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APRIL 2020 | VOLUME 4 | ISSUE 4
ADVANCING MAGAZINE
IMAGING PROFESSIONALS
AI, AI, Oh! The Role of Big Data in Practice Management and Clinical Advancement PAGE 38
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INNOVATUS IMAGING Innovatus Imaging provides accurate probe and coil repairs via coveted industryleading warranty rates with fast turn-around times, easy access to loaners and more.
38 FEATURED ARTICLE
Artificial intelligence (AI) and machine learning has captured the collective imagination of the health care space. We look at how AI can reduce errors and improve workflow.
48 EXPERT ARTICLE
Mark Muraski explores the three basic causes of bad power, how to measure for it and how to correct it. 6
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EMOTIONAL INTELLIGENCE
Invest in your greatest assets – the people who do the work that makes your company operate, and 10 years from now you’ll still be receiving dividends from your investment. ADVANCING THE IMAGING PROFESSIONAL
APRIL 2020
32 PRODUCT FOCUS
ICE shines a spotlight on the latest and greatest X-ray devices.
21
IMAGING NEWS
A look at the latest news and hot topics from the medical imaging field.
28 GE HEALTHCARE
Digital Expert is one of the new ways the GE Healthcare is providing innovative solutions for education and training.
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MD Publishing 1015 Tyrone Rd. Ste. 120 Tyrone, GA 30290 Phone: 800-906-3373 Fax: 770-632-9090
CONTENTS SPOTLIGHT 10
In Focus Ernesto A. Cerdena, AtlantiCare
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Rad Idea Here’s My Card
14
Rising Star Bryana White, Resurgens Orthopedics
Kristin Leavoy kristin@mdpublishing.com
16
Off the Clock Brad Reed, Oregon Health & Science University
Editorial
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Company Showcase Innovatus Imaging
28
Company Showcase GE Healthcare
Publisher
John M. Krieg john@mdpublishing.com
Vice President
John Wallace Erin Register
Art Department Jonathan Riley Karlee Gower Amanda Purser
Webinars
Linda Hasluem
NEWS 21
Imaging News A Look at What’s Changing in the Imaging Industry
Jayme McKelvey Megan Cabot
PRODUCTS
Editorial Board
Account Executives
Laurie Schachtner Nicole T. Walton-Trujillo Mario Pistilli Jef Williams Christopher Nowak
Circulation
Lisa Lisle Jennifer Godwin
Digital Department Cindy Galindo Kennedy Krieg
Accounting Diane Costea
ICE Magazine (Vol. 4, Issue #4) April 2020 is published by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to ICE Magazine at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.theicecommunity.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2020
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Market Report X-ray Market Forecast to Eclipse $15 Billion
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Product Focus X-ray
INSIGHTS 44
Rad HR How to remove barriers for your people, even when the barrier is you
46
Director’s Cut Reverse Monitoring
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Expert Article Avante Health Solutions
50
PACS/IT Text Messages Provide Health Care Options
52
Department/Operational Issues 2020 Vision – The Next Decade for our Industry
54
Coding/Billing Those Crazy Edits
56
Emotional Intelligence Investing in Employees – Your Greatest Asset
58 62
ICE Break
Index
ADVANCING THE IMAGING PROFESSIONAL
CT-20-NAM-648 The scientific overlay is not that of the individual pictured and is not from a device of Siemens Healthineers. It was modified for better visualization · 8369 1119
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SPOTLIGHT
IN FOCUS ERNESTO “ERNIE” A. CERDENA
BY JOHN WALLACE
A
n altruistic outlook is an ideal trait for health care professionals. Ernesto “Ernie” A. Cerdena is the corporate director of radiology services for AtlantiCare, a member of Geisinger Health. He is transitioning to senior vice president, Medical Technology Management Institute (MTMI). He is among those with a gift for caring about others.
Ernesto “Ernie” A. Cerdena is an experienced imaging professional.
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His unselfishness is no doubt a part of his DNA, as well as a personality trait obtained via life experiences, especially those instances when his parents modeled the golden rule. When asked about his decision to work in diagnostic imaging, his answer seems to explain his overall outlook on life. “I have been in the medical imaging field for nearly 34 years. I started as an imaging technologist in 1986 performing plain X-ray, CT and interventional radiology for 13 years prior to moving my way up as a medical imaging leader,” Cerdena says. “Growing up from the Philippines, my father worked at a maternity hospital as an attendant, helping the midwives to prepare patients delivering babies. He instilled in me the value of kindness and helping people in need. I remember my dad helped a homeless woman find a space in
our own home with her newly born baby until she was strong enough to find a place of her own. The mom and the baby stayed for a few days. This inspired me greatly to get into the medical field.” Cerdena’s entire family was impacted by his father’s role, career choice and altruism. “Further, my older brother is a radiologic technologist in Texas, my younger sister is a pediatric registered nurse in Abu Dhabi and my wife is a cardiac step-down registered nurse,” he explains. “I believe the medical field is our calling. However, what genuinely inspired me is the notion of helping the people who are sick to get better. Working in medical imaging is very special, the feeling that you can make a difference to the patient’s healing process and recovery is truly a rewarding experience.” His outlook is further realized when asked about his greatest work accomplishment. “The absolute measurable accomplishment in my medical imaging career is being able to contribute to medicine and the health care needs of our community. Whether by achieving the customer service goals, maintaining top quality metrics, exceeding financial margins, investing in advanced technology or enhancing employee engagement, each of these important elements serve as the true drivers toward success,” Cerdena says. “In addition, volunteerism is a huge part of my
ADVANCING THE IMAGING PROFESSIONAL
commitment with the medical imaging industry and leading to advance our professional association (AHRA) gave me a great sense of accomplishment.” The former AHRA president explains that he truly enjoys what he does for a living. “I love my job because this is what I was born to do,” Cerdena says. “I feel that I am executing my life’s mission by leading the people I work with to do the right thing for our patients. As a lifelong learner, I am also passionate in learning and mentoring students or less experienced imaging leaders to fulfill their full potential.” His desire to help people extends to his leadership style and how he sees himself as a director of radiology services. “Leading health care has been a roller coaster ride. The changing landscape brought by the disruptions from many aspects of regulatory, technological advancement, reimbursement methodologies, appropriate staffing model, employee resiliency and burnout require a leadership filled with creativity, innovation, taking risk and lots of visibility,” Cerdena says. “I am particularly akin to transformational and transactional leadership styles and behaviors.” “Transformational because we need to sustain the basics of leadership by motivating and engaging our employees to perform well by doing more with less,” he explains. “As leaders, we need to maintain a culture of transparency and open communication. We need to instill within our team a desire to challenge the status quo and support transformation and change. With the quality mandates and cost cutting measures, a transactional approach to leadership is equally important. Leaders must recognize the efforts of employees working together to achieve zero quality failures and reduce cost. Rewarding the team with a pizza luncheon or an individual $5 gift card goes a long way and validates their contributions to the success of the team. Both leadership styles are interdependent and serve me well with achieving our organizational excellence.” Mentoring others is another aspect of his leadership. “I have mentored a few imaging professionals. The first one was a mammo tech that I hired in 2002. She did not have any experience but demonstrated a high initiative to lead and willingness to learn. She took on our first generation PACS project and eventually was
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promoted to radiology manager. I encouraged her to complete her MBA. Currently, she works as a director of radiology in a hospital in New York. I have also mentored a few up-and-coming leaders from all over the country through the AHRA Partners in Learning mentorship program,” Cerdena shares. Giving back to the profession is actually a way that Cerdena pays it forward. He says he had mentors help him along the way and now he aims to help others. One way he is helping is by continuing to teach others. “As a lifelong learner, completing my doctoral degree is a dream I realized in 2016. I always had a passion to teach and mentor students and imaging professionals. Immediately after graduation, I had the opportunity to teach strategic management and healthcare policy courses for the radiologic sciences graduate program at the University of Texas MD Anderson Cancer Center in Houston Texas,” he said. “Currently, I am teaching 18 medical imaging students to help them complete their master’s degrees. Furthermore, I recently accepted a senior vice president role at the Medical Technology Management Institute (MTMI) with an overarching goal of improving health care delivery in medical imaging through advancing the organization’s focus on providing top quality training and continuing education for medical imaging technologists, physician assistants, nurse practitioners, physicists and radiologists. I firmly believe that having a medical imaging degree is not enough; continuous training and education have an immense positive impact on quality patient outcomes.” Cerdena grew up in a large family and was impacted a great deal by his father’s health care career. His two sons may soon continue the family tradition of helping others. “As mentioned earlier, I grew up in a big family in the Philippines. I am the second youngest of a family of eight. Both of my parents are deceased. I am married to my lovely wife who is a telemetry RN,” he says. “We have two boys; our oldest son graduated from Stony Brook University and is currently working to obtain his clinical hours to pursue a physician assistant program. The youngest one is a senior in high school and recently received admission to Fordham University to pursue a psychology major.” •
ERNESTO A. CERDENA
Corporate Director of Radiology Services for AtlantiCare 1. What is the last book you read? Or, what book are you reading currently? “Health Policy Analysis: An Interdisciplinary Approach by McLaughlin & McLaughlin” 2. Favorite movie? “Star Wars” (all of episodes) 3. What is something most of your coworkers don’t know about you? I have traveled to 22 countries. 4. Who are your mentors? Janet Ready, MBA, Chief Operating Officer, St Joseph’s Health, Syracuse, N.Y. and Clark Yoder, MBA, Chief Executive Officer, Advanced Radiology, Fairfield, Connecticut 5. What is one thing you do every morning to start your day? Check cellphone 6. Best advice you ever received? Work hard and never give up! 7. Who has had the biggest influence on your life? My father 8. What would your superpower be? Emotional Intelligence (EQ) 9. What are your hobbies? Watching Netflix series and movies, clay shooting, bowling, surfing the net 10. What is your perfect meal? A Filipino meal called “Chicken Adobo with white rice.”
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SPOTLIGHT
Rad idea HERE’S MY CARD
A
recent study indicates that it might be a good idea for radiologists to give every patient a business card.
The ACR’s Imaging 3.0 initiative is a roadmap to transition the practice of radiology from volume-based to value-based imaging care. The program is designed to help radiologists shape their future using tools and processes for practice management and patient care. A business card template or suggestion could become a part of the Imaging 3.0 initiative. The aim of the study was to investigate how well patients can remember a radiologist’s name under normal circumstances following breast mammographic and ultrasound examination, and the importance attached to being able to reach the radiologist afterwards if they have further questions or concerns. Researchers also explored whether remembering the name of the radiologist, radiologist-patient bonding and if patient satisfaction can be improved by giving each patient a business card after a radiological examination, with the aim of improving the service quality for patients.
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In conclusion the study found that, “Under normal conditions, patients find it difficult to recall the name of the radiologists who undertake their imaging studies, and therefore may not be able to contact the radiologist for questions although they may like to do so. The act of giving the patients a business card significantly increases their recall of the radiologist’s name and could be an important factor in improving the relationships between patients and radiologists. The desire to be able to contact the radiologist when questions may arise later needs to be regarded as an important aspect of their care.” •
REFERENCE Gutzeit, A., Fischmann, A., Forstner, R. et al. “I was seen by a radiologist, but unfortunately I can’t remember the name and I still have questions. What should I do?” Radiologists should give thoughts to improve service professionalism and patient esteem. Cancer Imaging 20, 18 (2020). https://doi.org/10.1186/s40644020-0292-7 Share your RAD IDEA via an email to editor@mdpublishing.com.
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SPOTLIGHT
RISING
STAR
BRYANA WHITE
Bryana posing with the artwork she created.
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ICEMAGAZINEADVANCING 14 THE IMAGING PROFESSIONAL
BY ERIN REGISTER
O
ur featured “Rising Star” of the month is Bryana White, 29, from Atlanta, Georgia. She graduated from McEachern High School and is currently enrolled at Cambridge College of Healthcare and Technology to become a radiologic technologist. She began working full-time as an X-ray technologist at Resurgens Orthopedics in November of 2018. ICE Magazine learned more about this Rising Star in a question-and-answer session.
