufacturing date on the probe means almost nothing, because if it sat in a drawer unused for 10 years in a climate controlled environment, it will still be like new in useful life and performance.

Drew Brown

Director of Operations at GMI

how they receive their training. The length of warranty is a strong indicator of quality as companies that repair the products in-house have the capability to support the products and services. For the most part, the independent market supports all of the transducers currently

Tomory: People should always purchase on quality first and price second. I see probes advertised on places such as eBay for a fraction of what they would sell for by a reputable organization. A transducer is a sophisticated instrument and going back to my scenario of you or a loved one on the exam table, where would you want the probe to come from? I would look for a company that has transducer care training programs dedicated to educating people on how to care for probes. A program that examines every aspect of the transducer care and handling process within a facility to include environment, storage, transportation, chemicals, soak times and staff training. Even within a single make and model, there may be different approved disinfectants approved for the materials the various probes are composed of so education is critical to probe longevity.

Brown: Most probes are available from every third-party vendor. Don’t purchase based purely off of price. Consider the other complement of services that the vendors offer as well as the warranty.

“I would look for a company that has transducer care training programs dedicated to educating people on how to care for probes.

A program that examines every aspect of the transducer care and handling process within a facility” – Matt Tomory

Probes lose sensitivity and bandwidth over time due to use, and dead elements are a sign of defects or damage that could worsen quickly. Even new probes from the OEM may have dead elements and, from working with and for transducer manufacturers, I can tell you that even one dead element is a sign that something went wrong in the manufacturing process, and that only gets worse over time.

Nguyen: Purchasers have a lot of control over where they procure equipment and

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manufactured by the OEMs, providing significant savings on the initial procurement cost. Additionally, purchasers can control the total cost of ownership by using reputable transducer repair companies that guarantee their work and repair the equipment back to OEM specifications. Training literature is available through the OEMs and some independent service providers also provide high-level training enabling users to properly care for their highvalue equipment.

Often perceived transducer problems turn out to be system issues. Can the vendor help you if that happens? The care documentation is usually available from the OEM and sometimes on the OEM website. However, often OEM care and handling instructions are lacking. Ask the vendor if they offer specialized training for your needs. Not only the documentation, but hands-on training for your biomed and clinical departments.

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IMPROVEMENTS IN

DISTANCE

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MAY 2014

SUPPORT

A REMOTE HELPER

TECHNOLOGY

BY K. RICHARD DOUGLAS

DISTANCE SUPPORT

F

or years, members of corporate IT teams have remotely accessed employees’ workstations to discover problems and unlock frozen computers.

They could do so without leaving the IT department and without entering the workspace of the employee.

Sometimes they did this from the same building and sometimes from across the country.

For the employee, the process was often surreal, with their computer coming to life, looking like some invisible force had taken control.

Remote support is not a new idea, but its application and acceptance have increased and improved over time.

Today, support from a remote location is common and practical. Remote access to a medical device also provides the means for diagnostics, providing software

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updates, applying patches and doing repairs. It allows engineers to monitor the device and foresee maintenance issues or provide a troubleshooting heads-up.

Monitoring equipment remotely often allows for the detection of minute changes that may go unnoticed otherwise.

Environmental factors, undetected by those present, may be picked up on by the remote engineer and communicated to those providing patient care.

“Since most of the medical equipment these days is not purely mechanical; and even the mechanical pieces are computer controlled, and are constantly providing and logging data, much of the support of the equipment can be done remotely,” says Qusai A Shikari, clinical systems engineer with Kaiser Permanente Clinical Technology. “The constraints start when there is a pure mechanical part failure, and a replacement is necessary. Up until this point, most of the services can be

“Today almost every service action, except physically touching the system, can be performed remotely.”

– Mike Swinford

“Today almost every service action, except physically touching the system, can be performed remotely,” says Mike Swinford, president and CEO, GE Healthcare Global Services. “In addition, the constant monitoring of equipment parameters, makes possible contextual maintenance actions (service actions based on how the system is used).”

“With the use of predictive algorithms, we are able to anticipate and tailor service actions in order to increase efficiency.

Beyond maintaining equipment in the best condition of safety and availability, new technologies are also offering many possibilities for workflow and operations optimization,” Swinford says.

The intention of the manufacturers, who have utilized this technology for a long time, is reflected in the experience of users. While some HTM professionals complain that remote service is an expensive addition to a service contract that doesn’t offer much return, others like what they see.

provided remotely; it is only the constraints of the implemented IT infrastructure the system resides on, that prevents remote service for medical equipment.”

“As the service engineering workforce continues to age, and many knowledgeable and highly experienced technicians retire, remote support is an excellent way of consolidating much of that knowledge and experience and making it available in today’s work environment,” says Joseph A. Haduch, MBA, MS. He is the Director of Imaging Services for University of Pittsburgh Medical Center PMC and BioTronics.

Haduch’s facility uses the remote support offering from GE Healthcare.

“Every organization in healthcare or healthcare manufacturing is looking for ways to streamline operations and find more efficient and cost-effective ways of delivering service,” Haduch says.

“Remote service technology is one means of providing hospitals with a higher level of service at minimal cost.”

