ICE - May/June 2017

ADVANCING THE IMAGING PROFESSIONAL

MAY/JUNE VOL.1 NO.2

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THE MAGAZINE FOR IMAGING ENGINEERS & ADMINISTRATORS

ISO OR IN-HOUSE? How Effective Outsourcing Delivers Cost Savings and Reliability. P.38

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contents

ICE FEATURES

May/June 2017

“ A willingness to participate is probably the greatest variable in this from the customer side,” he said; “and a long-term commitment to the plan.”

38 ISO or In-House?

26 P rofessional

Cost-saving techniques continue to be popular in health care.

Kari Prince-Adams did not

Many imaging departments are looking to outsource the ser-

start out with a goal to work

vice and maintenance of clinical equipment to cut costs. With

in diagnostic imaging, but

vendors – whether original equipment manufacturers (OEMs)

her early focus on customer

or independent service organizations (ISOs) – able to drive sav-

service has paid off and

ings of 15 to 30 percent by farming out those responsibilities,

continues to serve her well as

the consideration is becoming less about whether to strike up

the senior director of Imaging

such a bargain, and more to what extent.

Services at Piedmont Fayette

About The Cover Photo Srini Koneru, Director for Sodexo Clinical Technology Management at Palisades Medical Center, inspects a x-ray collimator.

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near Atlanta.

ICEMAGAZINE

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contents

ICE DEPARTMENTS

17

28

May/June 2017

32

39

news

people

products

insight

12 Industry News

26 Professional Spotlight

31 MRI Product Focus

44 Imaging Matters

20 ICE Show Preview

28 Department Spotlight

32 MRI Gallery

46 Imaging Service 101

37 Tools of the Trade

48 Career Center

22 Imaging Webinar 24 People on the Move

MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269 Phone: 800-906-3373 Fax: 770-632-9090

50 Bridging The Gap

Vice President

Account Executives

Editor

Contributors

Kristin Leavoy kristin@mdpublishing.com

John Wallace jwallace@mdpublishing.com

Publisher

John M. Krieg john@mdpublishing.com

Art Department Jonathan Riley Jessica Laurain Kara Pelley

Jayme McKelvey Lisa Gosser

K. Richard Douglas Matthew N. Skoufalos Jim Carr Cindy Stephens John Garrett Alan Moretti

Accounting Kim Callahan

Circulation

Lisa Cover Laura Mullen Jena Mattison

Web Department Cindy Galindo Kathryn Keur

Webinars

Linda Hasluem

ICE Magazine (Vol. 1, Issue #2) May/June 2017 is published by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 30269-1530. POSTMASTER: Send address changes to ICE Magazine at 18 Eastbrook Bend, Peachtree City, GA 30269-1530.

For subscription information visit www.imagingigloo.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. © 2017

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IMAGING NEWS A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

CIS Expands Cardiac Ultrasound Capabilities with Toshiba Medical Systems To bolster its technology and treatment capabilities for coronary and peripheral artery diseases across all of its locations, Cardiovascular Institute of the South (CIS) installed 20 new Aplio 300 Platinum CV ultrasound systems from Toshiba Medical. To further expand its ultrasound technology, CIS also upgraded 20 existing ultrasounds to Toshiba Medical’s Aplio 300 Platinum platform to ensure staff were offering consistent and more confident cardiac diagnoses to all patients.

“Purchasing ultrasound systems that are extremely easy to use and installing them across all of our facilities to make exams consistent was very important to us,” said Jaime Aubin, ultrasound team leader, Cardiovascular Institute of the South. “The Aplio 300 Platinum and Aplio 300 Platinum CV ultrasounds offer the best image quality and the cardiac applications we need to make it easier for sonographers of all levels of experience to easily capture images with little to no pressure to the body, improving patient comfort. Toshiba Medical has also been an excellent partner in training all of our staff, as well as helping us create cus-

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ICEMAGAZINE | MAY/JUNE 2017

tom reports that fully integrate with our EMR platform.”

The Aplio 300 Platinum CV offers a comprehensive suite of dedicated cardiac technologies, featuring 2D Wall Motion Tracking, spectral and color Doppler, and Toshiba Medical’s latest suite of guidance and workflow technologies. Delivering detail and resolution throughout the entire field-of-view, the system provides excellent definition of the endocardium, which results in an accurate and easy-to-use 2D strain resolution. Furthermore, Toshiba Medical’s Wall Motion Tracking technology allows providers to quantify isolated movement within the heart to assist with detection of cardiotoxicity.

The Aplio 300 Platinum features a high-resolution 19-inch monitor and an optional fourth transducer port. The Aplio 300 Platinum also includes advanced imaging features, such as Advanced Dynamic Flow (ADF), Differential Tissue Harmonics (D-THI), Precision Imaging and ApliPure+. In addition, BEAM needle visualization allows for better procedural accuracy leading to a better overall customer experience. •

ADVANCING THE IMAGING PROFESSIONAL

news

Conquest Imaging Announces Loyalty Rewards Club Program Conquest Imaging has launched its Loyalty Rewards Club Program for its hospital and health care facility customers. The program offers the opportunity for customers to qualify for special benefits only available to club members through the program.

“We wanted to find a way to reward our customers who already purchase from us and a reason for other hospitals and imaging facilities to try our parts, probes and probe repair. We know once they experience our quality, turn-around times and customer service, they will be a customer for life,” says Inside Sales Manager Adrianna England.

Once signed up with the program, club members can earn improved

benefits through increased purchasing of Conquest’s products and services.

Purchasing levels (loyalty tiers) can be achieved quickly through multidepartmental purchasing.

“It doesn’t matter if you are a biomed in the clinical engineering department or a buyer in the procurement department.

Each purchase is counted toward achieving your loyalty tier,” explains England.

Some of the benefits club members will be entitled to include: • Free probe evaluations • Free shipping • Discounts on parts and probes • Extended payment terms to Net 45 • Free ultrasound training

Because Quality Matters ISO 9001:2008 CERTIFIED

Conquest Imaging has been fulfilling hospitals’ ultrasound needs for 17 years, providing each medical facilities with parts, probes, probe repair and loaners with same-day fulfillment. •

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news

Lifetrack Medical Systems Announces Approval of Next Generation PACS

Acertara Launches New Website and E-Commerce Site Acertara, an independent ISO/IEC 17025:2005 accredited medical ultrasound acoustic measurement, testing, and calibration laboratory, and ISO13485:2003 certified probe repair and new product development facility invites visitors to explore its new website and E-store. The new website (www.acertaralabs.com) has been designed to provide the ultimate user-friendly experience with improved navigation and functionality throughout, allowing customers to access detailed product information and videos as well as the convenience to purchase ultrasound products and accessories online.

The newly added Acertara eStore offers a wide selection of ultrasound prod-

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ucts and accessories with a convenient, easy online shopping experience. Acertara plans to continue adding products that will provide visitors a one-stop source for ultrasound systems to probe cleaning products and maintenance products to quality assurance solutions.

“We have updated the look and feel of our site to represent our more modern, growing brand and enable our customers to easily access our site regardless of the device being used,” said G. Wayne Moore, President and CEO of Acertara, “With the addition of the Acertara eStore our team continues to define the market and provide customers with solutions that will enhance patient care.” •

Lifetrack Medical Systems Inc. has announced FDA approval of its Lifesys PACS, the first 4th generation PACS enabling truly distributed radiology for better health care.

Already deployed in Asia, Lifetrack’s patented platform is extending the reach of high-quality medicine by greatly simplifying and speeding deployment of digital radiology, all while significantly reducing costs, and solving the greatest challenges of bringing high-quality diagnostic reporting to large underserved populations.

The Lifesys platform, built applying Lifetrack’s SEPI principle of “Simple, Elegant, Powerful, yet Intuitive”, features unique and patented RadNav technology, which serves a guidance system to radiologists through its integrated decision support system and active templates.

Customers of the Lifesys platform report that they’re able to produce comprehensive and accurate reports consistently with turnaround times under 15 minutes, even on complex cases. Patients benefit from better more comprehensive reports leading to more rapid and effective treatment. • ADVANCING THE IMAGING PROFESSIONAL

news

FDA Clears SOMATOM go. CT Platform The Food and Drug Administration (FDA) has cleared the SOMATOM go. computed tomography (CT) platform from Siemens Healthineers – an entirely new CT platform designed for highly diverse sets of user needs. Created with extensive customer feedback, the new platform includes the SOMATOM go.Now and SOMATOM go.Up CT scanners, which offer automated, standardized workflows that help users achieve more consistent, profound clinical results at a lower total cost of ownership. The tablet-based workflow concept facilitates more comprehensive patient care and allows radiology pro-

viders to use a cost-efficient single-room concept for the first time.