Q: WHY DID YOU CHOOSE TO GET INTO THIS FIELD? A: Before starting my college career to become an X-ray technologist, I pursued nursing at Darton State College in Albany, Georgia. During my time there, I fell in love with patient care and discovered that radiology intrigued me more than nursing did.
Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: What interests me the most about the imaging field is the opportunity to grow and learn more. X-ray is only the foundation! I love the fact that we play such a huge role in diagnosis. To me, it is like we are the “eyes” for the doctor, which makes it so cool to be a part of imaging.
Q: WHAT DO YOU LIKE THE MOST ABOUT YOUR POSITION? A: I enjoy being a part of the diagnostic process for patients. Knowing that I have a skill that will help patients receive the care they need to feel better gives me a sense of accomplishment.
FUN FACTS Favorite hobby: Skating, bowling or wine tasting
Favorite show to binge watch: “Ozark” on Netflix
Favorite food: Pasta One thing on your bucket list: To travel across the world and eat different foods
Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR?
Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS?
A: Getting an offer to become a student tech during my first clinical rotation was such an accomplishment and honor. During my first rotation, Resurgens saw something in me. While getting a job offer is not completely unheard of, I never thought it would be a reality for me. I consider this job one of my greatest accomplishments and will always be thankful for it.
A: After earning my degree in radiology, I plan to travel while working. I also plan to further my education by studying mammography or MRI. Additionally, I would like to get a dog and buy a house. •
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ICEMAGAZINE
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SPOTLIGHT
BRAD REED
Off Clock Brad Reed’s hikes often come with breathtaking views.
THE
BY MATT SKOUFALOS
D
uring the workday, Brad Reed is the senior director of diagnostic imaging services at Oregon Health & Science University in Portland, Oregon. With responsibilities on both the health care and academic sides of the facility, Reed lives a meetingand planning-heavy day-to-day existence, overseeing performance improvement, budget and safety concerns. Reed, a Chicago native, has only been in Portland for five years, but during the transition, has really opened himself up to the regional outdoor opportunities there, from hiking and sightseeing to extreme trail running. This past fall, “it kind of all came together,” as he participated in a 93-mile hike around Mount Ranier, Reed said. 16
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“I love being outdoors,” he said. “I think the weather in the Pacific Northwest is perfect for that. It never gets too hot: cool mornings, warm afternoons, cool evenings. It’s the right elements for being outdoors and staying outdoors.” Portland offers access to a wealth of natural beauty, from the shores of the Pacific coast, to the Columbia River Gorge and the waterfalls and trails of its old-growth forests. Beyond that, the Coast and Cascade mountain ranges loom, along with next-level hiking trails. Reed considers himself a novice at such activities, but has nonetheless tried his hand at many of them in a relatively short amount of time. “The competitive nature of sports has always been part of my life,” he said. “As those years of playing rec sports came to an end, what was going to fill the void? I don’t want to be defined by the culture of golf; there’s other ways to challenge myself.”
Brad Reed says Oregon offers many outdoor activities.
Since the days when his wife first began volunteering for the Chicago marathon, Reed has participated in several. To date, he’s run 10 marathons, two 50-mile ultramarathons and a ADVANCING THE IMAGING PROFESSIONAL
50K ultramarathon. And yet, to his thinking, Reed describes himself as “an event participator,” and not a runner. He trains most heavily when there’s an event on his calendar, and in the interim months when there’s not, spends as much time outdoors as he can, albeit with a less strenuous agenda. In tackling monumental distances, however, the only approach is to start small. Reed’s 93-mile hiking adventure began as interval training with day hikes, before working up to a 40-mile hike around a less challenging mountain. With three children in his household, from elementary school to college ages, his schedule doesn’t always allow for a consistent exercise routine, so Reed maintains “a minimal level of training,” at the least. Despite preparing seriously for the 93-mile hike, when it was time to set off, he couldn’t shake the feeling that he wasn’t “100-percent ready.” The trail did its best to test his resolve, and when asked how he got by, Reed said, “A lot of it was grit.” “There were days on that hike when it was nothing but 10 hours of elevation climbing,” he said. “You learn a lot about yourself. You come out of it really believing you’re stronger and wiser.” “[The experience] gives you this energy that you can really apply in your work life or in your home life,” Reed said. “It’s more than just accomplishing something as an event. It had a broadWWW.THEICECOMMUNITY.COM
er-scale impact for me. I have found it goes well beyond the activity.” The experience offered many emotional takeaways, including the lesson that “there’s payoff from every effort,” even if it’s just attaining a beautiful view at the end of a long walk, Reed said. The physical exertion was itself a constant presence on the trip – the entire journey shaved 20 pounds off his frame, which he regained fairly shortly afterwards, Reed said – that reminded him of the effort the attempt demanded. “It also renewed my energy and capacity for work and for life,” he said. “There’s going to be challenges that come up; there’s going to be different opinions, tensions, frustrations, but how do we weather the storm?” “Just being out there, it’s that experience of re-finding and re-defining yourself,” Reed said. “All those things are indirect positives. The average problems seem smaller. Even when you don’t think you can go further, there’s one more step.” Taking that philosophy back to his leadership role at Oregon Health & Science University, Reed steeled his resolve for tackling larger problems in the workplace with incremental confidence. The approach has helped him find the ability “to really step into any one of our teams, help prioritize anything that’s a problem, break it apart
and stay positive through the whole process,” Reed said. “The forefront of the ultra-challenges I’ve participated in has caused me to pause and improve my engagement at work, or improve my relationships, both personal and at work, and add elements that weren’t there before that help me to energize,” Reed said. “It deepens my vision. Developing recognition options, taking the time to say thank you and lift others – that’s what this has helped me with.” The biggest change that Reed is working to incorporate is making those approaches into a way of thinking that sustains forward momentum in the office, “instead of a one-off, hot-andcold, flavor-of-the-month” tactic. He’s also a proponent of the same pathway serving others who might benefit from his experiences. “We are challenged with health care today,” he said. “[Being outside] is the perfect outlet. It challenges you on a different level and encourages you to think creatively.” “I advise anybody interested to start small; start with a day hike,” Reed said. “Get an expert, somebody who’s more experienced, who can help you. Read about where the safe hikes are. Start small. See how you feel. Find the overall appreciation for things that we might take for granted; things we drive by that we don’t stop and see.” • ICEMAGAZINE
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SHOWCASE The Innovatus Imaging headquarters are located in Pittsburgh, Pennsylvania.
A LEGACY OF INNOVATION FOR DECADES
A
lthough the name, Innovatus Imaging, has been around only since 2017 when Bayer MultiVendor Service, MD MedTech and Wetsco merged into one organization, the expertise, talent, processes and exceptional outcomes have been around for decades.
Together, teams of engineers, subject matter experts and repair technicians have repaired more than 150,000 ultrasound probes and 30,000+ MRI coils, accumulating tremendous amounts of failure analysis data which serves as a massive knowledge base for continual innovation, design and development. As a result, Innovatus Imaging has been able to not only provide accurate repairs with coveted industry-leading warranty rates, they have been able to do so with fast turn-around times, easy access to loaners and more for both probes and coils. 18
ICEMAGAZINE | APRIL 2020
“Based on the particular probe model, with a high degree of certainty, we know what to expect before the customer’s product arrives at our facility. This is due to our proprietary, expansive and verifiable data which tells us not just what parts are likely to fail, but also how and when,” says Jon Hoffman, General Manager, Ultrasound Center of Excellence. In 2008, the company pioneered the industry’s first “swap at the repair price” program (TotalRepair) that other providers attempt to mimic. Innovatus is the only company that publishes a list of fully repairable products. “Customers know, up-front, that their product is repairable. No more send-it-in-and-we’ll-let-you-know,” says Matt Tomory, Vice President of Ultrasound. There are currently over 100 probe models on the TotalRepair list. Through its RapidRepair program, Innovatus Imaging is able to repair Philips X7-2t
and X8-2t TEE probes in 3-5 days with consistently high levels of success. Another industry-changing program offered by Innovatus is its MyInventory program which guarantees qualifying probe customers loaner availability by creating reserves specific to their operating inventory. Through this program, health care providers can avoid the high costs of market-priced exchanges and maintain continued, worry-free workflow.
CENTERS OF EXCELLENCE FOR PROBE AND MRI COIL REPAIR, AND DESIGN AND DEVELOPMENT Innovatus Imaging is the only company in the imaging industry to operate three Centers of Excellence focusing on both ultrasound and MRI coil repair and servicing, engineering, product development, research and testing to uncover more efficient methods, products and processes for extending the ADVANCING THE IMAGING PROFESSIONAL
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life of highly critical diagnostic equipment, allowing health care facilities to operate more efficiently and cost effectively. Headquartered in Pittsburgh, Pennsylvania, Innovatus Imaging Centers of Excellence are located as follows: • MRI Coil Repair and Radiography Systems – Pittsburgh, PA • Ultrasound Probe Repair – Tulsa, OK • Engineering, Design and Manufacturing – Denver, CO The vision behind operating Centers of Excellence that go beyond traditional depot repair facilities, according to Innovatus Imaging CEO Dave Johnson, is to continue to improve upon the status quo to not just save lives through accurate diagnosis due to high-performing devices, but to also enable facilities to operate with greater efficiencies, less operating costs and thus be in a position to improve access and costs for patients.
TECHNOLOGICAL AND COST ADVANTAGES Beyond passing on efficiencies to health care providers, Innovatus Imaging continuously explores new ideas and improves methodologies for repairing probes and coils to not only assure they perform as originally intended, but to also enable providers to extend the life of their equipment investments and lower overall operating cost. Innovation comes to life at Innovatus’ FDA-registered Center of Excellence for Design and Manufacturing, located in Denver, Colorado, and led by Innovatus co-founder and Chief Technology Officer Mike LaBree. At this FDA-registered facility, specialty probes are manufactured for sophisticated medical equipment, such as robotic and other surgical systems. Other devices, intended to help physicians and other clinicians diagnose and treat patients, are designed and manufactured as well. All facilities employ an ISO 13485:2016 certified quality WWW.THEICECOMMUNITY.COM
management system. “Restoring both the functional performance and the physical condition of all devices we service is needed to meet the requirements of our OEM customers and to meet the rigorous quality standards set by leadership at Innovatus Imaging,” Johnson says. Johnson, formerly CEO of Joerns Healthcare, Vice President of Healthcare for Resilience Capital, and a greenbelt in Six Sigma, brings a deep understanding of operational excellence to assure efficiency, performance and quality at all levels of the organization. His focus on research, testing and continual development of improving the company’s best practices already guiding the industry have helped strengthen Innovatus’ position as the leader for excellence in probe and coil repair, and for delivering value that impacts budgets and equipment ROI for customers of all sizes. Additionally, Johnson has streamlined the company’s operations to assure financial viability and stability. At a time when many providers are struggling to meet profitability goals, Innovatus Imaging has grown exponentially in recent months. “Medical device service is a life-saving business and practices need to be built upon the values of patient safety, performance standards, operational efficiencies and ROI for health care facilities, in that order,” says Johnson. “It is imperative to our mission that we continue to be the leading provider in all of these areas. This is what drives what we do every day and at every level, from repairs, research and development to customer service.”
