Medical Dealer - July 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

IN T E R O P E R A BIL ITY, SEC U R I TY A N D THE EV O LU T IO N OF

EMR TO EHR

JULY 2016 | WWW.MEDICALDEALER.COM

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CERTIFICATION PROS & CONS P. 60

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Good as new. Better, in fact.

p. 41 PATIENT TRANSPORT

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BUILT TO LAST! The MCS-6074 GE PerformixÂŽ Replacement Tube now with a 12 month full replacement warranty!

TM

Varian Imaging Components is continuously investing in new technology and engineering to improve our product portfolio.

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The MCS-6074 CT tube is compatible with GE LightSpeed, Discovery, and BrightSpeed series CT scanners.

To learn more, visit our website at www.varian.com/mcs-6074 VARIAN IMAGING COMPONENTS tel: 843.767.3005 or 800.468.3729 e-mail: interay.sales@varian.com The GE Performix trademark is owned by General Electric Company. Š 2015 Varian Medical Systems, Inc. Varian and Varian Medical Systems are registered trademarks. All rights reserved.

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60 60 ISO CERTIFICATION: THE PROS AND CONS OF QUALITY ASSURANCE

Quality certification through the International Organization for Standardization (ISO) is a topic for debate in the medical device industry, especially when it comes to third-party suppliers and service organizations. We asked those in the industry to share their thoughts and look at the ISO certification process.

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CONTENTS_Features 48 INTEROPERABILITY, SECURITY AND THE EVOLUTION OF EMR TO EHR Electronic medical records (EMR) and electronic health records (EHR) have become far more sophisticated mechanisms for providers, patients, and health care in general since the 2010 passage of the Affordable Care Act. Experts discuss the status and future of EMR and EHR in the U.S.

56 CORPORATE PROFILE: TENACORE Tenacore provides a comprehensive platform around the needs of the Biomedical Engineering departments within the hospital environment and prides itself on creating a business model that is adaptable to the needs of its customers.

Medical Dealer (Vol. 20, Issue #7) July 2016 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

POSTMASTER: Send address changes to Medical Dealer at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.medicaldealer.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. Š 2016

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MEDICALDEALER 11

INDUSTRY UPDATE 15 News & Notes 20 Company Showcase: Probe Hunter 24 OEM Updates MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269 (800) 906-3373 Fax: (770) 632-9090 Publisher

John M. Krieg john@mdpublishing.com

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John Wallace jwallace@mdpublishing.com

Art Department Jonathan Riley Jessica Laurain Kara Pelley

Account Executives Jayme McKelvey Chandin Kinkade Warren Kaufman

Contributors

Jim Fedele Matthew N. Skoufalos Dan Bobinski

Accounting

Kim Callahan

28 Used and Refurbished C-Arms: How Important Is System Age?

MARKET ANALYSIS Radiology: C-Arms 31 Market Analysis 32 Product Showroom 36 Preferred Vendors Med/Surg: PatientTransport 41 Market Analysis 42 Product Showroom 46 Preferred Vendors

SLICE OF LIFE 66 The Other Side: Who cares about Bad Parts?

68 Dan Bobinski: Workplace pet peeve lists are like gold 72 Pay It Forward: Mending Kids’ Collaboration Improves Lives 74 Success story: St. Luke’s Healthcare System

Circulation

Lisa Cover Laura Mullen

Web Department Taylor Martin Adam Pickney Cindy Galindo

79 Marketplace 80 Categorical Index 82 Alphabetical Index

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MEDICAL EQUIPMENT, PARTS & SERVICE

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INDUSTRY UPDATE_News and Notes

DUNLEE CELEBRATES 70 YEARS OF EXCELLENCE IN IMAGING advanced technology to shape how On July 13, 2016, Dunlee, a division of Philips celebrates 70 years of lead- today’s images are made. Through ership and innovation. The company advanced engineering techniques, Dunlee’s CT tubes are designed to was founded in 1946 by Dunmore have a long tube life while keeping in Dunk and Zed Atlee, two former mind our customers’ budgets. engineers from General Electric.

As a pioneer in the multi-venOperations first started in Chicago dor service and in-house movement, but moved to Bellwood, Illinois. In Dunlee sparked innovation by using 1994 Dunlee moved to its current reverse engineering to manufacture location in Aurora, Illinois. budget friendly OEM quality tubes.

In 2001, Philips Medical Systems These products, like the DA200 acquired Dunlee from Picker Interreplacement for LightSpeed scanners national. Today, Dunlee has become a strategic part of Philips, as well as a and the Reevo 240G replacement for leading manufacturer of CT tubes for VCT scanners, have empowered hospitals around the world to reduce third-party and OEM applications. system life cycle costs.

Dunlee is one of the world’s Dunlee’s customers benefit from primary sources for CT tube replacements, designing and manufacturing programs that go hand-in-hand with doing business with Dunlee, offering CT tubes. For over 70 years, Dunlee has employed the quality people and same-day delivery, 24/7/365 cusOLYMPUS LAUNCHES THE OLYMPUS KNOWLEDGE EXCHANGE (KE) SYSTEM and the reprocessing rooms.

Olympus, a global technology leader “The connectivity of our Olympus in designing and delivering innoKE System is a significant advantage, vative solutions for medical and making the system even more valusurgical procedures, among other able to facilities with popular EMR core businesses, has announced systems,” said Kurt Heine, Group Vice the launch of its Olympus KnowlPresident of the Endoscopy Division edge Exchange (KE) system, a next at Olympus America Inc. “It allows generation software platform offerhospitals to leverage the expense and ing facilities centralized endoscope effort they’ve put forth to implement reprocessing record and image management through expanded con- an enterprise EMR solution.”

In the procedure room the KE sysnectivity of Olympus devices. tem can save time and reduce data The KE modular platform is built entry errors by expanding the conaround standard communication nectability of the Olympus CV-190 protocols HL7 and DICOM, which video processor. Furthermore, the provides interoperability with most KE system provides users with the modern electronic medical record ability to transfer procedure images (EMR), radiology information systo a PACS or EMR system at the tem (RIS) and picture archiving and highest resolutions available today. communication systems (PACS).

Outside the procedure rooms, When the KE communication and the KE system offers connectivity endoscope reprocessing manageto the Olympus OER-Pro endoment modules are used together, scope reprocessor. By adding the patient and procedure data flows OER-Pro, documentation of the seamlessly between the procedure WWW.MEDICALDEALER.COM

Staff Reports

tomer care, and exclusive Glassware Solution programs that help to minimize risk. Dunlee also has trusted partners that can be utilized for imaging parts, expert CT installation, and extensive multi-modality training.

“Dunlee has the privilege to commemorate this important milestone this July. This wouldn’t be possible without the continuing support of our customers and the hard work of our employees. Employee and customer events have been planned for this summer and we look forward to celebrating with all who have contributed to our success and longevity,” Heather Funk, Sr. Manager of Marketing and Business Development and Dunlee veteran explains. • For details, visit www.dunlee.com.

endoscope reprocessing outcomes can be tracked electronically helping users identify quality issues that can adversely affect patient safety.

The Olympus KE System was developed to assist hospitals in establishing and monitoring quality assurance programs in compliance with the guidelines of several medical societies including the Society of Gastroenterology Nurses and Associates Inc. (SGNA); Advancing Safety in Healthcare Technology (AAMI), the American Society for Gastrointestinal Endoscopy (ASGE), and the Association of periOperative Registered Nurses (AORN). •

MEDICALDEALER 15

INDUSTRY UPDATE_News and Notes

Staff Reports

VARIAN MEDICAL SYSTEMS ANNOUNCES PLAN TO SPIN OFF IMAGING COMPONENTS BUSINESS Varian Medical Systems has announced different directions. We believe making inspection industries. that it plans to spin off its imaging com- these businesses independent will give “This business will be able to capponents business as a new, stand-alone each of them more freedom to invest italize on trends in digital imaging public company via a tax-free distriin and pursue new growth strategies in and build a larger presence in security bution to Varian stockholders in a their unique core markets. This should and industrial applications,” Wiltransaction anticipated to be completed sharpen the focus of each business and son said. “The new company will be by the end of this calendar year. align their employee incentives and able to leverage its world-renowned “The spin-off will create two performance more closely with servX-ray engineering team to work with strong, independent companies,” said ing the specific needs of their respective equipment manufacturers and system Dow Wilson, CEO of Varian Medmarkets. Investors should get greater integrators to develop new, next-genical Systems. “It will enable Varian transparency and understanding of eration imaging systems.” to focus on expanding its position as each of these businesses.”

The new imaging components a global cancer company with leadVarian Imaging Components is a company is expected to have annual ing technology and services. It will high-volume manufacturer of X-ray revenues of about $575 million and empower the new company to grow tubes, flat panel detectors, connectors has approximately 1,300 employas a global leader in components, and accessories for imaging as well as ees around the world. It is expected software and services for expanded a supplier of workstations and softthat the new company’s manageimaging applications and markets.” ware for computer-aided diagnostics ment team will include Sunny Sanyal, “By executing this transaction, we and image processing. When compresident of Varian Imaging Comwill give two fundamentally different pleted, the spin-off would establish the ponents, as the new Chief Executive businesses independence to optinew company as a global supplier of Officer, and Clarence Verhoef, Varian mize their strategies and operations to components, software and engineering Controller, as Chief Financial Offienhance their growth,” Wilson added. services for imaging equipment mancer. Additional details regarding the “The objectives and growth strategies ufacturers and system integrators in name, structure, leadership and finanof our imaging components and oncolthe medical diagnostics, dentistry, vetcial operations of the new company ogy businesses are now taking them in erinary care, security and industrial will be disclosed at a later time. • 16 MEDICALDEALER | JULY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

_News and Notes

ALPHA SOURCE INC. BECOMES AUTHORIZED SERVICE PROVIDER FOR GE HEALTHCARE BMD Alpha Source has announced that it will become the authorized service provider for GE Healthcare’s bone mineral densitometry (BMD) products in the United States.

The servicing of GE Healthcare’s BMD equipment complements the ultrasound imaging service Alpha Source has been providing on selected GE Healthcare ultrasound products since 2014.

Alpha Source provides a trusted service solution for GE Healthcare’s BMD and selected ultrasound products. The national network of trained field service engineers will be supplemented with depot repair operations in Milwaukee to support this growing multi-modal installed base of imaging equipment.

“Alpha Source is building on its growth as an innovative service provider to health care organizations by offering solutions that extend the life of medical equipment, reduce equipment costs of ownership and support improved patient care. We’re pleased GE Healthcare selected Alpha Source as its bone mineral densitometry service partner, based on our commitment to delivering value, quality and reliability for our mutual health care customers,” said Rick Lytle, Alpha Source’s Chief Executive Officer.

Customers received notification of the service transition in May. The full transition of BMD service from GE Healthcare to Alpha Source will take place during 2016.

GE Healthcare will continue to design and manufacture BMD equipment and will maintain service in geographies outside the United States. •

AVANTIS MEDICAL SYSTEMS RECEIVES 510(K) CLEARANCE Avantis Medical Systems Inc. has practices without the need to invest announced that it has received 510(k) in expensive infrastructure. clearance from the U.S. Food & Drug “This clearance represents a signifAdministration (FDA) for its Third icant milestone for our organization, Eye Panoramic device for use as a res- as we can now offer the resposable posable product for colonoscopies.

Third Eye Panoramic device to the Previously cleared as a disposable medical community in the U.S.,” said device, this latest clearance now Anthony DiTonno, CEO of Avanallows Third Eye Panoramic to be tis Medical Systems. “The resposable marketed in the U.S. as a resposversion of our device provides the able device that can be used multiple same ultra-wide-angle view of the times prior to disposal. colon as the disposable predicate Third Eye Panoramic is a widedevice, with a much lower cost per view visualization device designed to procedure. Physicians and faciliprovide gastroenterologists (GIs) and ties will benefit from this innovative other endoscopists a better look at technology from both clinical and areas of the colon where cancers and financial perspectives, and the ultipre-cancerous polyps may be hidden mate winners will be their patients.” from the view of a traditional coloThe Third Eye Panoramic device noscope alone, such as behind folds. contains two video cameras that are This is the only optical device on the directed laterally from its left and market that can easily be used in con- right sides. The device is attached junction with any commonly used to the tip of the colonoscope at the colonoscope to improve visualization. beginning of the procedure, and can Physicians can integrate the Third be used during both the insertion Eye Panoramic within their current and withdrawal phases. The Third WWW.MEDICALDEALER.COM

Eye Panoramic’s lateral images are displayed on each side of the colonoscope’s forward image, resulting in an ultra-wide-angle view of more than 300 degrees. This “panoramic” view reveals areas behind folds and flexures (sharp turns) in the colon.

The cleaning and disinfection protocols for this device are similar to the methods used to reprocess colonoscopes between uses.

Following this FDA clearance, the company plans to launch the product as a multi-use device and is currently evaluating strategic partnerships to drive commercial availability. •

MEDICALDEALER 17

INDUSTRY UPDATE_News and Notes

BLOCK IMAGING AND MIT ANNOUNCE PARTNERSHIP Block Imaging has announced a new strategic partnership for GE CT Parts with Medical Imaging Technologies (MIT), an independent imaging equipment service provider throughout the southeastern United States. This shared investment in GE CT technology will increase equipment uptime for MIT customers and expand Block Imaging’s capabilities and capacity in CT parts inventory and repairs.

Chad Seelye, Vice President of Parts Sales at Block Imaging expressed his excitement at the new partnership saying: “As a company focused on servicing imaging equipment across the southeastern United States, MIT is always looking for new ways to get their customers the parts they need faster than ever. As a global equipment and parts provider, Block Imaging is always looking to build relationships within the field service community. This partnership is a big win for both companies and the doctors, techs, and patients we serve – especially in the area of GE CT scanners.”•

POWER SOURCES UNLIMITED INC. BUYS ASSETS OF OEM MARKETING & SALES Power Sources Unlimited Inc. recently announced that it has signed and executed a definitive agreement to acquire the assets of OEM Marketing & Sales-Franklin for an undisclosed amount. The acquisition is expected to close in late June 2016. The company will finance the acquisition using available cash and expects the acquisition will become accredited to earnings in early fiscal 2017.