The 32-slice SOMATOM go.Now CT scanner is particularly suited to radiology providers who want to leverage a low-cost but clinically robust CT solution. With a wide detector that provides up to 64 slices, the SOMATOM go.Up offers faster scanning and tin filtration, which is particularly important for lung imaging (e.g., to screen for lung cancer). It also uses some of the lowest radiation doses achievable for a CT of this class. For this reason, the SOMATOM go.Up is ideally suited for organizations that want to expand their portfolio.

Users of the SOMATOM go. platform can control routine examinations using only the tablet and remote, paving the way for a new, mobile workflow. Standardized work steps allow users to run the scan with just a few inputs. Automated postprocessing facilitates efficient scanner operation with zero-click reconstruction tasks that enable technologists with wide-ranging proficiency to generate consistent, high-quality studies. The standardization also provides radiologists with greater assurance regarding diagnostic image quality, helping them avoid errors and repeat scans, and thus unnecessary wait times. •

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news UC-5000 X-Ray Solution Designed for Urgent Care Source-Ray Inc., a manufacturer of portable X-ray systems has announced FDA 510(k) approval for its new X-ray unit – the model UC-5000. It is a fully direct-digital turnkey system for the urgent care market.

“Source-Ray Inc. was able to utilize its 15-year experience as the largest American manufacturer of portable X-ray systems to design and manufacture a higher power mobile digital X-ray unit for the urgent care market,” said Ray Manez, president of Source-Ray Inc. “The UC-5000 utilizes standard 115 AC voltage and requires only minimal shielding resulting in zero installation

expense for the urgent care owner.”

“This system was designed to provide both a clinical and radiographic business solution for the urgent care arena,” said John Schaumburg, Director of Business Development for SourceRay. “The UC-5000’s design and mobility virtually eliminates the need for a dedicated X-ray room thereby allowing urgent care entities to significantly reduce their radiology expenses and overhead cost while increasing their clinical efficiencies. The unit’s high-quality diagnostic X-ray images have earned major endorsements within the radiology/urgent care space.” •

GE Healthcare investing and expanding operations GE Healthcare is growing its existing operations in Florence County, South Carolina with a $40 million capacity expansion, which is projected to create about 100 new jobs.

The company will be expanding its existing production of magnetic resonance imaging (MRI) components due to several new products recently added to the portfolio. This 500,000 square foot site specializes in designing, manufacturing and testing the superconducting magnet components of the system.

The expansion will be completed in phases with initial operations underway this spring. Hiring for the new positions is underway and interested applicants should visit the company’s careers page online.

GE Healthcare’s Florence facility has continued to expand over the past several years due to a growing MRI product line and a recent addition of a $17 million liquefaction facility for helium recycling during the manufacturing process. Helium is a critical component in MRI manufacturing. The team also recently added a solar farm to help reduce their carbon footprint.

With 30-year roots in South Carolina, GE Healthcare’s MR magnet production facility in Florence is home to 350 local employees and represents Florence County’s sev-

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enth largest industrial employer.

GE Healthcare team members in Florence are high-skilled welders, advanced technicians, assemblers and engineers who boast an average tenure of over two decades, and are intimately involved in their communities – with over 3,600 local volunteer hours just last year.

GE Healthcare’s Florence facility utilizes 2,500 unique parts from a diverse base of suppliers to manufacture each MR magnet, which helps support over 8,400 US jobs.

GE Healthcare’s Florence facility is Voluntary Protection Program-certified for safety performance by the State of South Carolina, and also aligns with both ecomagination and healthymagination, two of GE’s global initiatives aimed at transforming health care delivery through innovation, partnerships and sustainability. It is deploying some of GE’s latest Brilliant Factory software around automation and efficiency to drive improved production flow, and sharing Lean continuous improvement practices to improve the customer experience from order through delivery and install. •

Varex Imaging Renews Pricing Agreement with Toshiba Medical Systems

Varex Imaging Corporation has entered into a renewed three-year pricing agreement with Toshiba Medical Systems under which Varex Imaging will continue to supply its computed tomography (CT) tubes for integration into Toshiba Medical’s CT imaging systems for the global market. This renewed agreement became effective April 1, 2017.

Potential sales of CT tubes associated with this renewed agreement are estimated to be in the range of $345 million to $385 million. Orders under this renewed agreement will be booked when placed over the three-year term. CT tube pricing and expected volume ranges under this renewed agreement are consistent with CT tube purchases made in the past two years under the prior pricing agreement. Innovation and product performance also factor into the supply agreement with Toshiba Medical, with some tube pricing incorporating price adjustments based on extending CT tube performance.

In addition to this renewed pricing agreement, Varex has in place separate one-year pricing agreements to supply to Toshiba Medical other imaging components, including digital detectors and high voltage connectors. Annual sales of these additional components have ranged from $20 million to $30 million per year. •

ADVANCING THE IMAGING PROFESSIONAL

news

Toshiba Medical Launches New Aquilion Lightning CT Providers can now offer enhanced care and safe imaging to patients with a compact and economical solution via Toshiba Medical’s Aquilion Lightning 80 CT system. The 80-detector row (160 slice with Conexact) system is designed for full body imaging and routine volumetric scanning with the premium CT technology found on high-end systems so that providers can deliver a better patient experience.

The Aquilion Lightning 80 is designed to be a total cost of ownership solution for the mid-tier CT space. The system delivers fast

reconstruction speeds of up to 50 images per second at full resolution, and with the industry’s thinnest slices at 0.5 mm and a 78cm bore, it optimizes workflow and patient comfort. To simplify exams, the Aquilion Lightning 80 comes standard with Adaptive Diagnostic solutions, such as Single Energy Metal Artifact Reduction (SEMARTM) and SURESubtraction. The system can also be reconfigured from 40 to 80 to 160 slices without replacing hardware. Design features of Aquilion Lightning 80 make this scanner a wide, fast and small solution for CT providers. •

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news

Transtate Announces Partnership with Jordan Health Products Transtate is the latest addition to the growing Jordan Health Products(JHP) group of health care companies.

“We couldn’t be happier about the partnership with Jordan Health Products,” said Dan Wheeler, President of Transtate. “Partnering with JHP allows Transtate to become part of an integrated team, offering a broader range of industry-best solutions without sacrificing the quality our customers have come to expect.”

“We’ve been hearing from our customers that they would like to see Transtate expand the quality services we already provide and develop new offerings,” Wheeler said. “JHP provides the needed capital and market presence and is the ideal partner to back us in achieving these

customer objectives.”

JHP’s health care equipment and service business is focused on the complete lifecycle of medical, surgical, diagnostic imaging and oncology equipment, including sales, install, service, repair, sourcing and refurbishing.

Transtate will be part of the JHP group of health care companies, providing incremental resources, networking and cross-selling opportunities. JHP is focused on a strategic expansion into the rapidly growing, highly fragmented global equipment market. Transtate joins Global Medical Imaging LLC, DRE Medical Group Inc., Integrated Rental Services Inc., Oncology Services International Inc. AND Pacific Medical Group Inc. as part of

the JHP portfolio.

JHP expects additional acquisitions to further augment service expansion and growth across these platforms.

Founded in 1998 by Wheeler, Transtate Equipment Company services and sells medical imaging systems across the United States, specializing in catheter angiography equipment. Transtate has grown to become a leading independent service organization in the cath/angio space by providing top quality refurbished replacement parts and systems along with unmatched expertise in technical support and on-site services. • FOR MORE INFORMATION, visit www.transtateonline.com.

Carestream Introduces Software to Reduce Effects of Scatter Radiation Carestream Health has introduced SmartGrid software that can reduce the damaging effects of scatter radiation in a radiographic image and help eliminate the need for an anti-scatter grid.

This optional capability is available for use with Carestream’s portable and room-based DRX imaging systems as well as its DRX-1 retrofit system that converts computed radiography systems to digital radiography. The SmartGrid feature has received FDA 510(k) clearance and is scheduled to begin shipping in the third quarter of 2017.

Scatter radiation degrades image quality by creating a haze within the image that reduces both contrast and detail. It is prevalent when imaging thicker anatomy and when collimation is not close enough to the anatomy of interest. An anti-scatter grid can be placed over a detector but it’s heavy and bulky, which makes positioning and alignment difficult and typically requires an increase in radiation dose.

In addition to enhancing image quality, use of SmartGrid software can boost productivity by reducing the need for technologists to place cumbersome grids over detectors.

SmartGrid is an enhancement algorithm that estimates low-frequency scatter distributed throughout an image and removes it. Many physical factors affect the properties of scatter including energy spectrum of the beam, thickness and size of the

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object, and collimation. Using physics and empirical modeling, SmartGrid software can accommodate these factors through estimation of the algorithm parameters that are tuned to replicate anti-scatter grid visual performance.

SmartGrid image processing software is available for roombased and portable AP chest, AP abdomen, AP pelvis, AP hip and AP spine exams for adult patients. •

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ICE2017 IMAGING CONFERENCE & EXPO

IMAGING CONFERENCE & EXPO JULY 24-25, 2017 • Washington, D.C.

