ICE Magazine May 2020

THEICECOMMUNITY.COM

MAY 2020 | VOLUME 4 | ISSUE 5

ADVANCING MAGAZINE

IMAGING PROFESSIONALS

MATTERS OF URGENCY

IMAGING, URGENT CARE CENTERS, AND THE GROWTH OF CHOICE

PAGE 31

PAGE 36

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PRODUCT FOCUS

computed tomography PAGE 31

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FEATURES PRODUCT FOCUS

The global computed tomography market is projected to expand at a compound annual growth rate of 6.5% by 2026.

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ICEMAGAZINE | MAY 2020

18

OFF THE CLOCK

Medical Dosimetrist Bryan Streitfeld’s love for performing music has taken him to venues across the United States.

ADVANCING THE IMAGING PROFESSIONAL

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MAY 2020 AMSP MEMBER PROFILE Preferred Diagnostic Equipment Service Inc. (PDES) has been a familyowned and operated company since its establishment in 1992.

IMAGING NEWS

ICE shares news, trends and hot topics from throughout the diagnostic imaging community.

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55 FEATURED ARTICLE

As urgent care centers continue to expand the array of treatment options they provide, where do medical imaging modalities fall in their continuum of services?

16 50 WWW.THEICECOMMUNITY.COM

RISING STAR

Jillian Stevenson, 23, “is a rising star in the diagnostic imaging field because of her ability to learn and apply her skills with great customer service!”

EMOTIONAL INTELLIGENCE

One of the most important principles for anyone who supervises others is this: Ensure the people working for you have what they need to do their jobs.

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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 Brenda DeBastiani, Mon Health Medical Center

12

Rad Idea Email Strategies

16

Rising Star Jillian Stevenson, Resurgens Orthopaedics

18

Off the Clock Bryan Streitfeld, BSRS, R.T.(R)(T), CMD, Helen F. Graham Cancer Center

Publisher

John M. Krieg john@mdpublishing.com

Vice President

Kristin Leavoy kristin@mdpublishing.com

Editorial

John Wallace Erin Register

Art Department Jonathan Riley Karlee Gower Amanda Purser

NEWS 21

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

28

Webinar Wednesday Webinars Provide Remote Learning Opportunities

Webinars

Account Executives

PRODUCTS

Linda Hasluem

Jayme McKelvey Megan Cabot

Editorial Board

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

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30

Market Report Reports: Continued Growth for CT Market

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Product Focus CT

INSIGHTS 40

Rad HR Addressing “What’s In It For Me?” May Not Be Enough

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Director’s Cut COVID Crisis

44

PACS/IT Always On!

46

Department/Operational Issues When Life Changes in a Moment

48

Coding/Billing Correct Billing for Extenders

ICE Magazine (Vol. 4, Issue #5) May2020 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.

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Emotional Intelligence Managers: Please Think Like Trainers

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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ICEMAGAZINE | MAY 2020

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SPOTLIGHT

IN FOCUS BRENDA DeBASTIANI

CRA, FAHRA

B

renda DeBastiani, CRA, FAHRA, is the director of imaging at Mon Health Medical Center in Morgantown, West Virginia. As a West Virginia native, she enjoys giving back to her community.

She is a lifelong learner who recently completed her Master of Business Administration and is longtime member of the American Healthcare Radiology Administrators (AHRA). She serves as a member of the AHRA board of directors, is a noted speaker/presenter, a textbook editor and holds a Lean Sigma Six green belt.

All of these accomplishments assist her in her career and with her passion to serve as a leader. DeBastiani has served in medical imaging management for 20 years and has been active in the medical imaging community for 35 years.

It all began when she was a teenager.

“When I was in high school, I knew I 10

ICEMAGAZINE | MAY 2020

wanted to go into the medical field. So, I was looking all around,” she said. “When I went in for a radiology interview and job shadowing, I fell in love with radiology.”

Her career started via a 48-month program with only two months off.

DeBastiani loved the work from the beginning.

“I love helping people so that is why I knew I wanted to go into health care and radiology,” she said.

However, it was not easy work by any means. Early in her career she worked for a variety of different places – at the same time. She had at least two jobs from July 1986 until October 1989.

She worked at an orthopedic clinic, a family practice, an after-hours clinic and a hospital.

“I had three jobs when I first started.

I did that for two years,” she shared. “I got a full-time job at ortho clinic and came here (to the hospital) and worked the midnight shift. In 1989, I came back

to the hospital full-time.”

When asked about her greatest accomplishment, DeBastiani paused and shared several.

“That is really a tough question because I believe having a full-time job, raising my two kids – who are adults now – and furthering my education all at the same time was my greatest accomplishment,” she said. “I started late and went back and got my bachelor’s degree. I just got my MBA in December.”

The combination of a career she loves and her relentless desire to learn serve her well in her leadership role at Mon Health Medical Center.

“I am very passionate about imaging and I can’t imagine doing anything else,” DeBastiani said. “I love helping people. I love change and my job requires me to embrace change with new technology which can also mean new complications and new puzzles to figure out.”

“All those things make me love my

ADVANCING THE IMAGING PROFESSIONAL

job,” she added. “It is never boring.”

DeBastiani practices transformational leadership with a focus on team building.

She empowers everyone she works with and never ceases to be amazed at what they can accomplish from everyday tasks to problem solving major issues.

“Our team will step up and come up with a fix that I never even thought of,” she said when praising those that she works with at Mon Health Medical Center.

Her leadership style is ever evolving and is a trait she constantly tries to improve.

She holds the title director of imaging, but she knows being a leader requires good communication including listening to others.

“I have been a leader for most of my life, so I know when to lead and when to follow. Being a good leader sometimes means being a good follower, so I am able to do both very well,” DeBastiani told AHRA during her candidacy for the board of directors.

“I have good facilitator skills which are necessary for an excellent leader. I am always willing to pitch in to help a person in need, and that means that I’m not telling someone how to do something, but guiding them,” she added. “That makes for an excellent leader.

I am always honest, fair and reasonable, which are all characteristics required to be an excellent leader.”

Her work ethic and management skills may also be in her DNA. “Dad was a mechanic who worked on heavy duty mining equipment like coal trucks and bulldozers. My mom was a stay-at-home mom and was wonderful. She was the family WWW.THEICECOMMUNITY.COM

manager,” DeBastiani said.

She also values the mentors who helped her rise through the radiology ranks.

“Peggy Pust was a great mentor for me. She was my director when I was a supervisor. She is the one who actually got me involved with the ARHA and that was life changing for me,” DeBastiani said.

She recalled how she was on a design team which required her to step outside of her comfort zone and be more of an extrovert. The change was noticeable.

“My husband joked with me, ‘Who are you?’” she recalled with a laugh.

Her mentor made such a strong impression that DeBastiani is now serving as a mentor to others.

“I have been mentoring two young leaders who are supervisors who report to me.

They are awesome,” she said.

“It is really rewarding for me to watch them grow.”

Away from work, DeBastiani said she enjoys living in close proximity to her extended family. They are able to see and interact with each other on a regular basis. She said it was great when her children were younger because many of the cousins could come to birthday parties.

“My mom, dad, brother, sister and all of their families all live close together, probably within 30 minutes. I have great nieces and nephews and we celebrate birthdays with them,” she shared.

The medical imaging community is stronger with individuals like DeBastiani among its ranks. Her strong work ethic, leadership skills and desire to help others indicate a bright future for the imaging community. •

BRENDA DeBASTIANI Director of Imaging Mon Health Medical Center

What is the last book you read? Or, what book are you reading currently?