“We expect that this acquisition will enhance our customer base as OEM has an extensive and very detailed targeted mailing list that will help us drill deeper into the New England Market and secure additional design wins and OEM production business,” Ray Newby, President and Founder of Power Sources Unlimited Inc., stated. “When coupled with our aggressive marketing campaign, inside sales tenacity and build-out strategy will provide the opportunity for accelerated market share and future growth in sales and profitability. • Find more information at www.psui.com.

18 MEDICALDEALER | JULY 2016

Staff Reports

GLOBALDATA: MEXICO’S MEDICAL DEVICES MARKET TO HIT $6.5B Mexico’s medical devices market is set to grow from $4.9 billion in 2015 to $6.5 billion by 2020 as the population increases, adopts more unhealthy lifestyles, and grows older, according to research and consulting firm GlobalData.

The company’s latest report states that the resultant prevalence of non-communicable diseases such as cardiovascular disease, respiratory disease, metabolic disorders and cancer means that Mexico’s health care infrastructure has had to grow to keep pace.

Adam Dion, GlobalData’s Senior Analyst covering Industry Dynamics, elaborates: “A large part of the demand for medical devices in Mexico is met through imports. The U.S is the leading supplier of medical devices to Mexico, followed by Brazil, China, Canada, France, and Germany. Domestic medical technology companies attribute the high dependence on imports to low expenditure on research and development.”

Companies leading the medical devices sector in Mexico include Fresenius, Roche, DePuy, Medtronic, Siemens Healthcare, Baxter, Gambro and GE Healthcare.

Dion explains: “With Mexico’s increase in health care demand, a number of opportunities are open for such manufacturers. Indeed, the government has been aiming to provide universal health care coverage, which would increase public health care expenditure and create better market opportunities for the medical device industry.”

“In addition, it has signed various free trade agreements, which will increase the opportunities for businesses in Mexico and strengthen its exports and imports. It will also benefit from a large number of medical tourists, primarily from the U.S., seeking treatment for conditions not covered by U.S. insurance, such as cosmetic surgery, dental procedures, and weight-loss surgery.” •

MEDICAL EQUIPMENT, PARTS & SERVICE

INDUSTRY UPDATE_Company Showcase

Special Advertising Section

ON A MISSION FOR PATIENT SAFETY IN ULTRASOUND

T

ogether, Ann-Christiné and Björn Segall run the Swedish company BBS Medical AB. They have a worldwide market for their ultrasound probe test system – ProbeHunter.

the company BBS Medical AB. The business was sold to GE in 1999.”

Björn and Ann-Christine met in 1983, when Ann-Christine was working in public relations at one of Sweden’s leading newspapers.

OEM ULTRASOUND PROBE CHALLENGES

“I have been in the ultrasound business for more than 30 years, I started as a service technician in the early 1980s. My background at that time was as a TV repair service man, and I did my military service in the Marines where I learned how to use radar.

There are a lot of similarities between radar and ultrasound,” says Björn. “I started at Kontron with service on ultrasound and quickly ended up in sales. At this point in time, ultrasound was a new diagnostic method and you had to convince the users to use it. I had the opportunity to work with the best scientific people in Norway.

Together with a friend I developed an interface and a solution for CW Doppler and that was my way to the position as European Manager at Vingmed (now GE). In 1986, I started 20 MEDICALDEALER | JULY 2016

In 2002, BBS Medical AB was offered the opportunity to take on an ultrasound test system: First Call. From that point in time, Ann-Christiné and Björn decided to work together. In the beginning, the biomedical engineers were very reluctant.

“You can’t see the problem, that’s the problem, you need a tester – we told them,” Björn says. “We had all the OEMs against us.”

“Finally, we got a region in Sweden to test through their inventory of probes. They had 100 systems and approx. 400 probes on service contracts. We found that 40 percent of the probes where defective,” Björn explains. “And the hospitals cancelled all service contracts and the OEMs lost substantial revenue.”

The company BBS Medical AB came away with a proven solution

and more hospitals in Scandinavia wanted to test probes and buy their own testing systems. From 2008 to 2010, The Royal Institute of Technology in Stockholm (KTH) wanted to use the company’s database for study purposes. The studies confirmed the results that BBS Medical had after its initial testings: 35-40 percent of nontested hospital probes had defects and there were confirmed incidents on patients due to faulty probes.

In Scandinavia, BBS Medical continued the dialog with the biomedical engineers and today there are demands when buying new ultrasound systems. The OEMs have to provide quality protocols with the probes and provide proof of how they monitor the probes over time.

“This is still unique, it took BBS Medical 14 years to implement this on the Scandinavian market, but we foresee that this will spread across Europe and then to the rest of the world,” says Ann-Christiné.

In 2013, GE decided to get into the probe repair business, they realized that aftermarket sales did not belong to them and that it is a fruitful busiMEDICAL EQUIPMENT, PARTS & SERVICE

Probe Hunter_Company Showcase Together, Ann-Christiné and Björn Segall run the Swedish company BBS Medical AB.

“ The driving force is, of course, patient safety and quality assurance, because we will all end up under a probe, and you want to know that it is fully functional.” – Ann-Christiné ness. They acquired Unisyn probe repair business in Denver, Colorado and the IP to First Call.

“We at BBS, knew that it wasn’t any development on the First Call since 2009. We knew since we had developed our own probe adapters to our customers,” Björn explains.

GE decided to keep the First Call for internal use and left a gap on the market.

“It took us three months to recover and to decide what to do,” says Björn.

“We discussed with our customers, asked them what they wanted and everyone wanted to know more about the probes, to test in real time and wanted new features.”

“Ann-Christiné and I made a decision, let’s challenge First Call with improved features. The new project started,” Björn continues. “We found what we were looking for, WWW.MEDICALDEALER.COM

and decided to invest the financial recourses ourselves. After a year we had it! ProbeHunter was born. And we made First Call Adapters to fit on ProbeHunter so that everyone with a First Call could benefit from the ProbeHunter features as well.”

“It was a great day when we introduced ProbeHunter, a real-time tester, at Medica in a closed VIP demo room in November 2014. The ProbeHunter was released in December the same year at a seminar arranged by BBS and it was sponsored by Toshiba, Siemens and Philips. Everyone in the business was curious about what we had developed. And many were impressed about the fast development, that such a small company like ours from Scandinavia had introduced such an advanced test system for the ultrasound industry,” Ann-Christine says.

Since then sales are taking off, adapters for all probe types are being developed. The system is now accepted and installed by all market segments: array manufacturers, hospitals, probe repair companies, distributors of ultrasound and OEMs. “The driving force is, of course, patient safety and quality assurance, because we will all end up under a probe, and you want to know that it is fully functional,” she continues. “As we see it, every probe that is traded or in use should be frequently tested and have a test protocol.”

Until the entire industry understands the importance of testing ultrasound probes, we will continue on our mission, Björn concludes.

FOR MORE INFORMATION, about Probe Hunter, visit www.probehunter.com MEDICALDEALER 21

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INDUSTRY UPDATE_OEM News

RAYENCE INTRODUCES NEW PRODUCTS Rayence has announced the availability of the new XmaruView Image Acquisition Software, Version 4.0. The new software comes with a host of new features. Most notable is its newly developed Rayence engine. XmaruView 4.0 is Microsoft Windows 10 compatible and, unlike previous software versions, it does not require a dongle. It also includes such new features as Auto JPEG Exporter, legacy PACS compatibility, EMR integration readiness, Auto-stitching, and a faster interface.

“This is a significant step for Rayence. We’ve taken features requested by our users and integrated them into the design of our newly developed software products,” said Stalin Calvache, Chief Technical Officer at Rayence Inc. “It is a noteworthy advancement to our software offering that will be well received by our customers.”

Along with the introduction of their new image acquisition software, Rayence has upped its game with its viewer software XmaruView mini-Archive Viewer, Version 3.02. Similar to the new XmaruView 4.0, the new viewer software is Microsoft Windows 10 capable and includes new features such as cine tools and the ability to work in landscape and portrait mode.

Shipments of the two new software products began in early May. • 24 MEDICALDEALER | JULY 2016

Staff Reports

CARTI INSTALLS FIRST TOSHIBA INFINIX 4D CT Cancer patients at the CARTI Cancer Center now have access to Toshiba America Medical Systems Inc.’s Infinix 4D CT. CARTI is the first health care provider in the United States to install the Infinix 4D CT and its unique merging of the Infinix-i angiography system and Aquilion ONE ViSION Edition CT system that may help clinicians improve visualization and work flow, and increase patient safety.

CARTI is utilizing the system for interventional radiology and oncology to plan, treat and verify in a single clinical setting. Real CT imaging available on demand may help interventionalists improve visualization of tumors and feeder vessels, as well as provide whole organ body perfusion, to help them not only plan and treat but also verify their procedures. For example, during hepatoma embolizations, interventionalists can immediately visualize and confirm that treatment is hitting the right areas with CT, and identify feeder vessels enabling the interventionalists to guide catheters into the vessels with the angiography system’s 3D roadmap. CARTI is also using the system during liver ablations and kyphoplasty procedures, among other applications.

“Interventional radiology and oncology is born from innovation, and technology advancements like the Infinix 4D CT create exciting new possibilities and prepare us for the future of care,” said Dr. David Hays, director, Diagnostic and Interventional Radiology, CARTI. “For today’s patients, the system makes procedures that were difficult to perform and turns them into manageable cases that are easier, faster and more accurate.”

The Infinix-i enables clinicians to provide precision and flexibility during intervention with fingertip-to-fingertip and head-to-toe coverage, and enables unprecedented patient access with the Access Halo. The Aquilion ONE ViSION Edition is capable of capturing an entire organ in one rotation with 640 slices and 16 cm of true anatomical coverage, producing image quality that far exceeds CT-like imaging of the interventional lab. The combination of the interventional lab and CT eliminates the need to transfer patients between departments and allows clinicians to decrease procedure time and maintain patient safety. Toshiba’s third-generation iterative dose reconstruction software, AIDR 3D (Adaptive Iterative Dose Reduction 3D), offers simplified CT dose reduction, while the Infinix has a suite of dose management features including the Dose Tracking System. • MEDICAL EQUIPMENT, PARTS & SERVICE

_News and Notes

AMPRONIX RELEASES NEW LARGE SCREEN DISPLAY Ampronix has announced the release Upon request, Ampronix can also of its ultra high definition medical dissupply a Hybridpixx video manager, play, the Hybridpixx. The 8MP display which gives physicians the ability to is sleek and lightweight while deliverselect desired images from the display, ing clear and consistent images. making it an ideal candidate for large At 58 inches, the QFHD display and scale viewing or multi-screen monitorautomatic luminance stabilization sys- ing. With hundreds of potential layout tem ensure precise and reliable images, options, the amounts of customizawhich will indeed make Hybridpixx tion possibilities are infinite. The video especially useful in hybrid operating manager also makes it remarkably easy rooms, where visualization is the key to maneuver or scale images to custo performing minimally invasive protomize viewing at the discretion of the cedures. But it’s not just limited to that individual. Additionally, it can input up – Hybridpixx can be utilized for any to 27 analog or digital signals. surgical or interventional radiological With many medical institutions needs, or anywhere else where moniadopting 4K resolution, a common toring is critically important. issue was connectivity – whereas some WWW.MEDICALDEALER.COM

modalities did not have the appropriate cables, some did but still could not make their modality network to their new display.

To correct this issue, Ampronix created 4KBoxx422 and 4KBoxx22, a converter and emulator that ensure the video manager and modality will interact.

“Hybridpixx will definitely benefit the medical imaging industry – it will have a positive impact on those that matter; the physicians and patients,” said Nausser Fathollahi, CEO and President of Ampronix. •

MEDICALDEALER 25

INDUSTRY UPDATE_OEM News

Staff Reports

MD ANDERSON AND VARIAN EXPAND RELATIONSHIP ator capable of fast and precise Varian Medical Systems has image-guided radiotherapy and announced the University of Texas radiosurgery. The system is equipped MD Anderson Cancer Center signed with a high dose delivery rate that an agreement to acquire six Trueenables most treatments to be comBeam linear accelerators. Scheduled for delivery over the next 24 months, pleted faster than was possible with earlier generations of radiotherapy the six TrueBeam systems will be technology. added to the 24 Varian linear accel“Varian is proud of its years of erators already treating patients at working with MD Anderson,” said the cancer center.

Kolleen Kennedy, president of Vari“We have been able to deliver critan’s Oncology Systems business. “We ical cancer treatments to thousands have worked together to improve of cancer patients as well as collabothe quality and eff ectiveness of canrate on strong translational research cer care for patients who come from programs and clinical trial supall over the world for treatment. port through Varian’s technology,” TrueBeam opens the door to some said Steve Hahn, chair, Division of exciting cutting-edge treatment Radiation Oncology at MD Andercapabilities that will be made availson Cancer Center. “The additional able to patients in coming years.”

