Medical Dealer - October 2017

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METHOD TO LEAN-NESS

BIG BENEFITS ONLY POSSIBLE FROM

BIG CHANGES

“We’re talking about the change of the culture of the organization.

Where the leadership really

“There’s a lot of people wanting to

understands the difference between

move into these areas, and people

tools and cultural change, that’s

trying to move out of the big cities.”

where you get the breakthrough

42

types of results.”

56

CONTENTS_Features 42 METHOD TO LEAN-NESS: BIG BENEFITS ONLY POSSIBLE FROM BIG CHANGES

In the endless search for cost savings and process improvement in health care, one of the more popular areas of interest to emerge within the past 20 years is lean methodology. Medical Dealer takes a look at how health care staff can use the method to their advantage.

56 OFF THE CLOCK GREGORY HEMPHILL

After 14 years at PartsSource, Gregory Hemphill has grown with the organization.

He recently decided to try out the business techniques he’s learned by launching his own house-flipping company, The Hemphill Group.

Medical Dealer (Vol. 20, Issue #10) October 2017 is published monthly by MD Publishing, 18 Eastbrook Bend, Peachtree City, GA 302691530. 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. © 2017

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MEDICALDEALER 9

INDUSTRY UPDATE 13 News & Notes MD Publishing 18 Eastbrook Bend Peachtree City, GA 30269 (800) 906-3373 Fax: (770) 632-9090 Publisher

John M. Krieg john@mdpublishing.com

Vice President

Kristin Leavoy kristin@mdpublishing.com

Editor

John Wallace jwallace@mdpublishing.com

Art Department Jonathan Riley Sarah Sutherland Karlee Gower

18 People on the Move 20 OEM Update

MARKET ANALYSIS Imaging: Mammography 27 Market Analysis 28 Product Showroom 33 Preferred Vendors Med/Surg: Lasers 37 Market Analysis 38 Product Showroom 41 Preferred Vendors

Account Executives Jayme McKelvey Lisa Gosser Nicolle Endoso

Contributors

Jim Fedele Matthew N. Skoufalos Dan Bobinski

SLICE OF LIFE 50 Jim Fedele 52 Dan Bobinski 56 Off the Clock

Accounting

Kim Callahan

58 Marketplace

Circulation

60 Categorical Index

Lisa Cover Melissa Brand

62 Alphabetical Index

Digital Services Cindy Galindo Jena Mattison Travis Saylor Kathryn Keur

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INDUSTRY UPDATE_News and Notes

PRIVATE EQUITY FIRM BUYS BAYER’S MULTI VENDOR SERVICE, WETSCO AND MD MEDTECH The private equity firm Resilience Capital Partners has announced that a fund managed by the firm has acquired three medical device service and manufacturing units. The move establishes Resilience Capital Partners as one of the leading providers in this growing segment of the health care industry, which is relying on these third-party device repair companies to control costs. The units acquired by Resilience Capital Partners are the Multi Vendor Service (MVS) unit of Bayer’s Radiology business; Wetsco Inc.; and MD MedTech LLC (MDMT).

All three businesses – MVS, Wetsco and MDMT – are being combined and will operate under a new holding company, Innovatus Imaging Corporation.

The fund also has reached a definitive agreement to acquire the European operations of MVS, based in Maastricht, the Netherlands. This transaction is expected to close by March 31, 2018. In the interim, Innovatus Imaging will continue to serve European customers through a transitional service agreement with Bayer.

“The creation of Innovatus Imaging through the acquisitions of MVS, Wetsco and MDMT gives us the scale and synergies to succeed in a market that is projected to grow by double-digit figures over the next five years as health care providers are asked to do more with less and extend the life of costly medical devices through repair and servicing,” said Steven H. Rosen, co-CEO of Resilience Capital Partners.

Ensuring continuity, Innovatus Imaging will draw its leaders from the senior ranks of the acquired companies.

• Dennis Wulf, former president of Wetsco and chief executive officer of MDMT, will serve as chief executive officer (CEO) of Innovatus Imaging and is a co-investor in the new company.

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• Bill Kollitz, formerly general manager of MVS, will serve as president and chief operating officer (COO) of Innovatus Imaging.

• Michael LaBree, co-founder, chief operating officer and vice president, engineering of MDMT, will serve as chief technology officer (CTO) of Innovatus Imaging.

“All three of these businesses have enjoyed strategic partnerships and customer relationships over the years, and so it is a natural fit to combine them under a single company umbrella,” said Bassem Mansour, co-CEO of Resilience Capital Partners. “This combination of talent and resources will enhance performance in high-growth areas, helping increase the new company’s offerings in medical equipment repair while enabling it to develop groundbreaking medical imaging products.”

Pittsburgh-based MVS previously was part of Bayer’s Radiology business. It is a market leader in the third-party service-repair business for radiology devices, including ultrasound probes, magnetic resonance imaging (MR) coils and computed radiography readers, dry film printers and the sale of digital radiography detectors. MVS has been a frequent customer of MDMT, purchasing its ultrasound probe replacement components.

Staff Reports

Tulsa-based Wetsco is a leading third-party ultrasound probe repair provider that has an exclusive alliance with MVS since 2008, specializing in repair and capability development on standard and 3D/4D probes.

Based near Denver, MDMT designs and manufactures specialty medical ultrasound products for the OEM, third-party repair and research markets.

“The combination of MVS, Wetsco and MDMT within Innovatus Imaging will ensure our ability to support customers and the imaging community. It also will enable us to expand our service strategy and new product development,” said Wulf.

Resilience Capital Partners, which manages in excess of $625 million, has now completed 12 transactions over the past 12 months and 18 transactions in the past two years. Funding for the Innovatus Imaging transaction comes from Resilience Fund IV, which closed in October 2015 with $350 million in investable capital, and from co-investors including Pittsburgh-based North Park Capital Partners. The transactions involving MVS (U.S.), Wetsco and MDMT closed on August 31, 2017. Financial terms of the transactions are not being disclosed. • For more information, please visit www.resiliencecapital.com.

MEDICALDEALER 13

INDUSTRY UPDATE_News and Notes

SHARED IMAGING PROVIDES MOBILE DIAGNOSTIC IMAGING TECHNOLOGY TO KELSEY-SEYBOLD CLINIC Shared Imaging recently announced vice president of operations a partnership with Kelsey-Seybold at Kelsey-Seybold. “Our patients Clinic in Houston, Texas, in delivappreciate having imaging services ering comprehensive solutions via a within their community. They unique functional service business realize that without mobile imaging model. Through this model, Shared service, they would have to travel to Imaging provides Kelsey-Seybold another location.” with seven mobile medical coaches From determining the right tech(three MRI, three CT and one PET/ nology to customizing financial terms CT), along with clinical staffing, and managing day-to-day operations, maintenance and service, and ongoShared Imaging works with health ing operational oversight. care providers to deliver market-foAs the nation’s first designated cused diagnostic imaging solutions. accredited Accountable Care Or“We are committed to helping ganization with 20 clinics, more our health care partners fulfill their than 400 physicians in 55 medical mission in serving their communispecialties, and serving more than ties,” said Larry Siebs, president and 500,000 patients in Greater Houston, CEO of Shared Imaging. “We assume Kelsey-Seybold’s goal is to provide full responsibility for managing the patients with high-quality care that technology throughout its lifecycle is cost-effective and convenient. and the duration of our relationship “The partnership we have with so that our customers can remain Shared Imaging allows us to bring focused on their core competency, high-end imaging closer to our which is providing excellent patients, without having to bear the patient care.” cost of a fixed unit in each of our The long-standing relationship multiple locations,” said John Lyle, between Kelsey-Seybold and Shared

Staff Reports

Imaging began in 2004. The organizations recently extended their contractual agreement in which Shared Imaging assumes ownership of the technology and provides it to Kelsey-Seybold for a monthly fee. This model, which allows providers to retain the technology for much shorter term lengths than with a capital purchase, has allowed Kelsey-Seybold to upgrade all of its CT, MRI and PET/CT systems provided by Shared Imaging after using the previous technology for less than three years. •

FORT WORTH IS LARGEST STERILIZATION FACILITY IN STERIGENICS’ GLOBAL NETWORK Sterigenics International LLC has “Our investment gives Sterigenics announced the completion of anoththe extra capacity we need to benefit er major expansion, this time to its from these opportunities and Fort Worth, Texas facility, making it will help make us the provider of the largest sterilization facility in the choice for sterilization services in company’s global network. the Southwest.”

The $17.5 million expansion Opened in 1984, Sterigenics’ Fort includes the installation of a new, Worth facility provides routine world, Sterigenics is making signifstate-of-the art Nordion JS10000 gamma, GammaStat rapid processing icant investments in technology to gamma irradiator that will dramatand process validation, and offers expand both Gamma and Ethylene ically increase Sterigenics’ total calaboratory testing services through Oxide (EO) capacity throughout its pacity, allowing customers to better its Nelson Labs business. The exglobal network. On the Gamma side, address their geographic needs by pansion increases the facility’s total in June, 2017, Sterigenics completed taking advantage of Fort Worth’s sterilization throughput by 60 pera project that tripled throughput growing importance as a commercial cent, adding 50,000 pallets per year at its operation in West Memphis, gateway to the United States. in capacity, 20 new employees, and Arkansas, and opened a significant “Fort Worth’s location along 60,000 square feet to the building’s expansion in Gurnee, Illinois, in major transportation links makes it a footprint. At 145,000 square feet 2015. In addition, Sterigenics has exnatural distribution and logistics hub Fort Worth is now the largest operapansion projects underway at its EO for manufacturers and for imports tion in Sterigenics’ global network. facilities in Ontario, California, Costa into the United States,” said Philip To address the growing need for Rica, and Wiesbaden, Germany. • Macnabb, President of Sterigenics. sterilization in many parts of the 14 MEDICALDEALER | OCTOBER 2017

MEDICAL EQUIPMENT, PARTS & SERVICE

INDUSTRY UPDATE_News and Notes

Staff Reports

SUNTECH MEDICAL FEATURES OSCAR 2 FOR 24-HOUR ABPM SunTech Medical displayed its Oscar Oscar 2 with optional 2 ambulatory blood pressure monicentral blood pressure tor at the 2017 Florida International measurement is powered by Medical Expo.