“I believe remote support for equipment is the new platform for many of the manufacturers these days. In my experience, most of the IT-based medical equipment issues can have resolutions via remote service, in a quick and efficient manner,” says Shikari.

“It allows manufacturers to quickly diagnose errors and issues by viewing the logs and providing remedies for resolutions. Remote service is quickly becoming the new standard for the industry and will enhance the ability for the in-house BMETs to support the medical equipment,” he says.

Shikari says that remote service, for both software and hardware issues, should be based on a dual support solution.

“Dual support, so that depending on the type of error, the remedy might involve physical intervention and the in-house BMET can support those situations. These days, many — if not most — manufacturers provide remote service as a base package within their support service contracts (SSC),” Shikari says.

“In dual support situations, the SSC is quite a bit cheaper if a remote service is provided, because it saves the company money to send a field service engineer (FSE) out to the site, which adds travel and sometimes lodging costs,” he adds.

“A growing number like the idea of being connected, as it instills confidence with end users.”

- Art Larson

CURRENT TECHNOLOGY Several OEMs provide real-time remote monitoring programs to handle preventive service in addition to offering predictive features to stave off potential future problems.

Asked about GE Healthcare’s remote monitoring capabilities and their benefits, Art Larson, MBA, general manager of product service for the company’s U.S. business, points to a “significant investment in remote monitoring and diagnostics to manage systems and keep them ‘in spec’ to their ranges.”

Larson points out that the alerts that

Art Larson, general manager of product service for GE Healthcare

result from remote monitoring can notify remote engineers and field engineers when a remote check or field visit might be warranted without interrupting customer use.

“Trend data is also gathered to help customers improve their actual utilization of the equipment,” he says. “Big

data is a key component of our strategy, and is analyzed for both customer and OEM productivity and value.”

GE Healthcare’s InSite service allows the company to proactively monitor its diagnostic imaging equipment, and frequently, resolve issues on the spot.

When an onsite repair is required, this technology can provide the service engineer with detailed knowledge of both the equipment performance and potential problem, often cutting down on the service activity. With a digital broadband connection, GE can provide faster response and shortened repair time, minimizing the overall unplanned downtime for the customer.

By using a virtual private network and encryption technology, the proprietary broadband connection also provides safety and security of the data transfer.

“GE’s ability to provide productivity and effectiveness in covering an expanded install base, which is growing more complex with both product introductions and acquisitions,” are some of the reasons Larson gives as benefits to the biomed department. “Biomed departments are challenged to maximize their in-house resources,” he says.

In addition to these benefits, he points to “quick access to expert support as incentives for our in-house customers to drive productivity and uptime, building customer satisfaction” as incentives. “A growing number like the idea of being connected, as it instills confidence with end users. GE is here with you, even when you don’t see them,” Larson says.

The leaps and bounds in technology in recent years have made remote support a practical tool, according to Gerald Finis,

DISTANCE SUPPORT

“ The fact that everything is going to fiber optic backbones on the Internet now, enables us to transmit large amounts of data in a small amount of time.”

– Gerald Finis

MSEE, director of computed tomography (CT) service support for Siemens’ Service organization. Siemens Guardian Program uses remote monitoring to help predict and prevent service issues in real time. The program helps to improve workflows and increases patient safety by helping to avoid downtime during invasive procedures, according to the company.

Guardian is used for several imaging modalities such as molecular imaging, ultrasound, MR, CT, angiography, X-ray and women’s health. The program started with angiography and migrated to CT. “From service experience over the years, there are certain indications on a machine that will throw an error or malfunctions sooner or later,” Finis says.

“The purpose of Guardian is to find something that is a small issue indicated, and then either keep track of it, log it or take action to prevent a larger one.”

“When a hard drive starts having read/write errors, there’s nothing wrong.

Every so often, it happens,” Finis adds.

“Nevertheless, you can only have so many before your drive begins to fail. It’s not fast enough anymore. If it happens in the middle of a patient, it’s a bad situation. Internally, they are all monitored. If you look at your computer, you can see what your hard drive speed is, it’s temperature, the read/write errors, the bad blocks.”

The logic built into the machine can tell if the hard drive is producing errors and can send a message to the monitor that the machine has hard drive errors.

With this information, Finis says there

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are determinations that have to be made; which hard drive is it, how severe is the issue and what can be done about it.

“After that, we go to temperature.

Some machines are water-cooled, so we are looking at the flow rates of the water,” he says. “We’re looking at the incoming supply from the facility.

Often times, we can tell a facility that something is wrong with your chilled water supply.”

Finis says that the facility can then be notified that something is wrong with the water supply. Even if those in proximity to the equipment monitored don’t notice anything right away, the remote engineer can ask if they noticed the temperature or humidity creeping up.

He says that the CT or the angio or MR picks these things up.

“Components get overheated,” Finis says. “Therefore, we’ll have damage on the component when it may just be that the filter is clogged up.”

“It’s easier to go in between patients and check for a filter or have engineering checking if the chilled supply is switching to another cooling solution and in an hour, it’s OK,” he says.