“Strategist’s Toolkit” by Jared Harris and Michael Lenox Favorite movie?

That’s a tough one since I really don’t go watch movies much anymore. Who doesn’t love a good cry when watching “The Notebook”, right?

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

I am a thrill seeker and LOVE roller coasters!

Who is your mentor?

I have ties to several AHRA leaders who I consult with when I am not sure how to handle certain issues (so many that I don’t want to name names in fear that I might leave someone out). They are not only my mentors, but also my extended family!

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

I kiss my husband, Eric, hug my dog, Zoey, say prayers, and drink Coke Zero every morning to start my day!

Best advice you ever received?

When I moved from a tech role into the supervisor role, I was really hurt when one of my employees (coworker/friend who newly reported to me) had something negative to say about a decision I made. The HR generalist who I was working with at the time gave me great advice: “If you want a friend, get a dog.”

She shared that I will never ALWAYS make everyone happy, so I shouldn’t be too hard on myself. Now a dog will love you unconditionally!

Who has had the biggest influence on your life?

My parents have obviously had a big influence on my life. My husband has probably had the biggest influence on my life since we’ve been together for almost 40 years. He is my rock, my sounding board, my voice of reason and my encourager.

What would your superpower be?

I think my superpower is definitely “super-sized intuition.”

Because my mom was indirect, I had to rely on tone of voice, body language, and hints to determine what was really meant to be said. That caused me to become a person who studies other people. I can tell a lot by what isn’t said versus what is said. My “intuition” tells me what is going to happen next. I might say, “I haven’t heard from a certain person for a while, and one hour later, they call me.” Starla (supervisor who reports to me) is totally freaked out by it sometimes!

What are your hobbies?

I love to spend time with my family, play with my dog, watch birds, work in my vegetable and flower gardens, cook, bake and learn new things. I recently took ukulele lessons because I can play the piano but never learned how to play a stringed instrument. That was so much fun!

What is your perfect meal?

If you’re talking about what I would request for my last meal, I would say filet mignon, baked potato, salad, asparagus and a roll with sweet butter. My perfect meal involves having my entire family eating together.

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SPOTLIGHT

Rad idea MARIO PISTILLI

EMAIL STRATEGIES

I

suspect that email is as overwhelming at your institution as it is in mine. Email has become the go-to medium of communication and can be a significant time commitment in a day. I for one do not want my job to just be writing and answering emails all day.

Out of frustration over the amount of time I spent in a day on emails, I have employed some strategies to conquer my inbox and stay at the mythical inbox zero on a daily basis (and yes I receive triple digit emails daily). I am by no means the email expert, and some may disagree with my strategies, but these have worked wonders for me.

•

•

12

Only check your inbox and devote certain times each day to email. I handle email only three times a day, first thing in the morning, lunchtime, and end-of-day.

I have my notifications turned off and my outlook closed so I am not tempted to get sidetracked by an incoming email. If there is something really urgent my team knows how to contact of me outside of email.

When you can, unsubscribe. When you can’t unsubscribe, but do not really need to read these regular emails then create a rule. You can right click a message and there is a choice for “Rules” and then

ICEMAGAZINE | MAY 2020

• •

•

“Create Rule.” Using this strategy you can mark an email complete and auto move it to a created folder for later use. I have these rules created, for example, to handle routine reports or data that I may not need real time, but want to have access to when needed.

You can also set a rule to auto delete emails from internal bulk mailing lists that are not needed.

I am a big fan of organizing my emails into files. You can create folders in Outlook to organize your inbox.

Use the task bar to mark important emails that you need to follow up on later. Just click the little flag next to the email and it gets listed on your task list. This allows you to find that email no matter which folder you put it in. This also ensures that you do not forget to handle it later if it gets lost in your sea of inbox messages.

Have a strategy for taking some type of action the first time you open an email. I used to find myself rereading the same emails over and over, because I did not just do something with them the first time. If it can be deleted then just delete it. If it is just informational and no reply or action needed, then move it right away to its proper folder. If it just warrants a quick simple reply, just do that. If it needs something else that you cannot provide then flag it as a task that you will come back to later when you have what you need.

ADVANCING THE IMAGING PROFESSIONAL

I really want to be responsive and make sure that others see me as accessible and having good follow-up. There are plenty of times that you cannot respond to an email timely during your three times a day email routine. For those times, I always send a reply immediately so that I acknowledge having read it. I also set the task flag to ensure I do not drop the ball. You can set your task on when you expect to achieve it. I always set it for a couple days earlier then I say I will respond. So if I say that I will get back to you in 5 days, I flag to complete it in 3 days. I usually reply with one of four responses: 1. Thank you for including me in this discussion, I will follow up with you in about X amount of time.

2. Hello, I read your email and I am coming up on a deadline for a project. I would like to respond in about X days once I have finished up that project.

If this creates any issues for you then please let me know.

3. Hello, I would like to run this by my colleague who is currently out of the office and returning [insert a timeframe].

4. Thank you for the email, this is a very important

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issue and I would like to give it the thought and attention it deserves. I will follow up with you in about X amount of time.

In addition to working my inbox three times a day, I also work my task list three times a day to ensure that I am following through on my commitments. If I have something tasked and still cannot answer then I send a courtesy email explaining whatever is preventing me from answering (still waiting on other replies, waiting on data, etc).

Utilizing these strategies, I am always at inbox zero at the end of the day. Everyone has gotten some type of reply promptly that needs it and I can get way more done in a day by not getting sidetracked into emails. • MARIO PISTILLI, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Children’s Hospital Los Angeles. He is an active member and volunteers time for ACHE and HFMA organizations. He is currently serving on the AHRA national Board of Directors. He can be contacted at mpistiili@chla.usc.edu.

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

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SPOTLIGHT

RISING

STAR

JILLIAN STEVENSON Jillian Stevenson hopes to have a long career in health care.

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ICEMAGAZINE | MARCH 2020

ADVANCING THE IMAGING PROFESSIONAL

BY ERIN REGISTER

J

illian Stevenson, 23, grew up in Cartersville, Georgia but is originally from Mt. Clemens, Michigan. She graduated from Woodland High School, where she was part of the performing arts program. Following high school, Jillian attended the Savannah College of Art and Design (SCAD) for performing arts. She realized she did not want to pursue an acting career, so she focused on singing and finished her core classes at Georgia Highlands. “As time went on, I found a love for radiology,” Jillian said. She then began school at Cambridge College of Healthcare and Technology, where she is a full-time student and pro re nata. Jillian will graduate in April as a radiologic technologist. Resurgens X-ray Director Lisa Hecht noted, “Jillian is a rising star in the diagnostic imaging field because of her ability to learn and apply her skills with great customer service!”

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: I chose radiology because I became intrigued by X-rays through my experience and research. It fits my personality, and I have found a love for this career.

Q: WHAT INTERESTS YOU THE MOST ABOUT THE IMAGING FIELD? A: What interests me the most is getting to be the first in line for diagnosing a patient, as well as getting to

Jillian Stevenson Student tech at Resurgens Orthopaedics

reassure the patient that they are going to be OK and are in good hands. Also, the image itself is fascinating to me. The different parts of the body that can be imaged and the different positions and angles that create a beautiful image of the body is amazing. These are just a few reasons why I love this field and my job!

Q: WHAT DO YOU LIKE THE MOST ABOUT YOUR POSITION? A: I love getting to be a part of the diagnostic process for doctors. I also get to play a role in helping patients feel comfortable and putting them at ease during their exam, as well as seeing their progress as the weeks go by.

