ICE Magazine - February 2020

THEICECOMMUNITY.COM

FEBRUARY 2020 | VOLUME 4 | ISSUE 2

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

A MATTER OF PATIENTS

PAGE 32

Director's Cut

The Data Trap PAGE 42

CONFLICT RESOLUTION PAGE 60

5

PRODUCT FOCUS

PACS SOLUTIONS PAGE 26

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FEATURES PRODUCT FOCUS

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We look at some of the latest picture archiving and communication system (PACS) offerings from OEMs.

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ICEMAGAZINE | FEBRUARY 2020

IN FOCUS

COVER STORY

For many years, patient satisfaction in the health care business turned on fundamental questions like whether your medical condition was resolved or whether you were seen in a timely fashion. In 2020, the concept has become more complicated and is tied more substantially to financial outcomes for health care practitioners and the institutions for which they work.

32

Chris Tollefson, radiology operations manager at the Mayo Clinic in Arizona, began his career in nuclear medicine and prides himself on maintaining those skills while also serving in an important leadership role.

19 ADVANCING THE IMAGING PROFESSIONAL

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Developed by Landauer medical physicists, Optimize allows health care providers to focus on caring for patients rather than data.

46 IMAGING NEWS

ICE shares news, trends and hot topics from throughout the diagnostic imaging community, including news about the medical device tax, conference education opportunities and more.

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14

PACS/IT

Technology continues to advance at a rapid rate. Is it moving too fast? Find out about how some IT vendors added a clause to contracts to acquire more patient data and how to be aware and prepare for this and more in coming years.

ICEMAGAZINE

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SPOTLIGHT 10

Rising Star Tyneeta Silmon, CHI Baylor St. Luke’s Medical Center

John M. Krieg john@mdpublishing.com

12

In Focus Chris Tollefson, Mayo Clinic

Vice President

14

Rad Idea Landauer Optimize

16

Off the Clock Master Sergeant John J. Beall III

Publisher

Kristin Leavoy kristin@mdpublishing.com

Editorial

John Wallace Erin Register

Art Department Jonathan Riley Karlee Gower Amanda Purser

Webinars

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Editorial Board

Laurie Schachtner Nicole T. Walton-Trujillo Mario Pistilli Jef Williams Christopher Nowak

Circulation

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Accounting Diane Costea

ICE Magazine (Vol. 4, Issue #2) February 2020 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290.

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CONTENTS

ICEMAGAZINE | FEBRUARY 2020

NEWS 19

Imaging News A Look at What’s Changing in the Imaging Industry

32

Cover Story A Matter of Patients

PRODUCTS 24

Market Report Orthopedics Fuels PACS Growth

26

Product Focus PACS

INSIGHTS 38

Rad HR Intent Versus Impact – Are We Really on the Same Page?

42

Director’s Cut The Data Trap

46

PACS/IT Data Usage Agreements and the New Normal

52

Coding/Billing Breaking Down the GI Codes

56

Department/Operational Issues The Changing Role of the Patient

60

Emotional Intelligence Conflic Resolution 401: Conflict Resolution in Action

64 66

ICE Break

Index

ADVANCING THE IMAGING PROFESSIONAL

Making our customers heroes™

Lowering Healthcare Facilities’ Total Cost of Ownership

ISO 13485:2003 Certified

Quality Management System

P: 866-586-3744 E: info@mysummitimaging.com W: mysummitimaging.com YouTube.com/SummitImaging

SPOTLIGHT

RISING

STAR

TYNEETA SILMON

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ICEMAGAZINE | FEBRUARY 2020

ADVANCING THE IMAGING PROFESSIONAL

O

ur featured “Rising Star” of the month is Tyneeta Silmon. Tyneeta, 39, is a Field Service Specialist I at CHI Baylor St. Luke’s Medical Center. She was born and raised in Waco, Texas and is the oldest of five children. “I have always felt that I needed to set a good example for my younger siblings,” Tyneeta stated. She graduated from Waco High School in May of 1998. In 1999, Tyneeta enlisted in the United States Navy, where she served eight years as an avionics technician with four of those years being in the calibration field. In 2012, she graduated from Texas State Technical College in her hometown of Waco. Tyneeta transferred to the imaging field in September of 2019. Catholic Health’s Director of Clinical Engineering John Garrett noted, “Tyneeta Silmon is a great example of the future of imaging.”

ICE Magazine learned more about this Rising Star in a question-and-answer session.

Q: WHY DID YOU CHOOSE TO ENTER THE FIELD OF IMAGING? A: After getting out of the Navy, I decided I would like to enter into a field that I would be able to put my electric background to use outside of the aviation field. One day, I was talking to my father about what I wanted to do.

He began to tell me about a program he was currently in called Biomedical Equipment Technician at TSTC in my hometown. I looked further into the details and knew it was definitely something I wanted to pursue.

After comparing different programs, I chose Texas State Technical College (TSTC) because it offered the most hands-on training.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: I was first introduced to the imaging field while attending Texas State Technical College. When the opportunity

Tyneeta Silmon Field Service Specialist I at CHI Baylor St. Luke’s Medical Center. arose to take an additional semester dedicated to the theory and troubleshooting of radiology equipment, I decided to take advantage of it. I was blown away and knew that I wanted to work in the imaging field due to the complex capabilities and advanced technology. I knew I had to be a part of the process. I am looking forward to the many challenges and rewards that come within the imaging field.

Q: WHAT DO YOU LIKE THE MOST ABOUT YOUR POSITION? A: I like that I am able to apply some principles from the radar and laser systems that I have worked on to understand the basics of how an X-ray works.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: My greatest accomplishment is being able to pursue a career as an imaging technician after seven years as a BMET. My supervisor chose me out of a talented, diverse shop, with many biomeds, to become an imaging specialist.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT FIVE YEARS? A: In the next five years, I plan to be proficient in mammography maintenance and repairs, as well as obtain some OEM training for mammo, ultrasound and CT systems. I want to focus on learning as much as I possibly can on the different modalities within imaging. I am not certain of the future, but the thought of starting my own biomed and imaging servicing company is a possibility. •

FUN FACTS Favorite Hobby: Spending time with my kids, family and friends Favorite Food: Steak tacos Dream Vacation: Hawaii and Italy Other Skills/Talents: Managing to stay focused and determined even when life is very challenging

WWW.THEICECOMMUNITY.COM

ICEMAGAZINE

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SPOTLIGHT

IN FOCUS

BY JOHN WALLACE, EDITOR

CHRIS TOLLEFSON

RADIOLOGY OPERATIONS MANAGER, MAYO CLINIC

C

hris Tollefson, radiology operations manager at the Mayo Clinic in Arizona, began his career in nuclear medicine and prides himself on maintaining those skills while also serving in an important leadership role.

Chris Tollefson enjoys work and time with family

12

Patient safety and patient satisfaction continue to be buzz words in the health care industry, but for Tollefson it is more a way of doing one’s job. It is an important responsibility for everyone who works in health care.

“I started as a nuc med technologist. I actually still take calls at another facility to keep my skills up and I enjoy the patient interaction,” Tollefson shares. “It does help you keep a fresh perspective on the forward-thinking radiologists and what their challenges are. It helps show what you can do as an operations manager to help them and their workflow.”

Tollefson’s journey to a leadership position began as a search for more ways to have a beneficial impact

ICEMAGAZINE | FEBRUARY 2020

on patients and their health care journey.

“I looked at expanding the positive impact I could have at other areas in radiology. I started to look at a master’s degree and other leadership roles in radiology. I ended up applying for and being given the radiology informatics role,” he recalls.

It turned into an ideal role for the self-professed “techie.”

“I am a big techie. I love all the analytics. I did that for three and half years while continuing to look at career growth. I talked with a few mentors here at Mayo. We all agreed the best way to get future growth was looking at operations management,” he says. “I enjoyed all the workflow efficiency projects and that is what kind of lead me.”

“To be honest, I have not been at a position here at Mayo that I didn’t like,” Tollefson adds.

Tollefson, the 2019 winner of the Most Effective Radiology Administrator/Manager Minnie Award, has a knack for having fun while at work and it shows in his performance.

“If you strive to be excellent in what you do, everything is challenging but it is enjoyable,” he shares.

The Aunt Minnie article about his award shines a spotlight on Tollefson.

“Among Tollefson’s most recent accomplishments at Mayo was a recent Kaizen event, a short-term event of a few days or week designed to improve business productivity, that helped improve the radiology department’s productivity. The goal was to standardize technologist workflow, and it helped shorten the time from an exam order to when a study begins from 21% to 41%, depending on the department ordering the test,” the Aunt Minnie article states. “Tollefson enjoys the challenge of managing a large, diversified radiology

ADVANCING THE IMAGING PROFESSIONAL

service, especially one that’s growing as fast as Mayo. He tries to keep in close contact with referring groups, such as sports medicine clinics or the operating room, but he notes that even the addition of a single portable X-ray machine or C-arm can cause workflow issues that can reduce technologist productivity.”

One would expect his recent Minnie Award to be perhaps his greatest accomplishment. However, Tollefson is not defined by his career or work accomplishments.

“I would say my greatest accomplishment is, personally, I have three kids and raising upstanding good people is my greatest accomplishment,” he says. “In a professional sense, I’ve strived to make a difference in the enterprise and each area I was in to really improve the area.”