AN EVOLUTION “There are two major developments; one is called Internet and the other one is called computer technology improvement,” Finis says. “Twenty years ago, I had remote connectivity to my CT systems. I could dial in and see some things, but it was rather slow and didn’t lend itself to alert somebody. The amount of data back then would have been overwhelming on the little phone

lines that we had. But the fact that everything is going to fiber optic backbones on the Internet now, enables us to transmit large amounts of data in a small amount of time.”

Finis says that the other improvement is in technology itself. He points out that about every 18 months new computer technology, including faster processors, becomes available.

“In the medical environment, we cannot slow down the purpose of the machine. My home computer, if I’m

Gerald Finis, MSEE, director of computed tomography (CT) service support for Siemens’ Service organization

rendering graphics, whether I’m doing this in five minutes or six minutes, it really doesn’t make a big difference to me,” he says. “To a customer, who is in an imaging environment in a hospital, it makes a difference whether they sit there for five minutes or for seven minutes waiting for results to come up.

There are some medical needs, the faster you can get the patient to the medical treatment, the better it is.”

“Therefore, the backbone monitoring programs that are being written have

“Remote support can provide a more efficient and cost-effective means of repair, even when remote support is unable to repair the problem more often than not they can provide the on-site engineers with some level of direction with respect to troubleshooting the equipment.”

– Joseph A. Haduch

very little footprint on the CPU usage itself,” Finis adds. “The faster CPUs are, and the more ROM we have, the less it will impact on the percentage. If 10 years ago, I needed 10 percent of that capability, today, I only need point two percent of the capability. Therefore, it makes it feasible to utilize the technology.”

Finis says that the nuclear power industry has used the technology for several decades.

“We’ve been using remote support for our imaging equipment for many years. All of our high-end pieces — MRI, CT, PET/CT – have OEM remote support,” Haduch says. “We are now incorporating remote support on some of our lower-end equipment as well, ultrasound and portable X-ray units. Remote support is an excellent place to start when our staff experiences equipment issues. Often our in-house engineers will work with our technologist to directly reach out to an online engineer.”

“With some issues, such as corrupted files or oversized queues, the online support engineer can repair the problem in a very short period of time,” he adds.

“In these situations not only do we minimize our downtime and maintain a higher level of patient satisfaction, but we are able to do so while minimizing, our in-house engineers’ time.”

“Remote support can provide a more efficient and cost-effective means of repair,” Haduch says. “Even when remote support is unable to repair the problem more often than not they can provide the on-site engineers with some level of direction with respect to troubleshooting the equipment. Again, this minimizes the amount of time the engineer has to spend troubleshooting and repairing the equipment. It can also help the engineer determine what parts may be needed for that particular call.

In other instances, remote support can easily diagnose X-ray tube problems and start the process of ordering a new tube and arranging for installation.”

Finis says that not everything can be predicted, but many preventative events can be caught.

He talks about the tubes in CTs as an example. Tubes are prone to vacuum leaks or filaments that burn out. Having one go out can interrupt clinical workflows and often require repair people to be working when it is inconvenient with patient loads. With his company’s remote service, they can predict when a tube will fail based on “novel operating parameters.” A tube can then be replaced at a more convenient time for the facility.

The days of a phantom invader taking over a computer have been replaced with a more seamless monitoring capability. The unseen engineers will become a more common addition to healthcare facilities.

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CAREER CENTER

Resumes in 1 Minute or Less

By Todd Rogers

B

y my estimate, it’s been at least six months since I’ve provided TechNation readers with input regarding resumes. Since my last installment on this subject, I estimate that I have viewed about 5,000 resumes and since I’ve been involved in about 30 new people being hired by my employer, which means that approximately 99.4 percent of the resumes that I have viewed were sent to us by people that were not hired.

Todd Rogers Talent Acquisiton Specialist for TriMedx, Axess Ultrasound, eProtex and TriMedx Foundation

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One possible assessment from this is that the odds of applying, interviewing, and being offered a job are pretty bleak.

I think that it’s more accurate to say that overall, the employment market is pretty tough right now and employers in general have very little tolerance for applicants who don’t meet (or exceed) minimum job requirements. If you take the numbers that I mentioned above, and you assume that I interview an average of five people each work day, the story gets less encouraging. That translates to five daily hours of interviews and about 3-4 daily hours of emailing, coordinating, interacting with colleagues and lots of other stuff, leaving a small portion of time for reading resumes. In the effort to be efficient, I budget about 1 minute per resume. Many resumes deserve and receive about 5 seconds of consideration; many are an easy “Yes” and many more are an easy “No.” Herein, I will reveal some of the less often disclosed aspects of resume-review that tend to have a resume routed into the “No” pile.

My mental system for resume-review is most easily captured with +1 or -1. I use a simple rating mechanism. I examine a resume and when I see positive attributes, I give the resume a

+1. When I see negative attributes, I give the resume a -1. I don’t actually tally my +1s and -1s. I just go by my gut and after I read a resume, you’re either above zero or you’re below zero. The positive resumes go in the “Yes” pile. All of the others go into the “Maybe” pile or “No” pile.

Let me provide an example. I double click on the attached resume, it opens and I glance at the whole resume without paying much attention to any single item. Myriad things are crossing my mind, almost at the same time. These things are: • Does he work in this industry?