Q: WHAT HAS BEEN YOUR GREATEST ACCOMPLISHMENT IN YOUR FIELD THUS FAR? A: My greatest accomplishment in my field to date is getting hired as a student tech at Resurgens Orthopaedics. I take each day here as an honor and hold pride in my position. I am so thankful for this amazing opportunity to be at Resurgens.

Q: WHAT GOALS DO YOU HAVE FOR YOURSELF IN THE NEXT 5 YEARS? A: After becoming a radiologic technologist, my goals are to continue my education in MRI and become a physician’s assistant. •

FUN FACTS Favorite hobby: Singing with my husband, who is a musician Favorite show to binge watch: “The Office” Favorite food: Tacos from BarTaco in Atlanta Bucket List: Ride in a hot air balloon Secret skill/talent: Saying my ABC’s backwards fluently

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SPOTLIGHT

Off Clock THE

MEDICAL DOSIMETRIST BRYAN STREITFELD, BSRS, R.T.(R)(T), CMD

BY MATT SKOUFALOS

F

or medical dosimetrist Bryan Streitfeld, the working day is a long one.

It begins with a 4:30 a.m. wake-up and 6:30 a.m. arrival to the Helen F. Graham Cancer Center in Newark, Delaware, where he spends the next several hours developing radiotherapy treatment plans for patients battling a cancer diagnosis.

It’s a high-wire act that requires insight from a number and variety of health care professionals; a mix of artistry and precision science. Beyond his years of career-specific schooling, Streitfeld has been cultivating the skill set that most prepared him for the challenges of the job since the age of 10, when he first picked up the saxophone.

Some 30 years later, music has taken him through venues across the United States, in front 18

ICEMAGAZINE | MAY 2020

of audiences great and small, with fellow artists of all kinds. Those workdays that start at 4:30 a.m. can stretch 20 hours or more if he’s playing a show afterward, but the reward they offer is worth more than a little additional cash.

“When I was thinking about what career I wanted to get into, one of the important things was having availability Friday and Saturday nights,” Streitfeld said. “I was going through radiography with the intent of going into radiation therapy, and when I was in therapy school, got to hang out with a dosimetrist and realized, those are my people. It was a perfect fit for my brain.”

“It’s the same thing when I’m onstage,” he said.

“Every new song is a puzzle you’ve got to solve, just like there’s no template that will work with every patient. It takes creativity and analytical thought.”

Streitfeld’s musical path was set as a child because his mother liked the saxophone, and once he took it up, “she said I wasn’t allowed to quit.” His ADVANCING THE IMAGING PROFESSIONAL

Bryan Streitfeld has been influenced

by Kenny G and punk music.

relationship with the instrument began with Kenny G and elementary school band, until eighth grade, when he was introduced to the Boston alt-rock band, Morphine. Their prodigiously talented saxophone player Dana Colley was known for playing both the baritone and tenor saxophones, often at the same time. The other band that was a formative influence at the time was Washington, D.C. hardcore/punk outfit Fugazi, with whose raw energy and presence he formed an instant connection.

By 16, Streitfeld and his neighbors in Hammonton, New Jersey had formed their own ska-punk band, The Havoctones. On Friday and Saturday nights, they’d pile into a car and drive across the tri-state area of Pennsylvania, New Jersey and Delaware, “opening many times for bands that went on to become bigger,” he said.

“It was really hanging out with your friends and playing music,” Streitfeld said. “We were just a bunch of idiots having fun.”

The band pressed on for a few years, until its frontman “fled the state due to unpaid parking tickets,” and Streitfeld joined up with another New Jersey skapunk project called SGR. He’d already shared the stage with them multiple times when he was invited to join the horn section in 1999, while the band was recording its second studio album.

“They were way more talented than I was,” Streitfeld said. “I felt like I was moving up a little bit. It did feel a lot more professional.”

At the time, he felt himself brushing up against his limits as a young performer (“I couldn’t improvise; I couldn’t figure stuff out,” Streitfeld said), but the band was a 10-piece powerhouse, and its live energy was more than enough to book shows across the region. They made an impact at the Warped Tour in Camden, New Jersey, and later signed with an independent label out of Pennsylvania, which paid for the recording of its third album. From there, the band began touring throughout the WWW.THEICECOMMUNITY.COM

United States and Canada, opening for Grammy-winning acts, and enduring personnel shuffles over nearly a decade of work.

“We stopped being so one-dimensional; we started playing a lot of different things,” Streitfeld said. “We toured the most we’d ever toured. It was some of the best times of my life. I got to see places I never thought I’d see.”

When SGR finally called it quits, Streitfeld took a few years off from performing. He focused on his day job in information technology, and went back to school to pursue a radiography degree.

After a while, he realized he missed playing, and started to pick up different instruments to expand his repertoire. At the same time Streitfeld was pushing himself to study radiation therapy and medical dosimetry, he was learning keyboard, harmonica, accordion, violin, mandolin, ukulele; “basically everything except for drums and brass.”

“It didn’t have to be for anybody, or for any specific purpose; it was just for the joy of playing,” he said. “I was definitely depressed not playing music, and that’s when I joined a cover band that got me playing again. I used any break in school partially to supplement my income, but also to learn a new instrument. That was my goal.”

After sharpening his skills, Streitfeld joined an acoustic duo called Overworked and Unemployed. It was a departure from the large ensembles in which he’d previously toured, and adding saxophone into a musical environment with so much open space “really clicked,” he said. The duo expanded into a bigger act with rotating players called The Indelible Groove. The project has been performing regularly through-

Bryan Streitfeld shares his love of music with his daughters.

out the Jersey shore for the past three years, and Streitfeld is happy to be a part of it.

“We have a large circle of friends that are on the level with how we operate as a band,” he said. “These are quality musicians who can jump in, and the color of our performance changes.

We can complete each other’s sentences musically. If someone new enters the mix, we’ll change it up as we’re performing.”

When he’s not gigging, Streitfeld continues to write and record at home.

He’s even passed on his gifts to his daughters, one of whom is already writing her own music and lyrics. Someday when they’re ready to begin touring and performing, they won’t have far to go for advice – or a bandmate.•

Bryan Streitfeld enjoys playing live shows and writing music and lyrics at home.

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NEWS

Imaging News A LOOK AT WHAT’S CHANGING IN THE IMAGING INDUSTRY

MW IMAGING ACHIEVES ISO 13485:2016 CERTIFICATION MW imaging, a third-party ultrasound company focusing on the repair, servicing, maintenance, distribution and sales of diagnostic ultrasound systems, probes and parts has achieved ISO 13485:2016 certification for medical device and quality management systems. ISO 13485:2016 certification aligns with FDA regulatory guidelines and is an international standard that outlines the requirements for a quality management system specific to the medical device industry.

“MW Imaging’s commitment to quality has always been the foundation of our success and obtaining ISO certification represents our continued commitment to quality,” said Amber Sportsman, MW Imaging vice president of operations.

“We initiated this process a few years ago when we implemented our service management system and began the development of our training pro-

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gram. Forecasting where the industry was heading, we knew this would be one of the certifications we would need to achieve. Without sacrificing our daily activities, implementing a team effort was the catalyst to completing the ISO 13485:2016 certification,” said Bob Grzeskowiak, president of MW Imaging.