TrueBeam systems will enable us to The order for the systems was make advanced cancer care accessibooked in March during the second ble to even more patients.” quarter of the company’s fiscal year Varian’s TrueBeam system is an 2016. • advanced medical linear acceler-

FDA APPROVES STAND-ALONE 3D SCREENING Siemens Healthineers has announced study in which participating radiolthat the Food and Drug Administration ogists demonstrated their ability to (FDA) has approved the use of 3D-only increase cancer detection at a lower screening mammography utilizing radiation dose than combined 2D the company’s Mammomat Inspiraand DBT. In the study, radiologists tion with Tomosynthesis Option digital decreased average recall rates by an mammography system. The Siemens average of 19 percent without the system is the first and only 3D digital need for a 2D image. breast tomosynthesis (DBT) platform “Siemens is proud to announce to be approved by the FDA as a standthe availability of 3D-only screenalone screening and diagnostic system; ing with our Mammomat Inspiration all other mammography systems on the with Tomosynthesis Option digital market require a combination of 2D mammography system,” said Marand 3D examinations. tin Silverman, Vice President of X-ray FDA approval of the 3D-only Products at Siemens Healthineers. application follows a pivotal reader “Although this is the first breast 26 MEDICALDEALER | JULY 2016

tomosynthesis solution on the market to demonstrate statistically superior results to 2D as a stand-alone breast exam, we know many providers will continue using 3D tomosynthesis as an adjunct to 2D screenings. Those providers who use our platform, however, will do so with confidence, knowing our 3D is a proven standalone option.”

Siemens’ Tomosynthesis Only Option is available on the company’s Mammomat Inspiration and Mammomat Inspiration Prime Edition digital mammography systems. •

MEDICAL EQUIPMENT, PARTS & SERVICE

PROOF APPROVED

PROOF SHEET

CHANGES NEEDED

CLIENT SIGN–OFF: PLEASE CONFIRM THAT THE FOLLOWING ARE CORRECT LOGO PHONE NUMBER WEBSITE ADDRESS

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INJECTOR SUPPORT & SERVICE • Loaner injectors • Depot service • Parts identification and sales • Preventative maintenance tools • On-site service • Injector sales

To learn more visit www.injectorsupport.com or call 888.667.1062

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MEDICALDEALER 27

INDUSTRY UPDATE_Block Imaging

By Chris Sharrock

USED AND REFURBISHED C-ARMS:

HOW IMPORTANT IS SYSTEM AGE?

O

ne of the first questions we’re asked when we propose a used or refurbished C-arm to a customer is, “What year was it made?” This is a logical question to ask; a question one asks almost any time they buy something used. In the case of used C-arms, there are several reasons this information seems important, but simply knowing the date of manufacture (DOM) of a system can be deceiving. The following are a few better ways to find out what you really want to know about used and refurbished C-arms.

Software Version Why it matters: Later software releases are more stable and can indicate a hardware upgrade as well.

Why it matters more than system age: While it is true that newer C-arms leave the factory with newer versions of OEM software installed on them, it’s not necessarily true that a more recent DOM translates into newer software in the field.

Which software version is installed on a system comes down to the frequency with which the software has been upgraded. For example, it is entirely possible that an OEC 9800 made in 2002 could have a higher software revision installed than a 9800 made in 2004.

28 MEDICALDEALER | JULY 2016

Chris Sharrock

If you’re looking at buying a used or refurbished C-arm, your vendor can easily find out the exact software revision installed on the machine.

Just ask.

Does It Have Onboard DICOM? Why it matters: If DICOM capability isn’t built into the unit, you will need to purchase an accessory device before you can send any images to your PACS server.

Why it matters more than system age: Onboard DICOM is the most direct way to get your images to your PACS server. Not all manufacturers made this feature standard at the same time, so it is possible for a system without onboard DICOM to be a couple of years newer than a system with onboard DICOM.

Component Life Why it matters: The image intensifier (II), X-ray tube, and CCD camera are some of the more expensive parts to replace on a C-arm system.

Why it matters more than system age: System DOM can be a misleading indicator of the usable lifespan remaining on a component.

An older system used in a low-traffic facility may have much more component life remaining than a newer system used in a high-traffic environment. Moreover, a used system may not even be carrying its original parts anymore.

A better way to inquire after component life is to ask the DOM of each major component and to ask your C-arm vendor if they can tell you what type of facility the machine was last installed in.

Overall Condition Why it matters: Any part of a C-arm that is wearing now will need replacement that much sooner.

Unseen wear and tear can start to nickel and dime you just a few months after you buy a system.

Why it matters more than system age: DOM can be every bit as misleading on overall condition as it can be on component life. In fact, the same principle applies: higher facility traffic generally translates into more wear and tear. More movement is harder on C-arm components like casters, brake pads, cable casings, and locks. More frequent use is MEDICAL EQUIPMENT, PARTS & SERVICE

harder on internal components like high voltage tanks and collimators.

Beyond that, as with the major components we discussed earlier, it may also be that some of the other parts installed on your system are not the originals. An older C-arm could be operating with much newer parts than a more recent system.

In the case of refurbished C-arms, a quality refurbishment process all but eliminates these concerns with repair and replacement of worn or damaged system components.

In the case of used C-arms, more relevant information to get from your vendor is the individual DOM for each of the following: • X-ray tube • Image intensifier • CCD camera • Collimator • High voltage tank You should also request some photos or video of the system. These will be more indicative of its condition than assumptions based on DOM. The Takeaway Ultimately, system age is still valuable information that can help you manage your expectations as you consider a C-arm. However, it is not the best indicator for some of the most important aspects of the equipment. As you search for the best C-arm for you, we encourage you to look into further details for a more inclusive picture of what the secondary market has to offer.

CHRIS SHARROCK is the C-arm Product Manager at Block Imaging.

Sometimes referred to as the “The C-Arm Guy,” he has a passion for music, fitness and genuinely enjoys helping others make decisions about C-arms.

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MEDICALDEALER 29

IMAGING PARTS, SUPPORT & EQUIPMENT

STOP BY BOOTH 312 DURIN G ICE JULY 2 0-21

Back Where It All Started After selling his first business, Edward A. Sloan Sr. decided to retire in 2008. Less than a month later, he came out of retirement to establish Ed Sloan & Associates, which began as an equipment sales company, specializing in quality tested medical and diagnostic

started! where it all

imaging equipment. Now, with over 25 years of experience, Ed Sloan is coming full circle and expanding into the facility where it all began.

OUR FACILITY PROVIDES • 100,000+ sq. ft. facility • Stocked inventory of quality tested parts • Free Technical Support

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30 MEDICALDEALER | JULY 2016

• 26 CT, MRI & XRAY QA bays • Hands-on training from industry professionals

ED SLOAN & ASSOCIATES

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PRODUCT FOCUS_C-Arm_Market Analysis

Staff Reports

C-ARM MARKET STILL GROWING

T

here are many diagnostic imaging modalities. C-arms are among these helpful medical tools and new developments, especially mobile C-arms, are factors contributing to the growth of this sector.

Several recent market analysis reports indicate continued growth in the C-arm market.

Global Industry Analysts Inc. (GIA), a worldwide business strategy and market intelligence source, is among those predicting C-arm market growth in coming years.

“The global fluoroscopy and mobile C-arms market is forecast to reach $2.4 billion, driven by the growing prominence of minimallyinvasive surgical (MIS) procedures, technological advancements, and expanding geriatric population,” according to a 2015 report on the GIA website. “Fluoroscopy is one of the most widely used medical diagnostic technologies worldwide. Unlike X-ray machines, fluoroscopy and mobile C-arm equipment generate real-time visuals of the body parts for assisting medical professionals in surgical procedures. These machines are used for minimally invasive imaging for procedures such as the insertion of intravenous catheters, cardiac catheterization, lumbar puncture, and biopsies.”

“Future growth in the market will be driven by increasing demand for radiology intervention and orthopedic procedures from the expanding elderly population and WWW.MEDICALDEALER.COM

sports-related injuries,” the report adds. “Mushrooming of public and private health care facilities across the globe is also expected to bode well for market expansion in the coming years. Additionally, unhealthy lifestyles and the large and growing geriatric population worldwide is fuelling the need for cardiology and vascular procedures, orthopedic care, and pain management that are performed using fluoroscopy and mobile C-arms systems.”

surgeries, on account of the increasing incidence of sports injuries and road accidents, is fueling the demand for fluoroscopy and mobile C-arms across the world. The rapid growth of the geriatric population is also boosting this market substantially in the global arena,” according to the Transparency Market Research study.

“According to the report, fluoroscopy equipment and mobile C-arms are the two major products available in the global fluoroscopy and C-arms market.

“The global fluoroscopy and mobile C-arms market is forecast to reach $2.4 billion, driven by the growing prominence of minimally-invasive surgical (MIS) procedures, technological advancements, and expanding geriatric population.”

A research report on the global fluoroscopy and mobile C-arms market, published by Transparency Market Research (TMR), states that the market is likely to register a moderate CAGR (Compound Annual Growth Rate) of 3.0 percent during the period from 2013 and 2019. The research report titled, “Fluoroscopy and Mobile C-arms Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013 - 2019,” indicates this market will increase from an approximate value of $1 billion in 2012 to more than $2 billion by the end of the forecast period.

“The rising need for orthopedic

In 2012, the fluoroscopy equipment segment led the worldwide market in terms of revenue and the C-arms segment dominated this market in terms of volume. The C-arms segment has been further categorized into mini C-arms and full-size C-arms. The fullsize C-arms segment is likely to record a faster growth rate among the two during the forecast period.”

Some major participants in this market, according to Transparency Market Research, are Toshiba Corp., Siemens Healthcare, Shimadzu Corp., Philips Healthcare, Omega Medical Imaging Inc., Hologic Inc., Hitachi Ltd., and GE Healthcare.

MEDICALDEALER 31

PRODUCT FOCUS_C-Arm _Product Showroom

Staff Reports

JULY PRODUCTS: This month, Medical Dealer explores C-arms

GE HEALTHCARE OEC 9900 Elite

G

E Healthcare Surgery OEC is recognized as a leading mobile surgical imaging producer with over 35,000 OEC C-arms installed worldwide. The OEC 9900 Elite boasts excellent image quality and an easy-to-use interface, ideal for surgical and minimally invasive interventions. From basic general surgery to orthopedics and vascular interventions, the OEC 9900 Elite has the power, precision and performance to meet the imaging needs of your facility. Whether it’s the proprietary “Super C” offering 55 degrees of over scan capability, or the Standard C with exclusive SmartView technology that combats parallax, GE Healthcare provides imaging access around the patient and procedure table. •

32 MEDICALDEALER | JULY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

C-Arm _Product Showroom

SIEMENS Cios Fusion mobile C-arm

O

ffering the state-of-the-art flat panel detectors of the Cios Alpha in the medium price segment, the new Cios Fusion mobile C-arm has two detector sizes – 30 cm x 30 cm and 20 cm x 20 cm. It offers most of the same software and hardware features of the Cios Alpha, including a touchscreen remote that can be positioned at the operating table to control the C-arm from within the sterile work area. •

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MEDICALDEALER 33

PRODUCT FOCUS_C-Arm _Product Showroom

Staff Reports

PHILIPS Veradius Unity

P

hilips is re-defining teamwork during surgical imaging with the introduction of its newest interventional X-ray system, Veradius Unity. Veradius Unity is Philips’ third generation digital flat detector mobile C-arm system and with its unique tablet-like user interface it is extremely user friendly. Combined with breakthrough image quality and dose efficiency features such as Philips’ unique BodySmart and the various exposure modes, you can perform difficult cases with confidence on virtually any patient. ClearGuide, Color Coding and Position Memory further enhance the communication amongst the team in obtaining the most optimal image with the lowest possible radiation. Find more online at www.usa.philips.com/healthcare. •

34 MEDICALDEALER | JULY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

C-Arm _Product Showroom

TOSHIBA Infinix-i cardiovascular X-ray systems

T

he Infinix-i cardiovascular X-ray systems provide unmatched flexibility in system design with C-arm movement and WorkRite technology. These features combine to make interventional procedures easier for clinicians, enabling them to improve patient care. The WorkRite technology features hovercraft-like C-arm movement and the unique Access Halo. It’s designed to maximize workflow and throughput to ensure that interventionalists are in an optimal ergonomic orientation during any procedure.

This helps reduce fatigue and injury that can occur when ergonomics are compromised. The systems also feature comprehensive dose management tools to provide safer exams, such as the Dose Tracking System (DTS) and Spot Fluoroscopy. •

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MEDICALDEALER 35

PRODUCT FOCUS_C-Arm_Preferred Vendors

Staff Reports

PREFERRED VENDORS

C-ARM

Blue Ox Medical Technologies 11016 Rushmore Dr #160 Charlotte NC 28277 Phone: 704-350-5768 Fax: 509-275-9442 Email: info@blueox1.com Website: www.blueox1.com

SEE OUR AD ON PAGE 38

Blue Ox has a diverse set of products and services that add value in today’s capital constrained environment. Our product line includes almost any multi-modality product or lab service used in private practices today, along with the software platforms to bill for your ancillary services. For practices who are not ready to take on the capital, we provide managed services with a minimal cost of service.

ED SLOAN & ASSOCIATES

Ed Sloan & Associates

SEE OUR 101 Old Stone Bridge Road AD ON PAGE 30 Goodlettsville, TN 37072 Phone: 615-448-6095 Fax: 615-448-6099 Email: sales@ed-sloanassociates.com Website: www.edsloanassociates.com Ed Sloan & Associates specializes in quality tested parts for GE CT, MRI, and X-ray. The company’s 100,000+ square-foot facility is equipped with 4 MRI bays, 8 CT bays, 4 X-ray bays and 2 C-Arm bays. Ed Sloan & Associates also offers complete systems sales as well as fixed and mobile system storage.

36 MEDICALDEALER | JULY 2016

Engineering Services 2200 E. Enterprise Parkway Twinsburg, OH 44087 Toll-Free: 888-364-7782 Phone: 330-425-9279 x.11 Email: ken@eng-services.com Website: www.eng-services.com

SEE OUR AD ON PAGE 22

We are an engineering repair company dedicated now for 30 years to providing a quality, completely repaired medical cable.

For customers looking to blend the gap between expensive OEM and unreliable used assemblies, we have your solution.