Heads to Washington, D.C.

T

he Imaging Conference and Expo (ICE) 2017 is expected to be the biggest one yet as the conference celebrates its fourth year (counting the inaugural MD Imaging Expo in 2014).

ICE 2017 will feature industry-leading speakers covering the hottest topics in imaging compliance, IT, management and equipment service. It also continues to be a top-notch event for networking and making connections within the diagnostic imaging service industry, especially with the very popular reverse expo.

ICE 2017 has been approved by the ASRT for 26 Category A continuing education credits. Adding to the conference’s reputation for world-class educational opportunities is a keynote address

by Andrea D. Browne, Ph.D., DABR, Diagnostic Medical Physicist Department of Engineering, The Joint Commission.

Dual “Super Sessions” will address the changing model of health care and five keys for the imaging service engineer.

The ICE 2017 exhibit hall will once again feature the latest technology, products and service offerings from the who’s who of imaging industry leaders.

Of course, no MD Publishing conference would be complete without its signature brand of networking events and ICE 2017 is no exception with a Welcome Reception on the first day of the conference and a a Grand Finale on the last day of the conference. These two events will provide a more casual and relaxed atmosphere for attendees,

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ICEMAGAZINE | MAY/JUNE 2017

“ Excellent atmosphere, professional instruction, and it was a reflection of the level of quality that goes into making an imaging department.”

Chris Bryant, CBET educators and exhibitors to share ideas and discuss the latest trends and issues within the industry.

Registration is available free of charge for hospital employees via a VIP discount available by reaching out to an exhibitor or MD Publishing. A limited number of booths and sponsorships are available. Company leadership should not hesitate to inquire about a booth or a sponsorship before they are sold out.

The first-ever MD Imaging Expo in 2014 exceeded expectations with rave reviews from industry veterans and a strong showing from throughout the United States.

More than 200 attendees registered for the event hosted by the same people behind the popular MD Expo. It featured 46 booths and sold out more than a month before the conference. Hundreds of attendees benefitted from educational opportunities with a variety of ASRT-certified classes.

ADVANCING THE IMAGING PROFESSIONAL

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MD Publishing President and founder John Krieg was thrilled by the success of the inaugural Imaging Expo.

“The show was in response to a demand expressed to us from industry leaders,” Krieg explained at the time. “We are excited to be able to host an event for a dedicated and loyal group of imaging service engineers and administrators. There is a huge void in the industry for an event and our early success is a great sign of good things to come.”

The conference returned in 2015 as the Imaging Conference and Expo (ICE) and continues to be a success. The conference meets a need for a community that supports the imaging service professionals and led to the launch of the ICE website (imagingigloo. com) followed by the ICE magazine you are holding in your hands. ICE FOR MORE INFORMATION about ICE 2017, visit AttendIce.com or call 800-906-3373.

THE CONFERENCE FOR IMAGING ENGINEERS & ADMINISTRATORS N AV I G AT I N G T H E F U T U R E FO R

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Webinar

Wednesday

IMAGING WEBINARS Remain Popular

T

he TechNation Webinar Wednesday Series continues to draw imaging service professionals seeking knowledge and tips to help them better do their jobs.

The webinar “Master RTI’s Ocean Quick Check QA Software” sponsored by RTI and presented by Key Account Manager Erik Wikström is just one example.

Wikström has global experience training imaging engineers and technicians in using X-ray QA software to drive workflow process improvements.

The webinar included a demonstration of RTI’s Ocean Quick Check QA software.

Ocean Quick Check has helped many imaging technicians reduce the time needed for QA testing, while at the same time improving the quality and accuracy of their X-ray QA reporting.

Webinar attendees gained valuable insights into new ways of improving efficiency in their X-ray QA workflow. The presentation concluded with a Q&A session.

Almost 200 people attended the live webinar and shared positive comments via a post-webinar survey.

“The information provided in the webinar was very interesting and explained well,” Erik B. said.

“It’s great to have a vendor showcase their new test devices and how to use those devices in the field, which helps us with budgeting new test equipment or enhancing our preventive maintenance program,” Brian G. said.

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ICEMAGAZINE | MAY/JUNE 2017

“ It’s great to have a vendor showcase their new test devices and how to use those devices in the field, which helps us with budgeting new test equipment or enhancing our preventive maintenance program.” Brian G Another recent webinar, sponsored by Universal Medical, was described by one attendee as “excellent.”

“An excellent balance of well-organized and delivered prepared comments covering a range of issues in maintaining nuclear medicine system with panel of in-house experts at Universal Medical that offered excellent responses to questions,” attendee Rob D. wrote in his post-webinar survey.

“Nuclear Medicine Service: A Guide for Selecting the Right Service for Your Facility” also offered attendees the opportunity to earn 1 CE credit from the ACI. Craig Snodgrass, National Service Manager at Universal Medical, did an outstanding job providing information to attendees.

He discussed choosing an independent service provider, selecting the ideal type of service contract, best practices one should be performing, and using fully reconditioned parts versus “as is” used parts. The webinar concluded with a Q&A session.

Rob D. wasn’t the only person who thought the webinar was “excellent.”

“If Siskel & Ebert were still alive, they would both give Webinar Wednesdays two thumbs up,” Michael N. wrote.

“Webinar Wednesdays are really informative, the best and easiest way for continuing education and always an eye opener,” Ouafa A. wrote in his survey.

“Innovations in Ultrasound System Diagnostics” was another popular imaging webinar. The webinar, which was sponsored by Summit Imaging, was eligible for 1 CE credit from the ACI. Summit Imaging Manager of Global Education and Training Kyle Grozelle discussed new and emerging tools and skills to troubleshoot and diagnose equipment in-house effectively. He explained how this approach to servicing and maintaining ultrasound equipment allows for a lower cost and reduced downtime. He showed how to use tools available in any biomed

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shop along with the knowledge of technicians to examine common symptoms and errors. Grozelle also discussed the installation of common parts that sometimes require additional steps and configuration to restore a system to working order. The presentation concluded with a Q&A session.

At the conclusion of the presentation, attendees had gained knowledge and skills that will enable them to diagnose a wide variety of ultrasound equipment as well as the resources to repair a system to full functionality.

Attendees had the opportunity to share their thoughts about the webinar via a post-webinar survey and they were not shy about how much they benefit from the presentations.

“I’ve attended several webinars over the years and they offer such a convenience in the material. Some are good, some great and some are simply fantastic,” Lee W. said. “This webinar would fall under fantastic and it grabbed my interest enough to send an email to my boss inquiring about the hosted product.”

“Great webinar on further in-house and third-party ultrasound service, that is not dependent on the OEM,” Robert M. wrote.

“This was a great webinar for me as a biomed who is very new to the ultrasound field. I am also happy to hear that Summit Imaging has such great support for us biomeds. Nice to find another company to call when we have equipment down. I am passing on their info to all my other co-workers,” Stephanie S. said. ICE FOR MORE INFORMATION about the TechNation Webinar Wednesday series, including the calendar of upcoming webinars and an archive of previous presentations, visit 1TechNation.com/webinars.

A SPECIAL THANKS to the following companies for sponsoring TechNation Webinar Wednesday:

“ Webinar Wednesdays are the best! Informative, convenient, and very interesting!” - Daniel S.

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ICEMAGAZINE

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news

PEOPLE ON THE MOVE 1

Toshiba Medical of Tustin, California has named Dan Skyba director of its Ultrasound Business Unit. Skyba joined the company from SuperSonic Imagine, where he had been director of product management and global director of product marketing and education; he also held various positions at Philips in ultrasound software launching and development.

2

InterMed of Alachua, Florida has added Brian Poplin, President-CEO of Elior North America to its board of directors. Poplin has also been President and CEO of both the former TrustHouse Services Group and of Medical Staffing Network. He is a USAF veteran and certified biomed who also holds a master’s of science in business management and a doctorate in health administration and policy from the Medical University of South Carolina.

3

HCA Gulf Coast Division of Houston, Texas has named Barrett K. Blackmon its regional vice president of oncology services. Blackmon joins the company from the MD Anderson Cancer Center, where he was chief administrator for surgical oncology. He is a fellow in the American College of Healthcare Executives and holds an MBA from Texas Woman’s University in Houston.

4

Kingwood Medical Center (KMC) of Kingwood, Texas, has named Mujtaba Ali-Khan its Chief Medical Officer.

Ali-Khan joined KMB last year as head of 24

ICEMAGAZINE | MAY/JUNE 2017

2

4

6

9

clinical and quality services at HCA affiliated hospitals Kingwood Medical Center and Conroe Regional Medical Center (CRMC), and transitioned into the KMC Chief Medical Officer role full-time while CRMC searches for its own Chief Medical Officer.

ny on May 8, 2017. His career has included management roles in financial planning and analysis, risk management, and commercial financing at Dell, and financial management consulting for Stern Stewart & Company, Xerox and the SK Group.