“I’ve tried to make a difference and improve things above and beyond just filling the job description of where I have been,” Tollefson adds.

Tollefson loves his job and perhaps that is why he is so good at it. He sees the impact his decisions and work have on patients and enjoys knowing that he has the ability to improve the patient experience for scores of individuals.

“When you are taking care of a patient, you are helping patients and their families,” Tollefson says. “In this operations role, when you make a change based on a efficiency project you effect a huge amount of patients.”

“We are still in a very clinical role,” he adds. “If I make a positive impact, I am helping a lot of people.”

He says he is fortunate to work at a facility with patient care goals that mirror his own desires and beliefs.

“Why do I enjoy working at Mayo? I guess the big thing, the first thing I always think of, is the needs of the patient always come first.

At Mayo that is not just a saying or a mantra that maybe isn’t followed if there is a hard decision to make. At Mayo, we all really live by that,” Tollefson says. “If the needs of the patient might not benefit from something, we talk about it and another decision will be made. And, that’s isn’t the same everywhere.”

His empathy for others comes naturally and was something he saw in his parents growing up. His mother worked for the Catholic Church her entire career and his father was an elementary school teacher.

Today, he and his wife, Jennifer, look to instill those same characteristics into their children – Emery, Jamis and Wyatt.

Tollefson says he learned a great deal going from technologist to manager.

WWW.THEICECOMMUNITY.COM

“The biggest thing that I have acquired, as far as the biggest thing I’ve learned and the most surprising, is all of the various costs and kind of managing that end of things,” he says. “I have learned a lot about the financial impact side of things.”

One example he shared is the impact a purchase agreement for something like IV kits can have on a facility’s spending and budget.

“I definitely have an eye for it, where before I didn’t,” Tollefson admits.

For those considering following in his footsteps and pursuing a leadership position, Tollefson suggests doing hands-on research before jumping in feet first.

“Definitely, start with job shadowing and make sure it is something you want to get into. A lot of the technologists I know love patient care and have a deep knowledge in a specific area,” he says. “I would definitely say find a mentor and shadow a couple of roles you are interested in.”

He also strongly suggests additional education.

“Some don’t take a master’s degree, but it is always good to have that education. You are never wrong to go for more formal education,” Tollefson says. “And, from my experience, if you can get a clinical or informatics certification. You never know when you can use that or go back to it if needed.”

“I wish I would have mentored, and job shadowed a little bit more. Not because I would have made a different decision, but because I would have been better prepared,” he adds.

The future of diagnostic imaging is bright and exciting. Tollefson says he sees technology as a tool to help radiologists and not as something that will replace them.

“The big thing is AI and machine learning.

That is going to transform radiology in the next 10 years,” he says. “Using predictive analytics to make care better and to better utilize staff. I don’t think, anytime soon, that anyone’s job is going to be eliminated.”

As far as the future, Tollefson wants everyone to understand the importance of data and the positive impact it can have on various aspects of heath care.

“You are going to have access to all this information, but you are going to have to know how to use it and how to make sense of it,” he says. “You are going to have to know what information is noise that doesn’t make sense to your operation and what information is key.” •

CHRIS TOLLEFSON

Radiology Operations Manager Mayo Clinic What is the last book you read?

Or, what book are you reading currently?

“A Short History of Nearly Everything”

by Bill Bryson Favorite movie?

“Tombstone” What is something most of your coworkers don’t know about you?

I have a fairly extensive fruit orchard in our backyard. I’ve planted oranges, apples, peaches, figs, Asian pears, mulberries, blackberries and three different types of grape vines that the whole family enjoys.

Who is your mentor?

I have several people that I consider mentors that I look to for advice and counsel. At each point in my career, I’ve been lucky enough to find colleagues who are good people and freely share their wealth of experience.

What is one thing you do every morning to start your day?

Make the bed. It ensures I always start the day with an easy win.

Best advice you ever received?

Give 100% in everything you do; it doesn’t matter if it is in your professional or personal life.

Who has had the biggest influence on your life?

This is an easy one to answer, my parents of course. They taught me the values and ethics that I now pass down to my children.

What would your superpower be?

Telepathy, Charles Xavier style. Not Jean Grey, that’s too intense.

What are your hobbies?

I enjoy spending time with my family camping, hiking, hunting and fishing. I also really like spending time tinkering on computer and electronic projects. I also coach youth tackle football.

What is your perfect meal?

A good steak is impossible to pass up.

ICEMAGAZINE

13

SPOTLIGHT

Rad

idea

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>> Share your RAD IDEA via an email to editor@mdpublishing.com.

14

ICEMAGAZINE | FEBRUARY 2020

ADVANCING THE IMAGING PROFESSIONAL

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SPOTLIGHT

Off Clock THE

MASTER SERGEANT JOHN J. BEALL III SENIOR CLINICAL NCO

BY MATT SKOUFALOS

A

fter 25 years in the U.S. Army, Master Sergeant John J. Beall III is coming to a grim realization.

“I have a year left to stop playing soldier and get a real job,” he said. “I’ll have to grow up someday.”

He’s kidding of course, but after a quarter-century of service, Beall has earned the levity as he stares down retirement. But with one daughter in college and another headed there soon, he’s also coming to grips with “not being the parent that takes my kid everywhere.”

“I guess I have to learn a hobby,” Beall said. “But I’m a terrible fisher and I’m worse at golfing.”

16

ICEMAGAZINE | FEBRUARY 2020

It won’t be all that bad. For an imaging professional with a degree in health care administration and a wealth of management experience – Beall is a senior clinical non-commissioned officer at Madigan Army Medical Center on Joint Base Lewis McChord in Lakewood, Washington – there’s likely room for him in a civilian radiology department somewhere between Tacoma and Seattle. If not, he’s also got experience leading pharmacy, lab and X-ray departments, “because I took advantage of what I had the opportunity to do” during his time of service, Beall said.

“It’s been very rewarding,” he said. “I’ve gotten to see the world and learn about different levels of health care that I probably would not have noticed if I had not ADVANCING THE IMAGING PROFESSIONAL

John J. Beall III is seen after his AHRA Fellowship Ceremony.

left Los Angeles. I got to meet a great group of people.”

The depth of experience he’s enjoyed throughout that career came full-circle emotionally for Beall when he was invited to present at the Radiological Society of North America (RSNA) Annual Meeting. His talk focused on the evolution of imaging technology from peacekeeping and wartime medicine over the last 25 years, and as Beall ran down the different makes and models of equipment, he started to think to himself, “I’ve been doing this a little bit too long.”

“In my own mind, I feel I’m still a punk kid who was joining the Army to get a job as a firefighter, and here I am 25 years later, almost done, not realizing that people reach out to me for advice,” Beall said. “It never clicked as to why.”

The West Covina, California native graduated from high school in 1991, and enlisted in the U.S. Army in November of 1994. Like many of his friends, Beall wanted to become a firefighter after the 1992 Los Angeles riots. But the popularity of the job spiked against the emotional backdrop of those events, and it was hard to get a placement. One of the fire chiefs suggested that he join the military for a few years to help bolster his application. After basic training, however, Beall ended up becoming an X-ray technician.

“I thought, ‘X-ray tech, how hard could that be?’ ” he remembered. “And now I was in physics class.”

Something else happened in the military, too: Sonia, the woman he would eventually marry, came into his life. She was from North Jersey, he was from Southern California; they met in the middle, at the St. Louis airport, waiting to catch a bus to basic training.

“We just started talking,” Beall said.

“It was first love for me.”

The couple would see each other from across the platoon at Ft. Leonard Wood. From there, they went to medic WWW.THEICECOMMUNITY.COM

John J. Beall III (left) met his wife, Sonia, while they were both on their way to basic training.

school in San Antonio, then to X-ray school, and “just started dating somewhere in there,” he said.

Sonia left the service after her first enlistment, and now works as an MRI tech at the University of Washington.

Their family grew on military bases in various deployments, and Beall is grateful to his wife for having stuck by his side throughout the tumultuous living conditions that can accompany a military marriage.

“It gave me a sense of direction,” he said. “She’s the real hero; she’s had to follow me around and disrupt her career every four to five years, get a new job, and work her way back up at a new hospital.”

As unexpected as it had been to find romance in the military, Beall’s service was punctuated by moments of other emotional intensity. A year before his first re-enlistment, he found himself in the streets of Sarajevo, picking through war-torn Bosnia on a peacekeeping mission. The experience was critical in his decision to re-up.

“I saw ‘this is what it’s all about,’” he said. “That was another reason I felt a sense of commitment to staying in the military.”

When fighting broke out from Afghanistan to Iraq, Beall was downrange

of the conflict in Germany. He served at Landstuhl Regional Medical Center military hospital, tending to wounded soldiers, including famous POW Jessica Lynch and her unit. Caring for them solidified his commitment not only to the work of being a soldier but to the professionalism of a medical career. It’s a benefit he hadn’t considered until recently, when it came up in conversation with a neighbor at Lewis McChord.

“The hospital I work at is where my family gets taken care of,” Beall said.

“Everybody here in the military takes care of ourselves. One of my neighbors – he’s an infantry guy – was talking to me, and just said, ‘Thank you; we love that hospital. I’m going to deploy if the army wants me, but knowing that you guys in that hospital are taking care of my family when I’m gone eases my mind. And if we get hurt, we know you’re there to take care of us.’”