• Does he structure his resume in a conventional format?

• Has he done or is he doing a job that is similar to the job to which he is applying?

• Does he write well?

• Did he attend college?

• Did he finish college?

• Are there words or phrases which indicate that he has any relevant skills or experience?

• Is his work history consistent or choppy?

At this point, about 5 seconds have elapsed and I have not actually read the

What I am trying to determine is one simple and rational possibility: does this resume represent someone who shows potential to succeed?

resume, I’ve merely glanced or examined it. That resume has accumulated a positive amount of points or a negative amount of points. It is correct that I disqualify some people at this point.

That doesn’t happen typically but there are applicants who, based on the data that they chose to supply, indicate quite loudly that they would be better suited working elsewhere. Upon entering the seventh or eighth second, I actually read some, if not most, of the resume.

Reading all of the resume simply isn’t possible, unless the resume has so many obvious positive indicators that not reading it all would be foolish. It is at this point that I start with my +1 and -1 method. A new set of questions cross my mind.

• Are there patterns of achievement?

• Are the words and phrases that he is using similar to other successful people that I have encountered?

• Does he clearly convey what he currently does on a daily basis?

• Are those things partially relevant or fully relevant?

• Are there words and phrases that indicate he meets or exceeds some or most of the requirements?

• Does this person convey professionalism?

• Are there any red squiggly lines indicating typos?

• Are there indicators that this person has relevant transferable skills to other positions?

There are plenty of other questions I am asking myself. But, what I am trying to determine is one simple and rational possibility: Does this resume represent someone who shows potential to succeed?

There is also a less palatable side to this process. I assign -1 to a lot of things.

• Did this person put his contact information on the top and is it centered or at least properly justified?

• Did this person use abbreviations?

• Are there multiple gaps in employment history?

• Is the grammar less than decent?

• Are there dates of employment in years but months aren’t included?

• Is it a functional resume?

• Are the sentences structured in such a way that would suggest this person has a positive attitude?

• Does it look like this person actually put in effort on the resume?

more than 35-40 seconds that have transpired, thus far. It is likely that at this point, I have already made a decision to either call this person or not contact this person.

There is a gray area. I see resumes of people who one might call a diamond in the rough. Some people just don’t write well. In fact, many people write very poorly. While they may have zero potential to be a published author, some people are excellent employees but they just can’t express that on paper. Such people leave other bread crumbs that would also indicate maybe they can’t write but they sure can learn and work hard. I do my best to isolate these people and try to read between the lines.

My concluding recommendation about writing a resume is this: if you’re confidence in your writing skills is suspect, do yourself a huge favor. Write a draft resume and share it with at least three friends. Ask them to read and critique it and then decide for yourself, should I start over, do a re-write with these suggestions, or did I get lucky and I’m good to go?

I am too frequently disappointed at what appears to be resume-laziness.

Added together, there is probably no

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This all changed about a decade ago when systems began running mainly Windows and UNIX with the OEMs applications software layered on top.

We began to see the dreaded “blue screen of death,� lockups, corruption and, now that there were moving parts, hard drive failures.

Nowadays, the vast majority of ultrasound systems have one or more hard drives and experience regular failures. How do we prevent these failures or perform rapid repairs when they do occur?

First we want to ensure we have the software that the system is currently running. Some OEMs will supply it with the systems and some require a purchase.

If you are in a purchasing cycle for systems, ensure the software (and service manuals, training etc.) are included in the negotiations. If you do not currently have it, make an inventory of all the different revisions of software you have and purchase it from the OEM and keep them in a central location for team members to access.

Next, please backup as much as possible on your system. The bare essentials are the presets and options but you can also create a backup of the entire hard disk to restore the system at a later date. This does have to be performed for every system you have for both technical and legal reasons and can be time consuming but in the event of a failure, these backups are a lifesaver as you can completely restore a system in as little as an hour. Also, by having these backups, you do not have to complete all the steps for a software reload or worry about options files or presets since they are all in your complete backup.

Please keep in mind that when a software reload is indicated, always perform on a new drive and preserve the old one. This way, if the load does not take or you need vital data from the old drive later on, there is a chance you can retrieve it. Also, if a drive has failed once, it is likely to fail again.

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THE FUTURE

Core Curriculum Conundrum

By John Noblitt

H

ave you ever had a “conundrum” at work such as a new management directive that you will have to implement knowing that it’s going to be extremely difficult? Here is my new “conundrum” at work … Maybe you could help me.

In 2013, Robert Stiefel, MS, CCE submitted the results to AAMI of their Core Curriculum Project. The AAMI Core Curriculum project consisted of many dedicated educational professionals, industry leaders and employers. The mission was to assemble a list of skills and knowledge necessary for entry-level employment and the knowledge to pass the biomedical certification exam upon graduation.

The overall goal of the project was to produce guidelines for biomedical education institutions and for employers to know what was covered in a program that implemented the project’s competencies and topics.

As the executive summary states, “These competencies and topics will not only provide guidance for these programs, but also help employers know what to expect from entry-level employees who have graduated from these programs.” My “conundrum” begins here, at the implementation. Let me give you some of the issues I’m struggling with.