SphygmoCor technology from The Oscar 2 uses patented sub-di- AtCor Medical. Backed by over astolic waveform measurement with 800 published studies, the motion tolerant technology to reduce technology is considered the failed readings and repeated studgold standard in pulse wave ies due to motion-related artifacts. analysis and central blood The device features AccuWin Pro 4 pressure measurement. • software for efficient programming and data analysis. Optional Bluetooth For more information, connectivity pairs with SunTech visit www.suntechmed.com.

Medical’s True24 patient diary mobile app, supporting patients with device tutorials and prompts to enter information about their activity, posture or symptoms after a BP measurement is taken.

THE INTERMED GROUP SELECTS NUVOLO’S CLINICAL EAM PLATFORM The InterMed Group, a provider of operational. The company provides multi-modal health technology mana range of services including a group agement (HTM) services, has selectof on-call, mobile professionals that ed the Nuvolo cloud-based enterprise supplement internal resources called asset management (EAM) platform “jump teams”, to fully managed to deliver next generation service services for ultra-sophisticated and efficiency, quality and reliability to its lifesaving health care equipment. clinical health care clients.

Reliable online and offline mobile Built on ServiceNow, Nuvolo is a and timely access to operational data cloud-based EAM company. Nuvolo is mission critical to InterMed for was honored this year by ServiceNow excellence in service delivery, maxand its clients for achieving the Amer- imum equipment uptime and safe, icas’ highest customer satisfaction quality patient care. Nuvolo’s modrating and ranking as the top indepen- ern, cloud-based clinical asset mandent software vendor (ISV) globally. agement platform is purpose-built to InterMed’s focus on clinical deliver these results. engineering services delivers better “We evaluated more than 10 patient care by ensuring that some CMMS or EAM technologies in the of the most complex and essential market, and chose Nuvolo because equipment used in the medical no other provider even came close,” industry today – including digital said Rick Staab, CEO of InterMed. “It radiography, X-ray computed tois by far the most flexible, advanced mography (CT), magnetic resonance and modern health technology imaging (MRI) and other nuclear, management platform. The compaultrasound and optical-imaging ny’s responsiveness is excellent and techniques – are safe, compliant and their platform is fully optimized to

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manage the complex and expensive devices we service and maintain.

We always strive to bring the best capability to our clients, and Nuvolo is clearly the best.”

“InterMed is a progressive and innovative services organization that has built a national network of top-tier technicians.

The InterMed team delivers industry-leading service management for a fleet of complex and sophisticated medical equipment,” said Tom Stanford, CEO of Nuvolo. “We are pleased to have such an exceptional group of clinical health care technology specialists select our EAM platform as a critical enabler of their health care service management business. We are excited to be moving ahead in this strategic partnership.” • For more information on Nuvolo and The InterMed Group, visit www.nuvolo.com and www.intermed1.com

MEDICALDEALER 15

INDUSTRY UPDATE_News and Notes

VISTAMED EXPANDS CATHETER MANUFACTURING OPERATION square feet; this includes four adFreudenberg Medical, a global developer and manufacturer of medical ditional ISO Class 7 cleanrooms for contract manufacturing of cathedevices, components, and minimally invasive solutions for the medical de- ter-based minimally invasive devices.

Also included in the new facility is a vice industry, announces VistaMed’s gym for VistaMed team members. expansion of its catheter manufac“This latest expansion is in turing facility in Carrick-on-Shanresponse to the strong demand that non, Ireland. VistaMed, a FreudenVistaMed is experiencing for its berg Medical joint venture company, products and services in the interis a leading provider of catheter national minimally invasive medical development and assembly services, device sector, specifi cally focused complex extrusions, and minimally on catheter-based technologies,” invasive devices to medical device said Patrick Mulholland, Managing OEMs. VistaMed is part of FreudenDirector of VistaMed. “The growth berg Medical’s Minimally Invasive we have experienced over the last Solutions group with five product few years would not have been development and manufacturing possible without the dedication and locations in the United States, Costa commitment of the VistaMed team Rica and Ireland. and our partnership with FreudenThe expansion of VistaMed’s existing facility has added 45,000 berg Medical.”

FDA RELEASES PLAN FOR DIGITAL HEALTH REGULATION fication (PreCert) pilot program that Recognizing that the traditional focuses on assessing the makers of approach to regulation cannot keep the software, not the product itself. up with the fast-paced iteration of “The Software PreCert Pilot digital health products, the Food Program is a voluntary program that and Drug Administration (FDA) has released a plan to promote “digiwill enable us to develop a tailored tal health innovation.” As part of approach toward regulating this technology by looking first at the software this regulatory plan, the Center for developer and/or digital health techDevices and Radiological Health nology developer, rather than primar(CDRH) will issue new guidance, pilot a firm-based approach to reviews, ily at the product, which is what we and strengthen its digital health unit. currently do for more traditional medical devices. This pilot will help FDA ”The challenge FDA faced in the past is determining how to best regestablish the most appropriate criteria ulate these non-traditional medical for standing up a firm-based precertification program for these new tools,” tools with the traditional approach the agency said on its website. to medical product review,” FDA The FDA will select up to nine Commissioner Scott Gottlieb wrote participants from across the specin a recent post on the FDA blog. trum of software developers that “We need a regulatory framework that accommodates the distinctive produce both low- and high-risk nature of digital health technology, products. During the pilot, the agenits clinical promise, the unique user cy and participating companies will interface, and industry’s compressed “explore the use of external software commercial cycle of new product development standards to reduce premarket software documentation introductions.” burden,” according to a July 28 FedTo accomplish its objectives, CDRH launched a software precerti- eral Register notice.

16 MEDICALDEALER | OCTOBER 2017

Staff Reports

In 2016, VistaMed opened a state-of-the-art research and development center, also located in Carrick-on-Shannon, which includes a cleanroom for prototyping and first-in-man builds. •

“The goal of our new approach is for FDA to, after reviewing systems for software design, validation, and maintenance, determine whether the company meets the necessary quality standards and pre-certify the company. Pre-certified companies could submit less information to us than is currently required before marketing a new digital health tool. In some cases, pre-certified companies could not submit a premarket submission at all,” Gottlieb wrote.

This approach should reduce the time and money it takes for developers who “reliably manufacture high-quality, safe, and effective digital health devices” to enter the market, according to the FDA. Eligibility requirements and procedures for applying to participate in the pilot program are available in the Federal Register notice.

The agency will hold a public workshop in January to report on and review its initial findings. •

MEDICAL EQUIPMENT, PARTS & SERVICE

INDUSTRY UPDATE_People on the Move

Staff Reports

PEOPLE ON THE MOVE

The Latest Personnel Moves in the Medical Equipment Field

Gian Cavallini, vice president of strategy and development for Advanced ICU Care, will chair the Industry Council of the American Telemedicine Association (ATA). The council comprises ATA non-hospital members, and is one of its two primary member groups.

Cavallini will coordinate its activities with those of the ATA Institutional Council. His two-year chairmanship expires in April 2019.

The Inova Health System of Fairfax, Virginia has named Michael Thomas director of its personalized health accelerator (IPHA). Thomas was most recently the founder and CEO of Appian Partners life sciences consultancy, has served on the boards of AdvaMed and Circadiance, and started his career in the pharmaceutical industry with Merck & Company and GlaxoSmithKline. He holds a bachelor’s degree in microbiology from Cornell University, and joins IPHA directors Hooks Johnston and Pete Jobse.

Henry Ford Health System EVP, CMO, and President-CEO of Henry Ford Hospital John Popovich will retire in mid-2018. Popovich joined Henry Ford Hospital in 1975 as an intern, and became its CEO in 2010, when he also became EVP and CMO of the health system. He has been senior staff physician for Henry Ford Medical Group and director of its medical ICU, headed up the pulmonary and critical care division for almost 10 years, chaired the department of internal medicine and was the health system’s senior vice president of clinical affairs. Popovich has written more than 150 journal articles, scientific abstracts, and book chapters, and created the blog “Doc In The D.” Anthem Inc. of Indianapolis, Indiana has named Jacquelyn Wolf its executive vice president and chief human resources officer. Wolf was most recently senior vice president and chief human resources officer for LyondellBasell. Wolf has a doctorate in human and organizational systems and a master’s degree in human and organizational systems from Fielding Graduate 18 MEDICALDEALER | OCTOBER 2017

University; she also holds a master’s degree of science, business management, and administration from Baker University, and a bachelor’s degree in organizational communications from Youngstown State University.

NuVasive Inc. of San Diego, California has named Rajesh J. Asarpota its executive vice president and chief financial officer. Asarpota has 25 years of experience in financial and executive leadership roles across the health care industry, 10 of which were at Life Technologies. He has an MBA from Marquette University, and a bachelor’s degree from the University of Bombay.

Thomas H. Lee has been named president of the American Orthopaedic Foot & Ankle Society, and a member of the Orthopaedic Foot & Ankle Foundation board of directors. Lee holds a medical degree from the Columbia University College of Physicians and Surgeons, completed his orthopaedic residency at the New York Orthopaedic Hospital at Columbia-Presbyterian Medical Center, and completed a fellowship in foot and ankle orthopaedic surgery at Thomas Jefferson University Hospital in Philadelphia. He is a foot and ankle orthopaedic surgeon in private practice in Pickerington, Ohio.