“I never really thought about it in that context,” Beall said. “We think about process improvement, patient flows, access to care and he summed up what our job is in that simple thankyou. One of the things I’m probably going to miss the most is being part of that when I retire.”

“If I’m lucky, I can come back as a civilian,” he said. •

John J. Beall III is a proud husband and father.

ICEMAGAZINE

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WE BUILD

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NEWS

Imaging News

A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

TRUMP’S SIGNATURE KILLS MEDICAL DEVICE TAX As part of Fiscal Year 2020 Appropriations Legislation, President Donald Trump signed a bill that repealed the medical device tax.

“The government funding bills I just signed into law contain big victories for my administration and the American people. They enable us to continue to advance our pro-growth, pro-worker, pro-family, America First agenda,” Trump said.

Later, he spoke about the medical device tax.

“We have now also repealed the Obamacare Medical Device Tax, which threatened access to cutting-edge devices that save lives and enhance the quality of life for all Americans. We also eliminated the Obamacare Cadillac Tax, which would have imposed a 40 percent tax on 1 in 5 employers in 2022, ultimately placing severe financial burdens on employees,” Trump said.

Advanced Medical Technology Association (AdvaMed) President and CEO Scott Whitaker was pleased with President Trump’s signing of legislation to repeal the medical device excise tax.

“This is a great day for American patients, American jobs and American innovation: The medical device tax is officially history,” Whitaker said. “With the end of this burdensome tax, the U.S. medtech industry can do what it does better than anyone else in the world: develop life-changing innovations that save and improve patients’ lives, and create high-paying, hightech jobs to keep the American economy booming.”

“We thank President Trump and his administration for their strong support of medical innovation and for their leadership as we worked with Congress to repeal this onerous tax,” he added. •

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THE WORLD MOVES FAST. WE MOVE FASTER.™

626 ACQUIRES INJECTOR SUPPORT AND SERVICE 626 Holdings LLC has announced the acquisition of Injector Support and Service LLC (ISS).

“ISS could not be a better fit. From a culture standpoint, a modality expansion standpoint, and listening to our customer’s needs, ISS hits on all objectives. We are very excited about our future with ISS,” stated Philip Revien, CEO of 626.

“The core question Phil and I continue to ask ourselves: is this the best move for our customer? If the answer is yes and it will increase our value to our customers and their patients, we have our answer,” says Michael Fischer, CFO, 626.

In business since 2011, ISS is a third-party provider in the injector industry. ISS delivers an end-to-end solution for medical contrast injectors.

“ISS and 626 have a lot in common. Both are family businesses, founded as a high quality, agile, cost advantageous alternative for support beyond the OEM, and both dedicated to our employees, customers, and their patients. After spending time planning next steps for optimal ISS growth with Phil and Michael, there was no doubt that the best decision was an alliance with 626,” said ISS President Ryan Clarke. •

ICEMAGAZINE

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NEWS

RSNA ANNOUNCES CAREQUALITY IMAGING DATA EXCHANGE IMPLEMENTATION GUIDE SUPPLEMENT The Radiological Society of North America (RSNA) and Carequality have developed the Imaging Data Exchange Implementation Guide Supplement, expanding the scope of the Carequality Interoperability Framework to detail technical standards that enable the exchange of medical images. The publication is the result of RSNA’s partnership with Carequality and the Sequoia Project, two organizations dedicated to expanding online access to health records.

Currently, CDs and DVDs are the most common method of transmitting medical images. Patients frequently endure inconvenience, delay and expense in obtaining images and shuttling them among their care providers.

A significant number of redundant imaging exams are performed each year, simply because prior images are not readily available. Network-based access to medical images addresses these quality, safety and efficiency issues in radiologic care.

A town hall event was held on December 2, 2019, at RSNA’s 105th Scientific Assembly and Annual Meeting in Chicago to announce publication of the supplement. David S. Mendelson, M.D., FACR, senior associate in Clinical Informatics and vice chair of Radiology IT at The Mount Sinai Health System, and Curtis P. Langlotz, M.D., Ph.D., professor of radiology and biomedical informatics research at Stanford University Medical Center and RSNA Board Liaison for Information Technology and Annual Meeting, spoke about RSNA’s longstanding efforts to develop and implement standards to enable secure and convenient network-based access to medical images.

Also at the event, Donald Rucker, M.D., the National Coordinator of Health Information Technology, spoke about the high value his agency places on enabling patient access to their complete medical record, including, critically, their imaging records, and Geraldine B. McGinty, M.D., M.B.A., FACR, chair of the American College of Radiology Board of Chancellors discussed the ACR’s shared commitment to this goal, championed through the #DitchtheDisk campaign.

The event also recognized Ambra Health, Life Image

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and Philips Healthcare for committing to be early adopters of the Carequality Imaging Data Exchange Implementation program. RSNA and Carequality welcome other imaging vendors to join them in the program.

“We are truly entering the era of safe, secure and expeditious exchange of imaging information, making it easily accessible for the patient’s benefit, when the patient most needs it,” Mendelson said. “We encourage other networks that support imaging to join and extend the availability of patient imaging exams.”

Carequality and Sequoia Project are closely allied, distinct nonprofit organizations supporting the advancement of health information exchange nationwide with complimentary strategies. The Carequality Interoperability Framework provides governance and technical specifications to enable the linking of health information exchange networks in the United States, regardless of geography or technology. More than 600,000 physicians exchange more than 80 million patient documents each month under the framework, which is now expanding with the adoption of the Implementation Guide supplement by imaging vendors.

“We look forward to working with the three pioneering imaging vendors and salute their commitment to empowering their customers to exchange imaging studies electronically via the Carequality Interoperability Framework,” said Dave Cassel, executive director of Carequality.

The Sequoia Project previously partnered with RSNA to administer the Image Share Validation testing program, which tests vendor compliance with the same standards used in the Implementation Guide. The standards on which the program is based were developed under Integrating the Healthcare Enterprise (IHE), an organization RSNA helped found in 1997. These standards were refined through their implementation in the RSNA Image Share Network, a pilot project funded by the National Institute for Biomedical Imaging and Bioengineering to demonstrate the feasibility of creating a nationwide network for image sharing. •

ADVANCING THE IMAGING PROFESSIONAL

ECRI, ISMP FINALIZE AFFILIATION ECRI Institute and the Institute for Safe Medication Practices (ISMP) announce the successful completion of their plans to join forces. ISMP is now an ECRI Institute affiliate.

By joining together, the two patient safety leaders have created one of the largest health care quality and safety entities in the world, driving greater value to the health care organizations across all care settings.

ECRI Institute and ISMP are globally respected, nonprofit organizations that promote patient safety by sharing adverse effects, near misses and unsafe conditions, including ones associated with pharmaceutical product and medical device use. Four out of five U.S. hospitals rely on ECRI Institute’s data and recommendations to protect patients from unsafe practices and ineffective products. During its 25 year history, ISMP has improved clinical practice and informed public policy changes, including drug labeling, packaging and administration practices.

“The health care industry urgently needs independent, fact-based, transparent evaluations of new technologies and treatments to ensure quality of care and patient safety,” says ECRI Institute President and CEO Marcus Schabacker, MD, PhD. “This affiliation strengthens our ca-

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pabilities and accelerates the creation of additional value for those we serve throughout health care, most importantly, patients.”

Under the terms of the affiliation agreement, ISMP will operate as a wholly owned subsidiary of ECRI Institute.

Both organizations retain their core missions and business operations, and seek opportunities to collaborate and develop new products and services. ISMP President Michael Cohen, RPh, MS, FASHP, and Executive Vice President Allen J. Vaida, PharmD, FASHP, continue to lead ISMP, working closely with ECRI Institute executives. Schabacker and two other ECRI leaders have joined ISMP’s board of trustees.

“This affiliation is the natural evolution of a stronger partnership between two leading organizations dedicated to improving patient safety,” says Cohen. “We will now be able to work more closely together to share lifesaving information and further a vision where safe, high-quality health care is more readily available.” •

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For additional information, visit www.ecri.org, call ECRI Institute at (610) 825-6000, or e-mail communications@ecri.org. For more information on ISMP, visit www.ismp.org, or call (215) 947-7797.

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NEWS ACI AND ASRT APPROVE ICE EDUCATION The educational sessions at ICE 2020 earned ACI and ASRT approval! The Imaging Conference & Expo (ICE), to be held February 9-11, 2020 in Scottsdale, Arizona, has been pre-approved by the ACI for a total of 7.5 CEUs. The CRES Prep Course has been pre-approved by the ACI for a total of 7.5 CEUs. ICE 2020 is the only conference dedicated to imaging directors, radiology administrators and imaging engineers from hospital imaging departments, freestanding imaging centers and group practices. ICE offers valuable CE credits from the ASRT and ACI and, keeping in line with our successful conferences in the past, offers comprehensive educational opportunities for attendees.

Santa delivered a big Christmas gift to ICE attendees in December when the American Society of Radiologic

Technologists (ASRT) approved the education offered at ICE 2020. Attendees can earn 10.5 CE credits by attending the keynote address and one educational presentation during each of the five time slots. Add the two-part CRES Prep (for an additional fee) and attendees can earn an additional 9 CE credits.

Whether it’s invaluable continuing education, productive networking or the exclusive exhibit hall, attendees have the perfect opportunity to enhance their careers and spend time with colleagues at ICE 2020. As an added incentive, ICE conference admission is complimentary for all hospital employees, imaging center employees, members of the military and students.