There are many competencies and topics listed in the curriculum project, but I will only use one area to demonstrate my conundrum. The area of “Medical Equipment” and the

John Noblitt M.A. Ed., CBET

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knowledge a graduate would supposedly have by employing these core curriculum standards.

According to the core curriculum report, prospective biomeds should learn the following in the area of “Medical Equipment”: Measurement, Signals, Noise, Signal processing and analysis, Fourier analysis, Physiological parameters, Sensors, Battery operated equipment, Electromagnetic interference, Temperature measurements, Pressure/ Force/Motion/Flow/Opticel/ Electromechanical/biopotential transducers, Biopotential amplifiers, Signal isolation, Electrical noise filtering, Defibrillation protection circuits, Displays, Sphygmomanometers, Stethoscopes, Electrocardiographs, ECG leads and electrodes, and 150 additional such items are listed.

The list of devices mentioned above is from a preliminary document from the AAMI Core Curriculum project and is not the entire list. So here is my conundrum. How do you teach all this information in a two-year program?

Remember, this is only one area of knowledge and the list is very impressive. Other areas have skills and knowledge sets that are just as large and extensive. We also have to squeeze in

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English classes, math, physics, communications, humanities, social science and more. You can see the time gets shorter and shorter to teach these core competencies.

In the educational world we practice what is known as pedagogy and andragogy. Pedagogy is the science and art of education. Literally translated the word pedagogy means, “to lead the child.” Andragogy consists of teaching strategies focused on adults and these take on different forms to deliver content.

Think of pedagogy as the student having an empty vessel to be filled with knowledge, so we begin filling up the vessel with facts and then we test for retention of those facts. Andragogy works a little different, as adults bring past experiences and knowledge into the classroom a child may not have.

Educational theorist have long determined that learning is connecting what we already know to new information. Adult learners perform best when they are what we refer to as self-directed learners, using groups or some form of social interactions and what is referred to as problem-based education. This allows the learners to investigate using new tools, but they can

also use experiences and knowledge they already possess. This process has been proven to generate long-term retention of the material covered. However, this process is very time consuming, especially when so many subjects need to be covered.

So, does an instructor use a style of andragogy to teach all this information or use a style of pedagogy which teaches facts but maybe does not address how all the facts fit together for a complete educational experience. I believe AAMI’s core curriculum is a great model for HTM education and I have implemented the learning objectives and goals but my conundrum is how do I teach all the information in the time allotted? Do I use an approach that is more centered on pedagogy and cover more information or use an approach that is more centered on an andragogy approach and cover less material but possibly provide a more in-depth study of the information?

Ah, the joys of curriculum development!

If you have a solution to my conundrum, I would love for you to share it with me.

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5 HTM Terms in Need of Definition

By Patrick Lynch

A

s the Healthcare Technology Management (HTM) profession strives to become uniform and cohesive, there are several major issues holding us back. They revolve around the common terminology which we use (or should use) to define and measure the things we do. Here are a few which are in need of work:

Patrick K. Lynch

Biomedical Support Specialist for GMI

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1. Benchmark When HTM departments compare themselves to one another, there are many things to compare. Cost. FTEs. Bed size. Number of devices. In-House/ Outsource Ratio. Contracts. PM Completion. Uptime. Productivity.

PM-preventable failures. Number of certified individuals. Customer Satisfaction. And many, many others.

But which ones matter? Which measurements are worth the time and trouble to collect and compare? Which measurements are even attainable? The current benchmarking options are either a) skewed toward unimportant, but collectable factors, b) based on plant engineering metrics, which do not relate to HTM, or 3) based on very simple, but unimportant factors that business managers can understand, but that have no relation to a good HTM program.

We must define benchmarking for the industry and create a standard that is not only accepted, but which is mandated for all HTM programs.

2. Best When we Benchmark, what is important? We have never defined “Best in Class.” If we haven’t a definition of “best,” how will we know when we reach it? Or even how close we are to the “best.” Until we define what is important and critical for an HTM program, we will never have an alignment of all of the HTM departments in the nation.

3. Cost What is the cost of an HTM program?

Does it include contracts? Does it include Parts? Does it include the cost to

maintain equipment that the HTM department does not directly repair?

How do we define the hourly cost of an in-house program labor? How do we account for non-productive time, people and activities? Should cost include a factor for square footage and utilities for the HTM department? Since many of our benchmarking metrics are based upon cost, it seems as if we should have a uniformly accepted definition of “cost.”

4. Service Materials In the old days, service materials merely meant a printed service manual.

Nowadays, it has expanded to mean digital manuals, online manuals, passwords, diagnostics, updates, software, training videos and a myriad of other service/support offerings. How much detail is needed? What is required if an HTM department wishes to perform in-house maintenance? And how can this definition be updated as technology continues to evolve?

5. COSR and COO When evaluating an HTM operation or a pending equipment purchase, two terms are often used. Cost of Service Ration is a little-used metric that measures the cost of maintenance as a percentage of the original price. It needs further definition and universality of use.

COO is Cost of Ownership. This can include the total cost of owning, maintaining and operating the device over its entire lifetime. Different organizations have different definitions of COO and COSR. These need to be uniformly defined and used throughout the industry.