Varian Medical Systems of Palo Alto, California named J. Michael Bruff vice president of investor relations, replacing the retired Spencer Sias. Bruff joins the company after a 19-year career at Dell, where he was most recently senior vice president of North America sales strategy and planning. He holds bachelor’s degrees in economics and science, both from the University of Maryland.

Verity Health System of Los Angeles, California appointed Richard Adcock as COO of its six-hospital chain. Adcock was most recently executive vice president and chief innovation officer for Sanford Health, where he has been director, vice president and executive vice president for Sanford Clinic as well as MEDICAL EQUIPMENT, PARTS & SERVICE

president of Sanford Frontiers. Adcock began his career in the medical field as co-owner and vice president of research and development at Micro Medical Systems.

Siemens Canada of Oakville, Ontario has named Faisal Kazi its new president and CEO, effective September 1.

Kazi replaces current chair of Siemens Canada Robert Hardt, who departed the company in June 2017 to become a catalyst partner at the Siemens startup unit, next47. Kazi has worked for Siemens since 1991 in the Netherlands, Germany, and the United States.

After announcing plans to spin off its Diversey division to Bain Capital as a standalone business, Sealed Air Corporation of Charlotte, North Carolina has named Ilham Kadri Diversey president and CEO. Kadri has been president of the Diversey Care business for Sealed Air since 2013; prior to that, she worked for companies including Shell-LyondellBasell, Cytec, Huntsman, and Rohm Haas-Dow. Kadri is the founder and chair of The ISSA Hygieia Network, an advisory board member of Catalyst, serves on the board of directors of A.O. Smith Corp., and is a chemical engineer with a master’s degree in physics and chemistry and a doctorate in polymer reactive extrusion.

Change Healthcare of Nashville, Tennessee named Samuel Allen Hamood as its executive vice president and chief financial officer, effective August 21. Hamood joined the company from TransUnion Corp., where he has been executive vice president and chief financial officer since February 2008. He succeeds retiring executive vice president and chief financial officer Randy Giles.

Find weekly installments of People on the Move at MedicalDealer.com/magazine.

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MEDICALDEALER 19

INDUSTRY UPDATE_OEM Update

GE HEALTHCARE MAMMOGRAPHY SYSTEM ALLOWS PATIENTS TO CONTROL COMPRESSION BY REMOTE CONTROL GE Healthcare has announced FDA 510(k) clearance of an industry-first, patient-assisted mammography device that literally puts women in control of their mammograms. Senographe Pristina Dueta is an innovative remote control that allows women to manage their own compression during the exam performed on the company’s new mammography system, Senographe Pristina.

“Mammograms can be uncomfortable or even painful,” said Agnes Berzsenyi, President and CEO of GE Healthcare Women’s Health. “Engineered by a team of women for women, GE Healthcare has transformed mammography with the creation of patient-assisted compression to decrease pain associated with the exam, improve patient experience and increase outcomes for breast cancer screening which we know saves lives.”

In traditional mammography, the technologist performing the exam compresses the patient’s breast, often causing discomfort. Patient-assisted compression allows women to control the application of compression to minimize the perceived pain and discomfort often associated with a mammogram. After the breast is properly positioned by the technologist, the patient can use a handheld wireless remote control to command Senographe Pristina to adjust the compression paddle based on the patient’s comfort level.

“This is a new age in breast imaging,” said Dr. Kathy Schilling, Medical Director of the Boca Raton

20 MEDICALDEALER | OCTOBER 2017

Staff Reports

Regional Hospital’s Christine E. Lynn Women’s Health & Wellness Center and the radiologist who conducted a clinical review of the new tool. “Patients who used the remote control said the exam was more comfortable and they were visibly more relaxed. Any breast radiologist knows that when patients are relaxed, we are able to get better images and better images lead to a more confident diagnosis. My hope is that increasing comfort during the exam and giving patients the option of working with the technologist to set their own compression will increase compliance, enable early detection and improve outcomes.”

Patient-assisted compression is the newest comfort feature available on Senographe Pristina, a totally

redesigned mammography system that has replaced traditional design with rounded edges and a thinner image detector to create a more pleasant experience for women as well as armrests that position women to relax rather than tense up during the compression and image acquisition process.

“No woman should miss out on the potentially life-saving benefits of regular mammograms out of fear or anxiety of discomfort,” Berzsenyi said. “Senographe Pristina was designed with empathy. It humanizes the mammography experience by increasing comfort and reducing patient anxiety. The system’s potential to help increase the number of annual screening exams is a critical advancement in women’s health care.” •

MEDICAL EQUIPMENT, PARTS & SERVICE

_OEM Update

CARESTREAM WINS AWARD FOR REDUCING ENERGY CONSUMPTION Carestream’s manufacturing plant in are adding additional equipment to Windsor, Colorado, earned a Colachieve production goals.” orado Industrial Energy Efficiency The Colorado plant achieved enaward from the Colorado Energy ergy savings of 5,119 megawatt hours Office. In the past two years, Careover two years with several major stream Colorado has reduced energy renovation efforts: consumption by 5.4 percent at its • Plant engineers rebuilt a Windsor manufacturing facility. The 40-year-old steam turbine chiller company’s goal is to achieve an addi- that significantly reduces electricity tional 5 percent reduction in energy consumption use from 2015 to 2020.

• Variable frequency drives were Carestream joined the Colorado installed on four cooling tower fan Industrial Energy Challenge (CIEC) motors; Eight cooling tower supin 2011 and has reduced energy conply pumps and three chilled water sumption by 21 percent during the pumps allow each system to use last five years. only the precise amount of energy “We continuously examine our required to obtain the desired flow of manufacturing processes and prodwater for manufacturing operations uct components to identify areas Carestream Colorado maintains where we can help preserve the envi- an ongoing list of projects designed ronment,” said Cavan Kelsey, Careto enhance production and reduce stream’s Corporate Environmental energy use. The facility has invested Health and Safety & Sustainability in training a certified energy managDirector. “Our aim is to reduce er (CEM) to more effectively analyze energy use by increasing the efficien- and prioritize opportunities for cy of our operations even when we energy savings.

DIVERSEY’S MOONBEAM3 DISINFECTION SYSTEM WINS AWARD Sealed Air’s Diversey Care division UVC light to quickly kill pathogens. announced it has received the 2017 The system has been third-party Association for the Healthcare Envitested and demonstrates three to ronment (AHE) Innovation Award for five-log reductions in harmful pathoits MoonBeam3 Disinfection System, gens such as MRSA, VRE, MDR a device that uses powerful ultraviolet Gram negative bacteria, and norovi(UVC) technology to kill pathogens rus in as little as 3 minutes and C. diff on high-touch surfaces. The anspores in as little as 10 minutes. nual Innovation Award recognizes “We are honored to receive this products, processes and technology award, and are very excited about advancements that help improve pathis portable, fast and easy-to-use tient outcomes. Designed to be used innovation,” said Carolyn Cooke, in conjunction with manual cleaning Vice President, North American and disinfection, the MoonBeam3 Healthcare Sector, Diversey Care. system’s three adjustable arms allow “Traditional UV disinfection tower users to target the UVC dose, taking designs are most effective on verdisinfection to the next level. tical surfaces, and often provide a The arms generate a broad umlower dose of UVC to horizontal brella (a 7 foot by 11 foot area) of surfaces like beds or overbed tables. intense, 254-nanometer wavelength With adjustable coverage, Moon-

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In addition, Carestream recycles a variety of materials and works to control hazardous waste from product manufacturing and maintenance activities.

Carestream is updating its Environmental Management System to meet the new ISO 14001:2015 standard. The latest standard includes goals for sustainable resource use and climate change mitigation, as well as the incorporation of lifecycle thinking into product design. •

Beam3 allows users to direct the dose to high-touch surfaces. Plus, it is significantly more affordable to own and operate than other technologies available in the market.”

Weighing less than 40 pounds, the MoonBeam3 system is ultra-portable, enabling environmental services professionals to disinfect even tight spaces like patient restrooms. It also incorporates a number of safety features, including infrared motion sensors, proximity sensors and a physical accelerometer. The bright yellow cover acts as a safety cone to alert staff and visitors that the device is in use, and as a remote control that starts the device from outside of the room and automatically stops the cycle if entry or motion is detected. •

MEDICALDEALER 21

INDUSTRY UPDATE_OEM Update

SHIMADZU CORPORATION RECEIVES AWARD Shimadzu Corporation was recogby Frost & Sullivan, a company that nized for its global strategies and employs more than 1,800 consultants product launch efforts for diagnostic and industry analysts in offices locatX-ray imaging systems and received ed in more than 40 countries around the 2017 Global General Radiography the world. The award is presented to Product Line Strategy Leadership the company that introduces prodAward from Frost & Sullivan, a major ucts and services that demonstrate global market research and consultthe highest leadership in the global ing company based in the U.S. The market for diagnostic X-ray imaging RADspeed Pro EDGE package gensystems in 2016 and employs the best eral radiography system, the Mobile- strategies for success.

DaRt Evolution MX7 version mobile Shimadzu, while continually X-ray system and the SONIALVIdesigning systems and software to SION G4 multi-functional universal reduce X-ray exposure to patient R/F system, were the systems that and caregiver alike and while also determined the merit for this award. improving the quality of images for The Global General Radiography diagnostic X-rays, was selected to Product Line Strategy Leadership be the first recipient of this award Award was newly created in 2017 for the year 2016. Additionally,

Staff Reports

Shimadzu continues developing leading-edge applications supporting numerous types of examinations and diagnostic procedures. These measures and the company’s ability to penetrate the global market with high-performance diagnostic X-ray imaging systems, that meet all types of customer demands and combine versatility and functionality, were highly praised, resulting in the winning of this prestigious award.