For additional information, visit AttendICE.com.

GEORGIA HOSPITAL RELIES ON VERSATILITY OF COMPACT MOBILE X-RAY SYSTEM Piedmont Rockdale Hospital (Conyers, Ga.), a healthcare provider with a Level III Neonatal Intensive Care Unit (NICU), has realized efficiencies and ease of workflow with the agility and affordability of Carestream’s DRX-Revolution Nano Mobile X-ray System.

“Having a large and high-census Neonatal Intensive Care Unit, we wanted a device that the neonatologists could utilize in the unit in real time,” said David Owen, Director of Imaging Services at Piedmont Rockdale Hospital.

“So, if they’re doing a line placement for example, then an image is available to the neonatologist right away.”

At only 220 pounds, the CARESTREAM DRX-Revolution Nano Mobile X-ray System has a compact footprint that allows for easy positioning in critical care units, like the NICU at Piedmont Rockdale. A mobile system, the DRX- Revolution Nano provides high image quality and convenient digital radiography imaging for patients in small rooms, the Intensive Care Unit (ICU) or the NICU. The DRX-Revolution Nano is ideal for portable chest, intensive care, orthopaedic and pediatric imaging. The portable, nonmotorized X-ray system uses Carbon Nano Tube technology and features an ultra-lightweight design for easy maneuverability and arm positioning.

“Because of its size and price point we thought it would be perfect for us to replace an aged unit,” Owen said. “To have a piece of equipment that is so versatile, that we can get in and out of isolated areas—with all the equipment around the babies—and still be able to take it out of the unit and use it on the floor, was a very attractive

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feature to us. As a director of the department, the price is very important to me also.”

Though Piedmont Rockdale purchased the DRX-Revolution Nano as a replacement for another unit in the NICU, the system has served as a reliable backup when other equipment fails. The 138-bed hospital has used the DRX-Revolution Nano to service other floors as well.

“In one building is our NICU, ICU and one of our patient floors,” said Owen. “We’re able to utilize the Nano to cover that entire nursing floor, NICU and ICU if our full-size portable doesn’t work—and we’ve had to do that a few times.”

In fact, when the DRX-Revolution Nano first reached Piedmont Rockdale, the system was used as a full-service portable unit. “It was used in the ICU and on patient floors as well as in the NICU,” Owen said. “Our backup plan on Day 1 actually became our main plan.”

Piedmont Rockdale, which houses a full-service imaging department, is known for having the only Level III NICU on the east side of Atlanta. The hospital delivered 1,712 babies in fiscal 2019. Placing the DRX-Revolution Nano within the NICU was a decision that came after careful planning.

“It’s not just Carestream’s digital technology, but also the ability of the unit to adjust the levels of radiation used for images,” Owen added. “It allows us to use lower dose on these very sensitive children.” •

ADVANCING THE IMAGING PROFESSIONAL

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PACS and RIS report from ResearchAndMarkets.com predicts growth in the global market.

Picture archiving and communication system (PACS) is used for management, retrieval, storage and distribution of medical images. In the field of radiology, it is used for sharing and viewing of diagnostic images. A radiology information system (RIS) is a network of the software system used for managing medical images and other related data. RIS keeps track of radiology imaging orders and data of bills. It 24

ICEMAGAZINE | FEBRUARY 2020

is used along with PACS and vendor neutral archives (VNAs). RIS manages image archives, records and billing.

The global PACS and RIS market is expected to exceed $5 billion in 2027, according to the report. The PACS and RIS market is estimated to grow with a compound annual growth rate (CAGR) of 7.4% from 2019-2027.

The market is driven by factors such as developments in diagnostic imaging modalities coupled with the rising number of diagnostic tests procedures, affordable price of new generation PACS software and new product launches and FDA apADVANCING THE IMAGING PROFESSIONAL

provals. However, availability of better substitutes and concerns regarding data privacy may limit the growth of the market to a certain extent, according to ResearchAndMarkets.com.

Some of the difficulties of the PACS software include quality of images, a short span of backup storage as well as the threat from data privacy. To combat the shortcomings of the software, other alternatives with better features are available, for instance, the vendor neutral archive (VNA). A VNA stores medical images in a standard format, making these images accessible to health care professionals.

In PACS software, there are significant issues concerned with vendor-specific software. However, in the case of VNA, the electronic files do not need to be converted into a different format, VNA converts a standard PACS more efficiently as well as cost-effectively. VNAs work through an open architecture, which has access across all domains within a hospital enabling efficient sharing of data with any health care facility across the country. Hence, the benefits offered by other systems over PACS is expected to hinder the growth of the PACS and RIS market.

Zion Market Research (ZMR) has published a report that states the global PACS and RIS market was valued at $2.6 billion in 2017 and is expected to reach $4.3 billion by 2024, growing at a CAGR of around 7.3% between 2018 and 2024.

North America dominates the PACS and RIS market. In 2015, ZMR reports that the North America PACS and RIS market held a major market share of around 45%. The North American PACS and RIS market are expected to grow at a CAGR of approximately 7% between 2018 and 2024, according to the ZMR report. The U.S. is the leading sub-segment in the North American PACS and RIS market, followed by Canada, and is projected to maintain its dominance in the forecast timeframe.

The European PACS and RIS market showed significant growth rate in 2017 and is expected to generate new opportunities in the upcoming years, according to ZMR. â&#x20AC;˘ WWW.THEICECOMMUNITY.COM

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ADVANCING THE IMAGING PROFESSIONAL

2 CHANGE HEALTHCARE

Radiology and Cardiology Solutions Change Healthcare Radiology and Cardiology Solutions provides a complete portfolio of diagnostic imaging and radiology and cardiology department management solutions. The web-based imaging platform has the stability, scalability and performance to accommodate enterprises ranging in size from single facilities to national health delivery networks.

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PRODUCTS

GE HEALTHCARE Centricity Open PACS AI

Centricity Open PACS AI brings the power of AI into the radiologist workflow, in the way they are familiar and comfortable, delivering the right information, at the right time, based on each patient’s context. Combining the latest release of Centricity PACS V7 with Edison Open AI Orchestrator, it combines the power of GE Healthcare and third-party AI clinical applications with robust automation tools, providing functionalities and capabilities that weren’t before possible. This new, integrated and unified user experience can empower radiologists even further, delivering a range of vital information for more confident diagnosis and faster treatment potential. That means patient care – and clinician satisfaction – can reach new levels.

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4 PHILIPS

Next-Generation Enterprise Imaging Solution Philips’ next-generation enterprise imaging solution seamlessly embeds intelligence at every step of each operational workflow and disease pathway, providing the foundation for advanced enterprise imaging today and the fully integrated precision diagnosis platform of tomorrow. It supports hospitals and imaging centers as they seek to connect and optimize performance, improving the patient experience, health outcomes and staff experience, while lowering the cost of care. Combining advanced clinical and operational capabilities, embedded with AI and analytics, it simplifies and enhances workflows across the enterprise imaging network, including image acquisition, viewing and data interpretation, and diagnostic patient management workflows. Announced at RSNA 2019, it will be commercially available in Q1 2020.

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By Matt Skoufalos

BY MATT SKOUFALOS

F

or many years, patient satisfaction in the health care business turned on fundamental questions like whether your medical condition was resolved, or whether you were seen in a timely fashion. In 2020, the concept has become more complicated and is tied more substantially to financial outcomes for health care practitioners and the institutions for which they work.

As the health care industry undertakes a shift toward providing concierge-level care on par with commercial consumer experiences – the better to improve the patient satisfaction scores that affect their reimbursement rates – imaging departments at hospitals and specialists at freestanding clinics 32

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are evaluating the entirety of their operations to best meet these elevated expectations. How facilities and equipment are designed, managed and maintained all play as much a part as how staff are trained, supported and incentivized to carry these priorities through.

Corey Gaarde, associate vice president and senior technology specialist at design firm Hoefer Wysocki of Leawood, Kansas, said that design trends in health care are urging consideration of the cumulative patient experience “outside the four walls” of the buildings they visit.

“It starts at home and doesn’t stop until the patient gets back home,” Gaarde said.

Gaarde said the challenge he lays at clients’ feet is “to think of that digital front door” that exists as soon as their patients begin to access information ADVANCING THE IMAGING PROFESSIONAL

PATIENTS about their facilities. Trying to get institutions that are focused on delivering vital medical services to equally value customer service requires a shift in thinking. He urges them to aim for a level of concierge care comparable to that found in enterprise-class hospitality businesses.

To get there, Gaarde asks clients to consider the experience from the patient perspective, and looks for ways to leverage common, consumer-grade technology to do so. It can start with things like GPS-led, pedestrian wayfinding and navigation through a large hospital campus, or sending an attendant to meet patients and family members at the front door and help guide them through a potentially complex, busy environment.

Once onsite, “the idea is to make it a much more pleasant experience,” from giving patients and family members control over the environment, from lighting to entertainment, to the thermostat; even where blankets and pillows are kept, Gaarde said. These slight touches particularly can have an impact on patient satisfaction in facilities where finance prohibits making more extensive, wholesale upgrades, but “the comfort of an environment is more modifiable,” he said.