UNMATCHED VALUE FOR HEALTH CARE FACILITIES To comply with current regulatory standards and those imposed by Innovatus’ engineers and executive team, the company takes a holistic approach to product repair, which helps ensure a lower total cost of ownership over
the entire product life cycle. Innovatus applies their manufacturing mindset to the repair model. Integrated into each repair are foundations in research, material science, engineering and technological innovation. The high success rate for repairs allows Innovatus Imaging to offer the industry’s longest warranty periods. “Based on our unique approach to repair and the methods of applying our 13485:2016 certified quality management system, we had the data to support a 12-month warranty period on all standard probes. We are very happy to be able to offer it to our customers,” says Johnson. Whether developing new technology as part of device manufacturing or engineering repair solutions on the latest probe and coil models, Innovatus Imaging continually invests in and focuses on R&D. They offer some of the widest and deepest breadths of repair capabilities across their service offerings. Currently, over 100 probe models are considered fully repairable and the company boasts a 99.9% repair rate across all MRI coil models. Very significant repair capabilities exist on today’s most advanced probe models, such as those employing single-crystal design or matrix array technology (Philips X7-2t, X8-2t, X5-1 and GE 6VT-D). Repair solutions are available on over 700 models of MRI coils and over 400 models of ultrasound probes. At Innovatus, the mission is to be the innovative leader in providing superior service solutions for customers across a wide range of medical devices. They are committed to delivering best-in-class, compliant solutions while reducing customer downtime and operating costs. •
FOR MORE INFORMATION, please visit www.innovatusimaging.com.
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Empowering the Engineer Providing the medical equipment service market with repair parts, technical training, technical support and refurbished equipment.
Setting the Industry Standard Setting the industry standard for after-market repair parts, technical training, and technician support
FACILITY
CERTIFIED
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60,000+ square foot facility used for parts repair, quality assurance testing, and hands-on technician training.
ISO 13485:2016 certification from registrar Orion for its imaging parts, equipment and training services.
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21 equipment bays (many with multiple systems) utilized for quality assurance testing and technician training.
The Tri-Imaging support team is available 24/7 with no contract required.
SOLUTIONS
Our mission is to help lower the cost of health care by providing cost-effective, high quality imaging parts, real-time technical support, service support, and technical training.
Call: 855.401.4888 | Visit: triimaging.com | Email: sales@triimaging.com Located in Nashville, TN • ISO 13485:2016 certified
NEWS
Imaging News A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY
PROBO MEDICAL ACQUIRES TWO COMPANIES Probo Medical has announced the acquisitions of Elite Medical Technologies LLC and Future Medical Equipment Ltd. The terms of the transactions were not disclosed. “Probo is tremendously excited to announce these significant acquisitions,” said Michael Asmer, CEO of Probo Medical. “Over the past five years, Probo Medical has become a leader in the global ultrasound market. As we look forward, our strategic plan involves expansion into adjacent imaging modalities where we can leverage our supply chain and sales channels. In terms of strategic fit, Elite Medical and Future Medical represent ideal partners and, as equally important, we share a cultural philosophy that places customers, suppliers and employees at the center. We are pleased to welcome the Elite Medical and Future Medical teams to our family and are excited to accelerate down this growth path as a combined organization.” Elite Medical is a U.S.-based wholesale reseller of preowned digital medical imaging equipment, including CT, MRI and PET/CT across all major OEM manufacturers. Future Medical, based in Bristol, UK, specializes in the de-installation, purchasing and sales of pre-owned medical equipment across a wide array of imaging modalities and equipment types. Both the Elite Medical and Future Medical management teams will remain in place leading their respective organizations. Probo Medical is backed by Varsity Healthcare Partners, a lower middle-market private equity investment firm focused on partnering with founders, entrepreneurs and management teams to build leading health care services companies. •
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KONICA MINOLTA HEALTHCARE EXPANDS ULTRASOUND-GUIDED SOLUTIONS Konica Minolta Healthcare Americas Inc. has announced a newly formed partnership with RegenLab USA LLC to distribute its regenerative medicine portfolio of bio-injectable products to the musculoskeletal (MSK), pain management, radiology and veterinary markets in the United States and Canada. The bio-injectable line includes preparation devices for Platelet Rich Plasma (PRP) and other blood cell therapies, delivered using ultrasound guidance. This partnership further broadens Konica Minolta’s UGPro Solution, a comprehensive program that unites ultrasound imaging with targeted therapies and hands-on education to help improve patient outcomes. The regenerative medicine market for sports medicine, orthopedics and pain management is experiencing rapid growth. “This growing demand for PRP and other cell therapies aligns with our UGPro strategy of bringing the highest quality, clinically validated solutions to our customers,” says Kirsten Doerfert, senior vice president of marketing, Konica Minolta Healthcare. “Our alliance with RegenLab is founded on our mutual belief in the importance of clinical evidence and the desire to help our customers better serve their patients.” • FOR MORE INFORMATION, visit www.konicaminolta.com/medicalusa.
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NEWS
THE INTERMED GROUP ACQUIRES SIGMA IMAGING TECHNOLOGIES The InterMed Group, a Granite Bridge Partners company, has announced the acquisition of Sigma Imaging Technologies, a New Jersey-based provider of imaging system services. “Established as an expert in MRI/CT/PET imaging technology, Sigma’s core services include preventive and corrective maintenance, MRI magnet services and part repair. Sigma is also a highly reputable provider of MRI/ CT/PET systems across North America, including mobile units, and offers equipment evaluation, refurbishment, installation, removal, relocation and storage,” according to a press release. “Sigma’s core competencies align strategically with InterMed’s focus on delivering best in class medical equipment servicing and program management,” The InterMed Group Chief Executive Officer Rick Staab, CHTM,
said. “This partnership is not only a strategic investment, but a cultural one as well as we expand our geographic footprint to serve clients faster and more efficiently across the East Coast. We are excited to also be able to enhance our existing customers within the MRI/CT/ PET verticals with the high quality Sigma brings in these areas.” Christen Martorana and Paul Morgan, co-owners of Sigma Imaging Technologies, released a joint statement that reads, “We are very excited to partner with The InterMed Group. They are the ideal organization to grow with, as we share a commitment to deliver on our promises and consistently provide high-quality services. Customers will be better served by our expanding product lines and geographic reach, along with the integration of resources and technical knowledge.” •
CANON MEDICAL RECEIVES FDA CLEARANCE FOR AQUILION ONE/PRISM EDITION Canon Medical Systems USA Inc. has received 510(k) clearance for the Aquilion ONE/PRISM Edition, enabling deep learning spectral capabilities that allow for more routine spectral imaging. Designed for deep intelligence, the advanced system integrates artificial intelligence (AI) technology to maximize conventional and spectral CT capabilities with automated workflows, while providing deep clinical insights to assist physicians in making more informed decisions across the patient’s care cycle. An innovative approach to CT reconstruction, Advanced intelligent Clear-IQ Engine (AiCE) on the Aquilion ONE/PRISM Edition uses deep learning to distinguish true signal from noise to deliver sharp, clear and distinct images at fast speeds. Trained using vast amounts of high-quality image data, AiCE provides enhanced anatomical resolution across the whole body including brain, lung, cardiac and musculoskeletal applications. By enabling deep learning spectral reconstruction, the Aquilion ONE/PRISM Edition helps physicians make more confident diagnoses with the spectral benefits of rapid kV switching with patient-specific mA modulation, full field of view acquisition and 16 cm of coverage, overcoming traditional trade-offs with spectral imaging. The fully integrated end-to-end workflow is seamless and can
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be incorporated into routine protocols. “Canon Medical’s DLR technology is pushing routine diagnostic imaging into the age of AI-assisted imaging, revolutionizing patient care by enabling excellent diagnostic confidence,” said Erin Angel, managing director, CT business unit, Canon Medical Systems USA Inc. “With deep learning spectral, Canon Medical is able to provide clinicians with a spectral CT system designed to address the trade-offs of traditional spectral CT and potentially expanding the utilization to more routine CT imaging.” •
ADVANCING THE IMAGING PROFESSIONAL
NEWS
SIEMENS HEALTHINEERS ANNOUNCES FIRST U.S. INSTALLATION OF ARTIS ICONO BIPLANE ANGIOGRAPHY SYSTEM UW Health’s University Hospital in Madison, Wisconsin, recently became the first health care facility in the United States to install the ARTIS icono biplane system from Siemens Healthineers. A member of the new ARTIS icono platform of high-precision angiography systems, the ARTIS icono biplane has been designed to enhance workflow as well as balance dose and image quality – specifically, when visualizing extremely intricate structures in 2D and 3D. A key feature of the ARTIS icono platform is the new OPTIQ imaging chain, which ensures optimal image quality while balancing radiation dose to patients and staff. Additionally, the ARTIS icono biplane boasts several new features for stroke treatment and other neuro procedures. syngo DynaCT Sine Spin, a new form of cone beam CT, delivers images with fewer cone beam CT artifacts in the basal area of the brain and near the skull. syngo DynaCT Multiphase produces time-resolved
cone beam CT volumes without requiring the patient to be moved to a CT scanner. syngo DynaCT High Speed can shorten low-contrast 3D imaging from 20 seconds to eight, for CT-like images that are less susceptible to movement artifacts. Finally, the Twin Spin feature enables seamless switching between 2D biplanar imaging and 3D imaging. Together, these features enable increased visualization of challenging anatomy and accelerate workflow. Additionally, the ARTIS icono biplane provides rapid flexibility for multidisciplinary lab use. With Lateral Plane Switch, the user can move the detector’s position from the patient’s right side (for interventional procedures) to the left side (for cardiovascular procedures) in under 90 seconds. • FOR MORE INFORMATION, visit siemens-healthineers.us/artis-icono.
EXPANSIVE SERVICE. ENTECH has been servicing major medical centers and hospitals, surgery centers and freestanding clinics throughout the Southwest for over 37 years. We service and maintain a wide scope of clinical equipment, including general biomedical, respiratory, anesthesia and medical imaging equipment. Our experienced technicians are based throughout the region so we can respond to your needs quickly and ensure your facility is running at peak performance with minimal interruptions.
EXPERTISE. ENTECH continuously monitors clinical equipment trends, licensing and accreditation agencies and service line procedures to support our customers with the most efficient, inclusive equipment services possible. Our proven technology management systems provide compliant clinical equipment service programs that free our clients to focus on their primary mission: patient care.
DELIVERING EXCEPTIONAL CLINICAL EQUIPMENT SERVICES F O R OV E R 37 Y E A R S Take advantage of our commitment to expanding our clinical equipment services by contracting with ENTECH today! Call us at 602-747-9081 to learn more.
VALUE. ENTECH is vested in solidifying partnerships with key healthcare vendors, expanding its operation and is committed to investing in financial and human resources in order to sustain and grow our clinical equipment services in this region and nationwide. ENTECH is able to deliver a complete suite of services both economically and efficiently that other companies can’t offer.
EntechBiomedical.com | Info@EntechBiomedical.com
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NEWS VAREX ANNOUNCES RENEWED PRICING AGREEMENT WITH CANON MEDICAL SYSTEMS Varex Imaging Corporation has entered into a renewed three-year pricing agreement with Canon Medical Systems Corporation effective for calendar years 2020-2022. “We are very pleased to continue our multi-decade long relationship with Canon Medical Systems and bring their next generation imaging systems to our portfolio of innovative X-ray based technology, which can accelerate time to market and reduce total cost of ownership,” said Sunny Sanyal, chief executive officer of Varex Imaging Corporation. Varex will continue to supply its computed tomography (CT) tubes and heat exchangers for integration into Canon Medical Systems’ CT imaging systems for the global market. Potential product sales associated with this renewed
agreement are estimated to be approximately $385 million over the term of the agreement. Varex also supplies Canon Medical Systems with digital detectors and high voltage connectors through separate agreements. In other news, Clarence Verhoef has informed Varex Imaging Corporation of his intention to retire as senior vice president and chief financial officer. Verhoef, 64, will remain in his current role until a successor is named, which Varex expects will occur during fiscal year 2020. Verhoef will continue to manage the company’s finance team and public company filing requirements while the company conducts a search for his replacement and will assist with an orderly transition of his responsibilities. •
CIRS LAUNCHES NEW DOPPLER PUMP AND PHANTOM CIRS has announced its new, improved Model 769 Doppler Flow Pump, that is compatible with both its ATS Urethane flow phantoms and its new Model 069A Zerdine flow phantom. The compact Doppler Flow Pump comes with a pump, tubing connections and a half-gallon of test fluid to simulate blood flow in a tissue mimicking phantom. This setup provides a complete solution for QA testing of Doppler ultrasound devices. “The Model 769 combines the best features of its predecessors, the model 069 Doppler Flow Simulator and Model 700-D Doppler Flow Pump. The model 069 featured a compact, easy-to-use setup and a lower cost, while the model 700-D was compatible with a number of different phantoms. CIRS obtained a great lineup of Doppler flow phantoms when it acquired ATS Laborato-
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ries in 2017,” says Ted Lynch, vice president of business development “and the Model 769 is the perfect platform to support all the Doppler phantoms that we now offer, and a number of others we hope to add in the future.” The Model 769 may also be used with the Zerdine hydrogel phantom originally developed for the model 069, Doppler Flow Simulator. This phantom, now repackaged as the model 069A Doppler Flow phantom, has both a top and bottom scanning surface that allows testing at varying depths and angles of orientation. This makes the phantom suitable for testing both peripheral flow and deeper abdominal vessels. • FOR MORE INFORMATION, visit cirsinc.com.