Our complete repair contains a new cable assembly, utilizing all OEM cable and components with a harvested plate and connector housing as they are proprietary items. These completely repaired products will have a significant cost savings and build quality over new OEM products and carry a warranty of 180 days, which is untouchable in the market.

First Call Parts 1351 Southside Drive Salem, VA 24153 Toll-Free: 800-782-0003 Fax: 540-375-6602 Website: firstcallparts.com

SEE OUR AD ON PAGE 37

First Call Parts is your trusted leader for imaging replacement parts. We specialize in cath, angio, and rad/flouro parts for Philips, GE and Siemens systems. Our commitment to quality is unparalleled and backed by a six month warranty. When quality and time matter, your only call is First Call Parts!

MEDICAL EQUIPMENT, PARTS & SERVICE

C-Arm _Preferred Vendors

M.I.T. / Medical Imaging Technologies #THINKRSTI 261 Quality Drive Thomson, GA 30824 SEE OUR Phone: 800-729-4776 R A D I O LAD O G I CON AL SERVICE TRAINING INSTITUTE PAGE 39 Fax: 706-843-9638 // Leading Diagnostic Imaging Systems Service ® Website: www.mit-tech.com Training for Over 30 Years

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Engineered for Life; Born in 2001 out of RSTI’s used equipment sales and a desire to add new layers of support for our students, RSTI Exchange provides fully tested, certified and warranted used equipment and replacement parts for most imaging modalities and manufacturers. Technical support and parts installation services are also available in conjunction with parts sales.

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MEDICALDEALER 37

BRING DIAGNOSTIC SERVICES IN-HOUSE

without the capital risks.

DIAGNOSTIC IMAGING

LAB SERVICES

Blue Ox Medical Technologies has a diverse set of products and services that add value in today’s capital constrained environment. Our product line includes almost any multi-modality product or lab service used in private practices today, along with the software platforms to bill for your ancillary services. For practices who are not ready to take on the capital, we provide managed services with a minimal cost of service.

LEARN MORE about our cost effective and diverse set of products and solutions. Contact the Blue Ox team today!

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PROOF APPROVED

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M.I.T. has been providing top quality products and service for over 28 years. We sell and service diagnostic imaging equipment and provide a full line of services that can be individually tailored to meet each of our customers’ needs. Rely on us for de-installs/reinstalls, transportation, storage and construction.

Now offering sales and service of Neusoft Medical equipment.

CONTACT US: 800.729.4776 www.mit-tech.com

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MEDICALDEALER 39

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Interpower’s North American hospital-grade power cords and cord sets are made in Iowa and approved to the appropriate UL and CSA medical standards. Replacement cords are available, as well as custom orders.

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PRODUCT FOCUS_Patient Transport_Market Analysis

Staff Reports

PATIENT TRANSPORT IS A KEY MARKET

F

rom stretchers to wheelchairs to slings that hang down from the ceiling, patient transport and positioning is an important part of health care around the world. Product development and an increased awareness and focus on caregiver safety and injury prevention are among factors fueling the patient transport market in the heath care sector of the world economy.

Transparency Market Research recently reported on a portion of this growing market.

“Hospital stretchers are apparatus used to transport a patient from one location to another, inside or outside of medical infrastructure premises. In addition to patient transportation, hospital stretchers are also used for several specialized functions such as hospital beds, surgical platforms, and diagnostic and emergency platforms,” according to Transparency Market Research.

“Rapidly aging population, increasing prevalence of chronic disorders, growing number of ambulatory care centers/day care surgeries are some of the factors that are likely to drive the growth of the market,” Transparency Market Research reports. “According to the Heart Foundation in Australia, cardiovascular diseases were major cause of hospitalizations (482,000) in 2009 and 2010. Moreover, the number of hospitalizations in the U.S. in 2010 was 38.6 million and respiratory and circulatory disorders accounted for 15 percent of WWW.MEDICALDEALER.COM

these total admissions. Additionally, continuous increase in number of ambulatory surgical centers (ASCs) due to growing demand of day care surgeries is also a major factor anticipated to fuel the market of hospital stretchers.”

Technavio, a global technology research and advisory company, recently reported on the global hospital stretchers market for the period of 2016-2020. Technavio sees emerging trends, something that has potential for significant impact on the market and contributes to its growth or decline, that it expects to impact the overall market.

“In 2015, the global hospital stretchers market was dominated by the Americas, which accounted for a share of 46.18 percent. The U.S. was the largest revenue contributor to this region. One of the major factors that contributed to the growth of the market was the rise in older population that increased the prevalence of chronic diseases including cardiac and gastrointestinal diseases, osteoporosis, and obesity,” said Barath Palada, one of Technavio’s lead

“In 2015, the global hospital stretchers market was dominated by the Americas, which accounted for a share of 46.18 percent.”

industry analysts for orthopedics and medical devices research.

“Advances in technology (in product design, structure, and usage) and shift from non-motorized to motorized hospital stretchers have also contributed to the growth of the market in the Americas. Vendors in the U.S. market are adopting new strategies such as technology innovation and development of lightweight models with better ergonomics for hospital stretchers,” added Barath.

Technavio’s market research study identifies the three emerging trends expected to propel the growth of the global hospital stretchers market. These trends are the growing importance of advanced hospital stretchers, a shift from conventional non-motorized stretchers to motorized hospital stretchers, and an increase in medical tourism.

MEDICALDEALER 41

PRODUCT FOCUS_Patient Transport_Product Showroom

Staff Reports

JULY PRODUCTS: This month, Medical Dealer explores Patient Transport

MAC MEDICAL INC. 5th Wheel Transport Stretcher (PTF-1000)

M

AC Medical Inc. announces the new 5th Wheel Transport Stretcher (PTF-1000). The retractable fifth wheel combines effortless directional movement and cornering with four swiveling wheels for ease of use, control and safety. Some standard features include a 750-pound weight capacity, 29-inch bed width, dual cylinder Fowler lift assist, 8-inch Tente total locking casters, six brake/steer pedals, 4-inch comfort mattress, full perimeter bumper, lift/Trendelenburg pedals on both sides, six IV pole sockets, four restraint belt locations, and an ergonomically located oxygen tank holder. For more information, visit www.macmedical.com.

42 MEDICALDEALER | JULY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

Patient Transport_Product Showroom

HILL-ROM Stretchers

A

rush to the operating room is not just about running down hallways and turning corners.

It’s about the minute details that contribute to a safe and comfortable experience for both you and your patient. Since stretchers have to accommodate all patient conditions as well as your functional needs in this uncertain environment, Hill-Rom prioritizes comfort and safety to enhance the patient experience. Hill-Rom Stretchers go beyond mobility for your patients and provide a safe and comfortable patient experience; simple and safe maneuvering; and durability to withstand your demands.

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MEDICALDEALER 43

PRODUCT FOCUS_Patient Transport_Product Showroom

Staff Reports

MEDLINE Freedom Plus Transport Chair

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eighing just 33 pounds, the Freedom Plus Transport Wheelchair folds down for easy storage and transport. Handbrakes, anti-tippers and a foam grip push bar make this an ideal choice for users seeking added safety and control. Features include easy-to-clean vinyl upholstery and 12-inch rear wheels for a smooth ride. The transport chair has a weight capacity of 400 pounds. •

44 MEDICALDEALER | JULY 2016

MEDICAL EQUIPMENT, PARTS & SERVICE

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MEDICALDEALER 45

PRODUCT FOCUS_Patient Transport_Preferred Vendors

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MEDICALDEALER 47

IN T ERO PERABILITY, S E CURITY AND THE EVOLUTION OF

EMR TO EHR

“The end goal is a growing culture of privacy and security, where patient health information is protected and secure, and cybersecurity is realized”

BY MATT SKOUFALOS

Since the 2010 passage of the Affordable Care Act and its 26 different mandates, which have specific implications for every business obligated to meet them, electronic medical records (EMR) and electronic health records (EHR) have become far more sophisticated mechanisms for providers, patients, and health care in general.

James Metzger, Vice President of Marketing and HIPAA Compliance Officer for the San Jose, California-based EHR provider, PrognoCIS, was on the Affordable Care Act task force of Blue Shield California when the statutes were released. Metzger was a subject matter expert on only three of those 26 mandates, and handling any one of them “was completely enough work for a team of people,” he said. One of the things the legislation did was expand the incentives (and eventual disincentives) initially offered in the Health Information Technology for Economic and Clinical Health (HITECH) Act for EMR systems that had a “meaningful use” component feeding aggregate population health reporting.

In 2006, maybe a quarter of provider clinical locations were Internet-connected and fully digitized in terms of a paperless workflow; in today’s landscape, where that number is probably closer to 95 percent, “there’s a scale of differences,” Metzger said.

I N TE R OP E R A B I L I T Y , S E C U R I TY A N D TH E E VO L U T I O N O F EMR TO EHR

JA M ES M ETZ G E R , VI C E P RES I DEN T OF MARK ET I N G AN D H I PA A C O MP LI AN C E O F F I CE R , P RO G N O C I S

“ The different systems that a re out the re today were fo rced by the ma rket to grow in order to achieve a n economy of sca le in order to help them meet these regulatory issues that weren’t pa rt of the la ndscape before.”

50 MEDICALDEALER | JULY 2016

“The different systems that are out there today were forced by the market to grow in order to achieve an economy of scale in order to help them meet these regulatory issues that weren’t part of the landscape before,” he said. “We’ve gone from the medical record, which is the medical detail pertaining to specifically everything related to the patient, to the health record, which is the additional metadata that surrounds the medical data.”

According to a May 2016 report from the Office of the National Coordinator for Health Information Technology (ONC), the EHR space has seen a number of interoperability milestones in the past few years. National rates of electronic data sending, receiving and retrieval have increased significantly between 2014 and 2015, with 96 percent of non-federal acute care hospitals having a certified EHR system, and at least eight of 10 small, rural, and critical access hospitals having adopted a basic EHR. “A substantial majority of hospitals were electronically sending and receiving summary of care records, and a little over half of hospitals were electronically finding information from outside sources,” the ONC noted.

“More hospitals reported that they had health information available electronically from outside sources at the point of care. About half of non-federal acute care hospitals nationwide had the necessary clinical information available electronically from outside providers or sources when treating their patients.”

Down in the same data brief was the percentage of U.S. hospitals that reported the absence of technical capability “to electronically send or receive information,” yet the report noted that “a high proportion of hospitals’ exchange partners continue to lack the technical capabilities to

receive data electronically.” Hospitals also continue to face difficulties matching patient data across systems and patient sites.

Finding the ways to integrate, secure, and share the information contained within those diverse data sets is a challenge for EHR vendors that has emerged in the decade since the market first distinguished itself as a niche within the health care IT space. Bruce Carlson, publisher of market-watcher Kalorama, says the space is still seeing double-digit growth in spending and vendor sales, but has settled down a bit since government stimulus funding for meaningful use has been withdrawn. In the post-incentive landscape, EHR is proving to be “a market on its own, like any kind of software market,” he said; one in which, absent of federal incentive dollars, products must sell themselves.

“It’s now a market based on vendors proving to customers that they’re offering value, saving money, leading to more efficient health care transactions and the like,” Carlson said.

According to Carlson, the market includes more than 150 companies “of any significance at all in EMR,” with the bulk of the revenue going to about 10 top vendors. The most significant EMR vendors include larger Health care IT companies like McKesson, Cerner, Allscripts, Epic Systems, eMDs, Athena Health, Next Gen, eClinicalWorks, and Greenway Health.

The remainder of the market, some 44 percent, is shared among multiple smaller vendors. The universal meaningful-use requirements for U.S. health care providers to provide digitally accessible and secure patient health data leaves the space open to lots of competition among developers.

Like any software market, companies can sell EMR and EHR products with very little physical overhead; in MEDICAL EQUIPMENT, PARTS & SERVICE

fact, “There’s a market for companies that can just sell over the web,” Carlson said.

“There’s no one EMR that you as a physician have to get,” he said. “You have to meet certain requirements that CMS has set up in order to get incentives or not to be penalized.”

In such a broad field, vendors distinguish themselves either in terms of the quality of product they provide or the level of support they offer.

Some target physician clients, and others provide institutional-level service; because of this, there’s the opportunity for a lot of mobility within the space.

Carlson cites the example of Epic Systems, which in the past half-decade has grown from being a minor EMR player into one of the three largest in the market. That ascension has a lot to do with the ability of a vendor to provide a high level of client service.

“When you’re operating in a market where everybody was a little bit behind the curve in IT, there’s this overarching incentive to purchase,” Carlson said.

“That negates a lot of your traditional market mechanics – build demand, find customers, market, grow sales. Epic put more resources into support than marketing.”

As the EMR and EHR market matures, product offerings will continue to improve in terms of programming upgrades, vendor realignments, and customer service through added consulting, client training, or software development features, Carlson said. Now that many hospitals have an EMR system, increasing its compatibility with other technologies is another way to derive greater value from their investments, whether at the user level or the administrator level. As those technological improvements increase in a marketplace where there’s less and less growth in the field for new installations, the space will head toward vertical integration. CarlWWW.MEDICALDEALER.COM

son said he already sees movement in that direction, spurred by a vendor interoperability push at HIMSS. Some vendors have already consolidated, and others have quit the space, he said.

“There aren’t new hospitals or new physician offices in the United States,” Carlson said. “Most hospitals have some kind of system now, even very small community hospitals; there’s such a disincentive to not have EMR. It’s a matter of upgrading them, upselling existing customers, acquiring new customers at the expense of another vendor, and holding onto your own.”

Carlson foresees new points of entry in the EMR/EHR marketplace as being based on technological advancements, like mobile computing, workflow, and analytics. Supports for revenue cycle, fraud management, and inventory control are areas of integration where Kalorama foresees future growth potential. “[Hospitals are] experts at hiring clinical practice personnel; when it comes to tech, this is not their specialty,” Carlson said. “Implementing EMR is a big job, and the more the vendors can do, the more they’ll succeed. On the institutional side, it’ll knock off small firms that cannot handle the volume.