“With our constant focus towards contributing to global health care, we are committed to offering the highest quality and most reliable products and services everywhere,” said Shimadzu. •

HOUSTON METHODIST HOSPITAL, SIEMENS HEALTHINEERS ENTER INTO COLLABORATION Houston Methodist Hospital and al hybrid CT/angiography suite This agreement will make Siemens Healthineers have entered with the latest in advanced imaging Siemens Healthineers a primary into a multi-year agreement to bring technology. The collaboration and provider of diagnostic imaging cutting-edge technology to Housunprecedented access to advanced equipment to all Houston Methodton Methodist that is not currently imaging technology provides an opist campuses. With this agreement, available in the Texas Medical portunity for seamless clinical trans- Siemens Healthineers will provide Center. This agreement will provide lation, bringing treatments quickly a comprehensive coverage model, innovative, world-class medical from the lab to the patient’s bedside. including onsite service engineers, technology to Houston Methodist The two organizations also will a dedicated service manager, and Hospital and all of its community enter into an agreement to cononsite research scientists. hospital facilities. duct joint research at the Houston “We are eager to start our work Under the terms of the agreement, Methodist Research Institute, where together and look forward to seethe Houston Methodist Research Siemens Healthineers is also deliving the outcome of this promising Institute will be equipped with the ering an investigational 7T MR to collaboration,” said Marc Boom, latest technology in the areas of anbe used for research only. Siemens MD, President and CEO of Houston giography, magnetic resonance (MR) Healthineers engineers will work Methodist. “We also look forward to imaging, computed tomography at the Research Institute on new working with scientists at Siemens (CT), molecular imaging, imaging advancements in imaging with Healthineers who share our mission IT, and ultrasound. A focal point of researchers from around the Texas of leading medicine.” • the facility will be two interventional Medical Center who will have access suites that incorporate a traditionto the facility.

22 MEDICALDEALER | OCTOBER 2017

MEDICAL EQUIPMENT, PARTS & SERVICE

_OEM Update

MOFFITT CANCER CENTER ADDS INFINIX-I 4D CT SYSTEM the interventional lab and CT scanCancer patients at Moffitt Cancer ner can transform workflow, elimiCenter in Tampa, Florida, now have nating the need to transfer patients access to advanced diagnostic imagbetween departments, decreasing ing for fast and safe exams with the facility’s Infinix-i 4D CT system from procedure time and maintaining patient safety.

Toshiba Medical, a Canon Group “Time is critical when treating company. Moffitt is the first health cancer patients, and we acquired the care provider in the state of Florida Infi nix-i 4D CT to help us provide to use the system’s innovative mergfaster and safer care to more paing of the Infinix-i angiography systients,” said Grace Cabral, Patient tem and Aquilion PRIME CT system Care Manager of Interventional for interventional radiology (IR) and Radiology at Moffi tt. “With the new oncology procedures. The system system we can capture high-quality may help clinicians improve visualimages more quickly than before ization and workflow and increase without having to transfer patients patient safety. between machines, which has alMoffitt is using the Infinix-i 4D lowed us to double our embolization CT for a variety of IR and oncology case load and significantly reduce procedures to more efficiently plan, wait times for ablations and bioptreat and verify in a single clinical setting. The system’s integration of sies. Additionally, the system’s small

footprint allowed us to install the Infinix-i 4D CT quickly, with little downtime for construction, so we could begin utilizing it with patients right away.”

The Infinix-i enables clinicians to provide precision and flexibility during intervention with fingertip-to-fingertip and head-to-toe coverage and enables patient access with the Access Halo. As a true CT system, the Aquilion PRIME produces image quality that far exceeds CT-like imaging of the interventional lab. Toshiba Medical’s third-generation iterative dose reconstruction software, AIDR 3D Enhanced, offers simplified CT dose reduction, while the Infinix-i has a suite of dose management features including the Dose Tracking System. •

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PRODUCT FOCUS_Imaging_Market Analysis

Staff Reports

GLOBAL MAMMOGRAPHY MARKET NEARS $4 BILLION T

he breast imaging and mammography markets continue to grow amid a more educated global population, increased awareness and advanced technology.

Grand View Research predicts the global mammography market will approach $4 billion within a decade.

“The global mammography market is expected to reach a value of $3.8 billion by 2025,” according to a report by Grand View Research Inc. “The market growth can be attributed to the rising initiatives by various governments and NGOs to raise awareness about early diagnosis of microcalcifications in breast tissue. Some significant organizations such as the National Breast Cancer Foundation, CDC, and Breast Cancer Organization are promoting the early diagnosis of mammary gland calcification, which is one of the crucial factors expected to drive the demand over the forecast period.”

“Based on a report published by the National Cancer Institute in 2015, it was stated that the proportion of women aged 45 to 65 years had increased to 81.1 percent in breast cancer screening,” according to Grand View Research. “Major mammography manufacturers are introducing new products and increasing the number of approved products, which is further expected to impel the deWWW.MEDICALDEALER.COM

mand in the coming years.”

“In January 2016, FDA approved a new manual for digital mammography quality control by the American College of Radiology. The growing number of awareness campaigns to promote womens’ health services is also anticipated to propel growth,” Grand View Research added.

MarketsandMarkets predicts even more growth.

“The market is expected to reach $4.14 billion by 2021, at a CAGR of 8.5 percent from 2016 to 2021,” according to MarketsandMarkets.

“Growth in the breast imaging market is driven by factors such as the rising incidence of breast cancer globally; growing government investments and funding for breast cancer treatment and related research; increasing awareness about early detection of breast cancer; rising geriatric population; technological advancements in breast imaging modalities; and launch of advanced breast imaging systems capable of detecting cancer in women with dense breast tissues,” according to MarketsandMarkets. “In addition, the growing demand for breast im-

“Based on a report published by the National Cancer Institute in 2015, it was stated that the proportion of women aged 45 to 65 years had increased to 81.1 percent in breast cancer screening.” aging in emerging Asian countries, and technological advancements in breast cancer detection are expected to offer high growth opportunities for market players. However, factors such as high installation cost of breast imaging systems, side-effects of radiation exposure, and errors in breast cancer screening and diagnosis are restricting the growth of the global breast imaging market.”

“North America is estimated to be the largest regional segment in the global breast imaging market in 2016, followed by Europe,” MarketsandMarkets reports.

Some of the key industry players are Fujifilm, Hologic, Philips Healthcare, Siemens Healthineers, Toshiba Medical Systems Corp. and GE Healthcare.

MEDICALDEALER 27

PRODUCT FOCUS_Imaging_Product Showroom

Staff Reports

IMAGING PRODUCTS: This month, Medical Dealer explores Mammography

FUJIFILM

ASPIRE Cristalle Digital Mammography System

T

he ASPIRE Cristalle FFDM system with DBT combines Fujifilm’s state-of-the-art hexagonal close pattern (HCP) detector design, advanced image processing and image acquisition workflow to optimize patient dose while maximizing image quality. With the DBT software option, the X-ray tube moves through an arc around the breast, acquiring a series of low-dose image slices at different angles, producing a three-dimensional view allowing radiologist to see through tissue less obstructed. The acquired images are reconstructed into a series of high-resolution 1 millimeter slices displayed individually or dynamically in a cine mode – making it easier to identify lesions that might be difficult to see in traditional 2D mammography images due to overlapping breast structures. This will bring a new level of diagnostic confidence in screening, and especially for those women with dense breast tissue who are at higher than average risk and more difficult to screen with traditional 2D only. •

28 MEDICALDEALER | OCTOBER 2017

MEDICAL EQUIPMENT, PARTS & SERVICE

Imaging_Product Showroom

GE HEALTHCARE

Senographe Pristina

S

enographe Pristina was designed to completely revolutionize the patient experience to make it more comfortable.

The gentle, rounded corners of the bucky, where the breasts are positioned, help reduce patient discomfort. Instead of requiring women to use conventional handgrips, which may cause tensing of pectoral muscles, making it hard to acquire pristine images, they can lean comfortably on armrests, relaxing their muscles to simplify positioning, compression, and image acquisition. Senographe Pristina’s DBT delivers superior diagnostic accuracy at the same low dose as a 2D mammography exam, the lowest patient dose of all FDA approved 3D mammography systems. •

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MEDICALDEALER 29

PRODUCT FOCUS_Imaging_Product Showroom

Staff Reports

HITACHI ALOKA MEDICAL AMERICA

SOFIA 3D Breast Ultrasound System

D

esigned for women whose breast density may result in an inconclusive mammogram, SOFIA uses ultrasound to create a 3D volume of the whole breast. Patients are imaged in the prone position, placing their breast onto SOFIA’s unique radial scanning array. With the breast compressed simply by laying prone, the patient rests comfortably during the system’s rapid automated 30-second scan. The acquired high-resolution ultrasound images are then sent to the SOFIA workstation and reconstructed into a 3D volume of the entire breast that can be quickly interpreted by the radiologist. Hitachi Aloka Medical America Inc. distributes the SOFIA 3D whole-breast ultrasound system through an exclusive agreement with iVu Imaging Corp. •

30 MEDICALDEALER | OCTOBER 2017

MEDICAL EQUIPMENT, PARTS & SERVICE

Imaging_Product Showroom

HOLOGIC

Genius 3D Mammography

T

he Genius 3D Mammography exam is FDA-approved as superior to standard 2D mammography for routine breast cancer screening of women with dense breasts. The Genius exam has been commercially available in the United States since 2011, and the newly approved physician labeling is based on clinical studies proving that the exam improves invasive breast cancer detection while reducing unnecessary recalls among women of all breast densities, including those with dense breasts. The Genius 3D Mammography exam is only available on a Hologic 3D Mammography system.