ISO 13485:2016 is a quality management system standard that was developed by the International Organization for Standardization, which is an association of governmental and nongovernmental organizations from multiple countries. The ISO 13485 standard is utilized to certify quality management systems that focus on continuous improvement, customer satisfaction and the active involvement of management and employees in a process-based approach. •

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NEWS

DIAGNOSTIC ERRORS TOP ECRI’S 2020 PATIENT SAFETY CONCERNS ECRI has released its Top 10 Patient Safety Concerns 2020, naming diagnostic errors and maternal health in the top two spots. The annual report helps organizations identify looming patient safety challenges across the continuum of care and includes suggestions and resources for addressing them.

“Unsafe health care delivery harms millions of patients,” said Marcus Schabacker, MD, PhD, president and CEO, ECRI. “Our annual patient safety report provides a roadmap to help health care leaders know what goes wrong and how to prevent harm.”

ECRI’s Top 10 Patient Safety Concerns relies on the analysis of more than 3.2 million patient safety events in its Patient Safety Organization reporting program, as well as the judgment and experience of its interdisciplinary patient safety and medication safety experts. This list identifies areas that are high priorities for a variety of reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention.

ECRI’s list of patient safety concerns for 2020: 1. M issed and Delayed Diagnoses – Diagnostic errors are very common. Missed and delayed diagnoses can result in patient suffering, adverse outcomes, and death.

2. M aternal Health across the Continuum – Approximately 700 women die from childbirth-related complications each year in the U.S. More than half of these deaths are preventable.

3. Early Recognition of Behavioral Health Needs – Stigmatization, fear, and inadequate resources can lead to negative outcomes when working with behavioral health patients.

4. R esponding to and Learning from Device Problems – Incidents involving medical devices or equipment can occur in any setting where they might be found,

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including aging services, physician and dental practices, and ambulatory surgery.

5. Device Cleaning, Disinfection, and Sterilization – Sterile processing failures can lead to surgical site infections, which have a 3% mortality rate and an associated annual cost of $3.3 billion.

6. Standardizing Safety across the System – Policies and education must align across care settings to ensure patient safety.

7. Patient Matching in the HER – Organizations should consistently use standard patient identifier conventions, attributes, and formats in all patient encounters.

8. Antimicrobial Stewardship – Overprescribing of antibiotics throughout all care settings contributes to antimicrobial resistance.

9. Overrides of Automated Dispensing Cabinets (ADC) – Overrides to remove medications before pharmacist review and approval lead to dangerous and deadly consequences for patients.

10. Fragmentation across Care Settings - Communication breakdowns result in readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures, and dissatisfaction.

The full Top 10 Patient Safety Concerns report provides detailed steps that organizations can take proactively to prevent adverse incidents. The executive brief version is available for public download at www.ecri. org/2020patientsafetytop10.

In keeping with its mission of effective, evidence-based health care globally, ECRI launched a publicly available COVID-19 (Coronavirus) Outbreak Preparedness Center at ECRI.org to help hospitals protect health care workers and patients as the threat of coronavirus rapidly spreads across the globe. •

ADVANCING THE IMAGING PROFESSIONAL

FDA CLEARS COMPRESSED SPEEDER TECHNOLOGY FOR 3T MR SYSTEM Physicians can now scan faster with the newly FDA-cleared Compressed SPEEDER technology from Canon Medical Systems USA Inc. Available on the Vantage Galan 3T MR system, Compressed SPEEDER technology speeds up MRI scan times by reconstructing full resolution images from under-sampled data through iterative reconstruction.

Scan times for MRIs have historically been a challenge. To reduce acquisition times, Com-

pressed SPEEDER supports image acceleration and can be used to avoid unfolding error artifacts sometimes seen with standard parallel imaging or can achieve higher resolution in 2D Fast Spin Echo (FSE) acquisitions. Reduced scan times also enhance patient comfort, which in turn may enable higher quality images by mitigating patient movement caused by patient discomfort during long scans.

“In advanced MR imaging,

shortening scan times is vastly important for both the patient and physician,” said Jonathan Furuyama, managing director, MR Business Unit, Canon Medical Systems USA Inc. “With the help of this new advanced imaging technology on the Vantage Galan 3T MR system, health care providers can provide a quick and comfortable exam experience for their patients.” •

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NEWS MAYO CLINIC ORDERS SYNTHETICMR’S SOLUTION FOR CLINICAL ROUTINE Mayo Clinic recently ordered SyntheticMR’s SyMRI, which will support shorter scan times while providing more information to the clinician.

“I see great potential in quantitative MRI and SyMRI as a product,” says Dr. Wende Gibbs, neuroradiologist at Mayo Clinic. “The ability to add multi-parametric maps and myelin into our clinical routine will be a great benefit to our patients.”

“I am excited to work with the clinicians at Mayo Clinic to bring the benefits of quantitative MRI to patients across their institutions,” says Kyle Frye, president SyntheticMR US Inc. “Our technology can speed up their imaging workflow while helping their radiologists and referring clinicians make the best possible diagnosis and treatment follow up.”

The product will be installed across all three Mayo Clinic campuses; Rochester in Minnesota, Phoenix/Scottsdale in Arizona and Jacksonville in Florida. SyMRI will be utilized in combination with three major vendors – GE, Siemens and Philips – as a fully vendor agnostic solution.

“I look forward to working with Mayo Clinic to bring quantitative MRI into their clinical practice,” says Ulrik Harrysson, CEO SyntheticMR. “The fact that such an important hospital group like Mayo Clinic is ready to invest in our product is a testament to its potential.” •

MEDICAPTURE OFFERS EASY-TO-INSTALL UPGRADES MediCapture has announced that unique upgrade packages are now available with all medical video recorders in its MVR Series, including the MVR Pro, MVR and MVR Lite.

Built to evolve over time, the package upgrades can be quickly and easily added to medical facilities’ MVR recorders when needed by using a simple, numeric activation key.

MediCapture’s upgrade packages include: • The 4K Ultra HD Upgrade Package – Instantly converts an MVR HD video recorder into a 4K recorder that provides four times the picture resolution for stunning, life-like videos. 4K resolution is perfect for delicate surgeries that require greater sense of depth and color distinctions.

• The Network Connect Upgrade Package – Gives the MVR Lite full network connectivity, including network storage, universal printing and remote access for IT personnel.

• The DICOM Made Easy Upgrade Package – Converts

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the MVR and the MVR Pro recorders to a fully-compliant DICOM modality, providing patient workflow and other timesaving DICOM benefits.

MediCapture’s unique iMave Pro Platform makes these easy upgrades possible, as each recorder in the series comes with an embedded, non-computer-based operating system that provides the flexibility for offering Smart Workflow upgrade functionality.

“With the Smart Workflow functionality and the upgrade packages, MediCapture fulfills the need for every medical use,” said Mike Bishop, CEO. “Outpatient facilities can start with our budget-friendly MVR Lite recorder and upgrade it when needed, and hospitals with integrated operating rooms, can benefit today from the MVR Pro’s fully-featured archiving systems and DICOM capabilities.” •

ADVANCING THE IMAGING PROFESSIONAL

RSNA PUBLISHES EXPERT CONSENSUS ON COVID-19 REPORTING The Radiological Society of North America (RSNA) has published an expert consensus statement on reporting chest CT findings related to COVID-19. The statement, published in Radiology: Cardiothoracic Imaging, is endorsed by the RSNA, the American College of Radiology and the Society of Thoracic Radiology.

“We believe it is important to provide radiologists and referring providers guidance and confidence in reporting these findings and a more consistent framework to improve clarity,” said Suhny Abbara M.D., editor of Radiology: Cardiothoracic Imaging and professor of radiology and chief of the cardiothoracic imaging division at UT Southwestern Medical Center in Dallas, Texas. “Clear evidence-based communication among health care providers, including radiologists, is imperative to improving patient care during this pandemic.”