ADVANCING THE IMAGING PROFESSIONAL
NEWS
ACCUMEN’S 3DR LABS PARTNERS WITH RESONANCE HEALTH Accumen Inc. has announced that its 3DR Labs LLC company is partnering with Resonance Health Limited to provide FerriSmart magnetic resonance imaging-based liver iron concentration reports for its clients. FerriSmart uses artificial intelligence (AI) to analyze magnetic resonance imaging (MRI) images and deliver a liver iron quantification result within seconds. This technology allows liver iron concentrations to be monitored effectively and efficiently for individuals with confirmed or suspected systemic iron overload, patients with thalassemia or sickle cell anemia who require regular blood transfusions, and recipients of artificial heart valves who may experience an increase in systemic iron levels over time. “We are excited to partner with Resonance Health to provide our clients with this additional resource for mining valuable diagnostic data from their MRI images,” said Accumen President and CEO Jeff Osborne. “3DR is already working with 900 hospitals in the United States, creating three-dimensional images from their MRI and computed tomography scans. We consider FerriSmart Reports to
be a natural extension to the comprehensive MRI analysis services that we already offer to our 3DR clients.” “We are delighted to partner with 3DR Laboratories and significantly increase the number of patients who can benefit from our non-invasive, MRI-based FerriSmart technology. This important liver iron concentration information can provide invaluable insights and help to guide their treatment options,” said Resonance Health CEO Alison Laws. “Iron deposition disorders, such as sickle cell disease and thalassemia, are a significant health problem not only in the U.S. but worldwide. 3DR is thrilled to partner with Resonance Health in delivering a safer, easier and less expensive AI-based technology to help care for these patients,” said 3DR Labs Chief Medical Officer Robert L Falk, MD. Resonance Health has received 510(k) clearance for FerriSmart from the U.S. Food and Drug Administration, a CE mark from the European Medicines Agency and regulatory clearance from the Therapeutic Goods Administration in Australia. •
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NEWS
MITA PARTICIPATES IN FDA WORKSHOP The Medical Imaging & Technology Alliance (MITA) participated in the Food and Drug Administration (FDA) public workshop, “Evolving Role of Artificial Intelligence in Radiological Imaging,” to engage interested parties on the rapidly expanding impact of Artificial Intelligence (AI) in the medical imaging space. The event featured presentations from MITA members and others who reviewed the importance of regulatory frameworks that ensure AI technologies are developed in a way that advances Quadruple Aim goals – enhancing patient experience and clinical satisfaction, improving outcomes and reducing costs. During the two-day workshop, participants discussed challenges and opportunities created from emerging AI software algorithms within medical imaging. MITA members led presentations on a broad range of issues, including the growing impact of AI on breast cancer screening mammography, ultrasound and other common medical tests. While acknowledging that ensuring the smooth delivery of innovative radiological AI software to the patient bedside will be challenging, industry leaders strongly encouraged the FDA to utilize existing regulatory clearance pathways that have proved effective for clearing AI algorithms. “The potential for AI in medical imaging is enormous, and the FDA will play an important role in navigating how physicians and patients will ultimately benefit,” said Dennis Durmis, senior vice president-radiology head of Americas region, Bayer, and Chair of the MITA Board of Directors. “It is timely that the agency encourages innovation by supporting regulatory frameworks that are predictable, transparent and fair to all interested parties.” Along with advocating for consistent regulatory oversight rooted in industry standards and best practices, MITA participants also emphasized the need to ensure emerging AI technologies can be trusted to safeguard patient privacy and security. As a shared responsibility among manufacturers, providers and other parties, protecting the data of patients who come in contact with AI radiological imaging software is critical. “We are greatly encouraged by the opportunity to participate in this important event and engage with agency professionals and other interested parties. We look forward to working with the FDA to advance the adoption of AI technologies while supporting Quadruple Aim goals,” Durmis concluded. The Medical Imaging & Technology Alliance (MITA), a division of NEMA, is a collective voice of medical imaging equipment manufacturers, innovators and product developers. It represents companies whose sales comprise more than 90 percent of the global market for advanced medical imaging technology. • FOR MORE INFORMATION, visit medicalimaging.org.
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MXR IMAGING INC. ACQUIRES OXFORD INSTRUMENTS HEALTHCARE MXR Imaging Inc. (formerly Merry X-Ray Corporation) has completed the acquisition of the Oxford Instruments Healthcare from Oxford Instruments PLC. Oxford Instruments Healthcare is a leading provider of CT and MRI equipment sales, maintenance services, parts and mobile imaging solutions, according to a press release. It is headquartered in Deerfield Beach, Florida and has additional operations in California and Michigan. MXR Imaging executives said this acquisition would expand their reach as a leading provider of diagnostic imaging solutions to hospitals and health care providers across North America. “Oxford Instruments Healthcare fills some important roles in completing MXR’s portfolio of comprehensive diagnostic imaging solutions” said Jeff Root, MXR Imaging executive vice president. “Their mobile fleet rentals, coil repair and refrigeration services are great additions to our company.” “We are very excited about the imaging expertise and talented people that are becoming part of the MXR Imaging organization. Our new colleagues will get us another step closer to our goal of providing complete imaging solutions for our customers,” MXR Imaging President Ted Sloan said. “Our mission is to improve the clinical and financial success of our customers by delivering innovative diagnostic imaging solutions. We believe the Oxford Instruments Healthcare team and products will help us do just that.” •
ADVANCING THE IMAGING PROFESSIONAL
BEDSIDE MRI SYSTEM RECEIVES FDA 510(k) CLEARANCE Hyperfine Research Inc. has received U.S. Food & Drug Administration 510(k) clearance for the world’s first bedside magnetic resonance imaging (MRI) system, clearing the way for device shipments this summer. “The Hyperfine system is 20X lower cost, 35X lower power consumption and 10X lower weight than today’s fixed conventional MRI systems,” according to a press release. “Nearly six years ago, a dream to create a portable, affordable MRI system was born. We assembled an astounding team, and they took the 10 million-fold improvement in computing power since MRI was invented and the best of the billions invested in green electronics and built something astonishing, something disruptive,” said Jonathan Rothberg, PhD, founder and chairman of Hyperfine Research. The Hyperfine point-of-care device represents multiple innovations in MRI design, architecture and workflow; more than 100 patents have been issued or are currently pending. The system is highly portable and wheels directly to the patient’s bedside, plugs into a standard electrical wall outlet and is controlled via a wireless tablet such as an Apple iPad. The Hyperfine system was designed to address the limitations of current MRI systems in order to make MRI accessible anytime, anywhere, to any patient. “More than 40 years after its first use, MRI remains a marvel. Unfortunately, it also remains inaccessible. It’s time that MRI made the jump
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to point of need just like X-ray and ultrasound have before it,” said Dr. Khan Siddiqui, Hyperfine chief medical officer. “Going beyond that, nearly 90% of the world has no access to MRI at all. With the FDA’s decision, we are now ready to rewrite the rules of MRI accessibility.” In developing the system, Hyperfine performed thousands of brain scans including those within investigational partnerships at Yale New Haven University, Penn Medicine, Good Samaritan Hospital Long Island, New York Presbyterian Brooklyn Methodist Hospital and Brown University, in addition to calling upon seminal work from the Martinos Center for Biomedical Imaging at Massachusetts General Hospital. The FDA clearance includes head imaging for patients two years of age and older. • FOR MORE INFORMATION, visit hyperfine.io.
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SHOWCASE
SPONSORED CONTENT
DIGITAL EXPERT Clinical Training at Your Fingertips
G
E Healthcare continues to deliver innovative ways to meet customers’ needs. Digital Expert is one of the new ways the company is providing innovative solutions for education and training on their LOGIQ™, Vivid™, and Voluson™ ultrasound equipment. Digital Expert by GE Healthcare enables live and face-to-face interactive training sessions. Utilizing a mobile tablet, Digital Expert can deliver instructor-led clinical training virtually. This personalized approach to training is tailored to the user’s own skill level and provided at their pace while taking into consideration when it is most convenient. The flexibility to schedule when it’s most convenient for them and their department can help decrease disruption to their patient scanning schedule thereby helping to avoid related revenue loss. Digital Expert can help ensure that users are getting the most out of their capital investment by ensuring that their staff knows how to use equipment to its potential. Digital Expert also facilitates the ability for more ongoing training which is essential to advanced usage of functions and features built within the ultrasound console. Through ongoing training and education with Digital Expert, Physicians and Sonographers can elevate their skills and techniques by becoming advanced users at their convenience. By using Digital Expert, they can learn new ways to enhance 28
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patient experience by understanding how to better use their GE equipment. This is also a key tool for departments to manage turnover and provides individuals the ability to control their own educational needs.
PERSONALIZED APPROACH TO LEARNING With Digital Expert, ultrasound users get one-on-one access to clinical trainers that can help them maximize the full potential of their GE ultrasound equipment. Because it’s one-on-one, the instructors can deliver a personalized experience by identifying a user’s skill level and ensure they get the proper and needed level of content. Whether users have questions about advanced features or need a refresher on the basics, GE Healthcare’s clinical trainers are there to help.
HANDS-ON EXPERIENCE Each 30 to 60 minute session is a mix of didactic plus hands-on learning and GE’s instructors are able to view the primary display allowing them to understand what the student is seeing. This provides the ability for users to learn on their equipment and in their department or environment. Ultrasound users can unlock the true capability of their system and its key features, especially on newer platforms.
FLEXIBLE AND CONVENIENT SOLUTION Departments are busy, that’s why Digital Expert offers next-day scheduling JB76708US
and in some cases, scheduling within two hours. It also provides flexible cancellations if needed. And the 30-60 minute Digital Expert training sessions ensure that learning does not disrupt patient scanning or staff’s personal schedule.
BE MORE, DO MORE The result of GE Healthcare Digital Expert is an elevated ultrasound experience for all users. Optimizing the potential of ultrasound equipment often requires significant time to learn proper usage and techniques. Digital Expert helps to expedite this process by connecting individuals to one of the clinical applications training experts. “With Digital Expert, customers can choose the content, timing and trainer best suited to accelerate their ultrasound training. We provide the tablet ADVANCING THE IMAGING PROFESSIONAL
and the support to get them setup. They have access to our comprehensive set of courses. The clinical application experts, with an average of more than 20 years of experience, are there to help them select the courses based on their skill level and expertise,” according to GE Healthcare. Offering beginner to advanced courses, Digital Expert can provide hands-on, in-depth and personalized training directly on the equipment to meet individual needs. It gives departments easy access to the training and education that they need in order to use the full clinical capabilities of their equipment. Take a look at a few of the topics GE Healthcare covers via its Digital Expert products: • Vivid Cardiovascular System: Get customized training to maximize the use of your Vivid CardiovascuWWW.THEICECOMMUNITY.COM
lar system. From basic operations to stress and strain tests, Digital Expert connects you with clinical application experts who help you learn what you need when you need it. Learning how to use your Vivid system is not a one-time occurrence. Beyond initial classes and installation, you need knowledgeable and customized training in order to ensure that you are maximizing the use of your equipment and utilizing the functions and features to its full potential. • LOGIQ General Imaging: When you register for LOGIQ ultrasound courses on Digital Expert, GE Healthcare provides the customer with a mobile tablet. The tablet provides access to personalized online content and training. It also allows the customer to communicate directly with a clinical-appliJB76708US
cations expert. It’s a learning experience that’s tailored to your needs — in the same way individual techs tailor care to each patient’s unique needs. • Voluson Womens Health: Get live, face-to-face personalized training covering a variety of topics from basic operations to more advanced features on 3D imaging, fetalHQ and more. Digital Expert provides on-going training to help techs maximize the full functions and features of their Voluson system. •
FOR MORE INFORMATION, contact your GE Ultrasound sales rep or visit https:// www.gehealthcare.com/digital-expert.