It consists of a 2D and 3D image set, where the 2D image can be either an acquired 2D image or a 2D image generated from the 3D image set. •

Photo: Courtesy of HOLOGIC, Inc. and affiliates WWW.MEDICALDEALER.COM

MEDICALDEALER 31

PRODUCT FOCUS_Imaging_Product Showroom

Staff Reports

SIEMENS HEALTHINEERS

Mammomat Inspiration with HD Breast Tomosynthesis

T

his digital mammography system with optional High Definition (HD) Breast Tomosynthesis builds on the company’s established DBT platform, which has the industry’s widest tomo sweep of 50 degrees, delivers exceptionally clear images, and is the first solution approved for 3D-only mammograms. HD Breast Tomosynthesis incorporates new EMPIRE technology, which combines iterative and machine learning algorithms for clearer, more concise 3D reconstruction. While EMPIRE technology is approved as a 3D-only exam, it includes Insight 2D and 3D – synthetic software-generated visualization of tomo volumes in 2D and 3D. Insight 2D allows breast imagers to obtain a 2D image from the EMPIRE 3D image set, providing navigational support for 3D-only exams without adding dose. Insight 3D adds depth to breast anatomy visualization. •

32 MEDICALDEALER | OCTOBER 2017

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PRODUCT FOCUS_Med/Surg_Product Showroom

Staff Reports

SURGICAL LASERS MARKET ON THE RISE T

he surgical lasers market will be worth $2.37 billion by 2021, according to a report from MarketsandMarkets. The report studies the global surgical lasers market over the forecast period of 2016 to 2021.

“The market is expected to reach $2.37 billion by 2021; growing at a CAGR (compound annual growth rate) of 5.1 percent from 2016 to 2021,” according to MarketsandMarkets. “Factors driving the growth of this market include technological advancements in surgical lasers, high prevalence of chronic diseases, high prevalence of ophthalmic disorders, and growing preference for minimally invasive surgeries.”

The market is not without challenges.

“However, limited medical reimbursements and high procedural costs associated with laser surgeries are expected to limit the optimal growth of this market during the coming years,” MarketsandMarkets reports.

The United States is expected to remain a part of the largest share of the surgical lasers market in coming years with Asia growing at a fast rate.

“North America is expected to hold the largest share of the global surgical lasers market, followed

by Europe in 2016. However, the Asia-Pacific market is expected to grow at the highest CAGR from 2016 to 2021. Factors driving market growth in the Asia-Pacific region include the presence of a large patient population for target diseases (coupled with rapidly growing geriatric population), rising awareness among health care professionals related to the procedural benefits of surgical laWWW.MEDICALDEALER.COM

ser products, and increasing government initiatives to reduce the burden of ophthalmic disorders,” according to MarketsandMarkets.

A research study titled, “Surgical Lasers Market by Product Type, Procedure, and Application - Global Industry Analysis and Forecast To 2025” published by Crystal Market Research, states that the surgical lasers market is projected to be around $3 billion by 2025.

“On the basis of applications, the urology market is poised to grow at a significant CAGR during the forecast period.”

“High prevalence of chronic diseases, increasing geriatric population coupled with rise in ophthalmic disorders and rise in demand for minimal invasive

surgeries is expected to propel growth of the market,” according to Crystal Market Research. “According to World Health Organization in 2010, around 524 million people were aged 65 and above and this number is expected to triple and reach 1.5 billion by 2050.

Between 2010 and 2050, the aging population in developing countries is expected to increase by more than 250 percent as compared to 71 percent increase in developed countries. Such high prevalence of elderly population will increase demand for surgical lasers. Furthermore, rapid technological advancements in the field of laser surgeries will fuel growth of the market in coming years. However, high cost of laser surgeries and limited reimbursement policies are expected to hamper growth of the surgical lasers market.”

“The CO2 laser market is expected to be the fastest-growing segment during the forecast period,” according to Crystal Market Research. “This market is projected to grow at a significant CAGR from 2017 to 2025 due to the development of advanced cosmetic lasers.

On the basis of procedure type, the laparoscopic surgery market accounted for the largest share of the global surgical lasers market in 2016 due to rise in demand for minimal invasive surgeries and advantages of laparoscopic procedures.”

“On the basis of applications, the urology market is poised to grow at a significant CAGR during the forecast period,” Crystal Market Research adds.

MEDICALDEALER 37

PRODUCT FOCUS_Med/Surg_Product Showroom

Staff Reports

MED/SURG PRODUCTS: This month, Medical Dealer explores Surgical Lasers

LIGHTSCALPEL

CO2 lasers

L

ightScalpel is a USA-based designer and manufacturer of state-of-the-art, high-precision, durable and highly ergonomic CO2 lasers with exclusive flexible fibers. LightScalpel CO2 lasers deliver predictable and repeatable tissue response, fast ablation and instant hemostasis. The extremely precise cutting, minimal collateral damage, clear and bloodless operating field and minimal postoperative pain make the LightScalpel CO2 laser the tool of choice for soft-tissue surgeries. LightScalpel CO2 lasers are FDA cleared for incision, excision, vaporization, ablation and coagulation of soft tissue in medical specialties such as: oral surgery, dentistry, plastic and reconstructive surgery, dermatology, ophthalmology, otorhinolaryngology, podiatry, gynecology, neurosurgery, urology and general surgery. •

38 MEDICALDEALER | OCTOBER 2017

MEDICAL EQUIPMENT, PARTS & SERVICE

Med/Surg_Product Showroom

LUMENIS

Moses Holmium Technology

L

umenis’ patent-pending Moses technology represents a breakthrough in holmium laser lithotripsy. Its unique pulse delivery method optimizes energy transmission by modulating the laser pulse into two consecutive parts. This results in minimized retropulsion and stone migration, leading to more efficient and controlled procedures. Moreover, Moses’ proprietary combination of holmium laser systems and fibers is designed to increase stone ablation rate, both full contact and remote, working distance from the target. The Moses tailored fiber range provides the right energy transmission, durability and maneuverability for the vast majority of flexible ureteroscopy needs. •

WWW.MEDICALDEALER.COM

MEDICALDEALER 39

PRODUCT FOCUS_Med/Surg_Product Showroom

Staff Reports

LUMENIS

UltraPulse Duo

T

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MEDICALDEALER 41

METHOD TO

LEAN-NESS:

BIG BENEFITS ONLY POSSIBLE FROM

BIG CHANGES

By Matt Skoufalos

In the endless search for cost savings and process improvement in health care, one of the more popular areas of interest to emerge within the past 20 years is lean methodology.

Credited with driving nearly $100 million in cost savings at the UMass Memorial Health Care System and a turnaround of more than $127 million at Denver Health, the idea of continuous process improvement can return anywhere from three to nine times the cost of investing in it. Results like those are head-turning, but experts in the �ield say they’re only achievable by those who are willing to commit to full-scale system change. In the age of larger and larger health systems, the scope of the rewards that are possible may be equaled only by the size of the institutions that take them on.

METHOD TO LEAN-NESS:

John Toussaint, CEO of Catalysis Inc. in Appleton, Wisconsin, said much of the thinking associated with lean methodology is often incompletely expressed, misunderstood or adopted piecemeal. There is no implementation of lean principles in that the approach doesn’t have a discrete end or a single execution, he said. Rather, it is an ongoing continuous improvement process that can take a variety of forms as it’s absorbed into institutional culture.

“You never really ‘implement’ lean,” Toussaint said; “you use the principles to, over time, change the way you think about your business.

It works really well, but it’s not as easy as it sounds.”

The concept of lean methodology emerged into Western consciousness from studies of the Toyota automotive production system in the late 1980s, but it didn’t find its applications in health care until some 20 years later.

As Toussaint notes, “nobody really knew if you could use the principles of great manufacturing companies and apply them to health care.” What its adherents did codify was a core set of principles for the identification of waste in production systems, and suggested they might have an application in the field of health care.

44 MEDICALDEALER MEDICALDEALER | OCTOBER 2017

As outlined by Sorin T. Teich and Fady F. Faddoul in the April 2013 edition of Rambam Maimonides Medical Journal, Journal, these areas of waste are: 1. Overproduction – producing something in excess, earlier, or faster than the next process needs it.

2. Inventory – the cost of managing a large supply inventory may not be obvious at first glance; beside consumption follow-up and space required to store, there is a need to follow expiration dates and to constantly ensure that the items in the inventory are not technologically obsolete. It was already shown that the overall cost of smaller and more frequent shipments is lower than a large-volume purchase for which a discount was provided.

3. Motion – a lot of walking waste can arise from poor design of the working area.

4. Transportation – in health care this can be evident when moving patients, lab tests, information, etc.

5. Over-processing – there are times when material provided to the customers (patients) mandated by regulations can be confusing. For example, multiple insurance claim forms, including ones that are not bills, can confuse the inexperienced “novice.”

6. Defects – there are many examples for these defects that can be related to poor labeling of tests, incomplete information in patients’ charts or in instructions provided to referrals, etc.

7. Waiting – there is not much need to explain why waiting a few hours in line is a wasteful activity.

8. Under-utilizing staff – under-use is not only time-depen-

dent but also involves deeper levels such as not sharing knowledge or not taking advantage of someone’s skills and creativity; under-use typically shows in hierarchical structures and not using teams.

Addressing system issues like these doesn’t start at the manufacturing floor, however – it starts at the C-suite, with principles, behaviors and systems. Toussaint said most institutions gloss over in their approach to going lean, “and that’s why they have their problems.”

“Lean has a toolbox, but we underline sustainable behaviors related to the method,” he said. “We’re talking about the change of the culture of the organization. Where the leadership really understands the difference between tools and cultural change, that’s where you get the breakthrough types of results.”

Leadership style and actions in a lean company are “quite opposite” the style and actions in a traditional, autocratic health care system, Toussaint said: instead of telling people what to do, lean principles are focused on building systems that deliver the desired results every time. In a health care industry that has multiple levels of senior and executive management, it often requires banishing egos from positions of influence in favor of wholesale system change. That’s not easy to achieve without a top-down commitment to certain leadership styles within the broader framework of an organization.