“There are 50-60 different technologies that help define a hospital environment,” Gaarde said. “We try to take a comprehensive look at the whole environment, and see what people are doing. There are a significant amount of opportunities from a design perspective to enhance patient care.”

“Even using traditional, real-time locating solutions has shown marked impact on throughput and the ability to manage tracking staff, patients and equipment to expedite procedure times and wait times, so it’s less on the patients themselves,” he said.

Gaarde also pointed to technology that has given hospitals the ability to inject simplified surveys into the in-room patient experience, the better to correct problems as they arise and before people are discharged.

“There is this drive to make it a much more comfortable level of reporting, and really making sure that caregivers are walking in and explaining to patients, ‘We want to know if you’re comfortable,’” Gaarde said. “If they’re not getting the results, they can interact digitally.

Unit managers and quality teams can look at that data real-time as the patient is in-house and figure out what’s going on.”

Within the imaging space, Gaarde points to environmental changes that consumer technologies like digital displays can deliver in leveraging the aesthetics of a room to de-stress a patient. By presenting an aquarium, a scene from nature, or even just dimming the lighting, digital displays can help set a scene that improves conditions in the room. For patients stuck in a proceWWW.THEICECOMMUNITY.COM

dure-level room for long periods of time, the ability for caregivers to update family members on their condition in real time also might be possible to deliver over video display.

“There is a definite push to be more proactive than reactive, especially while family members are in house, and technology is more able to support that,” Gaarde said. “Balance the population that still wants that hightouch [environment], but make it a much quicker, more streamlined process. From a standardization perspective, evaluating technologies that work in imaging that affect the actual equipment is important, but standardized care, standardized communication, cost, communication and support are, too.”

As the Centers for Medicare and Medicaid Services (CMS) continues to focus on institutional customer satisfaction surveys, the agency is also “evaluating changes to traditional responses,” Gaarde said, which means that organizations must find leaders who will champion such

“There is a definite push to be more proactive than reactive, especially while family members are in house, and technology is more able to support that.”

Corey Gaarde, senior technology specialist

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environmental improvements from a reimbursement perspective. He urges institutions, “don’t be afraid of doing the business case analysis” for making upgrades because they might discover that they can inexpensively tweak what they already have in-house and still reap dividends.

“There’s a fear that organizations need to do the whole thing,” Gaarde said. “It may not be too expensive if you understand what you’re trying to accomplish from the patient and caregiver experience level, and still have the maximum ROI. Sometimes just painting will enhance the perspective.” “[Begin] a cycle of evaluating what you have in house, and what can be done to improve processes and technologies: quick wins that can come out of small improvements,” he said.

Ken Luke, CEO of Allegiance Imaging and Radiology of Atlanta, Georgia, also believes in placing technological 34

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solutions at the forefront of the patient experience in the imaging world.

There’s plenty of devices, equipment and software focused on increasing patient safety and improving the speed at which exams are conducted, interpreted, and the results communicated to their ordering physicians. What’s just as important to delivering a high-quality experience, he said, is the empathy and care you show the patient from the first phone call through the study itself.

“An imaging center has a lot of moving parts, even with the technology, so taking care of each patient really well is a very important part of that,” Luke said. “Patients want something that’s fast and convenient to them, and accessible, because they think they might have a problem. It’s important to treat that patient with kid gloves, so the type of person we hire, we want to have empathy and be sympathetic to patients who may have issues.”

Luke codified that approach in an internal customer service program called “The Allegiance Pledge.” It formalizes handling of the patient within the imaging center, and defines how each staffer is to treat the patient, from administrative staff to technologists and center managers. He said that program has helped establish standards of care “to get everyone on the same page.”

“Answering the phone, how we meet and greet the patient, how we schedule – there’s a standard for that, and it’s part of the culture for the company, not just another procedural manual that you have to follow,” Luke said. “That’s what differentiates most companies from each other: what the culture is.”

When hiring employees who would align themselves with the Allegiance Pledge, Luke said he looks for staffers with “people-people” personalities and ADVANCING THE IMAGING PROFESSIONAL

PATIENTS

who are trainable and teachable in the skills required to do the job. Finding those who have both sets of skills can be more difficult, “but they’re out there, and it makes a difference in how the patient’s treated overall,” he said.

Often described in management speak as “high-tech, high-touch” personalities, Luke said those kinds of employees do “really what anyone in medicine should be doing today.”

“It’s a lot of common sense; the golden rule,” he said. “I think it’s about what kind of personality and approach you use. Start with a consulting approach and look at it from the bottom up. You’ve got to spend some time, interview people, and find out how they do things, what’s working well and not.

Sometimes it’s little things that need to be fixed, a tool that people need.”

“At the top or the bottom, it should be the same,” Luke said. “A business has to make money, but it also should WWW.THEICECOMMUNITY.COM

serve the customers really well. If you do, they’re going to tell others through word of mouth, and you get more return business and more referrals from those physicians. So it all balances out.

The profits follow if you’re running a good company from the front end.

You’ve got to make sure that you’re managing well both processes as well as people.”

Writing a pledge is one thing; instilling company culture that reflects its values is another. Luke said the success of any such aspirational goals is based on whatever management structure upholds them; whether the culture starts at the top. If it can filter down to center managers, they can keep

an eye on how the rest of the personnel are following through with it, he said.

“Those center managers are really the key to how each center performs or doesn’t perform, and they’re only as good as their personnel,” Luke said.

“Make it easy for the managers to do this.”

Subsequently, he advises that customer service outreach personnel follow up with referring offices to ensure that they’re satisfied with their results as much as are their patients.

“If patients are happy, it’s a confirmation that we’re doing a good job,” Luke said. “If they’re unhappy, then it means something went wrong. The best way is to admit that mistake versus sweeping it under the rug. Physician offices want that; they expect that. They’re entrusting their patient with us.”

This kind of follow-up and attention to detail at every stage of the patient experience is especially critical for outpatient imaging centers, he said.

Patients who have choices – and who are encouraged by their insurers to patronize the lowest-cost options for their care – will only come back to a center that provides a high quality of service. Hospitals don’t have the same burden once a patient is admitted, which is why Luke stresses the importance of managing relationships with patients and providers.

“Outpatient imaging is providing services, and they have to do it in a way to justify the referral source, who will like you well enough to give you repeat business,” he said.

COREY GAARDE Associate vice president and senior technology specialist at design firm Hoefer Wysocki of Leawood, Kansas.

DAVID WIDMANN President and CEO of Konica Minolta Healthcare Americas Inc.

To David Widmann, president and CEO of Konica Minolta Healthcare Americas Inc., the best way to improve the patient experience involves working toward technological solutions that speed clinical decision-making.

By providing significant, patient-specific information inexpensively, using proven, legacy technologies, Widmann believes that there’s a window of opportunity to drive meaningful change.

“The Affordable Care Act advanced a number of concepts that have put the patient, quality and meaningful use at the center of care, and all those things are moving the needle,” he said.

“We’ve centered ourselves around precision medicine in a unique way: imaging, genetics and research.”

“We really do think the power of digitalization can come together to change how information is used at the point of care, and realize the concept of personalized medicine by connecting radiomics and genomics together,” he said. “It offers quicker, better, longterm patient satisfaction. It triages everything back together.”

With the understanding that highend imaging technologies may not be readily available in every outpatient clinic, Konica Minolta Healthcare is focusing on increasing the reliability and efficacy of volume modalities like X-ray and ultrasound to quickly treat more patients and keep them out of the hospital unless it’s absolutely necessary for them to be there.

“We want to give the clinician the ability to gather initial insight that helps validate that decision process, and be very precise to patient needs,” Widmann said. “We don’t try to take a gold-standard modality and replicate it. But we do think that since an X-ray is done 100% of the time before an MRI 36

ICEMAGAZINE | FEBRUARY 2020

and a CT, the better information we can get from that, the better the patient gets an outcome faster.”

Operating from the standpoint that these primary imaging technologies are actually really good enough in a lot of instances, Widmann thinks they can be pushed to deliver more information faster, and with more personalized results for patients. He used an example from his own circumstances to illustrate the point.

After having taken a fall from a ladder in which he struck his knee on a step, Widmann was trying to push through the pain, thinking it was just a bruise. When an ultrasound showed that he’d fractured his patella, he made an appointment with an orthopedist.

There, an X-ray confirmed the fracture, and the ultrasound, which had shown his ligaments were fine, saved him the time and expense of an MRI study. This all happened while he was traveling and out of network.

“My experience was quite good using basic technology,” Widmann said.

“An MRI would have been good – it’s the gold standard – but I didn’t need it.”

X-ray and ultrasound technologies are value-driven solutions that encourage efficiency simply because so many are conducted for a first look. But by applying digitization to these legacy technologies, Konica Minolta is able to offer practitioners the ability to extrapolate X-ray studies into moving images, and adding ultrasound tools to guide non-interventional therapies. The result is that patients can receive screenings that match their risk protocols, not the average risk protocols. By changing the direction of preventative diagnostics unique to that patient, he

or she no longer has to go through the angst of not knowing what’s wrong.

“Our goal is to enable a clinician to deliver a better decision sooner,” Widmann said. “Once you embrace that thought, you start to look at the process of use, and the outcomes that come not just from the equipment but from the entire experience.”

“If an X-ray can provide more information toward clinical outcomes and be simple and just in-and-out for the patient, then it achieves two goals right out of the gate,” he said. “We can also use the data for analytics to make the user of the equipment more efficient to reduce the need for retakes.”