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63

THE ROMAN REVIEW

PAGS

By Manny Roman

T

wenty-five hundred years ago, Aristotle, the Greek philosopher, was the first to study logic and reason. He considered the emotions a sort of human failing and a disruptive force. Emotions interfere with logic and reason and should be suppressed so that decisions can be made through logical and reasoning actions. Since humans are capable of deliberation, we therefore are in control of our actions.

For most of the last 2,500 years, our beliefs have been that decision-making is a rational process and that our ability to reason can overrule our emotions. We have believed that our decisions have been based on facts and that analysis is key to good decisions. Emotions should not interfere with our decisions. We have essentially placed logic on a pedestal and kicked emotions to the curb.

So when we are attempting to influence others into agreement or

Manny Roman

Manny.Roman@me.com

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compliance, we use logic and reason. We supply a well-thought out presentation of the facts and figures that should lead others to the appropriate conclusion: the conclusion we want them to arrive at so that they will agree or comply. Well, guess what …

If you have been using logic and reason to influence others, science proves you wrong.

Modern real-time brain imaging techniques demonstrate that the logical thinking brain mostly does not even get a shot at making decisions. The primitive brain (limbic system), specifically the amygdala, receives all sensory inputs and will make quick decisions, based on the need to protect us, using our own life experiences.

The limbic system is the unthinking part of the brain that controls autonomic functions such as breathing and heart rate. The small, almond-shaped amygdala is the center of emotions. It is responsible for making us freeze when danger is detected and getting the body prepared to flee or fight. It protects us.

Another function of the amygdala is to store the emotions along with the facts of an event into memory. This emotional tagging is later used to compare new information with the stored events and make a quick decision based on the similarities with stored information. This process should make sense. How difficult would it be to have

to analyze every single daily event using our rational, thinking brain?

We begin the process of emotional tagging at birth and continue throughout our lives. When we remember some past event, the emotional tags come to the forefront, which is why witnesses to an event have such differing recollections of the facts. They remember the emotions better than the facts.

Therefore, we all walk around with a Personal Amygdala Guidance System – PAGS. Our PAGS makes it possible to function quickly and without undue thinking. The amygdala makes sure that the first reaction is always emotional. It is the gatekeeper. In cases where the amygdala is damaged, those individuals are incapable of making any decisions.

The Radiological Society of North America (RSNA) has stated, “A rational decision? Don’t bet on it. Could it be that there is no such thing as a rational decision when it comes to anything involving yourself?” Renowned neurologist, Dr. Richard Restak adds, “We are not thinking machines, we are feeling machines that think.”

So what does this mean to us personally and in our business? If you want to influence others, you have to talk to the emotional amygdala. Your presentation must be framed in an emotion-triggering format that appeals to the particular individual’s PAGS. Frame your presentation to your

audience ensuring to address the emotions.

I recently conducted a webinar for TechNation where I talked about 7 powerful triggers that can be used to help others feel the right emotions to agree and comply. These triggers cause the amygdala to agree and comply without having to get the thinking brain involved.

One of the triggers, and probably most powerful, is the friendship trigger.

We will do anything for someone who is our friend or at least perceived that way.

If we can invoke the amygdala’s friendship trigger by saying and doing the things that a friend would do, it takes the shortcut of agreeing and complying without getting the reasoning brain involved. This is why many of us get taken advantage of so easily. Our PAGS say go ahead and trust even in the face of logical reasons to the contrary.

Another very powerful trigger is the hope trigger. We buy lottery tickets, drink the beer with the good looking people in the commercials, we spend billions on cosmetics, and move to Vegas to play poker. President Snow in the “Hunger Games” movie said, “Hope is the only thing stronger than fear.”

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67

HTM WEEK Contest Winners

S

andra Calderon sang “Take Me Out To The Ballgame” during a trip to a Washington Nationals game as part of an HTM Week celebration, but now she is singing “Take Me To The MD Expo.”

Calderon is the grand prize winner of the TechNation HTM Week Contest.

Her prize includes an all-inclusive trip for two to the premier HTM conference, the MD Expo Orlando, for her and one other biomed from her shop! The prize includes travel and lodging to the Hilton Orlando Bonnet Creek, Orlando’s newest Hilton Orlando hotel, plus free passes to all Expo events and a daily stipend.

Calderon, BMET Supervisor, INOVA Clinical Engineering, Falls Church, Va., had a group from the department attend a MLB game between the Washington Nationals and New York Mets at Nationals Parks in Washington, D.C. “We celebrated HTM week by going to a Washington Nationals game the weekend prior. It was a great game although they lost,” Calderon said. “The weather was perfect and we got to enjoy fun times with coworkers.”

Calderon said she and Belinda O’neal, BMET 2, even got their picture taken with the Nationals mascot at the game.

The Monday of HTM Week the celebration continued.

“I brought breakfast for my staff and my manager bought lunch,” Calderon said.

Calderon’s entry in the contest was one of many. Each entry will receive a prize pack that includes a Biomed Bob stress ball. The other entries included Greg Goll from Erlanger Health System in Chattanooga, Tenn.