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INJECTOR SUPPORT & SERVICE
• On-Site Repair • Depot Repair • Parts Sales and Parts Identification • Loaner Availability • Technical Support • Training • Injector System Sales • Preventative Maintenance Tools To learn more visit www.injectorsupport.com or call 888.667.1062
PRODUCTS
Market Report X-ray Market Forecast to Eclipse $15 Billion STAFF REPORT
T
he global X-ray imaging market is forecasted to reach $15.4 billion by 2027, according to a report by Reports and Data.
The report, according to a press release, states that X-ray imaging systems are important tools that improve health care by diagnosing injuries, diseases and fractures. Technological advancement has led to the development of novel processes and devices. Digitalization of X-ray imaging has made data storage possible in digital signals. Large-area detection, lowdose imaging and high-energy resolution are transforming X-ray imaging technologies. The X-ray imaging market is expected to have less expensive hardware, high resolutions and less harmful smaller doses of ionizing agent in the coming years. The health care expenditure is expected to increase in the global platform, owing to the rising government and non-government initiatives and the growing prevalence of diseases. The increase in the market is due to a rise in accessibility and affordability of the X-ray imaging procedures for various medical conditions. Moreover, growing tie-ups between government bodies and research institutes, along with the presence of numerous manufacturers, are considered to be a high rendering factor of this industry. The growing prevalence of dental and cardiovascular diseases increases the need for X-ray imaging. This helps in increasing the global demand. The market for X-ray imaging in Asia Pacific is forecasted to grow at the highest compound annual growth rate (CAGR), mainly due to the enhancing health care infrastructure, improving reimbursement scenario, rising investments in diagnostic imaging and the growing insurance coverage in several APAC countries. The digital X-ray imaging segment accounted for more than half of revenues and is expected to show profitable growth during the forecast period. The growth of the segment is attributed to the advantages offered by digital sysWWW.THEICECOMMUNITY.COM
tems, including image enhancement, speed of execution and digital image transfer. Moreover, these digital X-rays provide real-time images and enable a more accurate diagnosis. Stationary X-ray systems held a larger market share in the year 2018, but its demand is expected to drop and be replaced with portable X-ray imaging systems. X-ray imaging machines are huge and heavy to move around. The constant movement of the system is not possible by the staff administering the procedure. Digital X-ray systems are less bulky, are wireless, take up less space in the office, and with technological advancement, they are becoming portable and more versatile. Digital X-ray imaging is more efficient and there are effective systems that help provide a superior patient experience. North America has dominated the market for X-ray imaging. Existing established health care infrastructure, state of the art equipment, highly skilled professionals and investment in research and development continues to boost market demand in the region. Moreover, a rapidly growing geriatric population will also propel market demand. According to the 2018 U.S. Census Bureau report, 78 million Americans are expected to be older than 65 by the year 2035. A press release from ReportsnReports echoes the prediction for growth. “The digital X-ray market is expected to reach $13.04 billion by 2023 from $8.68 billion in 2018, at a CAGR of 8.5%. The increasing geriatric population and the subsequent growth in global disease incidence, favorable regulations and government initiatives and investments, the advantages of digital X-ray systems, and technological advancements and product development are driving the growth of the digital X-ray market. On the other hand, market growth may be hindered due to high cost of digital X-ray systems,â€? according to ReportsnReports. A report focused on the medical X-ray market also predicts continued growth. The global medical X-ray market is set to surpass $16.5 billion by 2025, according to a new research report by Global Market Insights Inc. • ICEMAGAZINE
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PRODUCTS
Product Focus X-ray
1
CARESTREAM
DRX-Revolution Nano Mobile X-ray System The CARESTREAM DRX-Revolution Nano Mobile X-ray System provides high-quality digital radiography images in real time for patients in small rooms, the Intensive Care Unit (ICU) or a Neonatal Intensive Care Unit (NICU) where size and maneuverability are critical. At only 220 pounds, the portable, nonmotorized DRX-Revolution Nano has a compact footprint and is ideal for pediatric, chest, orthopaedic and intensive care imaging. This smaller, lower-cost mobile unit utilizes Carbon Nano Tube (CNT) technology, which differs from traditional thermionic tubes, and has an ultralightweight design for easy maneuverability and arm positioning.
*Disclaimer: Products are listed in no particular order.
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ADVANCING THE IMAGING PROFESSIONAL
2
HOLOGIC
Fluoroscan InSight FD Mini C-arm Extremities Imaging System
The Hologic Fluoroscan InSight FD Mini C-arm Extremities Imaging System provides diversified imaging options, an enhanced interface and a 24-inch HD touchscreen interface for extremities imaging. The state-of-the-art system also features a rotating flat detector, enabling imaging of long bones and minimizing radiation by preventing patient and surgeon exposure to the unused area of the detector. The larger field of view, higher quality images and modern ergonomic design offered by the system allow for more efficient imaging, improved accuracy and streamlined procedures. WWW.THEICECOMMUNITY.COM
3 KA IMAGING Reveal detector
Using only one exposure with a conventional X-ray source, KA’s detector Reveal can present three types of images: traditional DR, soft tissue and bone. The patented technology eliminates the motion artifact problem often seen in traditional dual-exposure dual-energy X-ray imaging systems. The detector also enables DR images with very high detective quantum efficiency (DQE) allowing for low-radiation exposures to the patient. In addition, it’s portable and retrofittable, fitting into any existing ISO standard case size tray. Reveal is in its final stages of development and should be submitted to FDA’s clearance in 2020.
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PRODUCTS
4
PHILIPS
MobileDiagnost wDR 2.2
Launched at RSNA 2019, Philips’ MobileDiagnost wDR 2.2 is a premium mobile digital radiography system that brings the superb image quality and high efficiency of its premium mounted systems to a mobile system. The MobileDiagnost wDR 2.2 includes Philips’ Eleva user interface, an easy-to-learn and customizable platform commonly found across a range of Philips digital radiography systems, which helps enable a smooth, efficient and patient-focused workflow. The system also includes a range of security and access management features, workflow enhancements and Philips’ UNIQUE 2 image processing, which provides high-quality images of all anatomical areas.
KONICA MINOLTA HEALTHCARE KDR Advanced U-arm
5
The KDR Advanced U-arm is one of the most versatile DR systems available today. It performs standard X-rays, weight bearing studies and the new Dynamic Digital Radiography (DDR), or X-ray that Moves. DDR provides a series of individual diagnostic quality images acquired at high speed resulting in a cine loop, enabling clinicians to observe physiological movement of anatomical structures over time and reach better decisions, sooner. The KDR U-arm also incorporates full body imaging, enhanced image processing software that provides more detail of bony structures, the high definition 100-micron AeroDR HD detector and table stitching for pediatrics.
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ADVANCING THE IMAGING PROFESSIONAL
SIEMENS HEALTHINEERS Luminos Agile Max
The Luminos Agile Max 2-in-1 fluoroscopy system from Siemens Healthineers enables patient-side fluoroscopy as well as unlimited radiography capabilities for increased system and room utilization. The Luminos Agile Max has a large 17”x17” flat panel detector for fluoroscopy and the same radiography workflow as a dedicated radiography room, including optional wireless MAX radiography detectors. These wireless detectors can be shared among other systems in the MAX family to further reduce investment costs and increase system availability. The system’s height-adjustable table permits easy patient transfer and offers a comfortable working height for technologists and radiologists. The advanced cybersecurity package complies with U.S Department of Defense requirements to help customers safeguard information technology and sensitive patient data.
6 GE HEALTHCARE Definium 656 HD
WWW.THEICECOMMUNITY.COM
7
Powered by Helix 2.0 advanced image processing, Definium 656 HD is GE Healthcare’s premium digital radiographic system for extraordinary anatomical detail and balanced contrast and brightness – all at low dose. The system features an expanded suite of AI-powered tools – including Critical Care Suite – that flag critical cases, automate workflow and improve image quality and consistency to help clinicians discern definitive diagnostic answers and expedite processes. Definium 656 HD also offers Patient Live Streaming Video, enabling technologists to monitor patient safety and help them potentially reduce rejected images.
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AI, AI, OH!
AI, AI, Oh! The Role of Big Data in Practice Management and Clinical Advancement BY MATT SKOUFALOS
L
ike medical imaging itself, artificial intelligence (AI) and machine learning technologies have captured the collective imagination of the health care space not only because of their seemingly limitless potential to improve the universal standard of care, but also because of the complementary value they represent to various branches of medicine. Taken together with the data-driven nature of the 21st century world at large, and AI is “something every industry will have to pursue,” said Wesley Gilson, In Vivo Lead for Artificial Intelligence at Siemens Healthineers North America. The task for those in medical imaging is
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learning how best to leverage AI to reduce errors and solve problems faster without being overwhelmed by the volume of newly available information. “AI was maybe the hottest buzzword of 2019, not just in health care, but across the board,” Gilson said. “Health care digitalization continues to grow with more and more data sources being introduced every day.” As that additional development of data sources progresses, however, the health care field isn’t adding a correlative number of physicians and radiologists to be able to address them, Gilson said. “Now you’re putting a larger demand on them,” he said, “and as you put more burden on physicians, there’s an increase in error rate.” But Gilson believes that as
AI-driven products introduce that wrinkle, they also have the potential to mitigate the mistakes that can come from reading through large amounts of data. By getting to significant findings faster and eliminating the need for manual testing, AI-driven solutions can offer an abundance of quantifiable information earlier in the diagnostic process, supporting radiologists’ workflow and avoiding the burnout that often is a precursor to such errors. They can also be leveraged to automate some of the manual work of the job, the value of which can be time-consuming and not always yield meaningful results. “If we can change practice management in the ordering of radiology exams, there are opportunities for AI to help in that process; making sure you get the right
ADVANCING THE IMAGING PROFESSIONAL
study read by the right radiologist for the right reasons,” Gilson said. “There could also be opportunities to explore things like triaging: an AI solution that could do a rapid read of imaging data could triage that study to a higher order in the work list, and earlier intervention could be done for that patient. It’s not taking away from a radiologist’s ability to read the images, but putting it in a priority list that highlights a potential critical finding for them to address.” “Machine learning can help improve the operation of our systems and the quality of the data that come from our systems,” he said. “Beyond that, what can we do with the broader context of data being generated in the health care system? Where are opportunities for AI to help us really make actionable
WWW.THEICECOMMUNITY.COM
the large amount of data that we have now in our electronic health records, so we can improve the ability to input data and consume the data that’s in those systems?” Michelle Edler, GE Healthcare senior vice president for enterprise imaging and care area solutions, said that AI-driven solutions address one or more of four practice areas: turnaround time in critical cases, applied time spent on image analysis, diagnostic quality and context for downstream clinicians. By creating what she described as “intelligent clinical context,” radiologists can get the tools to be more effective, and thereby able to devote more time to more complicated cases. “The big thing we’ve been hearing from the radiology community is, ‘Bring me tools to help me do
my job faster and better,’” Edler said. “That’s what they’re looking for, and that’s exactly what we’re trying to achieve.” “The intention is that we can coordinate the image analysis of any image that comes into your PACS system from any modality,” she said. “We’re working to try to drive efficiency for the radiologist, we’re looking to give them vital tools to verify what gets detected in the image, and ultimately, we’re enabling quantification of downstream reporting.” Susan Harvey, MD, vice president of global medical affairs in the breast and skeletal health division at Hologic Inc. expects AI to help radiologists, not replace them. The most effective solutions, Harvey said, will detect cancers earlier, “identifying the most relevant in-
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AI, AI, OH!