5

8

Precision Image Analysis of Kirkland, Washington has named Christian Teague its VP Strategic Relationships.

Teague is a 20-year radiology professional who has worked in research positions at UCLA Medical Center, and who co-founded RadCore Labs in 2009.

6

The Texas Medical Center (TMC) of Houston, Texas promoted EVP and Chief Strategy and Operating Officer William F. McKeon to President, CEO, and a member of its board of directors. McKeon has worked in leadership positions at DuPont, Stanford University Medical Center, US Oncology and Medtronic. General Counsel and EVP of Planning and Development Shawn W. Cloonan has been named TMC’s COO. Cloonan had been a public finance lawyer for Vinson & Elkins LLP and Bracewell LLP.

7

Varian Medical Systems of Palo Alto, California, named Gary E. Bischoping Jr. its CFO, replacing the retiring Elisha W. Finney. Finny spent 29 years with the company, 18 as its first CFO. Bischoping, who was previously CFO of Client Solutions at Dell Technologies, will join the compa-

Terumo Cardiovascular (CV) Group of Elkton, Maryland named Robert DeRyke its President-CEO following the retirement of long-time President-CEO Mark Sutter. DeRyke was promoted from the president of its electromechanical systems division, having joined Terumo in 2012 as VP of corporate quality, and has more than 25 years of experience with Baxter Healthcare, Hospira and Thermo-Fisher Scientific.

9

Kaiser Permanente Northern California has promoted senior executive CJ Bhalla to SVP and CFO. Bhalla joined Kaiser Permanente in 2006, and was eventually promoted to CFO of its national information technology unit and VP of national financial performance and planning. Bhalla’s career includes a senior vice presidency at Charles Schwab & Co. and senior management positions at Household International Inc.

Find weekly installments of People on the Move at imagingigloo.com

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people

By K. Richard Douglas

PROFESSIONAL SPOTLIGHT Kari Prince-Adams, MHA, CRA, CNMT

S

ince 1997, Piedmont Fayette Hospital, a 221-bed community hospital Fayetteville, Georgia, south of Atlanta, has provided award-winning care to its patients. The hospital is staffed by more than 1,600 employees and a medical staff of over 500 physicians. Piedmont Fayette has been named one of “America’s 50 Best Hospitals” by Healthgrades the last three years. It has also been recognized by Thomson Reuters as one of the nation’s “Top Hospitals” five times.

Overseeing the servicing of a hospital’s imaging equipment could prove to be a challenge. The hospital’s imaging service director did not even go to college, initially, to pursue imaging service, but she did begin to hone customer service skills back then.

Her first stop was to obtain a human resources degree, which indicated a real interest in people and that translates into being customer-focused. It would be a good beginning for anybody who provides a service in a hospital that customers and patients depend on.

It is the path that Kari Prince-Adams, MHA, CRA, CNMT, senior director of imaging services at Piedmont Fayette, took and it has served her well.

“In 1992, I graduated from Arkansas State University with a bachelor’s degree in human resources management. After many attempts at finding a job in the field, I decided to go back to school to study more science and apply to physical therapy school,” Prince-Adams says. “A random advertisement, regarding nuclear medicine students needed at the University of Arkansas for Medical Sciences, piqued my 26

ICEMAGAZINE | MAY/JUNE 2017

Kari Prince-Adams interest, so I applied and was accepted.”

While the human resources degree may have fizzled in the career department, nuclear medicine proved to be a more useful degree in 1999 when Prince-Adams graduated with a bachelor’s degree in nuclear medicine.

“After graduating with a bachelor’s of nuclear medicine, I moved to Baton Rouge, Louisiana to work at Woman’s Hospital of Baton Rouge,” Prince-Adams says. “This led me to a small community 80-bed hospital in Plaquemine, Louisiana, River West Medical Center, as the lead nuclear medicine technologist, to begin a cardiology program under Dean Valdez, M.D.” “During my time there, I became the director of the department and was mentored by the CEO Scott Smith [and] I fin-

ished my master’s in health administration. I knew little of the other modalities in radiology, so it was a wonderful opportunity to learn and be involved with many facets of the hospital,” Prince-Adams says.

Although she has a degree in nuclear medicine, Prince-Adam’s sights were set on leadership and that is where her training and background led her within the imaging services field.

“The specialty starting my career was nuclear medicine, but I always felt like I was born to be a leader,” she says. “As the only child of a salesman and a teacher/director of public television it seemed an obvious path. I’ve worked in the complaint/ camera department at a drug store, waited tables at Outback Steakhouse, rising to management levels and several other odd jobs in a hospital. Customer service, in all respects, is definitely in my wheelhouse.”

In any job, there can be challenges and those challenges can be intimidating or exciting. They can also prove to be a learning experience.

“My first challenge at Piedmont Fayette Hospital was adding a new radiologists group. Piedmont South Imaging was a superb addition to Fayette. The group also interprets for Piedmont Newnan, creating a special bond between the director, Randy Haynes, and myself,” Prince-Adams says.

“The directors of the system have also worked on a STARS team to organize a systematic approach to imaging under the direction of Executive Director of Imaging Randy Sprinkle. What an incredible growth experience for me to have a built-in support system in imaging,” she adds.

ADVANCING THE IMAGING PROFESSIONAL

GET TO KNOW THE PRO Favorite book

When Not on the Job Prince-Adams’ interests away from work include travel, underwater adventures and helping the disabled. She and her husband, Peter, also have three children between them.

“My husband and I love to travel and are both certified divers,” she adds. “We have also started training a service animal for the blind; a black lab named Claire.”

ministrators exam, Black Belt QPI training and been named Radiology Leader of the Quarter, July-September 2016,” she says.

“Currently, I’m enrolled in a High Impact Leadership class; thanks to Piedmont Healthcare for my continuing education,” she adds.

She is a member of the AHRA: Association for Medical Imaging Management and she maintains her status as a Certified Nu-

“ I have enjoyed every minute of the hospital and system. The vision and purpose of this organization is truly fulfilling. Every challenge and struggle I’ve had was to make sure I was prepared for this opportunity.”

Prince-Adams and her husband have traveled to Grand Cayman – their favorite place – and spent time diving in St. Maarten and St. Thomas.

Prince-Adams’ time in her current position has been a time for career growth and opportunities.

“While working at Piedmont Fayette, I have completed the Certified Radiology AdWWW.IMAGINGIGLOO.COM

clear Medicine Technologist.

What would Prince-Adams like readers to know about her?

“I have enjoyed every minute of the hospital and system. The vision and purpose of this organization is truly fulfilling.

Every challenge and struggle I’ve had was to make sure I was prepared for this opportunity,” she says. ICE

“The Greatest Salesman in the World” by Og Mandino and “How to Win Friends and Influence People”

by Dale Carnegie. I love any motivation type of book.

Favorite movie “Silver Linings Playbook” since that was my first official date with my husband.

Favorite food Mexican is my favorite cuisine.

Hidden talent I can pack a car with more stuff than it can hold and I have a green thumb.

Favorite part of being an imaging service professional “The people I work with are the absolute cream of the crop and I love Piedmont.”

What’s on my bench?

• My list of items I want to accomplish in a notebook that I never lose • A picture of my daughter • Vanilla Coke Zero • The morning text my husband always sends me to start my day!

ICEMAGAZINE

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people

By K. Richard Douglas

DEPARTMENT SPOTLIGHT The University of Maryland Medical System Corporate Imaging Services Department

I

n, and around, the city of Baltimore is the University of Maryland Medical System. The University of Maryland Medical Center is one of 12 hospitals that comprise the system. The medical center was established in 1823, making it one of the country’s first teaching hospitals. The University of Maryland was also the country’s first public medical school.

The health care system employs 8,261 people with 1,163 who are physicians and faculty. There are 929 resident doctors.

The health system’s emergency rooms have seen 73,285 patients. With all of those patients and doctors, it stands to reason that the system’s imaging equipment is in high demand and it is.

The University of Maryland Medical System Corporate Imaging Services Department is a free-standing corporate operation in its first year of service. The group is headed by Imaging Services Manager, Sean Connolly. The eight-person department also includes Imaging Service Engineer II, Geri Adofina, Imaging Service Engineer Specialist, Daniel Wickenheiser, Imaging Service Engineer Specialist, Mike Poole, Imaging Service Engineer I, Chris Poole, Imaging Service Engineer I, Patrick Dizon, Imaging Service Engineer Specialist Tim Lunczynski and Database Coordinator, Sheila McRae. The service engineer specialists areas of specialization include Mike Poole; OEM training in GE CV, radiography/fluoroscopy, CT, nuclear medicine and injectors. Tim 28

ICEMAGAZINE | MAY/JUNE 2017

Lunczynski has OEM training in Siemens, IR, CT, MR, GE CV and third-party general radiography/fluoroscopy. Dan Wickenheiser has OEM training in Philips CV and radiography/fluoroscopy as well as GE radiographic/fluoroscopy.