“Health care is one of the last regional markets [but] even that separation between physicians and hospitals will be eroded too,” he said.

One of the most significant changes in the past decade is how much the EMR and EHR business has migrated even beyond just paperless systems to cloud-based storage and delivery networks. Metzger recollects the change as particularly transformative not only from the perspective of simply digitizing paper forms, but into rethinking how information is gathered, disseminated, and analyzed altogether.

“If you’re just digitizing forms, are

B RU C E C A R L SON, P UBLISHER O F M ARKETWATC HER KALO RAM A

“ It’s now a ma rket based on vendors proving to customers that they’re offering va lue, saving money, leading to more efficient hea lth ca re tra nsactions a nd the li ke.”

MEDICALDEALER 51

I N TE R OP E R A B I L I T Y , S E C U R I TY A N D TH E E VO L U T I O N O F EMR TO EHR

you taking advantage of the quantum leaps in workflow that a digital workflow can provide?” he asks.

One of those quantum leaps is the push for greater interoperability of health care systems and the standardization of the data they share, which poses “an inherent conflict with the needs of the market and the needs of a manufacturer of anything to provide a uniform solution,” Metzger said.

“In order to have a business plan succeed in the medical marketplace, at what point do some companies decide to become market leaders by extending functionality?” he said.

These questions even stem as far back as 1996, when the Health Insurance Portability and Accountability Act (HIPAA) contained provisions for the development of a National Patient Identifier (NPI), which was philosophically intended to be “the cornerstone of all interoperability” in the health care space, Metzger said.

After the Social Security number “has gone through its own trajectory of mass adoption for purposes other than what it was originally intended for,” from bookkeeping to inter-practice communication, he said, it’s no longer as viable an option for that purpose.

“During the landscape of identity theft, it’s rare that you would find a provider or clinical location that was still using a Social S ecurity number as an identifier in a required sense,” Metzger said. “Now there’s more of a clamor for the development of the NPI because there’s a void there.”

One such possibility to resolving the questions of NPI, however potentially remote, is the emergence of biometric identifiers. Although the landscape is largely undeveloped for such a product in conjunction with patient records, the notion creates “a paradox of interoperable communication in an environment of patient-controlled, 52 MEDICALDEALER | JULY 2016

secure authorization and validation,” Metzger said.

“I can build you a very secure room, but you have to allow me to build you a room with no windows and no doors,” he said. “Who’s got access? Who controls that access? I don’t even think the courts have come down with a firm position on who owns the data.”

“The current understanding is that the patient owns the data and anyone else is just a steward of the data,” Metzger said. “Then there is medical data byproduct, which is population health – aggregate data, aggregate anonymized data. At what point can someone control their personal data?”

The most common reason given for hospitals not using information generated within their systems related to an inability to access the information from within their EHR, the ONC noted “whether that was due to clinical workflow or inability to integrate data from outside sources into their EHR.” “Continued increases in the interoperable exchange and use of health information from outside sources, along with the availability of information are important to the success of care transformation efforts nationwide,” the agency said.

The push for interoperability has even become a Congressionally mandated national health care objective with a July 2016 deadline to establish metrics for the same. In 2015, the Medicare Access & CHIP Reauthorization Act (MACRA) defines interoperability as hinging on the exchange of “clinical and other information” and common standards for the use of that information “to provide access to longitudinal information for health care providers to facilitate coordinated care and improve patient outcomes.”

Part of the issue comes in sourcing the data from things like health

care insurance claims, program performance data, health care system surveys, and EHR-generated data, as well as capturing a broad enough spectrum of data to effectively illustrate the scope of patients nationwide. Capturing specialized patient data may be another hurdle; for example, the ONC notes that “basic EHR adoption among children’s and psychiatric hospitals is significantly lower than [among] general medicine hospitals.”

Finally, the office also describes the paradox Metzger noted of the “shared responsibility” of cybersecurity among the institutions that gather and share patient data, patients themselves, and the clinicians who treat them. HIPAA established penalties for individual and institutional data breaches, and tasked the HHS Office for Civil Rights (OCR) with enforcement of its statutes; ONC works in conjunction with OCR to develop resources that can help providers establish better in-house policies and procedures for the implementation and enforcement of patient data privacy and security. Its two-year-old Security Risk Assessment (SRA) tool is one such mechanism for organizing risk mitigation; the Cybersecurity Framework published by the National Institute of Standards and Technology (NIST) is another.

As the marketplace for EHR continues to evolve, the regulatory statutes that govern its development provide another critical set of contributing factors.

“The end goal is a growing culture of privacy and security, where patient health information is protected and secure, and cybersecurity is realized,” ONC noted in a 2014 story published on HealthITBuzz. “If providers have this mindset, we are headed in a secure direction.”

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MEDICALDEALER 55

CORPORATE PROFILE

OUR COMPETITIVE ADVANTAGE T

enacore Holdings started in 2000 as a medical products distribution company with a primary focus on suction regulators, oxygen blenders and monitoring accessories. It did not take long to realize that many companies focused on a small product offering. Tenacore was one of the first to build a comprehensive platform around the needs of the Biomedical Engineering departments within the hospital environment.

Supply and demand is a well known force of the U.S. economy, as well as innovation. Tenacore prides itself on creating a business model that is adaptable to the needs of its customers. Vice President Albert Negron stated, “As the distribution business continued to grow, we saw a need for equipment repair.” In 2002, the first repair depot was launched and modeled after a hospital environment; we paired biomedical engineers with subspecialties such as patient monitoring, module repairs, telemetry, fetal transducers, and more.

Question 1 How long has Tenacore been in the depot repair business?

A. 10 years B. 16 years C. 14 years D. 20 years AN INNOVATIVE APPROACH

The Tenacore approach to biomed depot repair is a comprehensive platform that includes manufacturing, 56 MEDICALDEALER | JULY 2016

distribution and extensive repair capabilities. Tenacore now has multiple repair centers in order to provide cutting-edge services in respiratory, patient monitoring, infusion pumps, as well as ultrasound. To be effective as a full-service depot repair center, vertical integration and expansion of the Tenacore portfolio was mandatory. By comparison, a traditional “repair depot” may only service a fraction of the portfolio that Tenacore offers.

The expansion into the repair depot business opened another window of opportunity for Tenacore.

“There was a need for manufacturing high-quality components for device repair, reliable delivery of components, and reasonable pricing,” Negron explains. Tenacore purchased Newport Plastics in April of 2008, and started making its own FDA-regulated parts and repair kits for many of the products they were fixing. The increased quality, shorter lead times, and lower cost to the end user spurred even more growth.

Due to the vertical integration and manufacturing capabilities being on-site, Tenacore is able to utilize its service depot as a research and development platform. This allows us to work with hospital biomeds to identify needs and streamline the R&D process to help lower costs with in-house manufacturing. This also creates a more cost-effective alternative to traditional OEM or third-party distributorships.

Question 2 What competitive advantage does Tenacore have with on-site manufacturing capabilities?

A. Ability to identify real world needs of biomedical engineering departments B. Streamline the R&D process C. Create more cost effective alternatives D. All the above ADVANCING THE REPAIR DEPOT EXPERIENCE

The company’s numerous products and manufacturing capabilities are complemented by on-site Biomed education training programs. Tenacore provides introductory and advanced courses based on the needs of the engineer or hospital biomed department.

The mission of Tenacore is to advance repair depot techniques through research, peer-to-peer educaMEDICAL EQUIPMENT, PARTS & SERVICE

SPECIAL SPECIAL ADVERTISING ADVERTISING SECTION SECTION

The Tenacore Family

Tenacore provides many different solutions under one roof including, but not limited to, the following: Tenacore offers a quality repair depot modeled after a hospital environment that has paired biomedical engineers with subspecialties such as patient monitoring, module repairs, telemetry, fetal transducers, and more.

Repair Depot Tenacore consistently services hospitals across all 50 states and provides many hospitals with comprehensive solutions for all of their medical equipment needs.

Medical Device Manufacturing Tenacore proudly manufactures OEM spec products for thousands of hospitals including, but not limited to, wall suction regulators, oxygen blenders, fetal transducers, and many other parts for OEM products.

tion, and membership initiatives with IDNs. To accomplish this feat, we have built a platform that is brand centric and customized to the needs of our partnerships. Positive customer experiences, quality credentials, and a dedicated focus, are what Tenacore prides itself with. Exceptional customer service is coupled with emphasis on quality to guarantee the best patient outcomes.

“We’ve built a new online portal (tenacore.com/portal) where our customers can follow their order throughout the service process. Customers are also able to create shipping labels, look up service reports, approve estimates and find old invoices,” Negron says, when describing some of the perks customers receive. “The portal will also be able to pull up data and analytics for corporate directors and supervisors. An email is also sent out to notify the customer of status changes, i.e. order received, estimated and shipped.”

Question 3 What kind of educational offerings does Tenacore have?

A. Individual biomed training B. Group/modality based programs C. IDN focused programs D. All the above WWW.MEDICALDEALER.COM

A PERFORMANCE CULTURE

As a manufacturing facility, located at the company’s headquarters in Santa Ana, California, we have a competitive advantage to operate around the clock.

Pair that with the quality credentials, OEM trained and certified technicians, and you have a fully functioning machine that’s unlike any other.

“Jennifer Page, in our business development department, has done an excellent job building relationships and aligning Tenacore’s objectives with IDN, asset management groups and corporate customer objectives,” Negron says. “Oswaldo Chavez, our service manager, has built a top-notch team of trained technicians who service equipment to OEM specifications and customers’ expectations.”

Competition can be fierce in the medical device market for both repairs and manufactured products; however, our strong and proven reputation for quality work sets Tenacore apart.

QUALITY CREDENTIALS: ISO 13485:2003

ISO is the International Organization for Standardization and is the world’s largest developer and publisher of international stan-

Custom Molding Tenacore specializes in custom molding services such as DNA collectors, injection molding, CNC, Swiss screws, printing, and much more.

Tenacore UK www.tenacore.co.uk Tenacore recently expanded to the United Kingdom to provide products and services overseas, and will continue to expand to additional countries in the near future.

Medical Electronics www.medicalelectron.com Medical Electronics is a subsidiary of Tenacore which provides biomed contracts, compliance, preventive maintenance support, anesthesia support, and much more.

Newport Plastics www.newportplastics.com www.specialtyprods.com Newport Plastics provides promotional items including over 130 different items with over 40 years in business.

Mesh Candy www.meshcandy.com Mesh Candy offers a foundation for intelligent, real-time asset locating, messaging, environmental data collection and advanced analytics. The platform meets the needs of frontline workers (like health care professionals) who, on a day-to-day basis, need to keep track of equipment, comply with environmental monitoring regulations and communicate with team members.

MEDICALDEALER 57

CORPORATE PROFILE SPECIAL ADVERTISING SECTION

dards. They provide solutions that meet the requirements of business and the broader needs of society. ISO 13485:2003 provides requirements for quality management systems which aid in the design, development, manufacturing, installation, and servicing of medical devices.

Tenacore ensures a superior quality system over other service and manufacturing depots by: • Conducting 100% quality control inspection on all finished devices and repairs • Complying with ISO 13485:2003 • Periodically calibrating all equipment used for testing, measurements and calibration to the NIST Standards • Complying with most international standards and other industry standards for quality inspection procedures.

• Having complete traceability for all devices that are manufactured or serviced.

Question 4 What quality credentials does Tenacore adhere to?

A. ISO 13485:2003 B. CE Mark C. FDA regulated D. All the above CUSTOMER SUPPORT

Tenacore is not only focused on developing innovative technology, but also on providing superior repair capabilities and biomed support. The Business Development Team is dedicated to building a productive relationship that provides IDNs with all the resources necessary to create their own brand of repair depot. This team is committed to customizing and building teams around the specific goals of each group.

Tenacore has a distinct performance culture where its “A Players” are the critical drivers of the company’s success. This culture creates a 58 MEDICALDEALER | JULY 2016

unique edge that not only influences how Tenacore conducts business, but also drives how employees make decisions and surpass their goals.

Employees are driven to embrace the culture of teamwork, innovation, and sustained superior performance.

Tenacore’s team approach is designed to ensure happy customers.

“It takes a strong internal team in order to create a positive customer experience. Our entire staff, from the customer experience specialists to the account managers, genuinely care about each and every transaction and customer,” Negron says.

Question 5 How does Tenacore continue to drive innovative approaches with IDNs? A. Offer training programs for IDNs B. IDN repair depot branding C. Strong internal team to create positive experience D. All the above THE FUTURE

Through its tremendous growth and experience over the past 16 years, the fundamental focus of Tenacore has always been to provide cost-effective patient care solutions. Its mission, priorities, and performance continue to achieve extraordinary results at extraordinary speed, allowing the company to improve patients’ lives around the world.

Tenacore cares about quality products, customers and the planet. The

company occupies a 35,000 square foot facility that has recently been converted to solar power.

Business is booming at Tenacore due to its flexibility to meet market demands and its laser focus on quality and customer service. What began as a distribution company continues to adjust to meet market demands in the medical device service, repair, and parts markets.

Tenacore has experienced amazing growth since it first opened its doors a little over 16 years ago without losing sight of the lasting impact it has on the delivery of quality health care.

“Lowering the cost of health care without risking patient safety,” Negron says when asked to describe Tenacore’s mission. “Our employees’ process, service and care for each medical device is treated as if it’s their own parent, spouse or child using the device.”

Question 6 What is the mission of Tenacore Holdings?