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become increasingly prevalent worldwide, reaching a pandemic stage in March 2020.

While routine screening CT for the identification of COVID-19 pneumonia is currently not recommended by most radiology societies, the number of CTs performed in patients under investigation for COVID-19 has increased.

Some patients may have incidentally detected findings that could be attributable to COVID-19 pneumonia, requiring radiologists to decide whether to mention COVID-19 specifically as a differential diagnostic possibility.

COVID-19 pneumonia, which has a high mortality rate among the elderly and those with diabetes, hypertension, and other comorbidities, is spreading rapidly in communities.

As a result, including “COVID-19” frequently in radiology report could trigger a cascade of events including infection control measures and anxiety for both the clinician and patient. Importantly, CT imaging features of COVID-19 can overlap significantly with other causes of acute lung injury and pneumonia, complicating interpretations.

The consensus statement, developed by experts at nine U.S. academic medical centers, aims to help radiologists recognize findings of COVID-19 pneumonia and provide guidance on reporting CT findings potentially associated with COVID-19, including standardized language to reduce reporting variability.

Standardized reporting language will improve communication with referring providers and has the potential to enhance efficiency and reduce anxiety in management of patients during the pandemic.

The paper discusses the potential role of CT in COVID-19, parameters for structured reporting, and the pros, cons and limitations of adopting this strategy.

Because practice patterns may vary by institution, the document is meant to serve as a guide. The authors recommend that radiologists consult with clinical colleagues at their institutions to establish a consensus reporting approach. •

MXR IMAGING ANNOUNCES CONTINUED AVAILABILITY OF EQUIPMENT SERVICE SUPPORT ENGINEERS MXR Imaging Inc. (formerly Merry X-Ray Corporation) announced that it will maintain equipment service engineering coverage of health care facilities throughout the U.S. In a recent statement, MXR Imaging Inc. announced that it will continue to provide equipment service engineering coverage to the health care community with its equipment service support team of over 300 engineers.

“As we continue to adapt to these unprecedented times, we at MXR are dedicated to the continued support of our customers, GPO partners, the GPO

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members and the health care community as a whole; we remain available to provide equipment service support during this critical time,” said Shelby Lemler, executive vice president of operations, MXR. MXR stated it is committed to adhering to the COVID-19 policies and procedures of individual facilities. All MXR team members follow best practices, which include but are not limited to, frequent washing of hands and equipment repair tools, social distancing and staying home if they are not feeling well. Warehouses and distribu-

tion centers are staffed to ensure that all the equipment, supplies, parts and sales (CT, MRI, US and XR), and pharmaceuticals orders are being fulfilled.

Lemler stated, “We have experienced a sharp rise in the number of requests for portable X-ray system proposals and sales, and have met the demand. We believe this is potentially related to health care practice changes due to COVID-19. We are prepared and committed to the continued support of our customer’s equipment and service needs.” •

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NEWS

SIEMENS HEALTHINEERS INTRODUCES TEAMPLAY DIGITAL HEALTH PLATFORM Siemens Healthineers has announced the market introduction of the teamplay digital health platform. With the teamplay digital health platform Siemens Healthineers paves the way for healthcare providers´ digital transformation – facilitating easy access to solutions for operational, clinical and shared decision support.

Supporting operational efficiency and clinical effectiveness, Siemens Healthineers offers a vendor-, system-, and device-neutral platform which fosters cross-departmental and cross-institutional interoperability. Users benefit from a broad experience in connecting devices and systems, in aggregating data from various sources, and in providing advanced analytics to gain actionable insights. teamplay digital health platform provides the comprehensive portfolio of digital applications and software solution of Siemens Healthineers as well as applications from many curated partners. They can assist health care providers in making more informed decisions along the entire patient pathway – helping hospitals and clinics to streamline their operations management, supporting diagnostic and therapeutic decision-making or connecting care teams and patients with patient management solutions.

Enabling Internet of medical things (IoMT) the teamplay digital health platform benefits from more than 5,000 connected institutions and 23,000 connected systems in over 60 countries providing the technological infrastructure for already more than 10 million patient records. By offering interoperability, data integration and multiple real-time insights, teamplay digital health platform can also help to reduce costs in daily business.

The teamplay digital health platform makes health care providers future-ready by offering innovations in digital health, like AI or innovative partner solutions.

“Siemens Healthineers teamplay digital health platform connects data, people, institutions, systems, and applications; while supporting the digital transformation for health care providers and medtech companies combining flexibility and scalability with future readiness,” says Wido Menhardt, head of digital health, Siemens Healthineers.

“Our customers will not only be able to access our best-

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of-breed digital marketplace, but they will also benefit from the most advanced applications and best-in-class security.”

The teamplay digital health platform is a multifaceted foundation for all Siemens Healthineers offerings. Tangible parts of the platform include, a secure data sharing and connectivity service, a vendor-neutral, device-neutral, and system-neutral interoperability module, and a powerful marketplace. The digital marketplace will provide users seamless integration of a growing lineup of third-party AI applications, and a great selection of Siemens Healthineers decision support software.

Siemens Healthineers is introducing new applications to the digital health platform. These include teamplay Insights, AI-Rad Companion Chest X-Ray, AI-Pathway Companion Lung Cancer, and teamplay myCare Companion will each be enabled by the teamplay digital health platform. These new applications join the existing foundation of teamplay applications for performance management in health care that help institutions to make quick and well-informed decisions by offering a clear overview of performance data.

The new teamplay Insights application is designed with drag and drop data visualization to create personalized dashboards in which data views can be freely combined to get insights necessary to solve a sophisticated challenge or to monitor progress. Institutions can quickly identify opportunities, such as how to reduce wait times for diagnostic imaging appointments, all the while managing patient backlog.

Siemens Healthineers teamplay digital health platform also serves the need for Platform-as-a-Service (PaaS) scenarios for other medtech companies through secure endto-end data sharing capabilities transferring data from a hospital environment to an outside network service and back – in a privacy by design and default approach. In addition to the important compliance to the HIPAA standard as well as our EuroPriSe seal, it was recently certified with the ISO 27001 standard – a major requirement for CISOs for state-of-the-art platform technology. •

ADVANCING THE IMAGING PROFESSIONAL

FDA CLEARS TRANSPARA 3D The U.S. FDA cleared Transpara 1.6.0 manufactured by ScreenPoint Medical, the first breast AI solution for both 2D and 3D mammography in the USA. In order to obtain FDA clearance, the company performed a clinical reader study which demonstrated that accuracy of radiologists significantly improved when reading 3D mammograms with support from Transpara. In addition, 3D reading time was significantly reduced to about 35 seconds per exam, bringing it close to 2D reading efficiency.

“We are delighted that the U.S. FDA has cleared Transpara 1.6.0 to be marketed in the USA. This is a major breakthrough from ScreenPoint Medical and it means that our new and existing U.S. customers now have access to the power of Transpara 3D for the first time,” says CEO Nico Karssemeijer. “Multiple independent peer reviewed publications have already demonstrated that Transpara significantly improves accuracy in 2D mammography, now the same applies for 3D.” “We also understand that reading 3D mammography presents radiologists with huge workload challenges. With feedback from the field, we redesigned the Transpara 1.6.0 interface and utilized our patented co-registration slice technology to optimize reading workflow with advanced navigation support to significantly reduce reading times,” Karssemeijer adds.