Geri Adofina has OEM training and specializes in Philips and OEC (GE) mobile C-arms, Philips CT, and Shimadzu portables.

Chris Poole has OEM training and specializes in GE MRI, digital radiography and third-party general radiography/fluoroscopy.

Patrick Dizon holds the team’s first hybrid position. He is both in-house and part of the system with OEM training. He specializes in Varian linear accelerators and third-party training in general radiography/fluoroscopy.

“Our department is a free-standing corporate operation, although our most recent hire is stationed at one of the system hospitals that we service, which is a collaboration between this facility and our program, to better support the in-house radiological support needs at this facility,” Connolly says.

Keeping Current The group’s training regimen includes a cross between OEM, inter-team training and third-party training.

“Our primary approach is to have our staff trained by the OEM for makes and models in our inventory. As a team we use a cross-training approach with our staff working together to learn other vendors

where a specialty already exist in a modality, and new modalities where it may not,” Connolly says.

“We also rely on third-party training facilities for basic radiology training as we find this the most cost-effective way to address these needs for future OEM training,” he says.

Connolly says that his department currently provides services for 12 main facilities and many of their radiological services in addition to their primary facilities. The facilities range from a major 700+ bed world-class trauma/teaching facility to much smaller facilities that focus on specialty care.

The team handles the servicing of most imaging equipment with the exception of nuclear medicine cameras (except for at one facility) and mammography systems.

“The reason that we are not currently providing services for these devices is that we are a relatively new department and we did not feel that this would provide the best return on investment in reference to allocation of our training dollars,” Connolly says. “We intend to pursue support on these systems in the future when staff and training dollars show the proper return on investment.”

In terms of purchasing and planning decisions, the department’s involvement can depend on the facility. In the instances where they are involved, they bring their expertise to the table.

ADVANCING THE IMAGING PROFESSIONAL

“We collaborate on the right fit not only for the facility but also for the system to include all life cycle cost associated with the purchase and support of that equipment, as well as patient safety and comfort,” Connolly says.

Managing Equipment Made Easier When it comes to special projects, Connolly says he is excited about one that relies on internal resources. It is related to a Computerized Maintenance Management Database (CMMS) that will benefit his group and all of CE. “We had the good fortune of hiring an Imaging Service Engineer Specialist, Mike Poole, who was formerly a manager at one of our system facilities. Mike was the administrator for the CMMS at his facility and all of the facilities use the same CMMS, but we are not currently using it the same,” Connolly says.

“As part of our new department, the intent was to create a Radiology Services Segment in our CMMS, and Mike was willing to be the administrator of this until whatever time our Database Coordinator is fully trained and comfortable addressing this need,” Connolly adds.

Why is Connolly excited about this project?

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Standing in front of a Trauma CT from left to right: Geri Adofina – Imaging Service Engineer II, Sheila McRae – Database Coordinator, Daniel Wickenheiser – Imaging Service Engineer Specialist, Mike Poole – Imaging Service Engineer Specialist, Sean Connolly – Imaging Services Manager, Stephanie Petrisko – CT Technologist, Chris Poole – Imaging Service Engineer I, Patrick Dizon – Imaging Service Engineer I, Tim Lunczynski – Imaging Service Engineer Specialist

“The reason that I am so excited about this particular project is that Mike had created a valuable tool with the work that he has done with the facility where he was the manager and administrator for their CMMS. This particular segment of the CMMS has advanced capabilities to provide equipment history, life cycle information, down time, etcetera.”

Connolly says that the group is using that CMMS segment as a basis for their radiology segment and are in discussion with their clinical engineering managers group and senior leadership to use this format as system common for clinical engineering departments. He says that all may benefit from this very valuable tool.

When the need arises, some of the team members can switch to general biomed and pitch in when needed.

“We have provided support services to facilities that may have personnel out for vacation, medical leave, etcetera,” Connolly says. “They are provided to backfill these operations when requested and when we have the ability to do so. If one of the imaging staff are supporting such a request and receive a trouble call for a radiology system this call does take precedence and the technicians will respond to that call.”

Connolly says that of the six trained staff, five come from a strong general biomed background and this provides the team with the ability to provide support via a much more cost-effective approach versus contract support from a third-party vendor.

For a young entity, this imaging services department is making headway and bringing a world of talent to those who depend on diagnostic imaging. ICE ICEMAGAZINE

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MRI PRODUCT SPOTLIGHT Market Forecast to Reach $8 Billion

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agnetic resonance imaging (MRI) is a radiology technique health care providers use to diagnosis, assess and treat medical conditions. It uses strong magnetic field, radio frequency pulses and a computer to produce detailed image of internal body structures.

These scans can be used to examine musculoskeletal injuries, sports injuries, alignments of brain, vascular abnormalities, prostrate problem, female pelvic problem, gastrointestinal tract condition, soft tissue and bone pathology or condition and some ear, nose and throat conditions.

A report from BCC Research predicts continued growth for the medical MRI market.

“The global market for MRI systems reached $5.8 billion in 2015. The market should reach nearly $6.1 billion and $8 billion in 2016 and 2021 respectively, growing at a compound annual growth rate (CAGR) of 5.7 percent from 2016 to 2021,” according to BCC Research. “The North American market for MRI systems should reach $3.1 billion in 2021 and $2.4 billion in 2016, growing at a CAGR of 5.4 percent from 2016 to 2021. The MRI systems market in the Asia-Pacific region should reach nearly $2.1 billion in 2021 from $1.5 billion in 2016, growing at a CAGR of 7.3 percent from 2016 to 2021.”

MarketsandMarkets forecasters also expect continued growth.

“The global MRI systems market is projected to reach $7.19 billion by 2021 from $5.61 billion in 2016, at a CAGR of 5.1 percent from 2016 to 2021,” according to MarketsandMarkets.

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“The market should reach nearly $6.1 billion and $8 billion in 2016 and 2021 respectively, growing at a compound annual growth rate (CAGR) of 5.7 percent from 2016 to 2021.” at a compound annual growth rate (CAGR) of 5 percent during 2016-2022, according to a report from P&S Market Research.

“Based on architecture, the open MRI segment is expected to witness the faster growth during the forecast period, at a CAGR of 7.8 percent in the global market.

Among the various field strengths, the high field MRI segment is expected to witness the fastest growth during the forecast period,” according to the report.

Several factors are powering the market’s continued growth.

“The global magnetic resonance imaging market is growing at a significant rate, due to growing geriatric population, increasing prevalence of chronic diseases such as cancer, lung diseases and rheumatoid arthritis, increasing incidence of injuries, increasing awareness about early diagnosis, and increasing health care expenditure,” according to P&S Market Research. “In addition, the improving

health care infrastructure in developing countries, such as China and India, and technological advancement in MRI are also driving the growth of the global MRI market. The restraints associated with the growth of the global MRI market include stringent regulations for the approval of MRI devices, high cost and lack of trained professionals, and shortage of helium gas deposits.”

North America is expected to maintain its dominance in the global market of magnetic resonance imaging through 2022, according to the report.

“This is due to increasing health care expenditure, growing geriatric population, improved health care infrastructure, and growing prevalence of chronic diseases. In addition, the increasing research activity for the advancement of imaging technology is also driving the growth of the North American market,” according to P&S Market Research. ICE ICEMAGAZINE

31

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ISO or In-House?

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ICEMAGAZINE | MAY/JUNE 2017

ADVANCING THE IMAGING PROFESSIONAL

ISO or In-House?

How Effective Outsourcing Delivers Cost Savings, Reliability

By Matt Skoufalos

F

rom a business perspective, medical imaging remains a double-edged sword, both a significant source of revenues and often a big driver of cost. With reimbursements decreasing and no new billing codes on the way to recoup those revenues, any strategic decisions that generate bottom-line savings become, in many ways, the equivalent of new business. Many imaging departments are looking to outsource the service and maintenance of clinical equipment to cut costs. With vendors – whether original equipment manufacturers (OEMs) or independent service organizations (ISOs) – able to drive savings of 15 to 30 percent by farming out those responsibilities, the consideration is becoming less about whether to strike up such a bargain, and more to what extent.

Jim Salmons, vice-president of multivendor services for Philips Healthcare of Nashville, Tennessee, said his company has realigned itself to support in-house organizations that are built around a direct-service model. As customers become savvier about the needs of their departments, service vendors are tailoring offerings based on those specific needs. Gone are the days of limited-scope, “breakfix” contracts, Salmons said; instead, vendors are being measured against an array of customer-defined metrics.