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ISO CERTIFICATION The Pros and Cons of Quality Assurance

By Chris Hayhurst

it was any other industry, Jeff Smith

Solutions in Cincinnati, Ohio – is in the busi-

“It’s just my personal opinion,” he says, “but I think it’s important for us to make sure that the work we do meets the highest standard of quality.” For him that means not only being ready for FDA regulation, “which is clearly coming and should have happened a long time ago,” but getting ISO certified as well.

“From our standpoint, and being in health care, we just think that certification makes sense.”

ness of medical device replacement parts.

The Certification Debate

says, he might see things differently. But his company – Elite Biomedical

And because he’s dealing with products that affect people’s lives, and that could potentially lead to injury if they are substandard in any way, he’s decided it’s best to err on the side of caution.

60 MEDICALDEALER | JULY 2016

Quality certification through the International Organization for Standardization (ISO) is, of course, a topic for debate in the medical device industry, especially when it comes to third-party suppliers and service organizations. ISO, an independent organization with a membership of more than 160 national standards bodies – including, in the United States, the ANSI-ASQ National Accreditation Board – develops and publishes quality standards for industrial processes of all kinds. More than 21,000 standards are available for purchase through the ISO store on the organization’s website.

MEDICAL EQUIPMENT, PARTS & SERVICE

Once a company purchases a standard, it must work with an accredited certification body to earn the ISO stamp of approval.

Companies producing or refurbishing parts for medical devices, or service organizations doing repair work on those devices, tend to pursue two ISO certifications in particular.

“From our standpoint, and being in health care, we just think that certification makes sense.”

Jeff Smith, Elite Biomedical Solutions The first – ISO 9001 – verifies that a business has a quality management system in place that allows it to “consistently provide products and services that meet customer and applicable statutory and regulatory requirements.” Key areas of focus for 9001 include risk management, process control, record keeping, and continuous process improvement. ISO 13485, on the other hand, is specifically tailored to medical device manufacturers and service organizations. Businesses that pursue 13485, notes the ISO’s own summary of the standard, “can be involved in one or more stages of the life-cycle” of a device, from its design and development to its production, distribution, installation, servicing, and “provision of associated activities” like technical support. All ISO standards are reviewed every five years and updated as necessary to reflect industry expectations. The latest version of 13485 (ISO 13485:2016) was published earlier this year. ISO 9001:2015 came out last September.

“There are other quality management systems,” notes Diana Upton, president of IAMERS, “but I like ISO the most for two reasons.” First, she says, “their standards are absolutely recognized worldwide – all of our members in Europe have ISO certification, and they couldn’t get business without it.” And second, certification is “a form of discipline that will aid you in the event that the government decides to regulate the industry. If you’re purely a broker or in an ancillary business, you might not need 13485; but if you’re doing anything to the equipment – refurbishing, reconditioning, touching it any way – I really think it’s the best way to go. If you get ISO certified, you’re going to be safe.”

On the flip side of the argument regarding the merits of WWW.MEDICALDEALER.COM

“their standards are absolutely recognized worldwide – all of our members in Europe have ISO certification, and they couldn’t get business without it.”

Diana Upton, president of IAMERS

certification, Dana Smith, president and CEO of KMA Remarketing Corporation in DuBois, Pennsylvania, points out that once a company commits to an ISO standard, it might lose a certain level of “entrepreneurial flexibility.”

KMA, he says, does hold “many credentials,” including pharmacy and upholstery licenses, but it has not pursued ISO certification. “Because from our perspective we’re not locked into what seems to be happening across the country right now, where common sense is overrun by ‘qualifications’ and regulations.”

His team goes through many of the same things that certification would require, and “we’d never do shoddy work that might jeopardize a patient’s safety,” he notes. But it’s in their best interest to “maintain our ability to do certain things and approach certain situations in ways that we can really give our customers what they want.” Dana Smith uses the example of a small surgical center that might ask them to fix a broken sterilizer. “We can go in and say, ‘Well, your sterilizer is kind of FUBAR here, but I’ve got one of these in my warehouse right now, and I can pull off this assembly and put that in and hopefully fix your problem until you’re ready to buy a new one.’ ” An ISO-certified enterprise, he feels, “could never be that flexible because there are too many rules they have to follow.”

Greg Goll, clinical engineering supervisor at McLaren Macomb in Mount Clemens, Michigan, shares Dana Smith’s opinion that ISO certification isn’t necessary. In his decades in the profession at three different health care organizations, it’s rarely mattered to him whether a thirdparty supplier was ISO certified or not.

“If someone says they’re certified, that does show they’re committed to quality processes and customer service. But there are companies out there with great track records that aren’t certified and are still reliable and do great work,” Goll says.

He compares the ISO credential to certification as a biomedical equipment technician.

“There are a lot of regular biomeds, and then there’s the MEDICALDEALER 61

“If someone says they’re certified, that does show they’re committed to quality processes and customer service. But there are companies out there with great track records that aren’t certified and are still reliable and do great work.”

Greg Goll, clinical engineering supervisor

certified biomed. If you’re certified it does say something about you, but if you’re not that doesn’t necessarily mean you don’t know what you’re doing,” Goll adds.

Certification Considerations

One parts-and-service business that is ISO 9001 and 13485 certified, and has maintained those certifications for almost six years, is Oxford Instruments Healthcare in Deerfield Beach, Florida.

“For us it’s helpful when we’re working with new customers to prove that we really care about quality,” says the company’s president, Jeff Fall. “But I also think it makes us a better company. And it’s allowed us to enter foreign markets where certification is required.”

Each year, Fall says, he and his team go through two internal audits by an accredited certifying body that essentially acts like a consultant, helping them to fine tune their system if it doesn’t meet ISO requirements. In addition, once each year a separate certification body conducts an external surveillance audit to officially determine their ongoing compliance. If a deficiency is found, says Ray Chlebicki, North America director of sales for Connecticut-based ISO certifier TUV Rheinland, “you’re given time to address those nonconformities and put proper changes into place.”

Audits are priced in part according to company size, but growing businesses like Oxford Instruments Healthcare rarely see that as an issue.

“It has gotten more expensive,” Fall says, “but I really think it’s worth the investment.”

Other factors that typically influence cost (each certifying body prices its services differently) include the number of standards a company certifies to, the com62 MEDICALDEALER | JULY 2016

plexity and risks associated with a company’s products, and the travel expenses required for representatives of the certifying body. The company that did Elite Biomedical Solutions’ certification – Eagle Certification Group in Dayton, Ohio – charges a flat rate of $1,350 per audit day for a medical device certification, says Bryant Shillito, the firm’s director of business development. Initial certification for a company of about 20 people might cost around $9,000 plus travel, he says, while surveillance audits cost about half that amount. Certifications to current versions of a standard are good for three years.

The path to initial certification begins when a company purchases a standard and then develops or adjusts its management system according to its requirements. Once the system seems up to snuff (in Elite’s case the build-up took close to seven months, which Jeff Smith says was “actually pretty quick”), the certifying body comes in to do a readiness assessment.

“For us it’s helpful when we’re working with new customers to prove that we really care about quality.”

Jeff Fall, President of Oxford Instruments Healthcare “We’ll spend a day onsite,” Shillito says, “and determine if the company is ready to go forward.” If they are, they schedule “a full assessment,” which can take anywhere from a day to a week or more. If during that investigation it’s determined that “corrective actions” are required, “the certification process just proceeds as it normally would,” Shillito says. “We have failed companies before, but just because you have a few things to clean up doesn’t mean you won’t achieve certification. You’re given a chance to address your nonconformities before we make the certificate decision.”

Elite, which has been in operation since 2012, earned its first ISO 9001 and 13485 certifications last February, Jeff Smith says. And the pay-off ?

“Probably the biggest thing is it’s helped us become more efficient,” he says. “We didn’t have to make any big changes, but just going through the process we made a few tweaks, and we gained some insight we didn’t have before.”

Plus, he says, now they can prove to their customers “that we’re legit. You know, ‘You’re working with a good company here. You can feel confident about who you’re doing business with.’ ” MEDICAL EQUIPMENT, PARTS & SERVICE

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SLICE OF LIFE_The Other Side

By Jim Fedele

WHO CARES ABOUT BAD PARTS?

A

mainstay of cost control for the biomed program is second sourcing parts.

The second sourcing of parts has become an industry of its own with new vendors entering the market frequently. I am a proponent of sourcing parts through secondary sources, however not all parts companies are created equal.

Defective parts are a part of life in this industry, but for some companies it seems to be the rule instead of the exception.

During my tenure as a biomed second sourcing parts has always been the way to save money. Mitigating parts cost is the only way to manage an uncontrollable repair event that is going to impact your budget. When you look at any ISO their business model will include resources to second source parts in some shape or form. It is not a secret why, OEM prices for parts are regularly ridiculously high. Second sourced parts are typically 50 percent less than the OEM. I think part of the reason is to scare people into purchasing service contracts to “protect” us from the high cost of repairs. For instance, something as simple a cooling fan (often referred to as a muffin fan) typically cost $350600 from the OEM. The same exact fan can be purchased from an electronics supplier for about $35. These savings are significant when considering the amount of parts the average biomed shop orders.

Fortunately, today there are more companies than ever that offer parts for medical equipment. When you need a part you can simply do an Internet search or look through the pages of 66 MEDICALDEALER | JULY 2016

Medical Dealer to find almost anything you need. However, it is hard to know if the company is providing good quality parts. It is also hard to know the quality of the part you are getting. Some companies disclose if the part is tested only, rebuilt or removed from a working system, which can help you decide which part you want. The best way to select a supplier is on their reputation in the industry. It isn’t uncommon to get a defective part from a company, but it shouldn’t be a regular occurrence.

Talking to your colleagues and the supplier about their quality testing process can help you decide if the supplier is worth utilizing.

It is unfortunate that there are companies that do not have good quality processes to ensure they are not sending a defective part; these companies give the industry a bad name. What is worse is they either do not know or care about the impact of sending a bad part has on a department’s operations. Through no choice of their own the patient is the one who is affected the most in this situation. Imagine you are a cancer patient, you just finished a month of treatments, and now you are having a CT done to see if the cancer is going away. You go to the hospital with hopeful anticipation only to be rescheduled because the CT scanner is down. I have seen the disappointment on patients’ faces when this occurs, it is heart breaking. Some may say, OEMs especially, this is precisely why you should only buy parts from the OEM, however OEMS send bad parts too. I recently experienced that with our CT scanner, it took an extra day and 8 hours of overtime to get the unit back up.

Not all situations are as urgent as the situation I have described, and in those

Stating a part has been thoroughly tested or refurbished when it hasn’t been is not a good plan for future business. instances I am OK gambling on a “just tested part” or “pulled from a working machine” part. However, that is my choice and I usually have mitigation plans in place to ensure it doesn’t affect the patient. In many cases most reputable parts suppliers do ask which part I want so I can chose and plan accordingly.

It is just life that sometimes parts are defective. What I am suggesting is that everyone who sells refurbished parts understand how their actions can affect innocent patients. Stating a part has been thoroughly tested or refurbished when it hasn’t been is not a good plan for future business. I think everyone who sells parts for medical equipment should understand that there is a person who will be treated, connected or diagnosed with the device we are trying to repair.

For companies to say “yes” it should mean they would let their mom, dad, sister or brother be connected to equipment that was fixed with their parts.

JIM FEDELE, CBET, has been with Medical Dealer magazine for more than 12 years. He is currently the director of clinical engineering for Susquehanna Health Systems in Williamsport, Pa. He can be reached for questions and/or comments by email at info@mdpublishing.com.

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SLICE OF LIFE_Bobinski

By Dan Bobinski

WORKPLACE PET PEEVE LISTS ARE LIKE GOLD

I

s your workplace flawless like the Garden of Eden? Probably not. Some may come close, but no workplace is perfect.

And while we can usually perform well around people who have a wide range of idiosyncrasies, some behaviors just get under our skin.

We often call these irritants, “pet peeves.”

Many pet peeves are frustrating tendencies or bad habits that other people have (we never have any of our own). And, although we tolerate these behaviors, dealing with them is not something we look forward to everyday.

Wikipedia's entry for pet peeve is, "a minor annoyance that can instill great frustration in an individual."

So how is it that a “minor annoyance” can cause a great frustration? My view is that the offending behavior goes against our value systems. When somebody behaves in a way that's contrary to what we regard as acceptable, our sense of right and wrong jumps up and says, “That's wrong!"

Interestingly, a few years ago, the Georgia-based employment services company Randstad commissioned Harris Interactive to conduct a survey on workplace pet peeves. The results of this survey were picked up by newswires around the world, with newspapers, TV news stations, and bloggers all regurgitating the results.

What were the top offending behaviors? Line up 10 people, and 68 MEDICALDEALER | JULY 2016

six of them will be offended by gossip. Five and a half of them will be offended by other people's poor time management skills, and four and a half of them will be offended by messiness in communal spaces (break rooms, etc.).

I have to say that these results piqued my curiosity, because among the myriad clients in my workshops, gossip and other peoples’ poor time management skills are not even on the lists of their biggest pet peeves.

This caused me to look deeper into how this survey was conducted. Who was surveyed? What were the survey questions? What were the conditions of the survey?

After a little research I discovered that a little over 2,400 people were surveyed online, of which only about 1,500 were employed. I also learned that those surveyed were given a list of seven pet peeves from which to choose, and no information was given about how the list of seven was created.

Apparently, one of my new pet peeves is news outlets presenting unscientific survey results in a way that makes them sound very official.

While in my state of (not so) great frustration, I decided to conduct a little unscientific survey of my own. I emailed 20 people from my email list (all of them employed) and asked them to identify their top two workplace pet peeves. I didn't prompt them with a list from which they could choose, I just wanted to hear their gripes without influencing their response.

Dan Bobinski Workplace Consultant

Guess how many of their responses were related to gossip?

Zip. Zilch.

Nada.