Goll and his HTM team did a

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presentation in the hospital cafeteria on the history of heart lung bypass at Erlanger Health System. They displayed the hospital’s original Mayo-Gibbon Pump Oxygenator. Dr. James Headrick actually used this machine to do heart surgery at the facility in the early 1960s.

It sat in a garage from the mid-1960s until recently when it was cosmetically restored. It is one of three to still exist with one in the Mayo Clinic in Rochester Min., and the other one is in storage in Washington, D.C. The Erlanger team pulled open the device to show how electronics were done in the early 1960s. The shop also displayed a recently retired SARNS Heart Lung Bypass machine, so they could show the 40-year jump in technology.

Max Goldtooth Sr. celebrated HTM Week by wearing the T-shirts that he has received from TechNation, MedWrench, USOC, Pacific Medical and MD ExBowl for each day during HTM Week.

Horace Hunter and GBIS started preparing for HTM Week by having several GBIS members attend a proclamation signing and had a photo taken at the Georgia State Capitol in Atlanta, Ga. GBIS conducted a survey during the start of HTM Week to encourage participation.

The survey started with 9 organizations involved and grew to include more than 30 before the week ended.

Dr. Mike O’Rear celebrated HTM Week by posting a photo of Georgia

Gov. Nathan Deal signing a Proclamation for HTM Week at Chattchoochee Technical College where he is an instructor.

Edward Drone at Beacon Health System in Elkhart, Ind., said they had a lighter celebration in 2014.

“We normally like to have an openhouse, but this year has been a busy time for us. The manager provided us a full lunch this year,” he explained.

Wayne Craig in Glendale, Calif., said his department celebrated with a two-day display in the cafeteria and held an employee breakfast on the Tuesday of HTM Week. Each employee was also presented with a Leatherman tool.

TechNation applauds all HTM professionals and we look forward to celebrating with another contest in 2015.

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WHAT’S ON YOUR BENCH?

Sponsored by

TechNation wants to know what’s on your bench! We are looking to highlight the workbenches of HTM professionals around the country. Send a high-resolution photo along with your name, title and where you work and you could be featured in the What’s On Your Bench? page and win a FREE lunch for your department. To submit your photos email them to info@medwrench.com.

Level 2 high power roketry certification flight

Triumph insult comic dog for comic relief Yoda for sage advice Mini SCI-FI/aviation museum Wireless phone so I can never hide!

My diet coke; either keeps me going or slowly killing me My copy of TechNation magazine Preshow Planner for the MD Imaging Expo in July

orn, CBET, A+ Kirk Schermgerh ice Specialist 111 rv e S in ag Im ic , TN Diagnost em, Chattanooga st y S th al He r e g Erlan EVIL MINIONS

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Certificates Left to right: certificate from Microscope USA, CBET certification, Leadership Initative course that I attended

Star Wars Jedi decal. All three members of the shop have one.

Me and my wife, Dawn, my son Joshua, 19, and my daughter, Kristen, 18 Medwrench.com pulled up on the computer screen.

The biomed shop’s phone for people to get ahold of us.

A $1 million credit a vendor sent us as a promotional thing to show us how much money we could save Roll of stickers used to ID equipment that is good to use

Samuel A Alcala , CBET Biomedical Engine St Joseph Hospitaering Lead Tech l, Fort Wayne, IN

Graduation photo from military biomedical engineering equipment specialist school in 1990 at Aurora, Colo.

“Why Monster Energy cans? We are a 3-man shop responsible for a little over 5,000 pieces of equipment for the entire hosptial... ‘Nuff said.”

- Samuel Alcala

SEND US A PICTURE OF YOUR BENCH.

WIN A FREE LUNCH. Email info@Medwrench.com to participate

Photo from Michael Sheperd at Grande Ronde Hosptial featured in last months What’s on Your Bench?

BREAKROOM

SCRAPBOOK AAMI 2014 & TechNation Reader VIP Party

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2

The AAMI 2014 Conference and Expo in Philadelphia had a record-setting number of registered attendees and the TechNation booth was a popular destination with over 200 visitors stopping by to visit.

There were many familiar faces and some new ones as HTM professionals from around the country learned more about the magazine dedicated to providing them with comprehensive and reliable information about medical equipment, parts, service and supplies.

The highlight, as always, was the TechNation Reader VIP Party sponsored by Trisonics, where hundreds of our VIP fans enjoyed great food and beverages at the Field House Sports & Beer Hall adjacent to the convention center. Readers and vendors networked in the private upstairs dining area. Many partygoers commented on how great it was to put faces with names and catch up with old friends at the VIP event.

1. Ron Evans (right) speaks with an attendee in the Datrend Systems booth 2. Charles Neff speaks with Wendell Haight at the MedServ International booth at the annual AAMI Conference and Expo.

3. Members of the Armed Forces Biomedical Society, which is made up of former and current members of the U.S. military, gather for a group photo at the TechNation Reader VIP Party in Philadelphia.

4. Summit Imaging Team at their booth at AAMI 5. Bethany Williams of MD Publishing with Sue Brandt and Daniel Salgado of Government Liquidation at the TechNation Party.