“Quantifying some of the indications is time-consuming for a radiologist, but it’s easy for a computer to quantify the volume that’s been compromised.” – Michelle Edler, GE Healthcare
formation in a sea of data, quickly, to enable accurate diagnoses and improved patient outcomes.” AI-enhanced detection can also lead to fewer false positives while speeding diagnostic times, thereby eventually improving patient throughput and provider workflow, she said, but cautioned “there will be a learning curve for radiologists, as with the adoption of every new advancement.” Cutting the elapsed turnaround time in a critical care situation allows radiologists to save more lives. AI can help prioritize cases by recognizing patterns in images to draw physicians’ attention to cases where time is of the essence, Edler said. “Don’t let things sit in a queue, first-in, first-out situation,” she said. “Putting that AI into the device at 40
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the point of care as well as in the PACS system can help reduce the turnaround time in the detection and prioritization of these images.” Similarly, AI-driven image analysis can cut down the time a radiologist may spend analyzing an image, from taking manual measurements to scrolling through a significant quantity of them in order to find the most pertinent ones. Automating some of that work, and training AI-driven software to detect previously unobserved patterns, may improve the speed of a diagnosis as well as identifying issues that may have previously gone undetected. Furthermore, the idea of creating a “richer context for the downstream clinicians” involves leveraging AI to “quantify volume impact” of their findings, Edler said. “Today, radiologists may de-
tect or classify a collapsed lung as trace, small, medium, large, but there’s no [way to identify] how much of the lung has been compromised with this collapse,” she said. “Quantifying some of the indications is time-consuming for a radiologist, but it’s easy for a computer to quantify the volume that’s been compromised.” Given the breadth of the diagnostic imaging space, from the number of body parts to the number of image acquisition types and the kinds of diseases and conditions that may be categorized and analyzed in a clinical setting, AI-driven technology is fertile ground for innovation. Hundreds of startups are developing independent approaches to these issues, and established corporate entities are already covering ground in the ADVANCING THE IMAGING PROFESSIONAL
space. But to truly optimize the algorithms that make AI as effective as possible, collaboration is critical. “GE will never be able to cover every single one of these if we go at this in-house, organically,” Edler said. “We’ve been tackling the high-volume, high-frequency ones internal to GE, but the best way to provide that is to partner with those parties, and that’s exactly what we’re doing.” Edler said GE is working to be “a partner of choice to startup companies as well as to academic institutions that want to build their own algorithms,” and supports “a development ecosystem” for clinical partners who want to develop their own in-house algorithms. “We have tools to help them to go faster, whether that be a workbench to train and build algorithms WWW.THEICECOMMUNITY.COM
themselves, or imaging reconstruction services we’re piloting with some health care facilities to help with the visualization of the output,” Edler said. From a broad manufacturer perspective, Zack Hornberger, director of cybersecurity and informatics at the Medical Imaging and Technology Alliance (MITA), said the advanced imaging industry is incorporating AI technologies into its products “with the quadruple aim” of improving health outcomes at lower costs to deliver a better experience for patients and clinicians. “When it comes to AI that’s developed well, you’re not going to see the clinician experience suffer,” Hornberger said. “Imaging’s been doing AI since before AI was AI. But AI really makes a big difference
in things that happen behind the scenes right now. It’s also a lower cost on the system, and really, those sorts of seemingly small things have a big impact.” To Hornberger, the collaborative approach that will drive the success of AI among vendors and clinicians is familiar to his organization. By involving a variety of interested parties in the conversation, MITA believes that such opportunities can be uncovered to improve the act of image acquisition, patient experience and practice workflow. “Manufacturers are most excited about AI’s ability to improve the quadruple aim almost all at once,” he said. “Not often does technology come along that can address all those aspects in one fell swoop. Usually it’s the improvement of some at the cost of the other, and AI has really done well to improve them all dramatically and concurrently. “What gets measured gets better,” Hornberger said. “That’s the received wisdom at this point. If we have more metrics, we can make better decisions. We can use data to create some of those solutions.” The application of advanced data to the imaging suite isn’t only the province of AI, said Angelic Bush, director of radiology at the University of Texas Medical Branch at Galveston. Bush believes that measuring and managing the outliers in any aspect of practice data can create “a more precise, repeatable process for a timely performance,” whether that process is automated by machine learning or not. “What are we considering advanced data?” Bush said. “The data exist; it’s about looking at them from a different perspective.” As the old adage goes, when you’re a hammer, everything looks like a nail. If data is that hammer, Bush said, it’ll be used to strike at everything. But it will never have the capacity to build a house without the vision of an architect and the skill of a carpenter. Therein
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AI, AI, OH!
Angelic Bush,
ICEMAGAZINE | APRIL 2020
Director of
Director of radiology
cybersecurity and
at the University of
informatics at the Medical
Texas Medical Branch
Imaging and Technology
at Galveston
Alliance (MITA)
Wesley Gilson,
Michelle Edler,
In Vivo Lead for
GE Healthcare senior
Artificial Intelligence
vice president for
at Siemens
enterprise imaging
Healthineers
and care area
North America
solutions
lies the work of radiologists and practice administrators: “to start rewiring the way we think and look at the data,” she said. “We do need to get to the data easier,” Bush said. “We need to know what kind of data to get to, but we don’t know that until we start re-wiring our brain. It’s about really approaching every question from a lean process, and getting into that data and saying, ‘Let’s look at the data before making any assumptions.’ ” “You have to pretend you don’t know anything,” she said. “Once we do that, we have to make sure we have the right tools to look at that data. You don’t want to manually extract this over and over and over again. That’s where automation really is going to make a difference.” To Bush, any data can be re-evaluated from the perspective of ad-
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Zack Hornberger,
vanced analysis, whether it’s information about lines of service, staffing, equipment efficacy and more. By seeking out the extreme variances in the information that’s measured, directors and decision-makers can more effectively get to the root of driving their practices to greater success. “Bypass RIS and get machine-level data,” Bush said. “That’s a great way to justify new equipment; to have a level-setting conversation with a technologist who may not be meeting your expectations; to see what is your optimal opportunity for performance.” “I think we’re all looking at the same issues from different perspectives,” she said. “When we have those extreme variances, I’m absolutely sure it’s just as frustrating to the employees at the bedside as to the patients affected, and to cost avoidance.”
To identify baseline practice statistics and outlier data, Bush recommends a box-and-whisker plot approach. She describes it as “a very standardized, reproducible process with reliable outcomes,” whereby eliminating any of the extreme data points improves all quartiles measured. This approach to measuring key performance indicators illustrates visually where the outlying data are, which Bush described as an opportunity, whether addressing it with inhouse team members or third-party vendors. “Then you don’t have these extreme variances that we’re paying or getting reimbursed for,” she said. “Looking at those whiskers is the game-changer in operational efficiency and the data that allows us to address those. Most of us are not looking at the data that way yet.” •
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INSIGHTS
RAD HR BY JANEL BYRNE
HOW TO REMOVE BARRIERS FOR YOUR PEOPLE, EVEN WHEN THE BARRIER IS YOU
O
ften leaders feel the pressure to have all the answers. You might be thinking, “Well, yes – isn’t that what I get paid the big bucks for?” There’s often a misconception that leaders must have all the subject matter expertise when, in fact, a critical component of leading is getting barriers, including yourself, out of the way of your people so they can apply their subject matter expertise – so they can effectively do their job. While the late Steve Jobs’ leadership approach is the subject of controversy, a quote that still resonates is “It doesn’t make sense to hire smart people and tell them what to do; we hire smart people so they can tell us what to do.” As a leader, it’s time to pull yourself out of the direct practitioner role and look at the bigger picture. Where does your team, unit, department, organization, 44
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etc., need to go and what will it take to get there? What path needs to be paved so your team can know where they need to go and walk it alongside you (and, at points, jump ahead of you if they’ve found a better way)? Remember the stop, start, continue tool introduced in the February editionof ICE? When it comes to truly removing barriers and empowering and equipping your people, this coaching tool can give you valuable insight as to how to do this for those you lead. Pulled from a recent coaching conversation with someone I lead, I brought stop, start, continue to life. Me: A critical need is to prioritize all the work we are doing as a team so we can add the most value to the organization. Let’s talk about your world and what you perceive to be your top three priorities. My teammate shared what she perceived to be her top three priorities and I followed up. Me: For each of these priorities what needs to start, stop and continue so the ADVANCING THE IMAGING PROFESSIONAL
objectives for each are achieved? As she lists items within the categories of stop, start, continue, I realized a barrier that might be getting in her way is my communication style. I may not be as clear as I think I am being. Once she finished, I proceeded to dive deeper by weaving in the following questions to learn more. Me: With everything you just shared in mind, what am I doing or not doing that is getting in the way of achieving those objectives? What about my approach might be a barrier? What do you need me to start, stop, continue doing? I’m not going to lie, hearing about my opportunities (or as some would call constructive criticisms) was difficult. I found some of the feedback to be hard to hear and was tempted to challenge it. And then I remembered that this is the only way I would know what barriers need to be removed so my teammate can be successful. As leaders, we need to create the safe space for our team to give us this feedback. At times WE are the biggest barriers for our people and that’s not what we are intending. Remember intent versus impact? It does not matter if we intend to be the best leaders, our impact on those we lead is what they walk away with and what does, or does not, equip them for success. By asking these questions I was able to learn about some of my blind spots as a leader – which includes the need for me to be clearer about what is and is not a priority. I also demonstrated vulnerability and that I can be trusted. By managing my defense mechanism (i.e., the desire to challenge in that moment) I demonstrated that her experience of me is valid and as her leader it’s my responsibility to shift my approach so I can get out of her way. When we finished the conversation, I thanked her for her honesty, identified what I will be shifting in my approach (and gave her permission to hold me accountable to that) and asked her how the conversation was for her overall. And, you may have guessed it, I asked her what I could start, stop, continue doing when it comes to her giving me feedback in the future. I learned that my body language, in particular my face, shifts when I’m receiving feedback about my opportunities. The impact of my face shifting is critical for me to know as her leader. She is very different than her other teammates, has different barriers that are getting in her way and needs different things from me as her leader. Leadership is not a one-size fits all approach – it’s about adapting to what is and is not working for those you lead, and removing what’s getting in their way, to truly maximize where they can go and what they can achieve. • WWW.THEICECOMMUNITY.COM
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INSIGHTS
REVERSE MENTORING DIRECTOR’S CUT BY MARIO PISTILLI
W
ith the recent passing of Mr. Jack Welch, former chairman and CEO of GE, I thought it a good time to visit the concept of reverse mentoring. Welch informally began the concept in the late 1990s when he required many of his top executives to pair up with younger more junior members to learn this new-fangled technology called “the Internet.” From these humble beginnings, the reverse mentoring concept was born. I am so fortunate in my leadership role to serve as a mentor to many smart and talented colleagues around the country. I derive much joy when a mentee writes their first article, gives their first speech or enrolls for a degree in small part due to our shared relationship. I enjoy growing the skills and careers of my team. I have also been very fortunate to have wonderful mentors throughout my life, that are still a source of inspiration, wisdom and knowledge. At times it is just a friendly ear to listen and at other times I really need to pick their brain over an issue I may be struggling with. About a year ago, I started a reverse mentor relationship with an early careerist millennial that is advising me on how aspects of my leadership is being received and ways that I can improve. I would like to share some things I learned along the way that has grown this into a mutually beneficial relationship. • Defined Expectations: We each needed to get clear on what we expected. For example, I expected honesty and authenticity from her, while she expected from me a safe
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space to tell me what she really felt. • Agreed upon rules: We agreed together that what is said is mutually confidential. We also agreed that if at anytime we were feeling psychologically unsafe that we would voice that. • Trust: This is the hardest aspect. I had to show slowly by my actions that she could trust me that I would not hold a grudge and that nothing she shared in coaching me would be held against her. I did this slowly over time by valuing what she said, showing change, and thanking her for the great feedback both at the time and later once I had a chance to sit with it. • Curiosity: We spent some time talking about and committing to each other that we would be very curious in probing deeper on issues that we bring up. • Not an informant: This is not time for me to grill her to tell me any deep dark secrets in the department. She is not the department spy, or to tell me who is saying what. So, what are the benefits that I have gotten from this relationship? It has really helped me close the knowledge gap on both sides in the constraints or reasons I may have for not taking a particular course of action. It has also empowered and challenged her to think differently and really makes her feel that she has a voice. It has also enabled me to share what I have learned within my team to hopefully make others better also. I have learned much about social media from her, such as the emergence of TikTok (no you will not find any dance videos of me out there). She taught me much about the perspectives of younger employees that work is meant to support and enable the other ADVANCING THE IMAGING PROFESSIONAL
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• Don’t be quick to say what you think: I have learned to hold off on giving solutions; even proposed solutions. She taught me that no matter how much I might say, “it’s just an idea and I want to hear what other people think,” if I say it then others will just agree. Instead I have been just laying out the problem or purpose of the meeting spending some time discussing and getting agreement on the problem and then just asking for thoughts on strategies to solve it. Overall, I highly recommend putting some effort and purpose into finding a good reverse mentor from your more junior staff or someone from your network. It has really challenged me and oftentimes made me uncomfortable, but growth is uncomfortable. • 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
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aspects of life outside of work and that work-life balance is important and to be cherished. As a result of this relationship, I feel I show up differently as a leader in the following ways. • Delegate with more purpose: I have started to be much clearer when delegating and explaining why I think this is a good task to delegate and being very clear what success looks like. When I was maturing in my career, you just did what your boss told you and you didn’t question why. Reverse mentoring has helped me see that performance is better when one knows exactly why they are doing a task and what it looks like to do it well. • Don’t make faces: Unfortunately, I have a bad habit of showing my annoyance or displeasure in my face. She has been working hard with me to change that, but I am a slow learner in this regard. We have worked out a little signal that she will sometimes give me if we are in a meeting together, a sort of mind your face warning. Body language and facial expression matters.