“The most fascinating part is really how the radiologists are recognizing how it can benefit them by reducing the amount of time it takes for them to commit to this high-volume approach,” Widmann said. “If they can add additional insight to X-ray and ultrasound, they can spend more time on the tough cases that go to MRI and CT.” •

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INSIGHTS

RAD HR

BY JANEL BYRNE

INTENT VERSUS IMPACT – ARE WE REALLY ON THE SAME PAGE?

L

eader thinks: I need to let her know that her negative body language and aggressive comments in yesterday’s meeting were not appropriate and resulted in one of her colleagues, Margaret, feeling uncomfortable. It’s important she knows her impact and I need to give her coaching for how to modify her approach.

Leader says to direct report: “Hey there, your colleagues kind of struggle with your approach – you can come across as not very nice and we don’t want that, right? I think it would be better if you were not as aggressive in the future. Sound OK?” Leader thinks: Well done self! She knows 38

ICEMAGAZINE | FEBRUARY 2020

how she impacted Margaret and can now fix her behavior.

Direct report walks away thinking: Wait a minute! All of my colleagues don’t like me?

I’m going to go to each one of them individually and ask them why they are mad at me until they tell me the truth.

There’s what you intended to say – then there’s what you said – and, finally, there’s what the other person actually heard. You can intend wonderful things; it does not mean that’s the impact you had. People walk away with their perceptions, not your intentions.

If you’re up for the challenge, I’d like you to try an experiment. In a group of people, ask one person to volunteer to be the “tapper” and the rest to be “listeners.” Pull the ADVANCING THE IMAGING PROFESSIONAL

Communication is a lifelong journey, so don’t stop with contrasting. Every conversation is an opportunity to develop and learn how you can continue to improve.

tapper outside and ask them to tap a popular song. A good (and difficult) one to use is “The Star-Spangled Banner.” After they practice tapping outside, ask them how many of the listeners they believe will guess the tune they are tapping. I pose this question to you, let’s say there are 10 listeners, how many do you think will guess the tune accurately after the tapper taps? 50%? 75%?

This is an actual experiment, cited in the book Decisive

by Dan and Chip Heath, and earned Elizabeth Newton her doctorate in psychology from Stanford in 1990. Newton posed the same question I posed to you above and found the tappers predicted the odds were 50%. Over the course of Newton’s experiment, 120 songs were tapped out and listeners guessed only 2.5% of the songs—3 songs out of 120. This means the tappers got their message across 1 time in 40, NOT 1 out of every 2 times. This experiment exemplifies the “Curse of Knowledge” – we cannot unknow what we know. To the tapper, the song is so clear, and truly the only one that resonates. To the listeners, they hear “Happy Birthday”, “Twinkle Twinkle Little Star” or literally have no idea what song the tapper is trying to get across.

Imagine the conversations you have with those you lead (think about the example at the beginning). It’s clear in your mind what you hope for from them and plan to communicate, so you start “tapping.” Have you ever walked away from a conversation 100% sure you were on the same page, only later to find that the what you expected from the person (or group) is not what they did? Your intent is not always your impact, and the curse of knowledge makes it even more challenging for us to grasp that what is clear to us in our minds is not necessarily what we communicated, let alone what was heard by those we lead.

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A quick hack for ensuring your intent matches your impact is a tool called contrasting. Pulled from the book, “Crucial Conversations: Tools for Talking When the Stakes are High,” contrasting is stating exactly what you DO and DO NOT intend. Re-crafting the leader’s communication from above, “My hope for today’s conversation is to share my observations regarding how you showed up during yesterday’s meeting and the impact I witnessed. Specifically, when you said you were shocked that Margaret didn’t understand the simplest processes – while crossing your arms and using a stern tone, I saw her shut down and look physically upset. I don’t believe you were hoping to impact Margaret that way.

My intent is to better understand what you were hoping for and brainstorm together how best to achieve that hope in the future. Can I hear your perspective?”

Communication is a life-long journey, so don’t stop with contrasting. Every conversation is an opportunity to develop and learn how you can continue to improve. A final tool for you this month is called stop, start, continue. It’s a simple method to receive in the moment about what you should start doing, stop doing and continue doing to ensure your intent for the conversation is truly what people are walking away with. To coach our leader from the example: • Start: identifying specific examples of problematic behavior and their impact • Stop: using vague language that results in your direct report believing all of their colleagues may not like them • Continue: to have timely conversations with your direct report so they know what they are doing well and their opportunities for growth. • JANEL BYRNE, MSW, SHRM-CP, is an organizational effectiveness manager at Children’s Hospital Los Angeles.

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INSIGHTS

THE DATA TRAP DIRECTOR’S CUT

BY MARIO PISTILLI

I

am sure that everyone is dealing with copious amounts of data and dashboards in this era of key performance indicators (KPIs).

There is now a sharp focus on everything being measurable and performance goals must be measurable. This metric focus has bled into institutional strategies with many organizations tying their strategic goals to data outcomes.

It is not my contention that data is somehow bad, but what happens when the metrics and the pursuit of metrics replaces the actual strategy itself. This tendency to mentally substitute strategy with metrics is termed surrogation and is extremely common.

Harvard Business Review recently published an article on surrogation (HBR Sep-Oct 2019 p. 63-69) entitled “Don’t Let Metrics Undermine Your Business.”

The article used the Wells Fargo banking scandal as a great example of the concept of surrogation. At Wells Fargo, the strategic focus was on building long-term customer relationships and the metric they chose to measure this was cross-selling. The surrogation took place in the minds of the staff and they substituted cross-selling with the strategy and since rewards were based on number of cross-selling accounts not actually on long-term relationships built, the focus was placed on increasing the number of accounts not on building relationships. This surrogation of the strategy resulted in the exact opposite with the end result being the loss of many customers, in addition to huge fines, litigation and negative publicity.

In health care, I have seen this happen

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ICEMAGAZINE | FEBRUARY 2020

with many strategic initiatives. One great example is in patient experience. Providing great patient experience is a prime focus for every health care organization and has a huge impact on the bottom line. Most every institution utilizes a patient experience survey tool, compares their scores to benchmarks and have patient experience goals.

I have seen staff training that focuses not on delighting the patients, but on raising the scores. For example, one institution had a patient experience question that asked the patient how satisfied they were with their wait compared to their appointment time.

The metric was a comparison of appointment time to the time called for service. So, if the appointment was 9 a.m. and I called you at 9:05 a.m. that was tracked as 5 minutes. To increase scores, instead of focusing on the process for why people were waiting, they just lengthened the arrival time so that they could call everyone early or right on time. In other words, they said the appointment was 9:30 a.m. instead of 9 a.m., but told the patient to come at 9 a.m., and then if they called the patient at 9:15 it looked like they were 15 minutes early. The focus was not on the strategy of reducing patients time at the hospital, but how close did we get to the appointment time.

In the minds of the staff they were doing good and on paper wait times were shrinking, but the impact was the opposite.

Satisfaction was getting worse and patients were at the hospital longer. These examples of surrogation are probably all around you.

I am in no way suggesting that metrics should be scrapped or not used to measure success or progress toward a goal. I am suggesting that one has considered that and ADVANCING THE IMAGING PROFESSIONAL

maintain visibility to this tendency so that they do not fall into this trap. There are several techniques that may be helpful to you: • Employ multiple metrics instead of just one. This allows you to cross-check progress and will decrease the likelihood of hyper focusing on one particular metric.

• Spend time up front really analyzing the why of your strategy and the metrics you chose. Ask yourself, does this measure really get me to my why?

• Analyze, what could someone do to game this metric and how can we ensure that is not happening. I have learned if there is a way that someone can manipulate a measure for a favorable outcome, then they probably will do so. I always ensure that I know exactly how the data is being gathered and the possible way(s) that it could be manipulated.

• Make sure that you have analyzed any possible sources of error in your data.

• Get the people responsible for the strategy involved in the creation of the metric.

If those responsible are involved from the beginning and have a clear understanding of the end goal then they are less WWW.THEICECOMMUNITY.COM

likely to fall into the metric focus trap and remain focused on your real objective.

• Be mindful around what it is you reward and positively acknowledge. In the case of patient experience, is your biggest celebration of a win around achieving a score or is it around a really great patient story.

There is no way that we will ever escape KPIs, dashboards and metrics. I challenge you to take a little time to take a step back and consider what are all the metrics that you are focusing on and the strategies tied to those metrics and ask yourself some of the questions I outlined above. I certainly did not go into health care to get a certain score on a dashboard. I am in this to provide the highest quality and safest care for everyone.

I want the things I measure and reward to reflect that. •

Most every institution utilizes a patient experience survey tool, compares their scores to benchmarks and have patient experience goals.

MARIO PISTILLI, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Children’s Hospital Los Angeles. He is an active member and volunteers time for ACHE and HFMA organizations. He is currently serving on the AHRA national Board of Directors. He can be contacted at mpistiili@chla.usc.edu

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INSIGHTS

PACS/IT

BY MARK WATTS

DATA USAGE AGREEMENTS AND THE NEW NORMAL T his is my third revision of this article. I cannot seem to keep up with the pace of change in the health care provider-information technology giant corporation partnership development. Is your health care data being sold out the backdoor?

“The new normal is that companies that monetize data are in a land grab for health care data.”