“For lean principles to accomplish a complete transformation of a complex organization, that’s going to be very difficult to do unless the leadership is committed to making the personal change that’s required,” Toussaint said. “Where we see failure is where the top leadership handing it off to someone else.”

The challenge of shifting the thinking at the top of an organizational pyramid is also compounded MEDICAL EQUIPMENT, PARTS & SERVICE

by the fact that many health care CEOs don’t stay with a company long enough realize the potential of lean principles. Building excellence is a continuous goal, and required consistency at the top over a period of years to drive the system changes that lean principles can yield, Toussaint said. Further, with the constant shuffling of leaders, each new appointee implements a flavor-of-themonth style “versus being committed to this journey of excellence,” he said. And the promise of savings or efficiencies that lean thinking offers are often sold by consultancies who look to drive short-term gains among their clients and then cash out.

“Most organizations try to skip the behaviors, principles, and systems” because many leaders believe “change is great as long, as I don’t have to,” Toussaint said. They’ll say, “Why don’t we just open the toolbox, get out a couple of tools, and leave it at that?”

“I think a lot of people are in that boat now and they need to step back and deeply reflect on what they’re trying to accomplish,” he said. “If they’re working to build capability to identify and solve problems every day, they need to back up and examine these core elements of organizational change.”

Toussaint has identified five key personal changes that leaders who seek to drive a culture of improvement may adopt in order to realize the best results of lean methodologies. They are: willingness, humility, curiosity, perseverance and self-discipline.

The first of these, willingness, means that leaders must face the same critical eye with which they regard the entirety of the institution, assuming responsibility for “poor patient outcomes, as well as staff and physician burnout,” Toussaint wrote in an August 2017 article.

“To facilitate willingness, we encourage leaders to commit to 10 minutes of self-reflection weekly, WWW.MEDICALDEALER.COM

telling them to ask themselves, ‘What in my actions this week led to better thinking on behalf of my team about problems?’ ” Toussaint wrote. “Did my questions unleash the thinking capacity of my team, or did I blame them for not following up on my specific ideas?”

John Toussaint, CEO of Catalysis Inc.

1. willingness 2. humility 3. curiosity 4. perseverance 5. self-discipline Humility involves leaders knowing when to defer to another member of the team, especially if their expertise exceeds those of the people above them in the institutional hierarchy.

“Effective leaders know they do not have all the answers and are willing to ‘go see’ – to be present where the actual work is done –

and to respect workers by asking open-ended questions and seeking input,” Toussaint wrote. “Leaders should therefore proactively examine their interactions with others and ask themselves, ‘Did I ask questions that elicited the best thinking of the person or team with whom I interacted? Were there implied answers in my questions?’ ” Curiosity requires a genuine interest in problem-solving over dogmatic processes; again, being willing to “go see” the interactions at different organizational levels.

Perseverance requires the ability to believe “that no problem is unsolvable,” he wrote; it speaks to “psychological resilience and the persistence to attack any personal problem,” which again builds on the concepts of humility and willingness.

Leaders can stay true to the course of continuous improvement by opening themselves up to criticism and being able to receive honest feedback from an objective observer.

Finally, self-discipline involves the idea that leaders follow the same systems they instill for their entire institutions without absolving themselves from criticism. This approach “reduces second-guessing regarding what others need, allows for better-informed decision-making and problem-solving on the fly,” Toussaint wrote.

Without leadership, discipline, and support from the top down, an organization can’t really drive the lasting changes that sustain the benefits of being lean, said Dennis Delisle, an adjunct assistant professor at the Thomas Jefferson University College of Population Health in Philadelphia, Pennsylvania.

MEDICALDEALER MEDICAL DEALER 45

METHOD TO LEAN-NESS:

“Someone who doesn’t understand anything will challenge the hard-wired assumptions about why things are the way they are, but you have to understand people who work the process, because they are the experts.”

Dennis Delisle, Adjunct Assistant Professor at the Thomas Jefferson University College

Delisle said that connecting the personnel of an institution to the work they do and the people with whom they interact helps identify the problems that lean thinking can correct.

To identify the things that aren’t working requires understanding the patient experience at every stage of his or her journey within a system.

“If you go into a process, it’s understanding that process from everybody’s perspective who touches the patient, or a component of the process,” Delisle said. “You might talk to a triage nurse, attending physician, the charge nurse, the registrar, the environmental service nurse. Based on the patient’s experience and input, it starts to really form where opportunities are.”

The process of identifying those hiccups within the system subsequently reveals “the highest opportunity to solve the problems,” Delisle 46 MEDICALDEALER | OCTOBER 2017

said. When staff members throughout the institution are cultivated to recognize these issues, they’re also often inspired to ideate sustainably solutions to the same problems more so than a consultant who isn’t native to the institution, he said.

“Someone who doesn’t understand anything will challenge the hard-wired assumptions about why things are the way they are, but you have to understand people who work the process, because they are the experts,” Delisle said. “Lead with questions, not solutions, because nine times out of 10, a process expert will come up with a much better solution than you would because they understand what the problems are that they’re trying to solve.”

When Jefferson recently underwent a large EMR implementation, Delisle’s job was to speed the process by leveraging “purpose, process and people,” he said: managing governance committees, team and departmental meetings, and empowering staff to solve problems at their own levels. By supporting staff in doing their own jobs and providing clarity around their roles and responsibilities, the professionals with which Delisle worked were able to reduce unnecessary meetings, tasks and activities – the waste within the system.

These tools can be used to target specific aims – lowering rates of hospital-acquired infections, improving the quality of health outcomes – only “once you understand what you’re trying to do,” Delisle said. After identifying these aims, it becomes easier

to streamline activities and add tasks in pursuit of a common goal. But as lean adherents search for ways to drive ROI from the adaptation of those principles, qualitative results are frequently easier to identify than the hard savings or throughput numbers around which the data-driven industry typically revolves. In short, the perspective of seeking ROI can be lost in the opportunities and benefits that come from building a more sustainable institutional culture of excellence, Delisle said; much of the tangible results that follow are related to building better systems that then produce better results.

“When you have clarity around your purpose and you align processes, workflows, goals and responsibilities, expectations, the organization will become inherently more efficient,” Delisle said. “That does have an ROI because you’re able to do better with less, not just more with less. Often [observers] look for hard-dollar savings on the budget when there’s a lot tied to empowerment, which leads to retention and recruitment: soft benefits that you can extrapolate as well as operational efficiencies that are quantifiable.”

“If you don’t start from the base of what is the philosophy you have towards a lean management system, it’s really just a collection of management tools that you apply ad hoc as wanted or as needed,” he said.

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THE OTHER SIDE_Fedele

By Jim Fedele

THE OTHER SIDE TAKING TIME TO CARE

O

ne would think that all people working in health care are compassionate and caring, and I see examples of this every day, a stranger helping a stranger in a time of need or crisis. However, I also see health care workers who seem to not care very much at all. I believe people become numb because they encounter the same problems on a daily basis. When this happens it is easy to become indifferent and forget that each new patient may be experiencing the treatment for the first time. I think this happens to the biomedical technician too, and if we are not careful, we could be jeopardizing our own existence.

I am dismayed every time I hear words like, “they need to learn how to take care of their equipment better” and “that’s not my job.” As of late, I feel like I am hearing this more frequently from my colleagues in the industry. I really do not understand the angst; technicians should realize that if our customers knew everything about their equipment they would not need us. I especially like it when I hear techs complain about that “stupid five-minute fix.”

I say, “You should be thankful, you scored an easy win.” Without the occurrence of problems, we have nothing to fix.

It is no secret that equipment continues to become more reliable, so what is there going to be left for us to do? Frankly, I do not need a degreed technician to do safety checks 50 MEDICALDEALER | OCTOBER 2017

on equipment. Our paradigms about service need to start changing, or I fear that soon there will be no need for the biomedical technician. I have been monitoring equipment failures for many years, my experience has been that the majority of failures are caused by physical damage and accessories deterioration. Granted, theses failures lack the ability to test our technical abilities but to the users they are the same as any other problem. Therefore, we need to take them seriously and fix the problem or the user in a kind and caring way.

We need to remember that the users are trying to utilize the equipment on a patient. I am not stating that the user does not have ownership in the problem, my point is if we aren’t kind and thoughtful we may not find out what the real problem is with the equipment. I think it is safe to assume the user of the equipment doesn’t start their day thinking about how they can break the equipment they need to do their job. By being empathetic we are likely to discover the situation that is contributing to the failure, it may be environmental or educational.

In conclusion, we must never forget where we work; we are health care professionals who have the opportunity to impact a stranger’s life in a positive way. When we feel frustrated because the user physically broke the equipment or can’t find the “pulse ox thing” we should remember they were trying to use it on a patient and now the treatment or diagnosis is delayed. If we rightfully assume the user did not break

Jim Fedele Director of Clinical Engineering

the equipment on purpose, we can open our minds to find the root cause of the problem. We must always connect the dots between nurse and patient so we can understand how our actions impact others.

As equipment becomes cheaper and more reliable, our troubleshooting efforts will need to change from equipment-related problems to environmental and situational problems.

The only way we can get the information to solve these problems is to be caring and compassionate to the users so they feel comfortable giving us the information.

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 Daniel Bobinski

THREE THINGS THAT WILL IMPRESS YOUR BOSS M

messes, then efficiency isn’t all that valuable. To make a solid impression on a boss, there has to be a balance between efficiency and effectiveness.

aybe you’re trying to get a promotion or a raise. Or, maybe you’re just a solid team player and your work ethic is top drawer. In such cases, you probably like hearing the words “good job” from your boss. If that’s the case, one of the quickest ways to impress your boss is by making his or her life easier.

Although every supervisor is different and will be impressed by different actions, here are three things you can do that are likely to give any boss a favorable impression.