Only two responses came close to correlating to other's poor time management skills ("unreliable co-workers" and "unproductive meetings.")

Only one person mentioned messy communal spaces as a pet peeve ("people who don't clean out the company microwave or wipe off the counters.")

If I had to create a category to label the most common pet peeve from my respondents, by far it would be "Poor Interpersonal Communication Skills." Here are some of the pet MEDICAL EQUIPMENT, PARTS & SERVICE

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GE AMX-4+ peeves from my (unscientific) survey that would relate to that category: • Surprise confrontations during meetings • People sending email when they are emotionally charged • People who leave LOOOOOOOONG voice mails • A lack of full disclosure – and also people who stretch the truth • Lack of necessary communication • Lack of courtesy between professionals • People with big egos that won't shut up • People with little egos who won't speak up – even when they should • People who eat while on the phone • People who assume they know your motives My unscientific survey also had a lot of comments that could be categorized "non-collaborative efforts," or "not operating from the same page." Here are some of their pet peeves that would fit in such a category: • Employees disregarding company values • Co-workers who are not team players • A boss who sets a different standard for himself than for everyone else (his is lower) • Having unrealistic goals set for me by people living very far away • Spending too much time focusing on "what went wrong" instead of learning what could be done better next time.

I don't know about you, but throughout my years in the workplace, most of the pet peeves people tell me about are very WWW.MEDICALDEALER.COM

similar to what's listed above.

So yes, it’s a pet peeve of mine to see major media outlets touting the results of second-rate online surveys as reliable news. Call me silly, but when 36 percent of the Harris survey respondents are unemployed, it's hard to believe that the survey results represent the real workplace.

All that said, if my unscientific survey results are anywhere near accurate, it seems we could make our workplaces much better if we focus our attention on just two things: • improving workplace communication skills • getting everyone to think like a team and operate from the same page It’s not scientific, but it’s information coming from people who are actually working, and it aligns with what I’ve heard for years while working with management teams.

Now for the challenge: Make a commitment to improve your own workplace. Do a little informal survey of your own. Make it fun so people participate. Just know that the feedback you get will be pure gold. With it, you will know what areas need some attention to help improve your workplace!

DAN BOBINSKI is president of Workplace-Excellence.com and Everything-Training.com As a consultant, speaker, and trainer, he helps organizations of all shapes and sizes on issues of team building to create excellent workplaces. He is also the author of several books, including the best-selling “Creating Passion-Driven Teams.” Reach him at dan@ workplace-excellence.com or 208-375-7606.

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MEDICALDEALER 71

SLICE OF LIFE_Pay It Forward

By Matt Skoufalos

MENDING KIDS’ COLLABORATION IMPROVES LIVES

B

gando Weill Medical Center is the largest health care facility in Mwanza, Tanzania. Situated on Lake Victoria, a body of water that borders Kenya and Uganda, the tertiary hospital caters to 16 million people, fully a third of the country. That includes its population of children, half of whom are younger than 14.

The majority of patients are rural children from beyond the Serengeti.

“The ratio of medical provider to your average Tanzanian – your nurse, your doctor, your radiologist – is one in 30,000,” says Isabelle Fox. “In the U.S. it’s one in 300.”

Fox is the Director of Surgical Missions for Mending Kids, a California-based, nonprofit medical organization that works to provide critical pediatric surgical care in communities of urgent need around the world. Its partner physicians have traveled to China and Costa Rica, and most recently Tanzania, where a team of surgeons from Cincinnati Children’s Hospital was deployed to perform critical surgeries for children with anorectal malformations.

“Kids born with colorectal malformations and anal fistulas don’t have the ability to [defecate],” Fox said. “You need an emergency colostomy within the first 48 hours of your life or you’ll die of sepsis.”

72 MEDICALDEALER | JULY 2016

Dr. Steven J. Kraus images a patient at Bugando Weill Medical Centre in Mwanza, Tanzania, using Toshiba’s Viamo ultrasound system.

As children who survive the complications from these conditions grow to school age, they are often shunned because “there’s a whole shame factor that goes along with having a child like that,” Fox said. Simply put, the limited ability of many such children to adequately clean themselves can leave them isolated because they smell bad.

Corrective surgery can improve their lives, and often have a positive, cascading effect on the entire family.

“There’s so many factors that go into trying to fix these kids,” she said. “The bottom line is that once

they are [treated], it has an immediate effect on the family. When somebody can go to school, a second parent can now go to work. It’s less taxing in a place where 70 percent of the population lives on $2 a day.”

Throughout the duration of one week, five of which were surgical days, doctors were able to treat 15 children ranging from one month to 13 years old. The operations required three, complex surgeries per day; in the United States, Fox said physicians wouldn’t likely perform even two a day. Patients are selected who are the best candidates for success; for whom surgery “will have the most life-changing results,” she said.

Mending Kids recruits physicians for the trips, and pays for travel, logistics, and supplies. In addition to performing multiple surgeries in a short visit, their teams also educate local health care professionals on best practices for the surgical techniques they employ in order to create a standard of care that can be sustained after their departure.

One of the doctors on the trip was Steven Kraus, the Division Chief of Fluoroscopy at Cincinnati Children’s Hospital. His task was to help provide diagnostic imaging services to guide pre-surgery planning for physicians.

“The kids need to have some kind of diagnostic procedure in many cases to figure out how to prepare them [for MEDICAL EQUIPMENT, PARTS & SERVICE

_Pay It Forward

Dr. Steven J. Kraus trains the medical staff at Bugando Weill Medical Centre in Mwanza, Tanzania.

There’s an entire network of people in recovery centers who have all this equipment and virtually no back-up. surgery],” Kraus said. “That’s where I come in.”

Through connections with Toshiba America Medical Systems, the team from Cincinnati Children’s Hospital was able to borrow a portable Viamo ultrasound unit for use on the trip to Tanzania. With the device, physicians were able to identify not only anorectal malformations, but abnormalities of the genital and urinary tracts, of the kidneys, and of the spine. Such images WWW.MEDICALDEALER.COM

can’t be evaluated easily with fluoroscopy, Kraus said, and cross-sectional imaging – often ultrasound – is an immediate need. Plus, with the benefit of its portability, “we were able to move the Viamo to the places where the patients were,” he said.

“It’s been a wonderful experience to have that portable ultrasound,” Kraus said. “It helped for the patient care.”

“This surgical mission in Tanzania is just one example of how Toshiba partners with health care providers to help give their patients another chance at living a longer and better life,” Satrajit Misra, vice president of marketing for Toshiba America Medical Systems, said in a statement.

“Medical imaging technology continues to transform the way patients are treated, assisting providers in finding diseases early and improving outcomes,” Misra said.

In addition to helping manage surgical procedures and the planning that preceded them, the Viamo allowed for Tanzanian imaging technicians to observe the pre-operative imaging

techniques and their impact on surgical planning, thereby furthering the educational goals of the mission. Kraus spoke about the ultrasound as being “so important to the success of the surgery” on both counts.

“It was helpful to have somebody there to do all these procedures, not only just to help our surgeons, but to teach the people there how to repair these children,” he said.

Each of the operations was successful, and early reports show that the children are in good health, Fox said.

The team from Cincinnati Children’s Hospital will re-evaluate them during a return visit in November, and she said they are eager to return.

“I don’t know anybody that’s gone that doesn’t want to go back again with pride,” Fox said. “There’s a sense of peace and a sense of purpose we all come back with.”

“The amount of life and death that goes on in that hospital in any given day is in your face,” she said. “In the U.S., it’s not something we grow up with and think about, and it’s in your face in Africa.”

MEDICALDEALER 73

SLICE OF LIFE_Success Story

By Matt Skoufalos

ST. LUKE’S HEALTHCARE SYSTEM D riving medical device standardization and interoperability is among the most challenging and critical ongoing conversations in healthcare.

Whether greater connectivity means enabling a hospital or health network to capture best-of-breed solutions or simply connecting departments and devices across locations, the more they can communicate, the more efficiently things can run. That coordination drives workflow, patient throughput, and allows for intelligent data gathering that fuels the greater efficiencies driven by analytics. In the field of EMR and EHR, a variety of manufacturers are working to help enable the depth and smoothness of those digital conversations, including the Milford, CT-headquartered Bernoulli, which bills itself as a specialist in real-time connected healthcare.

Of course, it’s people who lay the groundwork for the coordinated integration of those devices. Jeanne Venella is a former ER nurse and the Chief Nursing Officer at Bernoulli.

Together with Jonathan Krieger, Director of Project Implementations for Bernoulli, she travels to client sites to help assess how the technology can change their current 74 MEDICALDEALER | JULY 2016

Jeanne Venella is a former ER nurse and the Chief Nursing Officer at Bernoulli

workflow, and helps educate staff during the transition.

In April, the two helped the nonprofit, Lehigh, PA-based St. Luke’s University Health System connect device data feeds from multiple departments at six different hospitals during a multi-site installation of Epic Systems electronic health records software. All the sites went online at the same moment, and thanks to the device integration at the back end, everything connected seamlessly, “unrecognizable in the blip of change that they made,” Krieger said.

Integrating feeds from hundreds of devices and 300 beds’ worth of

patients in departments with needs as different as gastroenterology, surgery, interventional radiology, obstetrics, intensive care, and catheterization requires coordination.

On the hardware side, Bernoulli uses a four-port IDM-3400, which collects serial data from various devices, translates it to the HL7 standard, and transmits it to Epic via a main gateway. The plug-and-play manager is auto-discoverable, and can begin streaming data immediately upon connection.

“Read any publication and interoperability is the topic of the day, every day,” Krieger said. “With our hardware and connection to that software, we’re able to recognize what’s plugged into the device manager. It saves so much time on the clinician side. Each one of those serial devices has a cable or adapter that’s designed to connect with our device. The data just starts collecting and sending.”

Even when dealing with equipment from a variety of manufacturers within the same space, Venella said the Bernoulli software can acquire and transmit data within about 30 seconds of access.

That ease of access helps speed the process of communication not only among devices, but among staff, too. There’s no drop-down menu to MEDICAL EQUIPMENT, PARTS & SERVICE

_Sucess Story

Jeanne Venella is a former ER nurse and the Chief Nursing Officer at Bernoulli

select from, or other software hurdle that appears on the clinician side of things, she said.

“It’s just plug in, and within 30 seconds the data is flowing.”

“That is a huge time-saver and makes the whole tech side of it simple,” Krieger said; “the clinicians don’t really have to interface with it at all.”

Even with technology that can provide a seamless connection among devices on the back end, the work that Venella and Krieger do on the end-user side of the equation extends from workflow to documentation. A significant part of the installation involved connecting with clinicians to determine “what they want to do and what they want to document, especially in the anesthesia areas,” Venella said.

“Before Epic, a lot of hospitals were on paper,” she said. “You have anesthesiologists having to document things on paper; our hardware and software frees them up to work.

[Now] all the measurements are coming in on the chart, and it allows them to concentrate more on the patient.”

Similarly, in critical care units, digital data streams decrease the risk of transcription errors, freeing nurses from observing and recording vital sign information to a patient chart.

Electronically “validating and not redundantly charting” such information decreases risk of errors while giving caretakers more time to observe the patient “instead of doing more of those tasks that are now WWW.MEDICALDEALER.COM

physically automated,” Venella said.

The installations integrate so smoothly in part because Bernoulli works to maintain relationships with EMR and EHR vendors, like Epic, as well as with device manufacturers, to push interoperability and integration. Although Epic accounts for “about 60 percent of the world of EHR,” Venella said, Bernoulli works with a library of about 2,500 devices, from other EHR and charting systems to individual manufacturers’ technology products.

“We have a lot of standing relationships with a lot of the device manufacturers that they’ll even come to us,” Krieger said. “Covidien, for some of their new monitors, would want to certify with us. We work closely with Draeger; they’re rolling out the Perseus anesthesia machine.”

The result of that work is that an installation like that at St. Luke’s has helped hospital staff on both the back and front ends of the system to perform their duties more efficiently, Krieger said.

“The feedback has been wonderful,” he said. “If you asked any of the end-user clinicians, they would never want to go back. We work with the IT department; we work with the biomed department in connecting the devices.

“On the technical side, the CE’s have been just focused for years on the devices, the upkeep, and maintenance,” he said. “Now you’re integrating biomed and the IT world.

We help them work through that and bring everybody together.”