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ICEMAGAZINE | FEBRUARY 2020

My second version was scrapped after I reviewed the announcement that the five British National health trusts have signed a partnership with Google to process sensitive patient records.

I received a call from a peer asking me about my knowledge and advice on signing a new contract with an established and trusted IT vendor. He said he noted a new clause, the vendor wants rights to the data. All contracts are subject to modification, I said he should remove the clause. The conversation ended but mine and our awareness of this potential new threat to you and our patients’ data is just beginning. I called a salesman from the IT vendor and he said that he was “surprised at how many people just sign the agreement, that they will give in exchange for free use of the data some comparative performance reports vs. peer in health care.”

HIPAA will protect us? In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was signed into

law to improve health care workflow.

Google was founded September 4, 1998.

In an Artificial Intelligence showcase, IBM Watson won Jeopardy in 2011. The laws that are written before the lightspeed change in technology cannot be seen as meaningful protection. We as shepards of health care data must be thoughtful and aware of its value and the unintentional exploitation of patients. Data is the new oil.

We quickly sign agreements with large information technology firms so that we can enjoy the benefits of their products. We do not pay directly for a Google search. We do give up information that is monetized. I searched for Greek cruises for my anniversary. Then, I find cruise offers popping up on my next search. This is an understood exchange of value. How are things different today?

Why am I concerned?A noted thought leader on health IT stated that today, unlike any previous time in American health care history, more patient data is under the stewardship of for-profit health care systems than academia. Pair that with the move to offsite cloud IT infrastructure and it means more patient data is primed for exploitation by Artificial Intelligence applications. A perfect storm, profits+data+technology.

At RSNA 2019, it was announced that a well-know IT solution provider was shifting to a new all-cloud solution ADVANCING THE IMAGING PROFESSIONAL

and had signed one of the largest for-profit health chain as a client.

The CIO of the health chain company was moving all imaging data to the cloud to control costs for his company.

The IT solution provider was partnering with Google to control the cost of providing the all-cloud services.

Google was getting access to one of the largest medical imaging data sets ever created and being paid to do it. Google could not pay to collect this much information.

The point of awareness is that this is happening through a business agreement license and data usage rights provided by the health care entity. The IT solution partner now can use the data without the consent of the patient as expressly dictated in the HIPAA law. Money laundering of data.

In my next article, I will cover why large data sets are so important for the development of AI machine leaning and how to correctly present protected health care information for research.

The new normal is that companies that monetize data are in a land grab for health care data. Why you may ask?

Here is one example: If my grandfather had a CT performed WWW.THEICECOMMUNITY.COM

in order to rule out dementia and I was to go and purchase a long-term heath policy, would the company like to know my grandfatherâ&#x20AC;&#x2122;s medical history before the underwriting?

Would my coverage be triple the cost even if my grandfather did not have nor ever developed dementia?

The people who wrote the HIPAA laws did not and could not have known how quickly technology would develop so that the patient would not be able to maintain the protections HIPAA intended.

My goal is to raise awareness of this rapidly changing dynamic and give you a reason to read your renewal contracts one more time before signing. â&#x20AC;˘ MARK WATTS has over 20 years as an imaging professional with vast expertise in imaging informatics and IT issues. He has served in many roles in both hospitals and industry as a health care vice president, imaging director and IT consultant. His knowledge and experience in the convergence of IT and imaging has made him a sought after author, speaker and consultant. He has authored a textbook on informatics and was a pioneer in the adoption and development of PACS and VNA technologies.

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INSIGHTS

CODING/BILLING

BY MELODY W. MULAIK

BREAKING DOWN THE GI CODES S

ome of the biggest changes for 2020 occurred in the gastrointestinal codes in the radiology section of the CPT® Manual. Many codes were revised to include the specific components of the exam (examples include scout neck X-ray, delayed imaging and oral contrast when performed). Other codes were deleted since the revisions eliminated the need for separate codes.

Per the CPT® Manual the esophagus studies 74220 and 74221 describe a procedure that is a component of an upper GI series and should not be coded separately. Instructional annotations have been added to the GI series codes stating that codes 74220 and 74221 are not to be reported in conjunction with 74240, 74246 and 74248.

There are corresponding CCI edits that cannot be bypassed with a modifier.

The upper GI codes have been revised for 2020 and are differentiated by the use of contrast. Additionally, the performance of a small bowel follow-through (SBFT) study is now reported with an add-on code. Code 74240 represents a single 52

ICEMAGAZINE | FEBRUARY 2020

contrast study of typically barium. Code 74246 represents air contrast studies. An air contrast study, also called a double contrast study, includes the administration of an effervescent agent, similar to Alka-Seltzer, which releases carbon dioxide into the stomach. This distends the stomach and allows for better visualization.

If SBFT is performed, add-on code 74248 should be reported. SBFT is a series of follow-up images taken to view the passage of the barium through the entire small intestine, all the way to the cecum.

This adds 1-2 hours to the time required for the upper GI series.

The small intestine and colon codes have been revised to maintain consistency in the code definitions for this section.

Ensuring the correct code assignment for diagnostic gastrointestinal codes is more straightforward in 2020 as long as the extent of the exam and the use of single or double contrast is properly documented in the radiology report. The current trend of revising codes to ensure clarity and consistency is welcome indeed. • MELODY W. MULAIk, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.

ADVANCING THE IMAGING PROFESSIONAL

Definition

CPTÂŽ Code 74210

Radiologic examination; pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study

74220

Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed, single contrast (eg, barium) study

74221

double contrast (eg, high-density barium and effervescent agent) study

74230

Radiologic examination swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study

74240

Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), upper when performed; single contrast (eg, barium) study

74246 +74248 74250 74251 74270 74280

double contrast, (eg, high-density barium and effervescent agent) study, including glucagon, when administered Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered Radiologic examination, colon; including scout abdominal radiograph(s) and delayed image(s), when performed; single contrast (eg, barium) study Radiologic examination, colon; double contrast (eg, high density barium and air) study, including glucagon, when administered

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ICEMAGAZINE

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INSIGHTS

THE CHANGING ROLE OF THE PATIENT

T

he role of the patient in health care is changing. What was once considered a unidirectional experience (the doctor runs the show) has become a consumer-driven model.

lessons associated with giving patients the ability to control their experience. There remain too many experiential downsides including paper forms, long wait times, confusing bills, labyrinthian corridors and, in many cases, travel hurdles. Some hospitals Whether we are considering and physician groups have DEPARTMENT/ patient satisfaction scores, revamped their models to OPERATIONAL ISSUES make access and experience measuring patient leakage or using analytics to assess simpler. There remains much

BY JEF WILLIAMS throughput and outcomes, it’s room for improvement. And clear that health care is performance based and until the patient gets a voice in the executive the consumer is becoming the central character decision-making, we will continue to overlook in the narrative. even the simplest of solutions to improve.

While there are still very important issues related to physician workload, technology costs SCHEDULING & ACCESS and reimbursement models, much of what Most of us are using apps for nearly everything drives the conversation with executives is pain our lives. We book hair appointments, dinner tient satisfaction and the accompanying retenreservations and travel without ever interacting tion. Defining the role of the patient is having a with a person. Yet in health care even the simsignificant impact on decisions related to care plest of appointments require phone calls and delivery, technology investment and operational calendar analysis in real time. It’s time health models. care improves its patient portals to allow for the common access needs (imaging, primary care, PATIENT EXPERIENCE urgent care) to be managed electronically. Sure, Much has been written over the years about the there are plenty of procedures that are complex Starbucks success story. It’s widely accepted and require a consult or advice, but as with that its rise to preeminence in caffeine products most problems there is an 80/20 rule at play. had less to do with the coffee itself and more Let’s stop using human resources to manage to do with the customer experience. Providing calendar appointments and making patients people the ability to walk into a coffee shop find a quiet and private place to make a call that elevated their morning experience (from and negotiate a simple visit. The EHR is there décor to customer service) as well as create to improve care and it holds nearly all of the a variety of options allowed the company to information required to automate scheduling grow exponentially. And while health care has and access. It’s time to leverage this warehouse a much different problem statement, there are of data to simplify this step.

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ICEMAGAZINE | FEBRUARY 2020

ADVANCING THE IMAGING PROFESSIONAL

TRANSPARENCY When was the last time you agreed to buy something on Amazon without knowing the price? When was the last time you enjoyed waiting on hold without knowing how long your wait time would be? We, as customers, no longer put up with any of these things. We can shop and compare prices for anything including electronics, auto insurance, even contractors. And when we call our airline or Internet service provider we are told how long our wait time will be and are even able to register our phone number for a callback when we present in the queue. This, unfortunately, is still a serious problem in the patient experience. Even with recent federal laws related to listing prices, there is no accommodation for when services are in-network versus out-of-network. And unless someone is willing to make multiple calls and reference multiple locations, there is no simple ability to compare prices. The current trend demonstrates large increases in co-pays which is driving more price sensitivity for patients – something that was almost a non-factor until recently.

In addition, there is very little accommodation for patient wait times. While this is easily quantifiable with many technological options to improve how patient throughput WWW.THEICECOMMUNITY.COM

is managed, we still find most waiting rooms in hospitals, clinics and physician practices full of people with no idea whether they will be sitting for another two minutes or two hours. We can, and must, do better to advance technology in a way to accommodate the needs of patients including concern for the value of their time.