Transpara 1.6.0 is marketed in North America by ScreenPoint Medical Inc., Siemens Healthineers USA and Volpara Solutions. •

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NEWS

WEBINAR WEDNESDAY

BY JOHN WALLACE

SESSIONS PROVIDE REMOTE LEARNING OPPORTUNITIES

W

ebinar Wednesday continues to deliver valuable content to the imaging community. Recent presentations have received positive reviews along with valuable information.

MEDICAL DEVICE SECURITY LIFECYCLE MANAGEMENT The recent Cynerio-sponsored session “Medical Device Security Lifecycle Management” was presented by Daniel Brodie and eligible for 1 credit from the ACI. This 60-minute webinar featured Brodie, co-founder and CTO of Cynerio Inc., as he examined the three stages of medical device security lifecycles. He focused on best practices and key milestones for effectively managing device lifecycles from an IT security perspective. He also discussed the importance of aligning the clinical engineering and IT departments.

The webinar, which drew almost 200 attendees for the live presentation, received positive reviews in a post-webinar survey.

“Encompassing illustration of life of medical devices with IT elements,” A. Warren, QA manager, said about Brodie’s presentation.

“Good information for our program and applicable for our use,” HTM Director K. Forsythe said.

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change in the future of how to develop IoMT into hospitals,” shared J. Tamaiz, general manager.

“Seemed very helpful to organizations starting the travel down the security road,” said M. Slater, supervisor, biomedical electronics.

“A good overview of medical device security lifecycle management, including risks and usage,” said M. Katz, associate.

“Cybersecurity is a growing concern at healthcare delivery organization. HTM must know how to countermeasure cyber threats for connected devices. This webinar provided us with a big scope in this area from the beginning to the end,” said T. Koh, MET. Attendees were also asked, “How would you describe Webinar Wednesday to your colleagues?”

“Worth the time, very informative,” said R. Cremer, director.

“Great source of information you wouldn’t normally be exposed to,” said J. Pleiman, senior biomedical electronics technician.

“A great resource for learning about the trending topics in healthcare technology management,” Biomedical Engineer A. Barth said.

“Easy to join meetings and moderation is excellent,” Equipment Support Technician J. Banuelos said.

“Informative on the day’s subject/topADVANCING THE IMAGING PROFESSIONAL

ic. Presenters possess a very good working knowledge of their subject matter,” said Design QA Staff Engineer S. Trainor.

“Gives you the ability to maintain your CBET as well as learn new skills or learn of new products,” said J. Carter, BMET.

RADIATION SAFETY The Webinar Wednesday presentation “Radiation Safety and Protection in Fluoroscopy – Utilizing RTI’s Piranha and Ocean Software QA Tool Measurements” was eligible for 1 credit from the ACI. The 60-minute webinar featured Christiane Burton, Ph.D., diagnostic medical physics resident at Boston Children’s Hospital and Harvard Medical School. She focused on radiation safety and how she utilizes RTI’s Piranha and Ocean Software QA Tool Measurement tools to increase efficiencies in the X-ray room. She also discussed how to obtain the necessary measurements and walk out with automated reports so she can focus on other tasks. The webinar was sponsored by RTI Group.

The webinar was popular with almost 200 individuals attending the live presentations. The webinar is available online where even more people are increasing their radiation safety and protection knowledge.

A post-webinar survey resulted in positive feedback and answers to the question “How will today’s webinar help you improve in your role?” “[It] gave me a better understanding of the types and use of different X-ray machines,” shared L. Barton, biomedical equipment service specialist.

“This would be good for users or people new to the X-ray field. I have been doing this for 20 years, so this was more of a review than anything new,” explained J. Monnig, biomedical equipment service specialist.

“Enables me to understand the radiology role in regarding patient safety as well as the employee,” Biomed D. Tomczak said.

“Radiation safety is without a doubt one of the most serious concerns that all staff members in health care should be aware of. This is because being invisible with no immediate signs, whether accumulative or a possible overexposure, can pose serious health risks. We must educate ourselves how to limit exposure to patients as well as all staff members. Radiation safety is on the top of my list along with infection prevention,” said B. Hayes, CBET III. “Reviewing dose and exposure concepts always help, especially listening to a physicist give me a great point of reference for the testing’s perception,” Technical Support Engineer M. Galeano said.

“As a radiology support engineer, this webinar broadWWW.THEICECOMMUNITY.COM

ened my knowledge base for radiation safety,” shared R. Harbick, BMET III.

MANY LANGUAGES OF DATA The Webinar Wednesday presentation “The Many Languages of Data: Finding a Common Dialect to Drive Change” was eligible for 1 credit from the ACI. It was sponsored by Accumen.

The 60-minute webinar featured Accumen’s Dr. Carla Harmath, physician advisor imaging operations; Stefanie Manack, operations manager imaging; and Judy Zakutny, operations manager imaging. The trio helped attendees identify the various “languages” that data speaks, how to probe for the details around the end goal and how to speak a stakeholder’s data language to ensure that the outside influencers understand one’s data, one’s goal and, ultimately, support one’s initiatives.

More than 100 people tuned in for the live presentation and more have viewed a recording of the webinar online. Attendees at the live presentation shared positive feedback via a post-webinar survey.

Attendees were asked, “How useful was the information presented in today’s webinar?”

“The content was indeed useful and well presented.

The discussion about interdepartmental communication was an eye opener for me,” said Field Service Engineer D. Banister.

“Very useful information. Found it very informative,” shared L. Santos, BMET III. “Information was good and usable for our program,” HTM Director K. Forsythe said.

“Good and interesting concepts. Lots to work on for the next project,” said J. Steinbrink, BMET III. FOR MORE INFORMATION about Webinar Wednesday, including recordings of previous presentations and a calendar of upcoming webinars, visit WebinarWednesday.Live. •

THANK YOU TO OUR SPONSORS:

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PRODUCTS

Market Report Reports: Continued Growth for CT Market STAFF REPORT

T

he global computed tomography (CT) market size was valued at $5.53 million in 2018 and is projected to expand at a compound annual growth rate (CAGR) of 6.5% by 2026, according to market research and consulting company Grand View Research.

A growing prevalence of various lifestyles associated with chronic diseases such as cancer and cardiovascular conditions and an increasing demand for advanced imaging solutions are among the factors expected to drive the overall market growth, according to Grand View Research.

CT scans are critical diagnostic tools – especially for lung cancer and traumatic brain injuries. The Centers for Disease Control and Prevention (CDC) reported more than 2.8 million people visited emergency departments in the U.S. for traumatic brain injuries in 2013. CT scans are the only option to assess a patient’s condition during emergency brain trauma.

Increasing demand for advanced assessment tools in emergency departments and the growing number of ambulatory emergency care units are factors expected to have a posi30

ICEMAGAZINE | MAY 2020

tive impact on CT market growth.

According to the National Center for Biotechnology Information (NCBI), more than 70 million CT scans are performed in the U.S. annually and 5 million are done in the U.K. every year with an annual increasing rate of 10%, signifying the growth potential of CT in the overall medical imaging market.

A steep rise in the application of CT scans and the growing trend of using CT scans for effective lung cancer screening are expected to boost the demand for CT scanners in developed as well as developing countries. Growing applications of CT also extend into dentistry where it is used to detect tooth decay and to assess infection.

The introduction of technologically advanced devices as well as the development of accessories to enhance image quality obtained by conventional CT scanners are major factors expected to fuel market growth. The introduction of advanced cone beam computed tomography (CBCT) systems is expected to be a major factor in widening the applications of CT in modern diagnostic imaging. Dual source and artificial intelligence enabled CT scanners are expected to be important milestones in the market growth. ClariPi Inc. received FDA clearance for its artificial intel-

ligence enabled CT scanner called “ClariCT.AI” in June 2019.