“We scale up and down to each customer,” Salmons said. “I have customers that just want asset management software that gives them the insight into what’s happening with the equipment. On the other side, I’ve got customers who want to outsource the entire service environment. They WWW.IMAGINGIGLOO.COM

want to cut one check and not have to manage those day-to-day activities.”

In the cases of imaging departments that are more focused on doing the bulk of their service work in-house, Salmons said “we’re happy to stand in the background and provide support.” For such clients, companies like Philips are able to transition from being a more deeply connected partner with a greater breadth of service responsibilities into a parts-and-service provider. Of course, regardless of the flexibility of services offered, if the metrics of the contracts aren’t met, clients will not hesitate to shop around.

“The custom solution probably just gets you to the table,” Salmons said. “Now that you’ve delivered on that custom solution, ‘it’s put up or shut up.’ Customers are more exact in

that situation, and hold their service providers accountable.”

The average length of time in which to prove the value of those services is three to five years, which also helps shape the larger market in which ISOs operate, Salmons said.

Some of the biggest drivers of change have more to do with health care industry itself, which has been in a state of merger and acquisition for years, than any individual institutional trends. As hospitals that are aligned with manufacturers are bought and sold, ownership of a given facility can have as large an impact on its service solutions as any contract agreement.

Large service managers like GE, Philips, Aramark, Crothall and Sodexo typically compete for customers among the largest integrated delivery network (IDN) space; those contracts ICEMAGAZINE

39

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Jim Salmons Vice-President of Multivendor Services, Philips Healthcare

tend to be whole-hospital awards or all-of-imaging awards, and Salmons said “most customers don’t see a big difference among them.”

“As fast as we’re changing, they’re changing even faster, whether it’s from an acquisitions standpoint to consolidation on the GPO (group purchasing organization) side,” Salmons said.

“Those drive a lot of the decision-making as far as what that potential selling opportunity looks like.”

Market evolution is also dictated by cost-reduction pressures and the availability of device management informatics, Salmons said. Customers design an outsourcing or in-house model depending upon the level of internal control they want to maintain around their programs. Outsourcing arrangements are typically predicated upon immediate cost savings or consistency in service delivery; insourcing models generally have more to do with the technical capacity of onsite staff and the resilience of their infrastructure to maintain day-to-day operations.

“A willingness to participate is probably the greatest variable in this from the customer side,” he said; “and a long-

term commitment to the plan.”

General customer savvy also creates a more competitive bidding environment, which Salmons said can be further complicated by the increasingly common inclusion of consultants in the bidding process. Often paid out of a portion of the savings the deals they negotiate generate, consultants can provide an extra level of due diligence for imaging departments or another level of relationship insulation among multiple vendors.

Scott Elston, director of strategic account development for GE Healthcare, said that although in-house service engineering is a more common arrangement among standalone imaging centers, ISOs can be recruited to support their operations “from an overall services model perspective,” whether through staff education and training or third-party technical contracts for service demands.

Choosing one or another method can offer the greatest savings, he said; while the best-of-breed approach still applies to technology selection and clinical preference, it yields mixed results when overlaid on service plans.

“The organizations doing this well are either looking to outsource everything or bring everything in house,” Elston said. “This fragmented approach is no longer working.”

Elston said GE is making inroads among large IDNs with a longstanding tradition of in-house clinical engineering programs, including customers like Aurora Healthcare of Milwaukee, Wisconsin and Sanford Health of Sioux Falls, South Dakota. Companies like GE are driving down costs by leveraging the scale of their operations, which Elston said dwarfs even that of the largest IDNs. He cited GE’s entry into the ISO market 20 years ago as having been driven by a request from Hospital Corporation of America (HCA) of Nashville, Tennessee to take on the management of their ADVANCING THE IMAGING PROFESSIONAL

medical device infrastructure. With more than 1,000 IDNs in the United States – and fewer every day, thanks to mergers and acquisitions – volume becomes a key part of the conversation in any ISO arrangement. In many cases, Elston said simply outlining the scope of device inventory and management services offers the greatest opportunity for savings.

“One of the number one drivers of service costs is that organizations have more clinical assets today than they’ve ever had,” he said. “Part of that is valid because of clinical need. Part of it is a function of not the right level of rigor around how you’re using and deploying your assets.

Where that plays into imaging is the planning for this technology.”

Typically, a baseline cost and inventory assessment can reveal system-wide opportunities for savings through the reallocation of resources or simply defining the age and condition of equipment. Particularly when dealing with million-dollar imaging devices like CT and MR scanners, eliminating even one device from service or future purchasing plans can have a demonstrable financial impact.

“Does the organization have the right level and numbers of technologies that they need for their care delivery?” Elston said. “In many cases, there’s an overage where they’re buying more than they really need, or nobody’s looking at what’s really needed versus who’s screaming the loudest.”

“Beyond the costs associated with equipment purchasing and utilization, those related to routine service is another key area in which ISOs offer a chance at cost savings. A good contract will build in ‘real service delivery teeth’ as well as ‘a significant quality component,’ with a timeline for preventive maintenance, equipment uptime, and Joint Commission compliance,” Elston said. It all goes to creating “a quality program based on rigorous ISO standards,” he said. Yet none of these commitments works without clearly defined roles and WWW.IMAGINGIGLOO.COM

Shawn Chatfield Vice-President of Imaging Services, The InterMed Group

responsibilities on both the client and provider sides of the relationship.

“This does need to be a partnership,” Elston said. “When you’re coming in and

with critical client stakeholders, and forming “ongoing programs to bring ideas of value to each organization,” he said. Those can take the form of executive sponsorships, quarterly meetings, and the like, but “where it works best is where it’s seen like a partnership,” Elston said; “that the organization has an obligation to communicate and drive this internally to make sure it’s done right.”

“Even if the dollars make sense, the quality makes sense, there’s still an amazing commitment to people,” he said.

“I think the fear on the part of many organizations is that this is going to have an adverse negative effect on those people who are currently employed by them. For the most part, 90-95 percent of everyone we hire is hired within, and why wouldn’t we want to do that?”

Here, too is another area where a company like GE can win on scale, Elston said.

If a third-party agreement means layoffs

“ Beyond the costs associated with equipment purchasing and utilization, those related to routine service is another key area in which ISOs offer a chance at cost savings.” – Scott Elston doing an outsource program, it’s never lost on us that this is a big deal to an organization. For many [customers], it’s a very new endeavor for them.”

In forming a successful service agreement, Elston said there’s “a real emotional component” that must be considered to help drive success. The partnerships that drive the best return on investment are those that secure the greatest organizational buy-in from both parties. For the ISO, that means establishing relationships

of in-house staff, many times they’re snapped up by the contracting company.

He said larger ISOs can offer a comparable or better total benefits package to their employees plus additional training and career opportunities that translate all the way to leadership roles.

“Outsourcing doesn’t have to be this evil, four-letter word,” he said. “There’s some real positives that go along with it, to even the people involved.”

Nonetheless, outsourcing isn’t for evICEMAGAZINE

41

ISO or In-House?

ery kind of circumstance. Elston maintains that the smaller the organization is, the less having an in-house team makes sense (“If you’re a 100-bed hospital with one CT, does it pay to have someone in-house to service one or two high-end scanners?”)

But when there are opportunities to leverage greater economies of scale – say an imaging team spread out over a large metro region – the benefit of devoting an ISO exclusively to that aspect of the business can pay dividends.

“There are some organizations where the in-house philosophy is 100-percent valid,” he said. “I think we have a point of view that it’s a very viable and beneficial alternative that should be looked at, but if you feel your in-house strategy is right for you culturally, we can bring value to that by bringing some of our scale.”

For companies that don’t want to tether their imaging service and maintenance needs to a “big three” OEM vendor, imaging specialist ISOs are another solution.

Unlike many of the biggest players in the market, which seek to sign clients to management contracts that encapsulate the entirety of their clinical engineering equipment, Renovo Solutions has made a name for itself in the intermediate market by focusing exclusively on servicing imaging equipment.

“Hospitals and health systems are shying away from putting a full-service contract out for everything,” said Renovo CEO Sandy Morford. “A service contract in and of itself is nothing more than an insurance contract. You’re paying a fixed price per year. As this equipment becomes more reliable and they fail less, hospitals are saying, ‘Maybe this isn’t the only way for us to get this done.’ ” Some Renovo clients are choosing to sign on with the company in a sharedrisk arrangement, Morford said. If their in-house staffers can handle scheduled maintenance needs, they may contract out for a time-and-materials agreement.

Offloading the risk of the program is a key 42

ICEMAGAZINE | MAY/JUNE 2017

Tim Riehm Regional Vice President, Sodexo Clinical Technology Management

“ It really comes down to a resource issue for hospitals. Are they going to spend time investing in figuring out clinical engineering, or are they going to be focused on patient care?” – Tim Riehm way in which imaging centers are able to save on their service agreements, he said.