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AHRA national Board of Directors. He can be contacted at mpistiili@chla.usc.edu.
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INSIGHTS
SPONSORED CONTENT
DIAGNOSING AND CORRECTING BAD POWER IN YOUR IMAGING FACILITY
I
’m sure most of us have heard the term “Bad Power.” In the simplest of terms, bad power is just a reduction in voltage quality as a result of three basic causes: Harmonics, Sag and Swells. Let’s learn what those mean, how to measure for it and how to correct it.
also allows you to see trends in daily activity. Perhaps unannounced late-night generator testing or other events could be causing a distortion in power. The data that will be recorded and can be sent in for analysis from a power specialty business, or specific software can be purchased. Any new room that gets installed should have this done during the first few weeks of clinical use. It can alleviate costly downtime and greatly increase the Harmonic frequencies are the result of power life of a system if it is found and corrected at the MARK MURASKI supplies, solid-state components and frequency beginning. Downtime affects everyone’s bottom AVANTE HEALTH drives. A distortion of harmonics reduces capacline and, more importantly, patient care. SOLUTIONS itor life, motor and transformer life, and causes Once it is documented that the power quality logic faults in machine controls. Higher harmonic is suspect, the typical resolution is to install an frequencies of power supplies can fool control circuits, and the online/double-conversion uninterruptible power supply (UPS). more numerous zero crossings of higher harmonic frequencies The online UPS is ideal for environments where electrical can falsely trigger timing operations. Harmonics, and the effect isolation is necessary or for equipment that is very sensitive to they have on frequency changing, is one of the reasons we see power fluctuations. In an online UPS, the batteries are always intermittent issues in the field. The logic gates of printed circuit connected to the inverter, so that no power transfer switches boards (PCBs) will give false outputs. In binary logic, a one are necessary. When a power loss occurs, the rectifier simmight become a zero or vice versa. ply drops out of the circuit and the batteries keep the power Sags in power are typically the result of a unit that genersteady and unchanged. When power is restored, the rectifier ates a massive power consumption anywhere from the input resumes carrying most of the load and begins charging the to the equipment all the way back to the source. This may be batteries. Online UPSs typically have a static transfer switch, related to having too many pieces of equipment feeding from these switches monitor the incoming power through programthe same source. The power supply’s reservoir capacitors mable line circuits with sensitive voltage and current sensors. don’t absorb transient energy, because their wiring inducThey monitor the incoming power and determine when to tance introduces isolating impedance at the MHz-equivalent switch the output from source power to the converted power. frequencies of fast-rise transients. As a result, transient enerOne major pet peeve I have is the how the UPS is sold to gy follows the line of least resistance, which is to the power the user. I often hear the talks of backup power and how long supply’s output. This can lead to damaging field replaceable the room can operate on the batteries. The UPS is not deunits (FRUs). signed as a backup generator. It maintains power to the equipSwells are just the opposite of a sag. They can cause data ment until hospital generators are online or when the power errors, flickering lights, electrical contact degradation, semiis more stable. The UPS internal fault protects devices if there conductor damage and insulation damage. Swells can destroy is a massive power disturbance. The customer may ask, “Why electronic equipment and drives. Swells can occur as a result of didn’t my UPS work?” The answer to this question is that it a single line to ground fault, which will briefly raise the voltage did work. Its job is to monitor and keep a clean output voltage level of the unfaulted phases. Swells are far less commonly asto the system or to isolate the system from damage. In some sociated with bad power and usually are the bad component. cases that means the UPS will need to absorb the impact and In the field this is where the engineer would say to the customprotect the system. Consider it a bodyguard for the system. er that this component “took out” another component. The most reliable way to diagnose this is via a power moniMARK MURASKI is a regional service director at Avante Health tor/analyzer. A power analyzer will record true incoming power, Solutions. For more information about Avante Health Solutions, detecting sags, swells, harmonics and outages. An analyzer visit avantehs.com. 48
ICEMAGAZINE | APRIL 2020
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INSIGHTS
TEXTS PROVIDE HEALTH CARE OPTIONS
A
second-year student asked me, “Should I be wearing a mask for portables in the Emergency Department?” I asked her if she thought she had the flu? “No, but I am concerned about getting it.”
PACS/IT BY MARK WATTS
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In my last column “Betty or Bots,” I spoke about a patient engagement company in Canada that used a simple SMS or text message to communicate with patients. I understood in January 2020 that this product helped with HIV patients to adhere to treatment plans in Kenya. I was intrigued by simple user-friendly information technology making a difference in patients’ lives. I have seen IT solutions send scheduling reminders or follow-up calls. I did not know what I did not know. This conversation with the student happened February 25, 2020, I said to her, “We do not have a policy requiring that you wear a mask, but if it makes you feel more comfortable please do.” On February 27, 2020 I read an article about a mobile text messaging service, successfully used in Kenya to
support HIV positive patients, and how it may soon be available to British Columbians where it could be adopted for those self-isolating at home to prevent transmission of the coronavirus. Richard Lester, an infectious diseases physician with Vancouver Coastal Health, was leading a pilot project involving Vancouver General Hospital for patients to test if the mobile health platform WelTel can reduce readmission rates by monitoring patients newly discharged from a hospital. With COVID-19 quickly becoming a global health concern, Lester is working with his partners in Kenya to make the program accessible to self-quarantined people in Canada and other countries. “This actually is an ideal opportunity to be able to check in on them by text. We can actually do phone and video as well,” he said. The concept that this product could play a role in a non-pharmaceutical intervention to limit the spread of COVID-19 was mindboggling to me. It was tested for one purpose (HIV adherence) and was successful in Kenya, was being applied to help reduce readmisADVANCING THE IMAGING PROFESSIONAL
sions into hospitals in British Columbia and then morphed into a disaster response platform for bi-directional patient engagement, education and monitoring. British Columbia has one of the highest hospital readmission rates in Canada – about 10 percent within 30 days of discharge. Lester said this costly issue is “an indicator of gaps in the health system,” and the WelTel platform can help to streamline the triage process and make health care less expensive. “The care management team from the hospital ... dedicated a team of nurses and other experts to help to manage ... the ‘my discharge plan,’ which has normally been in paper form, but patients can lose and forget it. Now, it’s all going to be available digitally on their phone as well as the managers to help them navigate that.” Lester said the virtual care system can cut unnecessary emergency visits by allowing patients to send timely texts to the care management team, which may decide to provide medical solutions in an outpatient setting instead. There are gaps in health care, there are information gaps, policy gaps, service gaps and availability gaps. Imaging providers can use tools like this to facilitate meaningful communication with patients without the need for EMRS or portals. The most meaningful communication for an imaging director may turn out to be the direct policies and updates we give our staff to keep them and their families safe during uncertain times in health care. When this article is published, the COVID-19 situation might be resolved. However, my recommendation to the student to wear a mask if it made her feel more comfortable to protect herself and family will stay a constant. •
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INSIGHTS
2020 VISION – THE NEXT DECADE FOR OUR INDUSTRY
A
s managing partmedia, startups and video ner for a medical game companies. I believe imaging consulting there is a need to reinvest in agency, I am required outreach programs to build to attend between 5-10 bridges to students who are conferences a year. Some interested in industries of real of these events are purely change and meaning. There is educational, some insomething special about involve client engagement, vesting a life into technology DEPARTMENT/ others are opportunities and innovation that is directly to present content as part OPERATIONAL ISSUES tied to improving health outof our effort to give back comes, patient experiences BY JEF WILLIAMS to the community that and even saving real lives. continues to challenge and inspire us. I have seen several associations and sociI began this journey in imaging in the eties doing more in this area and I applaud early 2000s and have worked with and their efforts. But all of us who have benefited for many different types of organizafrom careers in medical imaging and instrutions. I have had the opportunity to mentation can find mentees and people we watch as our landscape has changed. can coach. Talking to the same people at every While there are countless advances in event is great for maintaining our networks, health care, there continue to be chalbut we would serve our industry well by findlenges that are worthy of reflection as ing the first timers and welcoming them. We we begin a new decade. Here are some can share our stories and our experiences. Our things to consider as we embark on a companies need to create better career tracks new decade of improving our world. to attract smart, young talent so we don’t
AN AGING POPULATION Perhaps one of the biggest trends I have observed related to conference attendance over nearly 20 years is the rising median age of attendees. This is especially true in imaging technology and modality sectors. There are certainly very real reasons why we have not experienced a strong influx of new talent. We are competing for technology and computer science graduates who are drawn to social 52
ICEMAGAZINE | APRIL 2020
disrupt our industry with a massive retirement movement over the next 10 years!
WE’RE SO DIFFERENT As the industry accelerates due to shifts in delivery models, mergers and acquisitions, and technology innovation, we must address some of our legacy thought processes. When I entered health care I was told to prepare for working in an industry that sees itself as entirely different than every other industry. ADVANCING THE IMAGING PROFESSIONAL
Over the years that has proven true by observing the challenges to best practice exercises coming out of areas that are different. We struggle with simply sharing and adopting workflow and implementation models from other organizations within health care. That resistance is even greater when there are ideas and models brought to health care from outside the industry. There are, however, some very critical forces changing how we provide, pay for and support health care that require us to see where others have realized success with similar forces. Everyone is aware that the cost model for health care and it’s continued expansion of the GNP is unsustainable. Simply put, we must figure out how to do more with less. This problem statement has been a part of open market systems for as long as there has been free enterprise. We’ve observed the models adopted by finance, retail, manufacturing and others. While there are certainly both large and small differences, health care must move toward a learning model that takes proven ideas, contextualizes them within the health care space, and acts to adopt and mature these. The rise of Wal-Mart, CVS, Amazon and others WWW.THEICECOMMUNITY.COM
as health care providers proves that change has come and our ability to consume and adapt will be critical to our ongoing success.