1

PAY ATTENTION TO DETAIL.

There’s a distinct difference between getting something done so you can check an assignment off your list and doing something with an eye for detail. An illustration that just about everyone can relate to is getting your car washed. At one end of the spectrum, you can drive though a quick car wash just to rinse off the dirt, or, at the other end of the spectrum, you can have your vehicle “detailed.” If you’ve never had your vehicle detailed, the difference is amazing. It’s hard to be anything but impressed by how clean your car is after it’s detailed.

Now think about this in a work setting. All other things being equal, bosses 52 MEDICALDEALER | OCTOBER 2017

2

TAKE INITIATIVE.

Daniel Bobinski Workplace Consultant

will be more impressed by an employee who pays attention to key details over someone who merely checks off a box and says, “task complete.”

Roger, a supervisor of five, recently told me about his frustrations with Ann, one of his employees.

“She is a real go-getter and concerned about our company’s success, but sometimes she gets working too fast and doesn’t pay attention to detail. As a result, there have been times I’ve had to re-assign people for six or seven hours to fix a problem that occurred because of her oversights on very simple details. That gets expensive really fast.”

Yes, supervisors want jobs done in a timely manner, but if man-hours need to be devoted to mopping up

Think ahead and anticipate what must be done. Then, without waiting to be told, do it.

One example of an employee taking excellent initiative is Kristy, who received a promotion to a newly created supervisory position. Kristy’s boss would be the director of her department, and Kristy knew this person was someone who improvised as he went along. And so, before her first day in her new position, Kristy wrote out two pages of questions she had about how this supervisor wanted her to deal with various situations.

Sure enough, when Kristy’s first day as a supervisor came, the director had been negligent in creating a job description for Kristy. The director simply showed Kristy around and made some customary introductions.

Then he said, “I guess from here you’ll just need to ask me questions.”

Because Kristy was prepared, she opened her folder, took out her list of questions and started asking!

This spawned a three-hour conversation, and yes, Kristy’s boss was very impressed.

Again, a balance must exist.

Bosses love loyal, dedicated employMEDICAL EQUIPMENT, PARTS & SERVICE

_Bobinski

ees, but you won’t find many bosses impressed by employees who must be told exactly what to do and when to do it every step of the way. By the same token, you won’t find too many bosses impressed by someone who thinks ahead too far and then creates problems by not seeing the complete picture before taking action.

Communication, coordination and cooperation are essential.

3

HELP OTHERS WHERE NEEDED.

I was going to title this section “Show Team Spirit,” but I fear that term has become too cliché. The phrase has become so common that many people simply read over it and fail to grasp its meaning anymore.

Perhaps more practical and to the point is, “help others where needed.”

No doubt this attribute requires a bit of initiative (see above), but it’s a different trait altogether.

It’s one thing to be caring and wanting your team to win, but it’s something more to be useful. Yes, we must care about others and be concerned about team success, but “being useful” means acting on that concern, and therefore adding value to the team’s effort.

Something as simple as holding a door open for someone demonstrates the basic tone, but to really make an impact, we can take it much deeper.

In other words, it’s easy to notice when someone is overloaded and needs some help. But, if we get outside the focus of our own work, we can often see opportunities to assist others and make a greater impact for the team.

A common phrase that accompanies this mindset is, “Going above and beyond,” but I once heard someone say the mentality here is more often, “Going below and beyond.”

The idea is that often, the areas needing help are below us on the WWW.MEDICALDEALER.COM

“ She is a real go-getter and concerned about our company’s success, but sometimes she gets working too fast and doesn’t pay attention to detail.” organizational chart. One person I know says he has gained the respect of his boss by, in his words, “reaching out to help fill gaps.” He says this can be as simple as notifying someone that supplies are running low or volunteering to represent the company in community outreach activities.

How we go about assisting others will vary depending on the needs of each individual organization, but the point is that the whole team benefits when we do it. And, when the boss perceives we’re able to see a bigger picture and lend a hand outside of our normal responsibilities, it makes a good impression. The phrase, “That’s not my job,” is basically synonymous with, “I’m not a team player.”

Want to impress your boss? Pay attention to detail. Take initiative.

And, help others when you see a need. Besides, these aren’t just good habits for work. They’re good habits for life.

Next month: How bosses can impress employees!

Daniel Bobinski, M.Ed., is the CEO of Workplace-Excellence.com, helping teams and individuals learn how to use Emotional Intelligence. He’s also a best-selling author and a popular speaker at conferences and retreats.

Reach him at dan@workplace-excellence.com.

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SLICE OF LIFE_Off the Clock

By Matt Skoufalos

OFF THE CLOCK

GREGORY HEMPHILL A

fter 14 years at PartsSource of Aurora, Ohio, Director of Catalog Operations Gregory Hemphill has grown with the organization in a number of different ways. So in the past year or so, he decided to try out the business techniques he’s learned in that time on the open market.

With a longstanding interest in real estate and property management, Hemphill launched his own company, The Hemphill Group, in the northern Ohio market where he lives. He said the area needs more affordably priced, quality homes. Also, Hemphill said that he believes there’s an opportunity to restore some older properties to good use.

“There’s a lot of home builders now focusing on $250-300,000 price points and above in our market,” Hemphill said. “I see a recurring theme of [people asking] ‘Where can I buy a quality, well-built house for $120-200,000?’ If I can focus on getting foreclosures, working with the banks, and putting together a great team, I can get homes for a cheap price, put time and energy into it, and flip it.”

Hemphill assembled a group of friends with expertise in the building trades, parlayed some financial resources, and began to work out the best way to achieve his goal: to create housing that matches the experience of a $300,000 home for one-third to one-half the price. The best way to start, he reasoned, is to 56 MEDICALDEALER | OCTOBER 2017

Gregory Hemphill

do what PartsSource did, and build a high-quality, vetted supply chain that can lower those costs.

“We all have the same goal in mind: how do we build a high-quality house?” Hemphill said. “We strip everything to the studs, and we negotiate with the suppliers. If I can keep doing these houses and keep these guys working, they’re going to give me better price points.”

Hemphill and his partners look for underpriced homes in up-and-coming neighborhoods. They gauge target properties by their likelihood of selling quickly, which means considering a variety of factors, from school systems to crime rates and location. Most of their target area is in the Medina County communities within a halfhour of Cleveland, where Hemphill said, “It’s a seller’s market.”

“There’s a lot of people wanting to move into these areas, and people trying to move out of the big cities,”

he said. “When I talk to people, they settle for developments, [but] they’re looking for a rural-type house with a couple acres of land that they can go in and make their own.”

Their first project was an 80-plusyear-old home on Tonawanda Avenue in Akron. The three-bedroom, one-bathroom home was “rundown,” Hemphill said, but he and his partners could see it had appeal beyond its proximity to a local park.

“When we walked through, it just kind of made sense,” he said. “It was kind of quaint.”

After their bid was accepted, the group tore into the bank-owned property with gusto, stripping plumbing, flooring, and updating knob-and-tube electrical wiring.

They bolstered up the joists in the kitchen, fixed up a water line that had ben leaking from the second-story bathroom, restored the plaster walls, rebuilt the staircase, and added a den in the basement. Outside, they restored a sagging garage and replaced all the landscaping. When they were finished, the homebuyer who settled on the property, a single father with a 12-year-old son, was emotional, Hemphill said.

“He told the realtor, ‘I never thought I could afford something this nice with the amount of money I make,’” Hemphill said. “This guy is so extremely happy that he has a property he’s proud of. It’s not just making a couple dollars on the side; I can help people change their lives.”

Now the group is working on its second project, restoration of a walkaway project on May Avenue MEDICAL EQUIPMENT, PARTS & SERVICE

_Off the Clock

in Northfield, Ohio. After working with the bank and title agencies, Hemphill and his team got to work bringing the home up to code. They removed eight overgrown trees from the property, opening up the space to sunlight and removing the looming threat of falling branches.

That move made “a night-and-day difference,” Hemphill said.

“It didn’t look like that creepy dark house on the corner of the street anymore,” he said. “Everybody on the street got excited; it just increases the value of everybody’s home.”

Work is still underway on the 1,400-square-foot rancher, which is being restored from the ground up. The biggest changes will be the addition of a full, walk-out basement, a new back deck, and reconstructed front porch, which Hemphill said will feature an extended roofline and outdoor ceiling fan. The three-bedroom, two-bath home is also getting an all-new kitchen and lower-level half-bath.

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It’s a lot of work to manage construction projects after a full day at the office, and Hemphill said his evenings frequently run until midnight.

But it’s also a lot of fun and exciting, and involves close collaboration with friends. As the business grows, he foresees managing projects farther out of his immediate geographic area, too.

“I’m a certified project manager,” Hemphill said; “I manage [these projects] like I did the projects at PartsSource. We keep moving.”

Hemphill said the experience has also taught him a few lessons quickly, including how to hew closer to estimations on trash, demolition needs, and other hiccups that can inflate the costs of a project. To offset those issues in the future, he said he’s spent more time planning his work and promoting the jobs he’s doing.

“If you want to do it, then figure out a way to do it,” Hemphill said.