WHAT THIS MEANS FOR US As influencers in the decisions that affect delivery, technology and operations, we must advocate for the needs of our patients. We certainly have deep obligations to the satisfaction of our staff and physicians, but this isn’t a zero-sum game. Many other industries have found ways to improve operations while concurrently improving the customer experience. Too often in health care we see ourselves so unique that we can’t learn the lessons others can teach. This, I believe, is one area where there is no need to reinvent the wheel. It’s time to take a serious look at how we treat our patients – beyond the care – and build strategic initiatives to make significant improvements. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners.

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The RaySafe X2 is a multi-parameter, multi-modality instrument.

It combines state-of-the-art sensor technology with a simple user interface, making X2 the ultimate in user-friendliness.

• Easy to operate with large touch-screen display and a great overview of all measured parameters

• Quickly analyze measurements with full waveforms directly

Schedule a demo today at: www.RaySafe.com sales@flukebiomedical.com or call (800) 850-4608

in the base unit

• Just connect and measure. No special settings needed to handle different types of X-ray machines

©2019 Fluke Biomedical. Specifications subject to change without notice.

10/2019 6012969a-en

INSIGHTS

CONFLICT RESOLUTION 401

EMOTIONAL INTELLIGENCE

BY DANIEL BOBINSKI

Conflict Resolution in Action

T

his is the final installment of a four-part series on conflict resolution.

In my first column on this subject I wrote about the five universal fears and how they get in the way of conflict resolution. The second column reviewed the need for good listening.

The third installment explained the five steps for resolving conflict, which I call the Relationship Ladder. By way of review, the five steps of this ladder are: • Focus on the other person • Seek to learn if you understood • Look for trust • Gently discover the truth • Establish hope As a resource, you can see a video explaining the process ICE magazine’s website.

In this final installment, I present some examples of the Relationship Ladder in use.

EXAMPLE #1: JOANN “What’s wrong with you people?” Mr. Williams yelled into the phone. “You do nothing all day long. All I’m asking is that you do your jobs.

Why can’t you process my simple request?”

As a supervisor, JoAnn was accustomed to brash confrontations. Mr. Williams was a senior manager, but he had made his request just that morning. Moreover, it was missing some vital information, and other work had been flagged as higher priority.

Mr. Williams had a reputation for losing his temper but getting on his bad side was not something JoAnn really wanted to do.

JoAnn realized this situation was an opportunity for her to use the Relationship Ladder. Step One of the ladder was to focus on Mr. Williams’ thoughts and feelings, and Step Two was to seek confirmation that 60

ICEMAGAZINE | FEBRUARY 2020

what she perceived was correct. She also knew she had to avoid responding to his personal jabs.

JoAnn quickly reviewed what Williams had said: 1. What’s wrong with you people?

(Personal jab) 2. You do nothing all day long. (Personal jab) 3. All I’m asking is that you do your jobs.

(Personal jab) 4. Why can’t you get my simple request processed? (The real issue) JoAnn opted to seek confirmation on both his feelings and his thoughts. “Mr. Williams, this sounds very important to you. To clarify, you’re wanting to know how far along your request is in our system?”

Mr. Williams was a little surprised. Usually someone took his bait for an argument. “Exactly,” he said. “Why don’t I have what I asked for?” He tried to sound gruff in his response, but JoAnn thought she could sense his voice tone drop a bit. JoAnn thought. Step Three is “Look for Trust.” Did she sense some there?

JoAnn decided to build more trust. Mr. Williams needed to know his concerns were important, so she told him she would look into the matter and call him back. Not only did that give her time to think through her response, it also gave time for Mr. Williams to cool down, knowing that JoAnn was working on his problem.

When JoAnn called him back 10 minutes later, she wanted to make sure trust had been established, so she restated her concern for his needs. When she could tell that he was feeling respected, she moved on to Step Four, Gently Discover the Truth. When she realized he wasn’t giving her any resistance, she segued into Step Five, Establishing Hope. It sounded like this: “I see your request is related to the ADA ADVANCING THE IMAGING PROFESSIONAL

project, and that it’s an important component of that project.

In looking at our schedule today, our workload has quite a few jobs flagged as high priority, which you may not have been aware of. All our personnel are tied up on those jobs this morning, so it looks like we can get to your request this afternoon. However, while I have you on the phone, I have your request here in front of me, and I notice that some of the information is missing. Can I get that from you now, or would you rather I talk with someone else about it?

JoAnn knew this was a bold approach, but she also knew that no magical phrasing existed. She just needed to trust the process of using the Ladder.

As it turned out, Mr. Williams was impressed with JoAnn’s professionalism. He wasn’t thrilled to hear his paperwork had not been completed properly, but together they got everything worked out and his work request made it onto the schedule. Hope had been established.

STICK WITH THE FIVE STEPS It’s difficult enough dealing with our own and other people’s emotions when resolving conflict, so having a step-by-step process such as the Relationship Ladder serves as a useful guide. Thankfully, JoAnn had practiced using the Ladder, or she might have responded to one of Mr. Williams’s personal jabs. If she had done that, the ripple effects would not have been good.

Dennis is someone else who had studied the Relationship Ladder.

EXAMPLE #2: DENNIS As a middle manager attending one of my training classes, WWW.THEICECOMMUNITY.COM

Dennis put the Ladder to work when a disgruntled employee barged into his office all fired up and ready for a verbal shouting match. Instead of pushing back, Dennis used the Relationship Ladder.

As the employee stood and ranted, Dennis listened. He paraphrased. He restated. He clarified. He calmly acknowledged, without judgment, all that the employee had to say, even though he didn’t agree with everything being said.

Before long, the employee was sitting down and the two were talking calmly. Then Dennis asked, “So, what would you like from me?” This was his way of Establishing Hope.

As they wrapped up, Dennis said he would look into the situation, and the employee left Dennis’s office in a much better mood than when he entered.

Later, Dennis told me this same employee stopped him in the hall several weeks later. He expressed his gratitude to Dennis for the professional way in which he handled that emotionally charged situation.

These five steps don’t come naturally. You must make a conscious choice to do them. But the five steps, used in order, give you a proven plan for resolving conflict. Remember, conflict is inevitable, but unresolved conflicts demoralize a team. Therefore, you must resolve to resolve conflict, and the Relationship Ladder is a great tool for doing it. • DANIEL BOBINSKI, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach Daniel through his website, www.

MyWorkplaceExcellence.com.

ICEMAGAZINE

61

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“Wherever the art of medicine is loved, there is also a love of humanity.”

– Hippocrates

ICE PHOTO CONTEST

[QUOTE OF THE MONTH]

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Submit your photo online at TheICECommunity.com/Contest and, while you’re there, click on the “Subscribe” tab to get a FREE copy of the magazine delivered to your home or office each month.

ICEMAGAZINE | FEBRUARY 2020

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ADVANCING THE IMAGING PROFESSIONAL

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Fecal samples carry microbe DNA and waste products

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ICEMAGAZINE

65

INDEX

ADVERTISER INDEX Accumen p. 2

Fluke/Landauer/RaySafe p. 45

Agiliti p. 48

Fujifilm Medical Systems p. 67

ULTRASOUND QA & TRAINING PHANTOMS

Ampronix, Inc. p. 4 ACCURATE• DURABLE• RELIABLE • Multipurpose •Small parts • Doppler flow •ABUS

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ATS/CRIS p. 41

BC Group International p. 41

Increase your speed GE Healthcare and accuracyp. 15

MarShield p. 41

RSTI/Radiological Service Training Institute p. 37

MedWrench p. 54

DIAGNOSTIC IMAGING & SURGICAL SOLUTIONS

Shared Medical Services p. 30

Diagnostic Imaging with RaySafe X2 X-ray MeasurementMulti System Solutions Back Cover

Siemens Healthineers p. 29

Guerbet p. 23

Health Tech Talent Management p. 55

MW Imaging Corp. p. 5

Sodexo CTM p. 25

Injector Support and Service p. 58 Carolina Medical Parts p. 55 www.carolinamedicalparts.com

The RaySafe X2 is a multi-parameter, multi-modality instrument.

It combines state-of-the-art sensor technology with a simple user interface, making X2 the ultimate in user-friendliness.

Schedule a demo today at: PM Imaging Management www.RaySafe.com p. 63 • Easy to operate with large touch-screen display and a great sales@flukebiomedical.com

overview of all measured parameters

• InterMed Quickly analyze measurements with full Group p.waveforms 44 directly

Summit Imaging, Inc. p. 9

or call (800) 850-4608

in the base unit

• Just connect and measure. No special settings needed to

SOLUTIONS

handle different types of X-ray machines

TriImaging Solutions p. 18

Chronos Imaging LLC p. 51

RaySafe p. 59

©2019 Fluke Biomedical. Specifications subject to change without notice.

10/2019 6012969a-en

International X-Ray Brokers p. 49 College of Biomedical Equipment Technology p. 62

Diagnostic Solutions p. 49

66

ICEMAGAZINE | FEBRUARY 2020

Ray-Pac®

USOC Medical p. 31

Ray-Pac p. 3 KEI Medical Imaging p. 21

Konica Minolta p. 50

W7 Global, LLC. p. 44

Richardson Electronics Healthcare p. 63 Webinar Wednesday. p. 40 ADVANCING THE IMAGING PROFESSIONAL

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