THE EMPTY CHAIR The roundtables, conferences, webinars and thought leadership forums have been wrestling with all of this change for years. The last decade brought exponential momentum into how ideas are generated, shared and learned including telemedicine, payer models, artificial intelligence and patient engagement. There is no lack of opportunity to avail one’s self to an number of ways to participate and learn in the dialogue. The focus is nearly always on improvement – in care, delivery, access, management, operations, technology and engagement. But there seems to be almost always someone missing. Too much of our time in planning and strategizing on improvement, we move along without engaging actual patients. Out of the 5-10 conferences I attend every year, almost none have any way to accommodate patient attendance – let alone create forums and platforms for them to speak. We have, for years, lamented the lack of customer engagement in technology advances. Many argue that vendors design and innovate based on
product strategies more than on problem statements. It’s technology focused and not clinician or provider focused. I would argue we struggle along with our narrative toward improvement by making the same mistake. There is almost no dialogue that would not be improved by engaging actual patients. Consider patient monitoring and instrumentation – what is their experience? Consider image and medical record sharing – what is their experience? Consider payment and payer concerns – what is their experience? Consider the value of AI and where it should be applied to improve the entire care continuum – what is their experience? We need to engage patients beyond the care encounter or with post-care surveys. Let’s invite them into our quorums to apply their unique and critical perspectives. I’m excited for 2020 and beyond for health care. We have many hurdles and obstacles. We also have some of the most dedicated and intelligent people from clinicians to administration to technology. There is far to go, but together we can achieve great things. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners.
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INSIGHTS
THOSE CRAZY EDITS
S CODING/BILLING BY MELODY W. MULAIK
everal edits were implemented January 1, 2020 which have caused many radiology providers angst with unexpected denials. The extent of the impact depends upon the type of organization (imaging center versus hospital) and the provided services. These challenges are a good reminder of why new edits must be reviewed every quarter to identify potential areas of financial impact. First let’s discuss the nuclear medicine edits. The Correct Coding Initiative (CCI) edits have always bundled a long list of radiopharmaceutical codes into the bone imaging codes (78300-78315). This list has recently been expanded to include more codes such as: • A9503 (Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries) • A9524 (Iodine I-131 iodinated serum albumin, diagnostic, per 5 millicuries) • A9561 (Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries) You can find the complete list at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits. The biggest challenge is that the new edits do not allow the A codes to be billed on the same date of service as the imaging study. At this time, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) has confirmed at least some of these new CCI edits are errors. The SNMMI is working with Centers for Medicare and Medicaid Services (CMS) officials, the CCI contractor and the American Medical Association (AMA) to alert providers of identified errors. As SNMMI works to identify all potential errors, SNMMI recommends to continue billing as usual. Although payment
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for the radiopharmaceutical will currently be denied, providers should bill the radiopharmaceutical so they may be correctly reimbursed when the CCI edits are corrected. The second big edit issue is the bundling of the modified barium swallow exam (74230) into the speech language pathology service (92611) when both are performed at the same encounter. The CCI modifier indicator for this code pair is 0, meaning it cannot be bypassed using a modifier. This is problematic for health care facilities billing for both services. According to CPT® Assistant (July 2014), code 74230 represents the radiological supervision and interpretation (S&I) service associated with code 92611, which is a “clinical, observational procedure.” The CPT® Manual instructs to report 74230 for the radiological supervision and interpretation. However, CCI edits supersede CPT® guidance for Medicare and any other payers that follow the CCI edits. On February 3, 2020, the American Speech-Language-Hearing Association (ASHA) announced CMS is reversing the CCI edit retroactive January 1, 2020, and the edit will be corrected in the CCI files as soon as possible. This correction will allow health care facilities to appropriately bill for their services. CMS also stated that billing codes 92611 and 74230 on the same day required a modifier to indicate the services are separate and distinct. Therefore, the swallowing study is correctly reported as 92611 listed first, followed by 74230-59. Once the CMS has made the correction, all claims submitted since January 1 that correctly list 92611 and 74230 may be resubmitted for payment of code 74230 with the addition of modifier 59. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle and Coding Strategies Inc.
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INSIGHTS
EMOTIONAL INTELLIGENCE BY DANIEL BOBINSKI
INVESTING IN EMPLOYEES – YOUR GREATEST ASSET
T
he scene was a hospital lab. A dozen medical technicians were at various machines, running tests that doctors had ordered for their patients. Ruth was at a microscope when Sean walked up to her carrying a yellow piece of paper. “Here you go, Ruth,” he said. “Somebody caught you at your best. Thanks for going the extra mile.” It took Ruth only a second to realize what Sean was talking about. The lab had recently started a “Caught you at your best” program, allowing employees to thank or acknowledge other employees for doing exceptional work. On the yellow paper was a handwritten note, thanking Ruth for staying after her normal shift and helping in the chemistry department on the day they were shorthanded, but overloaded with work. Ruth put the note in her lab coat pocket and almost suppressed the warm smile that came across her face. “Someone noticed!” she thought to herself. It was a pleasant surprise. “Caught you at your best” type programs are becoming more popular, and for good reason. 1. They provide specific detail about a praiseworthy behavior or attitude 2. They are awarded soon after the praiseworthy activity occurred 3. All employees are eligible to receive recognition 4. All employees are empowered to give recognition In other words, it’s nice when a manager 56
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acknowledges you did something, but when coworkers notice and take time to write about their observations, it fosters esprit de corps – the spirit of a group that makes all members of the group want to succeed. The hospital laboratory mentioned above started this program a few years ago, and employees love it. One attractive component is that the program costs almost nothing to operate. The lab has nearly 180 employees but running the program costs only about $30 per month. What’s the expense? Each “Caught you at your best” recipient also receives a candy bar in his or her mailbox.
HOW DO YOU TREAT YOUR EMPLOYEES? Many companies proclaim their employees are their greatest asset. Unfortunately, the phrase has become somewhat cliché, similar to saying that employees are, “empowered.” My question is this: “If companies say their employees are their greatest asset, do they treat employees as if they are the most valuable part of the company?” After all, people care for and protect their most valuable assets. For example, if you were an art collector, your most celebrated asset might be a collection of paintings. Surely you would not haphazardly pile up your paintings in the garage or let them sit out in the rain. If you were a stamp collector, you would make sure your most valuable stamps were stored and protected with extra care. If you owned racehorses, you would ensure those celebrated and valuable assets were well-cared-for, too. ADVANCING THE IMAGING PROFESSIONAL
I’m not saying treat employees as if they can’t take care of themselves, I’m saying treat them well. Amazingly, for all the talk some companies give about how their employees are their most viable assets, when we read articles and books about protecting business assets, we never see any mention of employees.
WORKPLACE REALITIES Too often, senior managers believe that if employees are paid well enough they’ll be happy and productive. However, if they looked at workplace surveys, they would realize that is not true. In fact, it’s never been true. Year after year, survey after survey, “good pay” doesn’t even make the top five of what employees want. As just one example, a recent survey published by monster.com identified five things people want in the workplace: 1. A sense of accomplishment 2. Positive reinforcement 3. Getting along with coworkers 4. A level of autonomy 5. Being part of something that makes you proud If you look at the first three items on that list, you can see why employees like the “Caught you at your best” program. Coworkers are recognizing and reinforcing each other’s accomWWW.THEICECOMMUNITY.COM
plishments in a positive way. Bam. This one program checks the boxes for the top three things people want in their workplace. What else can be done to create commitment and esprit de corps? I strongly suggest making sure everyone knows the vision and mission of the team. Company T-shirts and other swag isn’t going to do it. People engage more when they know what they’re doing contributes to something bigger than themselves. Sadly, a recent Achiever’s employee engagement survey found that only 61 percent of employees are even aware of their company’s mission statement. I was surprised the number was that high. In several recent training sessions I’ve done with medium-sized companies, well over 90 percent of those in attendance could not tell me their company’s mission statement. Perhaps even more insightful, telling employees your mission statement isn’t enough. That same Achiever’s survey found that of the employees who knew their company’s mission statement, only 57 percent were motivated by it. In closing, let me quote Jeff Bezos, founder and CEO of Amazon.com and the world’s richest man. Bezos says, “It helps to base your strategy on things that won’t change. When I’m
talking with people outside the company, there’s a question that comes up very commonly: ‘What’s going to change in the next five to ten years?’ But I very rarely get asked, ‘What’s not going to change in the next five to ten years?’ ” Building on Bezos’ remarks, lists of what people wanted in the workplace from 20 and 30 years ago are similar to what we see today. Although the specific words change, the concepts are the same. And “good pay” is never in the top five. Bezos also says if we invest in things that won’t change, they’ll still be paying dividends 10 years from now. I happen to agree with the richest man in the world on this. Invest in your greatest assets – the people who do the work that makes your company operate, and 10 years from now you’ll still be receiving dividends from your investment. After all, our employees are most certainly our greatest asset. • – 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 on his office phone, (208) 375-7606, or through his website, www.MyWorkplaceExcellence.com.
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“Hire people who are better than you are, then leave them to get on with it. Look for people who will aim for the remarkable, who will not settle for the routine.” David Ogilvy
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Science Matters
Biomarkers: Body’s quiet signals Research on biological marker chemicals is beginning to allow previously impossible medical diagnosis, and it will be used to fine-tune medical treatment.
What is a biomarker? A chemical that indicates a specific diseased condition or a physiological state in a human or other organism To be usable, a biomarker must be: • Detectable • Measurable
A biomarker is one of these:
RNA code
sequence
DNA code sequence A protein
Other mammals’ biomarkers can be studied to understand those of humans:
They can be studied in human cells growing in culture dishes SOME RECENT APPLICATIONS
Indicating best treatment
A quick diagnosis
Cancer is often treated with a drug that kills cancer cells combined with a drug that shrinks the tumor’s blood supply
Emergency room doctors
A biomarker that is involved in DNA replication can identify the “window of opportunity” – the best time to block the tumor’s blood supply
Finding hidden disease Colon or rectal cancer cells
release a marker protein that is detectable in blood long before tumors appear
Healthy cells do not produce the marker protein Graphic: Helen Lee McComas, Tribune News Service
WWW.THEICECOMMUNITY.COM
can test for a biomarker protein, NT-proBNP, to determine whether a person suffering shortness of breath has acute heart failure
A familiar test Men routinely get a ‘PSA test,’ which looks for a biomarker, prostate-specific antigen, to detect prostate cancer
Source: Nobuyuki Takakura of Osaka University; American Journal of Pathology; Subroto B. Chatterjee of Johns Hopkins University; Biochemical and Biophysical Research Communications; James Januzzi of Massachusetts General Hospital; Journal of the American College; of Cardiology; Kinexus Bioinformatics
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Ice Writer
INTRODUCING
M e l o dy M u l a i k
Melody Mulaik is a featured writer for ICE magazine’s billing and coding column. Melody is the president of Revenue Cycle Coding Strategies in Powder Springs, Georgia. The corporate office is located in Cedar Park, Texas. She has a masters of science in health systems and a bachelor’s degree in industrial engineering from the Georgia Institute of Technology. Melody’s certifications include CRA, RCC, RCC-IR, CPC and COC. In addition to managing a consulting and publishing firm with clients in all 50 states, Melody is an active presenter and writer in the specialty area of radiology coding, billing and compliance. When she is not working, she is an extensive traveler, travelling to all 50 states, as well as quite a few countries. Melody’s billing and coding column can be found at www. theicecommunity.com.
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Webinar Wednesday p. 37
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