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CATEGORICAL INDEX ANETHESIA CIM med GmbH……………………………………………… 27 ASSOCIATIONS IAMERS…………………………………………………………… 14 AUCTION/LIQUIDATION Government Liquidation………………………………7 BATTERIES Eastern Diagnostic Imaging……………………… 69 BIOMEDICAL AIV Inc.…………………………………………………………… 63 Conquest Imaging………………………………………… 13 Elite Biomedical Solutions………………………… 71 Global Medical Imaging……………………………… 19 iMed Biomedical…………………………………………… 79 Imprex International, Inc.…………………………… 47 Integrity Biomedical Services, LLC…………… 55 InterMed Group………………………………………………8 Maull Biomedical Training, LLC………………… 64 Ozark Biomedical………………………………………… 64 Retrieve…………………………………………………………… 75 CARDIOLOGY Bionet America, Inc.……………………………………… 63 RSTI Exchange……………………………………………… 39 C-ARMS Blue Ox Medical Technologies…………………… 38 Clear Image Devices……………………………………… 63 Eastern Diagnostic Imaging……………………… 69 COMPUTED TOMOGRAPHY Blue Ox Medical Technologies…………………… 38 East Coast Medical Systems……………………… 71 Ed Sloan & Associates………………………………… 30 Exclusive Medical Solutions, Inc.……………… 77 KEI Medical Imaging Services…………………… 79 Metropolis International…………………………… 29 MIT/Medical Imaging Technologies…………… 39 Oxford Instruments……………………………………… 70 PM Imaging Management…………………………… 78 Retrieve…………………………………………………………… 75 RSTI Exchange……………………………………………… 39 Technical Prospects…………………………………10, 67 Tri-Imaging…………………………………………………………9 CONTRAST MEDIA Injector Support and Service, LLC……………… 27 Maull Biomedical Training, LLC………………… 64 DIAGNOSTIC IMAGING Blue Ox Medical Technologies…………………… 38 Eastern Diagnostic Imaging……………………… 69 ENMET, LLC…………………………………………………… 79 First Call Parts……………………………………………… 37 Injector Support and Service, LLC……………… 27 Multi Diagnostic Imaging Solutions…………BC Summit Imaging, Inc.………………………………………4 ENDOSCOPY Capital Medical Resources, LLC………………… 79 Endoscopy Specialists………………………………… 65 S.H. Medical Corporation…………………………… 23 GAS/AIR MONITORS ENMET, LLC…………………………………………………… 79

80 MEDICALDEALER | JULY 2016

GENERAL ALCO Sales and Service…………………………… 23,79 Eastern Diagnostic Imaging……………………… 69 Government Liquidation………………………………7 PartsSource, Inc………………………………………………2 RSTI Exchange……………………………………………… 39 IMAGING Injector Support and Service, LLC……………… 27 IMAGING/PARTS Ampronix……………………………………………………………6 Diagnostic Solutions…………………………………… 82 Eastern Diagnostic Imaging……………………… 69 InterMed Group………………………………………………8 PartsSource, Inc………………………………………………2 Technical Prospects…………………………………10, 67 Tri-Imaging…………………………………………………………9 INFUSION THERAPY AIV Inc.…………………………………………………………… 63 Elite Biomedical Solutions………………………… 71 LABORATORY MIT/Medical Imaging Technologies…………… 39 Ozark Biomedical………………………………………… 64 LASER IMAGERS Multi Diagnostic Imaging Solutions…………BC MAMMOGRAPHY RTI Inc.…………………………………………………………… 76 MODULE/TELEMETRY Bio-Medical Equipment Service Co.…………… 46 MONITORS/CRTs Advanced Ultrasound Elec./AUE………………… 65 Ampronix……………………………………………………………6 CIM med GmbH……………………………………………… 27 Technical Prospects…………………………………10, 67 MRI Carolina Medical Parts……………………………… IBC East Coast Medical Systems……………………… 71 Ed Sloan & Associates………………………………… 30 ENMET, LLC…………………………………………………… 79 Exclusive Medical Solutions, Inc.……………… 77 Imprex International, Inc.…………………………… 47 KEI Medical Imaging Services…………………… 79 MIT/Medical Imaging Technologies…………… 39 Oxford Instruments……………………………………… 70 Retrieve…………………………………………………………… 75 RSTI Exchange……………………………………………… 39 MOUNTING SOLUTIONS CIM med GmbH……………………………………………… 27 NUCLEAR MEDICINE E.L. Parts………………………………………………………… 76 Global Medical Imaging……………………………… 19 International X-Ray Brokers……………………… 65 RSTI Exchange……………………………………………… 39 Southeast Nuclear Electronics………………… 78 PATIENT MONITORING Bio-Medical Equipment Service Co.…………… 46 Bionet America, Inc.……………………………………… 63 CIM med GmbH……………………………………………… 27 Gopher Medical, Inc.…………………………………… 71 Integrity Biomedical Services, LLC…………… 55

Pacific Medical…………………………………………………5 PHANTOMS ATS Laboratories, Inc.…………………………………… 54 PROBES/PROBE REPAIR Conquest Imaging………………………………………… 13 Global Medical Imaging……………………………… 19 ONLINE RESOURCES MedWrench…………………………………………………… 77 POSITIONERS Clear Image Devices……………………………………… 63 POWER SYSTEM COMPONENTS Interpower Corporation……………………………… 40 RADIOLOGY Eastern Diagnostic Imaging……………………… 69 Engineering Services…………………………………… 22 ENMET, LLC…………………………………………………… 79 First Call Parts……………………………………………… 37 Greenwich Instrument Co., Inc…………………… 54 International X-Ray Brokers……………………… 65 InterMed Group………………………………………………8 Maull Biomedical Training, LLC………………… 64 Metropolis International…………………………… 29 Multi Diagnostic Imaging Solutions…………BC PM Imaging Management…………………………… 78 Radon Medical LLC……………………………………… 55 Rayence, Inc.…………………………………………………… 81 RSTI Exchange……………………………………………… 39 Technical Prospects…………………………………10, 67 Varian Medical Systems…………………………………3 X-Ray Parts, Inc……………………………………………… 55 RECRUITING Adel-Lawrence Associates, Inc…………………… 79 REPAIR/REFURBISH Advanced Ultrasound Elec./AUE………………… 65 AIV Inc.…………………………………………………………… 63 ALCO Sales and Service…………………………… 23,79 Ampronix……………………………………………………………6 Bio-Medical Equipment Service Co.…………… 46 Carolina Medical Parts……………………………… IBC Conquest Imaging………………………………………… 13 Eastern Diagnostic Imaging……………………… 69 Ed Sloan & Associates………………………………… 30 Elite Biomedical Solutions………………………… 71 Endoscopy Specialists………………………………… 65 Exclusive Medical Solutions, Inc.……………… 77 Global Medical Imaging……………………………… 19 Greenwich Instrument Co., Inc…………………… 54 Injector Support and Service, LLC……………… 27 Integrity Biomedical Services, LLC…………… 55 KEI Medical Imaging Services…………………… 79 MIT/Medical Imaging Technologies…………… 39 MTC/Medical Technologies Co.…………………… 54 Multi Diagnostic Imaging Solutions…………BC MW Imaging Inc.…………………………………………… 53 Pacific Medical…………………………………………………5 PM Imaging Management…………………………… 78 Radon Medical LLC……………………………………… 55 Southeast Nuclear Electronics………………… 78 Summit Imaging, Inc.………………………………………4 REPLACEMENT PARTS Advanced Ultrasound Elec./AUE………………… 65 AIV Inc.…………………………………………………………… 63 MEDICAL EQUIPMENT, PARTS & SERVICE

Categorical Index ALCO Sales and Service ………………………… 23,79 Carolina Medical Parts …………………………… IBC Classic Diagnostic Imaging ……………………… 47 Conquest Imaging ……………………………………… 13 Diagnostic Solutions ………………………………… 82 E.L. Parts ……………………………………………………… 76 Ed Sloan & Associates ……………………………… 30 Elite Biomedical Solutions ……………………… 71 First Call Parts …………………………………………… 37 Global Medical Imaging …………………………… 19 Government Liquidation ……………………………7 KEI Medical Imaging Services ………………… 79 MTC/Medical Technologies Co. ………………… 54 Multi Diagnostic Imaging Solutions ………BC Ozark Biomedical ……………………………………… 64 PartsSource, Inc ……………………………………………2 PM Imaging Management ………………………… 78 Radon Medical LLC …………………………………… 55 Southeast Nuclear Electronics………………… 78 Technical Prospects ………………………………10, 67 Varian Medical Systems ………………………………3 X-Ray Parts, Inc …………………………………………… 55 RESPIRATORY ENMET, LLC ………………………………………………… 79 SOFTWARE Probe Hunter ………………………………………… 20-21 STERILIZERS ENMET, LLC ………………………………………………… 79 Government Liquidation ……………………………7

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SURGICAL Capital Medical Resources, LLC ……………… 79 Eastern Diagnostic Imaging …………………… 69 Endoscopy Specialists ……………………………… 65 S.H. Medical Corporation ………………………… 23 SURPLUS MEDICAL Government Liquidation ……………………………7 TEST EQUIPMENT RTI Inc. ………………………………………………………… 76 TUBES/BULBS Government Liquidation ……………………………7 Technical Prospects ………………………………10, 67 ULTRASOUND Advanced Ultrasound Elec./AUE ……………… 65 AIV Inc. ………………………………………………………… 63 ATS Laboratories, Inc. ………………………………… 54 Conquest Imaging ……………………………………… 13 Diagnostic Solutions ………………………………… 82 Endoscopy Specialists ……………………………… 65 Exclusive Medical Solutions, Inc. …………… 77 InterMed Group ……………………………………………8 Probe Hunter ………………………………………… 20-21 Retrieve ………………………………………………………… 75 Summit Imaging, Inc. ……………………………………4 ULTRASOUND PARTS Advanced Ultrasound Elec./AUE ……………… 65 Conquest Imaging ……………………………………… 13 Global Medical Imaging …………………………… 19

InterMed Group ……………………………………………8 MW Imaging Inc. ………………………………………… 53 VCR REPAIR/SERVICES Advanced Ultrasound Elec./AUE ……………… 65 Conquest Imaging ……………………………………… 13 VENTILATORS Government Liquidation ……………………………7 VIDEO Endoscopy Specialists ……………………………… 65 Multi Diagnostic Imaging Solutions ………BC X-RAY Blue Ox Medical Technologies ………………… 38 Classic Diagnostic Imaging ……………………… 47 Diagnostic Solutions ………………………………… 82 Eastern Diagnostic Imaging …………………… 69 Engineering Services ………………………………… 22 Exclusive Medical Solutions, Inc. …………… 77 Government Liquidation ……………………………7 MIT/Medical Imaging Technologies ………… 39 PM Imaging Management ………………………… 78 Rayence, Inc.………………………………………………… 81 Retrieve ………………………………………………………… 75 RTI Inc. ………………………………………………………… 76 Tri-Imaging ………………………………………………………9 X-Ray Parts, Inc …………………………………………… 55 X-RAY PARTS Technical Prospects ………………………………10, 67 Greenwich Instrument Co., Inc………………… 54

MEDICALDEALER 81

ALPHABETICAL INDEX

Adel-Lawrence Associates, Inc …………………………………………………………… 79 Advanced Ultrasound Elec./AUE …………………………………………………………65 AIV Inc. ……………………………………………………………………………………………………63 ALCO Sales and Service ……………………………………………………………………23,79 Ampronix ……………………………………………………………………………………………………6 ATS Laboratories, Inc. …………………………………………………………………………… 54 Bio-Medical Equipment Service Co.…………………………………………………… 46 Bionet America, Inc. ………………………………………………………………………………63 Blue Ox Medical Technologies ……………………………………………………………38 Capital Medical Resources, LLC ………………………………………………………… 79 Carolina Medical Parts ……………………………………………………………………… IBC CIM med GmbH ……………………………………………………………………………………… 27 Classic Diagnostic Imaging ………………………………………………………………… 47 Clear Image Devices ………………………………………………………………………………63 Conquest Imaging ………………………………………………………………………………… 13 Diagnostic Solutions …………………………………………………………………………… 82 E.L. Parts ………………………………………………………………………………………………… 76 East Coast Medical Systems ……………………………………………………………… 71 Eastern Diagnostic Imaging ………………………………………………………………69 Ed Sloan & Associates …………………………………………………………………………30 Elite Biomedical Solutions ………………………………………………………………… 71 Endoscopy Specialists …………………………………………………………………………65 Engineering Services …………………………………………………………………………… 22 ENMET, LLC …………………………………………………………………………………………… 79 Exclusive Medical Solutions, Inc. ……………………………………………………… 77 First Call Parts ……………………………………………………………………………………… 37 Global Medical Imaging ……………………………………………………………………… 19 Gopher Medical, Inc. …………………………………………………………………………… 71 Government Liquidation ………………………………………………………………………7 Greenwich Instrument Co., Inc…………………………………………………………… 54 IAMERS …………………………………………………………………………………………………… 14 iMed Biomedical …………………………………………………………………………………… 79 Imprex International, Inc. …………………………………………………………………… 47 Injector Support and Service, LLC ……………………………………………………… 27 Integrity Biomedical Services, LLC …………………………………………………… 55 InterMed Group ………………………………………………………………………………………8 International X-Ray Brokers ………………………………………………………………65 Interpower Corporation ………………………………………………………………………40 KEI Medical Imaging Services …………………………………………………………… 79 Maull Biomedical Training, LLC ………………………………………………………… 64 MedWrench …………………………………………………………………………………………… 77 Metropolis International …………………………………………………………………… 29 MIT/Medical Imaging Technologies ……………………………………………………39 MTC/Medical Technologies Co. …………………………………………………………… 54 Multi Diagnostic Imaging Solutions …………………………………………………BC MW Imaging Inc. …………………………………………………………………………………… 53 Oxford Instruments ………………………………………………………………………………70 Ozark Biomedical ………………………………………………………………………………… 64 Pacific Medical …………………………………………………………………………………………5 PartsSource, Inc ………………………………………………………………………………………2 PM Imaging Management …………………………………………………………………… 78 Probe Hunter …………………………………………………………………………………… 20-21 Radon Medical LLC ……………………………………………………………………………… 55 Rayence, Inc.…………………………………………………………………………………………… 81 Retrieve …………………………………………………………………………………………………… 75 RSTI Exchange ………………………………………………………………………………………39 RTI Inc. …………………………………………………………………………………………………… 76 S.H. Medical Corporation …………………………………………………………………… 23 Southeast Nuclear Electronics…………………………………………………………… 78 Summit Imaging, Inc. ………………………………………………………………………………4 Technical Prospects …………………………………………………………………………10, 67 Tenacore Holdings, Inc ……………………………………………………………………56-59 Tri-Imaging …………………………………………………………………………………………………9 Varian Medical Systems …………………………………………………………………………3 X-Ray Parts, Inc ……………………………………………………………………………………… 55

82 MEDICALDEALER | JULY 2016

LENDING A HELPING HAND AT EVERY STEP.

Diagnostic Solutions is a customer service based parts provider that specializes in all imaging modalities and manufacturers. Created to offer hospitals and ISO’s a cost effective and time saving solution for ordering imaging replacement parts, equipment moves, ultrasound probe repair and on-site service.

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