With a majority of service calls able to be resolved within the first hour or so, the more needs that can be met by in-house staff, the less the institutional cost outlay.

“OEMs make the most money on full-service contracts that cover everything,” Morford said. “If they’re not making 50-plus-percent gross margins on that

contract, they don’t take those contracts.

It’s a company cultural thing. As a private company, we don’t have the same margin expectations that they do.”

Renovo also offers a vendor-neutral position that enables its negotiation of master service agreements with OEMs to return cost savings on specific pieces of equipment across its client base that may enable customers to get more favorable pricing or access to service technicians who have been trained at dedicated OEM schools.

“I see more and more hospitals looking outside their organizations, saying, ‘There’s no more sacred cows,’ ” Morford said. “Everything’s up for grabs these days.”

Shawn Chatfield, vice-president of imaging services for The InterMed Group of Alachua, Florida, said his ISO is most commonly tapped for troubleshooting, parts and service calls, as well as asset management. Uptime is typically among his clients’ greatest concerns, although Chatfield said the smoothness of integration among the client and ISO teams factors heavily in the decision to go with a custom service agreement “Our customers are educated that we are a partner with their facility,” Chatfield said. “InterMed has to respect their position within the facility and not come prepared with the notion to take over the services.”

There are also some services that an ISO can perform that an OEM may not.

Equipment inventories are aging amid lean capital cycles, and Chatfield said InterMed is often asked to service end-of-life devices that are no longer supported by OEMs. The flexibility to address those needs is just one key differentiator that ISOs offer, but Chatfield said ISOs must first overturn a conventional narrative that only the OEM is fit to service its own equipment.

“In days past, most in-house teams would defer the more difficult issues to the OEM,” Chatfield said. “The mindset nationally is [that] only the OEM is capable. We have proven this wrong over many years, but as everyone says, ‘You won’t get fired ADVANCING THE IMAGING PROFESSIONAL

DISCOVER

A Better Choice for signing a contract with the OEM.’ ” Chatfield believes that as costs continue to pressure hospital decision-makers, more will turn to ISOs to service their imaging departments. In the meantime, however, “we will just continue to position ourselves to provide the best services possible when requested,” he said.

Tim Riehm, regional vice president of Sodexo Clinical Technology Management, agreed that institutional flexibility is one of the keys to winning new business. The ability to create a structured, comprehensive program around clients’ needs starts with understanding what they want, from repair and preventive maintenance plans to those that help maintain regulatory compliance and manage inventory. Riehm said companies like Sodexo can help offload critical strategic functions that hospitals don’t necessarily have the opportunity to focus on amid questions of patient throughput and health outcomes.

“It really comes down to a resource issue for hospitals,” he said. “Are they going to spend time investing in figuring out clinical engineering, or are they going to be focused on patient care? When you’re looking at an ISO or an OEM, that is your core competency. Everybody in the organization understands what clinical engineering is and what they need to do to improve quality.”

ISOs can also support in-house imaging staff simply by adding extra sets of hands. When resources are maximized in the performance of normal duties, it can be impossible to find staff to help deploy new equipment, rewrite policies and procedures, or tweak a Computerized Maintenance Management System (CMMS).

“Now you’re trying to do a project mandated by the administration, and unfortunately, the biomed department comes back and says, ‘We can do that, but here’s the things we won’t be able to do because of it,’” Riehm said. “Access to resources is huge.”

When an ISO can tightly integrate with a hospital’s in-house staff, the facility gets the best of both worlds, according to Riehm: onsite equipment support with back-end support that offers a regional level of backup and greater technical expertise for higher-end devices. That expertise can even extend to help with longer-term planning to counteract the effects of existing service contracts institutions may be locked into.

“They’re becoming much more conversations around the imaging service component when it comes time for RFPs,” Riehm said. “They might say, ‘We know the cost is too expensive today, but how do we shift it two to three years from now? [Clients are] looking for long-term imaging strategy instead of a quick glance today.” ICE

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insight

IMAGING MATTERS Building the Future of Imaging

W

hen someone mentions building the future of imaging, there is often a mental image of an engineer deep in the bowels of some secret location devising ways to make service of imaging equipment as difficult as possible.

It would not be unreasonable to assume that the manufacturers are attempting to find a way to put proprietary air in the system that can be licensed annually. There is no way to conclusively say that isn’t true.

However, the reality is that the future of imaging will be created by a very complex and varied combination of stakeholders.

Each stakeholder will have a different impact on shaping the future of medical imaging. One of the most important voices has yet to be heard.

Those that service the imaging systems, mostly independent service organizations (ISO) and in-house employees, have not had adequate input into the designs of future equipment. The men and women who know the weakest points of the systems, the areas for the greatest improvements, and have heard every item on the operator and radiologist wish lists have no real voice.

Those who have gone to school when the newest units were installed, oversee the preventive maintenance (PM) and witness the full life cycle of the equipment are never brought in to help with the creation of the next generation.

What can be done to change that?

If you are reading this article, you are part of the first step. For years the concept of having a place on the Internet to bring 44

ICEMAGAZINE | MAY/JUNE 2017

all of the experience and knowledge of the ISO and in-house imaging service worlds together has been discussed. It is finally here. You are part of it right now!

The reason that this community has had no voice is that there has been no place to gather. No one place to bring all of those years of hard-earned knowledge together to speak as a voice that has enough weight to rise above the noise.

The power of the Internet and of social media is changing the world. The ICE website (imagingigloo.com) associated with this magazine is a place to bring your experience and ideas to share with others.

There is not any one person who has the best idea. But when ideas are shared, reviewed and built upon there is no limit to what can be accomplished.

The hardest part of this is that it requires participation. You must make sure you add your voice, your ideas, and your experience to the forum. You are an important part of the bigger picture. You cannot be replaced. This is an area where you can make a difference. Never assume that others see what you see or know what you know.

You may not think that something as simple as leaving a comment after an article will mean much. But you also don’t know who will see that comment. You don’t know what conversations will be started or ideas will be sparked. There are a number of things that can be initiated from a simple, honest, observation.

Building this community is how all of

Written by John Garrett Manager, Clinical Engineering at Catholic Health Initiatives.

those who have not been heard up to this point can create a voice that cannot be denied. Building the community requires participation. Start now. Where do you think the future of imaging is headed?

Where do you think it should be going?

What problems are the manufacturers missing?

Join the conversation now at imagingigloo.com/join-ice/. ICE

John Garrett has 20 years of experience in imaging service including general radiation, mammography, CT and nuclear medicine.

He has worked for third-party service companies, manufacturers, sales companies and in-house imaging teams. Currently, he is the manager of clinical engineering for Catholic Health Initiatives.

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insight

IMAGING SERVICE 101 Looking at Training

A

basic requirement for performing service on diagnostic imaging systems is knowing how to do the technical part of the job – maintenance, troubleshooting and replacement of parts. The level of knowledge the imaging engineer has about a particular system affects all aspects of performing service, including speed, quality, cost and safety.

The way that we initially gain most of that knowledge is through some sort of training. It is usually a combination of general modality training, self-learning by reading user and service manuals, being taught by a co-worker on the job (OJT) and maybe some system-specific training. Sometimes the only “training” we get is hands-on experience at the school of hard knocks.

Most of us have had the experience and paid the price of learning the hard way, and know that it is easier and less expensive in the long run to get trained by someone who already knows. There are two levels of knowledge or training that are needed for imaging engineers. Basic or introductory training on a particular imaging modality provides knowledge of the clinical applications, the physics and general theory of operation, typical design architecture, and how to safely perform general maintenance and testing. Advanced-level knowledge is how to maintain and service a specific model of an imaging system. This includes such things as knowing how to operate the system, running diagnostics, troubleshooting problems, how to replace parts, doing 46

ICEMAGAZINE | MAY/JUNE 2017

performance testing and calibration, and reloading software. Advanced training on specific models of imaging systems may be available from the OEM (manufacturer) or an independent service organization (ISO).

Determining the level and type of training needed is usually not a straight forward process. There are not many regulations or industry requirements to guide us. Basically, it comes down to a couple of questions: 1. What do you need to learn in order to be proficient at servicing the system? 2. How much time do you have until you need to be at that level?

Written by Jim Carr Director of Services and International operations for AUE

to get it. The OEM may have a school that you can attend. OEM schools are usually quite expensive, take longer than a training class from an ISO, and often are

Determining the level and type of training needed is usually not a straight forward process. There are not many regulations or industry requirements to guide us.

A common problem with OJT is trying to do training while one or both people are also doing their “regular” jobs. There is often a lack of reference material, and not all imaging engineers are good trainers. To make OJT as good as possible, a list of training objectives and methods, and a way to objectively measure the effectiveness of the training should be developed beforehand.

When formal training is available and is the best answer, the next decision is where

not very effective. The objective of an OEM school is not to make the customer capable of doing service on their own.