Similarly, in March 18, Siemens received 510k clearance for its dual source CT scanner, an innovative technology that emits a negligible amount of radiation producing high-quality image quality within a few seconds that is specifically suitable for pediatric patients and eliminates the need of holding breath during a thorax scan.

MarketsandMarkets, another research firm, also predicts market growth.

The global CT scanner market is expected to reach $6.20 billion by 2022, MarketsandMarkets reports.

MarketsandMarkets states that major factors driving the growth of the CT market include a growing need for effective and early diagnosis, a rising global prevalence of targeted diseases coupled with an aging population, increasing preference for minimally invasive diagnostic procedures, increasing benefits of CT scans over other imaging modalities and technological advancements. However, significant installation and maintenance costs, uncertain reimbursement scenarios across developing nations, a dearth of well-trained and skilled health care professionals may hinder the growth of the CT scanner market during the forecast period. • ADVANCING THE IMAGING PROFESSIONAL

PRODUCTS

Product Focus CT

FUJIFILM Persona CT

Persona CT is a no compromise, well thought out CT solution designed to streamline workflow and enhance confidence for both patient and provider every step of the way. A smart design, uniquely focused on ease-of-use, precision and patient comfort. The system’s large 85cm bore optimally matches the rotational arc of linear accelerator to help simplify accuracy in treatment planning, and its high resolution 64/128 slice imaging brings added versatility for general radiology to maximize return on investment.

Featuring a compact, streamlined design engineered for reliability, it fits tight spaces, installs fast, and is extremely versatile.

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*Disclaimer: Products are listed in no particular order.

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PRODUCTS

SIEMENS HEALTHINEERS SOMATOM X.cite

The new SOMATOM X.cite premium single-source computed tomography scanner from Siemens Healthineers has a large 82cm gantry bore for increased patient comfort and uses the Vectron X-ray tube.

The scanner’s new myExam Companion intelligent user interface concept guides the user through the exam workflow, enabling optimal utilization of all of the scanner’s state-of-the-art features. The myExam Companion combines available patient data such as gender and age with other user or machine-observable, patient-specific information to identify optimal acquisition and reconstruction techniques for each patient and exam. Together, these innovations make the imaging process more efficient, compensating for differences in user experience levels and scan complexities on even highly complicated acquisitions, including coronary CT angiography (CTA) studies.

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GE HEALTHCARE

3

Revolution Maxima with Auto Positioning

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ICEMAGAZINE | MAY 2020

Revolution Maxima is designed to simplify, streamline and automate the CT workflow with a variety of applications and services to improve efficiency, including its new, AI-based Auto Positioning. All patients are at risk of being mispositioned, which may lead up to a 38 percent increase in patient dose and up to 22 percent increase in image noise. Auto Positioning uses AI to take the guess work out of patient positioning and center a patient faster, with one click, for completely hands-free positioning. Altogether, it’s a powerful, high-performing and reliable CT designed to maximize every step of the CT workflow.

ADVANCING THE IMAGING PROFESSIONAL

PHILIPS

Incisive CT Philips’ Incisive CT incorporates a range of features to support high image quality at a low dose, while enhancing efficiency and workflow. With its industry-first ‘Tube for Life’ guarantee, Philips will replace the Incisive’s vMRC tube at no additional cost throughout the entire life of the system1. To minimize the cost of obsolescence, the system is available with the Philips Technology Maximizer program, which provides the latest available software and hardware updates.

4

1. Life of the product is defined by Philips as 10 years.

Tube for Life guarantee availability varies by country.

CANON MEDICAL SYSTEMS USA INC.

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.

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35

ACUSON P500 ultrasound system from Siemens Healthineers, designed to equip clinicians with a powerful line-up of clinical applications right at bedside

MATTERS OF URGENCY IMAGING, URGENT CARE CENTERS AND THE GROWTH OF CHOICE

BY MATT SKOUFALOS

I

n 2013, there were about 6,100 urgent care centers operating in the United States, according to the annual benchmarking report from the Urgent Care Association (UCA) of Warrenville, Illinois. In just six years, that count is approaching 10,000 (9,616), having climbed almost 10 percent year over year, the agency reported. As of March 2020, “an estimated 27 percent of all primary care visits and 14.9 percent of all outpatient physician visits take place in urgent care,” UCA reported, citing data from the Centers for Disease Control and Prevention (CDC) National Ambulatory Medical Care Survey and its own 2019 Benchmarking Report.

As those centers continue to expand the array of treatment options they provide, where do medical imaging modalities fall in their continuum of services, and who’s performing those studies?

Tracey Dennewitz, head of product marketing and operations for the X-ray products business of Siemens Healthineers North America, sees the growth in urgent care centers as being driven by patient demand, 36

ICEMAGAZINE | MAY 2020

the convenience of care provided at those centers, and the ongoing search in health care for greater cost controls.

Amid the explosion in urgent care center growth, Dennewitz also notes a shift in their ownership: five or six years ago, such centers were established by physician-led practice groups; today, they’re being opened by large health systems and investor-backed companies, he said.

They’re also picking up patients who don’t have primary care physicians. The lowest participation in primary care practices has been seen among Americans aged 18 to 34, as nearly 20 percent of American women and 30 percent of American men do not have primary care doctors, Dennewitz said.

“At the end of the day, patients that are seeking medical care don’t want to wait long periods of time in ERs, or deal with the hassle of primary care scheduling,” Dennewitz said. “It’s an on-demand society, and that’s a need that urgent care centers fill.”

As urgent care centers expand the array of services that they provide to include medical imaging, they will bear the cost of owning and maintaining the staffing and technology that delivers those services, Dennewitz said – even though, in most cases, patients still need to visit a primary care doctor to get their results interpreted. Given the versatility ADVANCING THE IMAGING PROFESSIONAL

MATTERS OF URGENCY

ALEJANDRO BADIA, co-founder and chief medical officer of OrthoNOW and the Badia Hand to Shoulder Center of Doral, Florida

of mature, commodity technologies like digital X-ray and ultrasound, the question of incorporating those services into an urgent care environment becomes largely arithmetic.

“To me, it’s a capital investment equation,” Dennewitz said. “X-rays aren’t just for broken bones. Urgent care centers use digital imaging to diagnose a number of complications – pneumonia, joint dislocations, bowel obstructions, kidney stones, fluid in the lung, foreign bodies – or to rule out the need for additional procedures. Most centers offer routine general X-ray, either DR or CR, and ultrasound. And clearly, there’s growth in the market. We’ve seen a steady increase over the years in this segment.”

As digitalization of health care continues to expand, Dennewitz foresees additional, “higher-end” imaging services could be added to those on offer in urgent care centers, be they mammography, CT, fluoroscopy and so on. If Americans continue to seek lower-cost care at urgent care centers instead of at hospitals or private-practice imaging centers, “urgent care centers will need to evolve and enhance their capabilities,” he said.

Likewise, Tracy Bury, senior vice-president of marketing, sales, and communications for ultrasound at Siemens Healthineers, believes in point-of-care ultrasound, or POCUS, as a growing market beyond urgent care center operations. The attitude “is perfectly matched with the urgent care philosophy of addressing non-life-threatening procedures and events for patients,” Bury said.

With total visit times at most urgent care facilities averaging less than an hour, including wait times, “it’s so much more convenient for patients than going to an ER, where they have to wait and constantly be put behind the more urgent cases,” she said.