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TRIM 4.5”

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GAS/AIR MONITORS ENMET………………………………………………………………59

ASSET MANAGEMENT Asset Management Associates, LLC……………35

GENERAL ALCO Sales & Service Co.…………………………… 41,59 Government Liquidation ………………………………33 Multi Diagnostic Imaging Solutions……………BC

AUCTION/LIQUIDATION Government Liquidation ………………………………33 BIOMEDICAL Ampronix ……………………………………………………………3 BETA Biomedical Services, Inc. ………………………54 Elite Biomedical Solutions …………………………… 17 Global Medical Imaging …………………………………23 InterMed Group……………………………………………… 11 Maull Biomedical Training, LLC ……………………62 Multi Diagnostic Imaging Solutions……………BC Retrieve Medical Equipment………………………… 24 Southwestern Biomedical Electronics, Inc.……8 C-ARM Technical Prospects…………………………………………25 CARDIOLOGY International X-ray Brokers……………………………34 Multi Diagnostic Imaging Solutions……………BC Southeastern Biomedical, Inc.………………………35 CMMS Phoenix Data…………………………………………………… 51 COMPUTED TOMOGRAPHY Dedicated Imaging Solutions………………………… 12 Dunlee……………………………………………………………………2 East Coast Medical Systems …………………………48 COMPUTED TOMOGRAPHY Ed Sloan & Associates ……………………………………34 Exclusive Medical Solutions……………………………26 International Medical Equipment & Service …… 19 KEI Medical Imaging Services ………………………55 Metropolis International ……………………………… 24 MTC/Medical Technologies Co. ………………………59 Multi Diagnostic Imaging Solutions……………BC Retrieve Medical Equipment………………………… 24 RSTI Exchange…………………………………………………… 61 Technical Prospects…………………………………………25 Tri-Imaging Solutions…………………………………………4 CONTRAST MEDIA INJECTORS Injector Support and Service………………………… 51 DIAGNOSTIC IMAGING Eastern Diagnostic Imaging …………………………54 ENMET………………………………………………………………59 Injector Support and Service………………………… 51 ENDOSCOPY J2S Medical, LLC…………………………………………………55

60 MEDICALDEALER | OCTOBER 2017

IMAGING Injector Support and Service………………………… 51 InterMed Group……………………………………………… 11 IMAGING PARTS Diagnostic Solutions ………………………………………53 Eastern Diagnostic Imaging …………………………54 INFUSION PUMPS J2S Medical, LLC…………………………………………………55 INFUSION THERAPY Elite Biomedical Solutions …………………………… 17 LABORATORY MTC/Medical Technologies Co. ………………………59 LASER Multi Diagnostic Imaging Solutions……………BC MONITORS/CRTS Ampronix ……………………………………………………………3 Bio-Medical Equipment Service Co. ………………25 Jet Medical Electronics……………………………………34 Multi Diagnostic Imaging Solutions……………BC MRI Carolina Medical Parts ………………………………………6 Dedicated Imaging Solutions………………………… 12 East Coast Medical Systems …………………………48 Ed Sloan & Associates ……………………………………34 ENMET………………………………………………………………59 Exclusive Medical Solutions……………………………26 International Medical Equipment & Service …… 19 International X-ray Brokers……………………………34 KEI Medical Imaging Services ………………………55 MTC/Medical Technologies Co. ………………………59 Multi Diagnostic Imaging Solutions……………BC Retrieve Medical Equipment………………………… 24 NUCLEAR MEDICINE E.L. Parts, LLC……………………………………………………55 Global Medical Imaging …………………………………23 InterMed Group……………………………………………… 11 International X-ray Brokers……………………………34 ONLINE RESOURCES MedWrench ………………………………………………………49 PATIENT MONITORING BETA Biomedical Services, Inc. ………………………54 Bio-Medical Equipment Service Co. ………………25

J2S Medical, LLC…………………………………………………55 Jet Medical Electronics……………………………………34 Master Medical Eelectroncis…………………………48 Multi Diagnostic Imaging Solutions……………BC Pacific Medical ……………………………………………5,36 Southeastern Biomedical, Inc.………………………35 Southwestern Biomedical Electronics, Inc.……8 PHANTOMS ATS Laboratories………………………………………………48 PROBE REPAIR Global Medical Imaging …………………………………23 RADIOLOGY Ampronix ……………………………………………………………3 Asset Management Associates, LLC……………35 Eastern Diagnostic Imaging …………………………54 ENMET………………………………………………………………59 InterMed Group……………………………………………… 11 International X-ray Brokers……………………………34 Maull Biomedical Training, LLC ……………………62 Metropolis International ……………………………… 24 Multi Diagnostic Imaging Solutions……………BC Radon Medical …………………………………………………35 RSTI Exchange…………………………………………………… 61 Technical Prospects…………………………………………25 RECRUITING Adel-Lawrence Associates, Inc.………………………59 REPAIR/REFURBISH ALCO Sales & Service Co.…………………………… 41,59 Carolina Medical Parts ………………………………………6 Dedicated Imaging Solutions………………………… 12 Eastern Diagnostic Imaging …………………………54 Ed Sloan & Associates ……………………………………34 Elite Biomedical Solutions …………………………… 17 Global Medical Imaging …………………………………23 Government Liquidation ………………………………33 Injector Support and Service………………………… 51 KEI Medical Imaging Services ………………………55 Master Medical Eelectroncis…………………………48 MTC/Medical Technologies Co. ………………………59 MW Imaging…………………………………………………………7 Pacific Medical ……………………………………………5,36 Radon Medical …………………………………………………35 REPAIR/SERVICES Ampronix ……………………………………………………………3 Bio-Medical Equipment Service Co. ………………25 Exclusive Medical Solutions……………………………26 Jet Medical Electronics……………………………………34 Master Medical Eelectroncis…………………………48 Multi Diagnostic Imaging Solutions……………BC RSTI Exchange…………………………………………………… 61 Southwestern Biomedical Electronics, Inc.……8 REPLACEMENT PARTS BETA Biomedical Services, Inc. ………………………54

MEDICAL EQUIPMENT, PARTS & SERVICE

CATEGORICAL INDEX

Carolina Medical Parts ………………………………………6 Dedicated Imaging Solutions………………………… 12 Diagnostic Solutions ………………………………………53 Dunlee……………………………………………………………………2 E.L. Parts, LLC……………………………………………………55 Ed Sloan & Associates ……………………………………34 Elite Biomedical Solutions …………………………… 17 Global Medical Imaging …………………………………23 Government Liquidation ………………………………33 International Medical Equipment & Service …… 19 Jet Medical Electronics……………………………………34 KEI Medical Imaging Services ………………………55 Multi Diagnostic Imaging Solutions……………BC Radon Medical …………………………………………………35 RSTI Exchange…………………………………………………… 61 Southwestern Biomedical Electronics, Inc.……8 Technical Prospects…………………………………………25 RESPIRATORY ENMET………………………………………………………………59 SOFTWARE Phoenix Data…………………………………………………… 51 STERILIZERS ENMET………………………………………………………………59 InterMed Group……………………………………………… 11

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SURGICAL Ampronix ……………………………………………………………3 Eastern Diagnostic Imaging …………………………54 SURPLUS MEDICAL Government Liquidation ………………………………33 TELEMETRY J2S Medical, LLC…………………………………………………55 Southwestern Biomedical Electronics, Inc.……8 TRAINING Maull Biomedical Training, LLC ……………………62 TUBES/BULBS Dunlee……………………………………………………………………2 International Medical Equipment & Service …… 19 Technical Prospects…………………………………………25 Tri-Imaging Solutions…………………………………………4 ULTRASOUND ATS Laboratories………………………………………………48 Diagnostic Solutions ………………………………………53 Exclusive Medical Solutions……………………………26 InterMed Group……………………………………………… 11 MW Imaging…………………………………………………………7 Retrieve Medical Equipment………………………… 24

ULTRASOUND PARTS Global Medical Imaging …………………………………23 ULTRASOUND SYSTEM SUPPORT J2S Medical, LLC…………………………………………………55 WHEELCHAIR ALCO Sales & Service Co.…………………………… 41,59 X-RAY Asset Management Associates, LLC……………35 Diagnostic Solutions ………………………………………53 Eastern Diagnostic Imaging …………………………54 Exclusive Medical Solutions……………………………26 International X-ray Brokers……………………………34 MTC/Medical Technologies Co. ………………………59 Ray-Pac…………………………………………………………… IBC Retrieve Medical Equipment………………………… 24 RSTI Exchange…………………………………………………… 61 Technical Prospects…………………………………………25 Tri-Imaging Solutions…………………………………………4 X-RAY TUBES Ray-Pac…………………………………………………………… IBC

MEDICALDEALER 61

ALPHABETICAL INDEX

Adel-Lawrence Associates, Inc.………………… 59

Elite Biomedical Solutions ……………………… 17

Metropolis International ………………………… 24

ALCO Sales & Service Co. ……………………… 41,59

ENMET ………………………………………………………… 59

MTC/Medical Technologies Co. ……………… 59

Ampronix ………………………………………………………3

Exclusive Medical Solutions …………………… 26

Multi Diagnostic Imaging Solutions ………BC

Asset Management Associates, LLC ……… 35

Global Medical Imaging …………………………… 23

MW Imaging ……………………………………………………7

ATS Laboratories ………………………………………… 48

Government Liquidation ………………………… 33

Pacific Medical …………………………………………5,36

BETA Biomedical Services, Inc. ……………… 54

Injector Support and Service …………………… 51

Phoenix Data ……………………………………………… 51

Bio-Medical Equipment Service Co. ……… 25

InterMed Group ………………………………………… 11

Radon Medical …………………………………………… 35

Carolina Medical Parts …………………………………6

International Medical Equipment & Service 19

Ray-Pac ……………………………………………………… IBC

Dedicated Imaging Solutions ………………… 12

International X-ray Brokers ……………………… 34

Retrieve Medical Equipment …………………… 24

Diagnostic Solutions ………………………………… 53

J2S Medical, LLC ………………………………………… 55

RSTI Exchange …………………………………………… 61

Dunlee………………………………………………………………2

Jet Medical Electronics ……………………………… 34

Southeastern Biomedical, Inc. ………………… 35

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………………… 55

Southwestern Biomedical Electronics, Inc.8

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Master Medical Eelectroncis …………………… 48

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…………………… 54

Maull Biomedical Training, LLC ……………… 62

Tri-Imaging Solutions ……………………………………4

Ed Sloan & Associates ……………………………… 34

MedWrench ………………………………………………… 49

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