There are a few ISOs that offer service training on imaging systems. A couple have technical training as their main product. Many ISOs that offer service training are companies that sell parts and systems.

The objective is typically to make the student capable of working on the equipment in order to sell parts or systems to them.

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evaluating a training provider is the level of expertise the trainer and the company have. An OEM will tell you they have the greatest knowledge of the system. That may be true, but are they going to share that knowledge with you? An ISO that repairs and refurbishes parts and systems usually developed that capability through reverse engineering, and as a result they learn a lot about how to test and repair the system. Before you commit and invest in a training class, make sure you will be able to get passwords or whatever you may need in order to service the system. An ISO class may include training on workarounds to the barriers OEMs have created.

Since most of the imaging engineers I know learn best by doing, and there are often certain “gotchas” to watch out for when working on a particular scanner, the availability of systems for hands-on sessions is important. Other factors to consider are whether updates to the training materials and ongoing technical support are provided after the training class.

Whatever method you use, be intentional about technical training. The best training not only teaches the student how to maintain and service the equipment, it makes them confident in their ability to do so. ICE Jim Carr is Director of Service and International Operations for AUE. He may be contacted via email at JCarr@auetulsa.com.

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insight

CAREER ADVICE Value of CRES Certification for Service Professionals

I

n over 20 years of recruiting and placing of diagnostic imaging service engineers, I have found that a very small percentage of that talent population have the Certified Radiology Equipment Specialist (CRES) certification or have even heard of it. I am sure this is because the radiology equipment service industry, considering that the ISE’s actual equipment training certifications to carry more weight or value.

This is understandable due to the ever changing technology and high cost of radiology equipment, service and parts that the hospital, health system, and/ or independent service organizations (ISOs) incur.

Even those radiology equipment training certifications can vary in value from an employer’s perspective with original equipment manufacturer (OEM) training carrying the most value, third-party training is often considered second in value, and on-the-job training (OJT) ranks third for many. The cost for an employer to provide training can be very high so if you already come with that training it saves them money and makes you a more desirable candidate.

However, years of experience and an ability to service several modalities, vendors and models can outweigh this.

48

ICEMAGAZINE | MAY/JUNE 2017

The career value of having the CRES certification for a diagnostic imaging service engineer is that it sets one apart since so few have this certification, especially if one goes into radiology or imaging service management.

So, what is CRES and it’s career value?

CRES is a certification that is a formal recognition by the Association of Advancement of Medical Instrumentation (AAMI) Credentials Institute for individuals who have demonstrated excellence in theoretical as well as practical knowledge of the principles of medical equipment technology.

The certification program recognizes healthcare technology professionals whose practice reflects a high degree of knowledge about medical devices and clinical practice as well as skill in imple-

Written by Jenifer Brown Health Tech Talent Management.

menting electro-mechanical talent in the repair and maintenance of devices used in the delivery of health care. Achieving AAMI Credentials Institute (ACI) certification indicates that an individual has demonstrated a broad knowledge skillset in the specific certification area of medical imaging technologies, including regulatory requirements.

Healthcare technology management professionals who desire a CRES certification are expected to have experience in a wide-range of medical imaging modalities, electromechanical devices, computers, networks and software used in the delivery of health care. Generally, candidates in this category may work for medical device manufacturers, hospitals, clinics, medical device repair companies, regulatory bodies/agencies, and software manufacturers – such as EMR or device integration providers.

The career value of having the CRES certification for a diagnostic imaging ADVANCING THE IMAGING PROFESSIONAL

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insight

BRIDGING THE GAP Clinician and Pro Discuss “Alternative Options”

F

irst and foremost, thank you to all ICE magazine readers for joining us as we chat. The theme of this column will focus on Bill H.R. 2118 Medical Device Servicing Safety and Accountability Act. What is the significance of this proposed legislation? The time of mandated registration with the FDA is now coming upon the independent or alternative service provider (ISO) industry sector. This tide of change has been building for many years and is now ready to come crashing on shore. Its benefits will be many and will drive a new era of healthy competition in both the OEM and ISO service market sectors.

As we “Bridge the Gap” in this edition, we have two very experienced and seasoned professionals. Clinical Radiology Administrative Leader Dina Loughlin and In-House Radiology Engineer Specialist Jack Minter join in a discussion around the theme of ISO and OEM options.

When health care clinical leaders, 50

ICEMAGAZINE | MAY/JUNE 2017

in their decision process regarding imaging equipment service support, consider options it can be an overwhelming preference toward the original equipment manufacturer (OEM). It is a natural polarization and safe direction for any clinical leader to choose. Is it always the most prudent and financially sound pathway to follow? That is generally where the debate begins. In posing this question to Loughlin, she shared that the main reason for this preference by most clinical imaging leaders is tied to confidence. OEMs are grown and supported organically from the vast research and development resources they possess from the creation and maintenance of products. Training, technical support and escalation processes are a few of the OEM tools available to OEM field engineers in supporting the manufacturer’s product. Minter echoed her comments adding that this is especially true with the “latest and greatest” of imaging technologies that come to market. ISOs and in-house

Written by Alan Moretti Healthcare Technology Management Advisor

support service capabilities are generally limited because of the “newness” of the technology. He also pointed out that OEMs are reluctant to train ISOs because they view them as competition. Training by the OEMs to in-house teams follows that same suit at least in the first and sometimes second years of a new technology coming to market.

The conversation points and comments from both Loughlin and Minter changed dramatically around clinical confidence when older imaging systems or “legacy equipment” came into play.

They concurred that in the “legacy technology” area ISOs and in-house do

ADVANCING THE IMAGING PROFESSIONAL

insight

This tide of change has been building for many years and is now ready to come crashing on shore. Its benefits will be many and will drive a new era of healthy competition in both the OEM and ISO service market sectors. tend to be an equal, and many times a better, alternative service resource to directly servicing through the OEM. Minter shared the reasoning that skill sets within the OEM workforce can be more focused on the “new product” technologies entering the field. He stated that in most hospital and imaging center settings it is more common to have 5, 10 and 15-year-old imaging technologies deployed in the clinical setting. These older technologies many times are sun-set internally with the OEM, in turn, no longer training staff or the legacy trained engineers are no longer employed with the OEM. Minter also points out that many times these “seasoned” engineers leave the OEM WWW.IMAGINGIGLOO.COM

to join ISOs or in-house teams bringing with them a wealth of knowledge and experience regarding legacy technologies. Loughlin said ISOs and in-house teams bring a dynamic the OEMs generally cannot in an ability to provide service across all imaging modality lines including different manufacturers.

She says that ability puts the ISO and in-house service model in a top-pole position compared to the OEM’s siloed engineer approach limiting crossover.

When the conversation came around to imaging service training, basic and advanced principle courses through an ISO were deemed an acceptable education path that provides a good foundation in developing service staff.

Equipment specific service training was a different story. They expressed an opinion that the OEM is a better resource in this area. ISOs can and do service train in this space, but can be limited as it relates to curriculum, training staff and access to equipment technologies for hands-on laboratory sessions.

Much can be gleaned from the diversity of offerings and options available when sizing up the question, “What is the desired and preferred service support resource?” Along this forked road is an OEM and a ISO/in-house pathway.

Each brings varied value propositions and opportunities as well as levels of risk – navigate wisely! ICE ICEMAGAZINE

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ADVANCING THE IMAGING PROFESSIONAL

Until the next issue stay connected online. news • blogs • forums • job listings • community

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ADVANCING THE IMAGING PROFESSIONAL

index

AUE

ADVANCED ULTRASOUND ELECTRONICS

D E FINING THE S TAN D ARD

Advanced Ultrasound Electronics p. 46 Injector Support & Service p. 35

Philips Healthcare P. 2

Bayer Healthcare p. BC

Summit Imaging p. 11

Technical Prospects p. 13, 15, 17 KEI Med Parts p. 49

PM Imaging Management p. 36

Diagnostic Solutions p. 47

KEI Medical Imaging Services p. 35

Radiology Business Management Association p. 49

The Intuitive Biomedical Solutions p. 40

Field MRI Services p. 25 Kopp Development, Inc. p. 34 Health Tech Talent Management p. 36

MEDICAL

SYSTEMS TECHNOLOGIES LLC

IMES (A Division of Richardson Healthcare) p. 43

THE JDIS GROUP

Radiology Data p. 6

RSTI/ Radiological Service Training Institute p. 4

Medical Systems Technologies p. 35

MedWrench p. 45

RTI, Inc. p. 25

SOLUTIONS

Tri-Imaging Solutions p. 19

Webinar

Wednesday

Webinar Wednesday p. 23

X-ray Parts, Inc p. 36

CT • MRI • PET/CT • MOBILE

JDIS Group p. 8

54

ICEMAGAZINE | MAY/JUNE 2017

PartsSource p. 5, 30

Sodexo CTM p. 3

ADVANCING THE IMAGING PROFESSIONAL

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