6. Tripp Lite booth personnel use the hula hoop from their display to make a frame during a group photo at the TechNation party.

7. DR and Deidra Flower of BETA Biomed Services at the TechNation Party.

8. TechNation readers celebrate at the annual TechNation Reader Appreciation Party.

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BREAKROOM

Advanced Ultrasound Electronics, Inc…………… 12 Ph: 866.620.2831 • www.auetulsa.com

Global Medical Imaging…………………………… 2 Ph: 800.958.9986 • www.gmi3.com

Pronk Technologies………………………………… 6 Ph: 800.609.9802 • www.pronktech.com

AllParts Medical…………………………………… 21 Ph: 866.507.4793 • www.allpartsmedical.com

Gopher Medical, Inc.……………………………… 29 Ph: 844.246.7437 • www.gophermedical.com

RTI Electronics……………………………………… 37 Ph: 800.222.7537 • www.rtielectronics.com

AMX Solutions……………………………………… 55 Ph: 866.630.2697• www.amxsolutionsinc.com

Government Liquidation………………………… 3 Ph: 480.367.1300 • www.govliquidation.com

Sage Services Group……………………………… 67 Ph: 877.281.7243 • www.SageServicesGroup.com

Atrix International………………………………… 33 Ph: 800.222.6154 • www.atrix.com

Hans Rudolph, Inc.………………………………… 21 Ph: 1.800.456.6695 • www.rudolphkc.com

Bayer Healthcare Services………………………… 45 Ph: 800.633.7231 • www.MultiVendorService1.com

Health Tech Talent Management, Inc.………… 55 Ph: 757.563.0448 • www.HealthTechTM.com

BC Group International, Inc. …………………… BC Ph: 888.223.6763 • www.bcgroupintl.com

Imprex International……………………………… 47 Ph: 800.445.8242 • www.imprex.net

BETA Biomed Services, Inc.……………………… 29 Ph: 800.315.7551 • www.betabiomed.com

InterMed Biomedical……………………………… 63 Ph: 800.768.8622 • www.intermed1.com

Bio-Medical Equipment Service Co.………………46 Ph: 888.828.2637 • www.bmesco.com

Fluke Biomedical ………………………………… 4 Ph: 800.850.4608 • www.flukebiomedical.com

Biomed Ed…………………………………………… 47 Ph: 412.379.3233 • www.biomed-ed.com

KEI Med Parts……………………………………… 61 Ph: 512.477.1500 • www.KEIMedPARTS.com

Bulb Direct Holding, LLC…………………………… 33 Ph: 800.445.2449 • www.bulbdirect.com

Maull Biomedical Training…………………………59 Ph: 440.724.7511 • www.maullbiomedical.com

CIRS, Inc.…………………………………………… 19 Ph: 757.855.2765 • www.cirsinc.com

MedServ International Inc.……………………… 26 Ph: 800.437.9189 • www.medservintl.com

Conquest Imaging………………………………… 11 Ph: 866.900.9404 • www.conquestimaging.com

MedWrench…………………………………………65 Ph: 866.989.7057 • www.medwrench.com/join5

Datrend……………………………………………… 63 Ph: 604.291.7747 • www.datrend.com

MW Imaging Inc.…………………………………… 5 Ph: 877.889.8223 • www.mwimaging.com

ECRI Institute………………………………………54 Ph: 610.825.6000 www.ecri.org/alertstrackerautomatch

National Ultrasound……………………………… 21 Ph: 800.797.4546 • www.nationalultrasound.com

Ed Sloan & Associates……………………………… 18 Ph:615.448.6099 • www.edsloanassociates.com General Anesthetic Services, Inc.…………………59 Ph: 800.717.5955 www.generalanestheticservices.com

INDEX

Soaring Hearts, Inc.……………………………… 37 Ph:855.438.7744 • www.soaringheatsinc.com Southeastern Biomedical………………………… 47 Ph: 888.310.7322 • www.sebiomedical.com Stephens International Recruiting Inc.………… 67 Ph: 888.785.2638 • www.BMETS-USA.com Summit Imaging…………………………………… 26 Ph: 866.586.3744 • mysummitimaging.com Technical Prospects LLC…………………………… 8 Ph: 877.604.6583 • www.TechnicalProspects.com Tenacore Holdings, Inc.…………………………… 27 Ph: 800.297.2241 • www.tenacore.com Tesseract…………………………………………… 18 Ph: 703.437.4230 • www.tesseractUSA.com Trisonics……………………………………… 7, 16-17 Ph: 1.877.876.6427 • www.trisonics.com Troff Medical…………………………………………46 Ph: 800.726.2314 • Troffmedical.com USOC Medical………………………………………… 13 Ph: 855.888.8762 • www.usocmedical.com

NETECH Corporation………………………………… 35 Ph: 800.547.6557 • www.Netechcorporation.com Pacific Medical LLC…………………………………69 Ph: 800.449.5328 www.pacificmedicalsupply.com

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“Here is your country. Cherish these natural wonders, cherish the natural resources, cherish the history and romance as a sacred heritage, for your children and your children’s children. Do not let selfish men or greedy interests skin your country of its beauty, its riches or its romance.”

-Theodore Roosevelt

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