And as ultrasound is useful in reliably WWW.THEICECOMMUNITY.COM

evaluating a number of conditions, from pregnancy to shock and trauma, it’s easy to imagine its broader use in the catchall business that urgent care facilities do.

However, the adoption of ultrasound modalities in urgent care clinics has lagged that of X-ray technologies, in part because of the skill level required of its operator. Urgent-care practitioners have to be broad generalists, and unless their clinics are being staffed with ultrasound technicians as well, the biggest shortfall in broader adoption of the technology lies in technical education.

“The U.S. differs from other countries in that we have a sonographer-based workflow in most hospitals and private physician offices,” Bury said. “Most of these physicians have not had sonography experience

cy with the modality in the broader context of all the other demands on their time.

“People graduating now have had exposure to ultrasound, whereas more and more years ago, they didn’t,” she said. “I feel this is growing symbiotically with the technology and the skill set.”

“As more digital education is available, more remote learning, more physicians will practice this,” Bury said.

“As it becomes more portable and the workflow is easier to use, it will enable them to do it.”

Katrina Catto, CEO of Urgent Care Occupational Health and Employment Services Division at Banner Health in Phoenix, Arizona, said that most urgent care centers are built upon a case-rate model, in which everything done in the office is covered under a

“The analytics we have show that 70 percent of people walking into our urgent cares are not even that urgent; it just might be some arthritis or tendonitis that has nothing to do with injury.”

– Alejandro Badia in school.”

“Ultrasound is a subjective art,” she said. “There are skill levels. I feel the education hurdle is a big one for physicians. More are becoming familiar and educated, even to the point of expertise with ultrasound equipment; many vendors recognize this and focus on education in modules.”

But even as ultrasound classes are filling up, there’s still “a long learning curve for these physicians specifically because they do everything,” Bury said. The biggest hurdle might be the time it takes to develop proficien-

single fee. Putting basic radiography under that umbrella is effectively a decade-old expectation, Catto said.

X-ray studies are widely performed at urgent care centers, in large part because after-image digital systems can fine-tune a study once it’s been captured, and not all states require that only a licensed X-ray technician may obtain the image, she said.

Yet although some 90-percent of urgent care centers offer X-ray services, Catto said ultrasound is only available at about 10 percent of them, and CT at less than 2 percent.

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MATTERS OF URGENCY

TRACY BURY, senior vice-president of marketing, sales, and communications for ultrasound at Siemens Healthineers

TRACEY DENNEWITZ,

head of product marketing and operations for the X-ray products business of Siemens Healthineers North America

She believes those umbrella payment arrangements are another factor that will keep more centers from investing in higher-cost imaging equipment, as even with increased reimbursements, volumes are low in that environment.

“There aren’t enough CT studies that really come through the urgent care to make the purchase of a large machine really show on ROI,” Catto said. “I see urgent care branching out into other types of service lines where accessibility is needed. There’s a lot of work around fusion and dialysis that patients will continue to drive out of the hospital space. I don’t see any increase of the level of imaging provided in urgent care centers any time soon.”

Beyond broadly expert physicians needing to develop their facility with imaging equipment, additional barriers to rolling out higher-level services

care providers to review them (which most people making use of urgent care centers may not have). But even if urgent care facilities don’t expand their imaging offerings, Catto doesn’t necessarily believe that patients are going to turn to hospitals for outpatient imaging services given the out-ofpocket cost.

“How imaging fits into a landscape like ours is really about creating continuity of care through our services: medical records, payment services, high-level care,” she said. “It’s a matter of having the best radiologists doing it.

Convenient access and that high-quality experience are very important within that continuum.”

“The consumer is really going to be the one that makes that change and drives the need for additional locations and availability of imaging services,” Catto said. “There will continue to be

“The consumer is really going to be the one that makes that change and drives the need for additional locations and availability of imaging services.”

– Katrina Catto, CEO of Urgent Care Occupational Health and Employment Services Division at Banner Health in Phoenix, Arizona

at urgent care centers include access to imaging technicians, the availability of radiology professionals to interpret the results of imaging studies performed, and patient access to primary 38

ICEMAGAZINE | MAY 2020

opportunity in that space for continued growth. There aren’t imaging centers in a number of places; people still go to hospitals for those studies. As consumers manage where that spend is going, ADVANCING THE IMAGING PROFESSIONAL

it’s going to drive a lot of that business out of the hospital.”

Alejandro Badia, co-founder and chief medical officer of OrthoNOW and the Badia Hand to Shoulder Center of Doral, Florida foresees growth in “specialty urgent care,” particularly orthopedics. Such facilities are particularly dependent upon imaging, “and that’s going to be an opportunity for the imaging market,” he said. Practices like Badia’s see many cases that are not always urgent in terms of their acuity, but may be the result of untreated chronic conditions flaring up.

“The analytics we have show that 70 percent of people walking into our urgent cares are not even that urgent; it just might be some arthritis or tendonitis that has nothing to do with injury,” he said.

Providing urgent orthopedic care “decompresses the entire system” in the same way that primary care and other urgent care centers do, providing a safety valve that relieves overall pressure on the system, Badia said. Patients who go to emergency rooms for treatment of their orthopedic injuries could be back-burnered there depending upon the volume of patients waiting to be seen and the severity of their cases.

“If you have knee pain, you don’t want to be sitting next to someone with a hacking cough,” Badia said.

“Still, people will go to a general urgent care all the time with their knee pain.”

As a specialty urgent clinic, Badia’s practice locations all make use of digital imaging, from X-ray to diagnostic ultrasound to miniature fluoroscopy, which Badia describes as one of his most powerful resources. Going forward, he believes mini-fluoro is the next advanced modality to which physicians at freestanding practices like his will turn.

“I use mini-fluoro every day,” Badia said. “If you do sports medicine, every knee and shoulder surgeon will need an MRI. You’re going to see more clinicians, even solo, having WWW.THEICECOMMUNITY.COM

these in-office machines that are much smaller and not as powerful, but useful if you have a good technician.”

Orthopedic urgent care centers like Badia’s fulfill a specific role between those of hospitals and primary care physicians; however, he is careful to say that there are limits to the types of cases that should present there, optimally.

“If something’s really severe and acute, that’s what hospitals are for,” Badia said. “We don’t want to go the other way either and bring everything to a patient walk-in center; you may need an ICU bed.”

Beyond urgent care centers and standalone imaging facilities, Badia also pointed to the presence of standalone emergency rooms as another option for patients in several parts of the country. From Texas to Florida, the growth of facilities like these reflect the degree of competition among large health systems and hospitals throughout America. Amid that pressure, the quality of available

imaging services and imaging-guided procedures will oftentimes be a differentiator for customers with multiple options in a marketplace.

And as customers have more options available to them, “the problem is, where are we as physicians going to be?” Badia said.

“If physicians want to remain independent, they’re going to need a little more business savvy,” he said.

“They’re going to have to realize they’re going to have to make an investment, and the investment is imaging.”

Rather than worrying whether devices will pay for themselves over their lifespan, Badia said physicians should consider what their ability to offer imaging services does for their practices when deciding to purchase.

“Walk in with shoulder pain, walk out with a definitive diagnosis, and I’m already on your surgery schedule to fix my rotator cuff,” he said.

“What physicians are going to make that jump and offer those services to their patients?” • ICEMAGAZINE

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INSIGHTS

ADDRESSING “WHAT’S IN IT FOR ME?” MAY NOT BE ENOUGH W e are in times of change. ture state. Only trouble is – this approach only Regardless of how radical captures the on and off phases of the change or incremental, the induslight switch. The future state is only 1/3 of the try continues to adapt and evolve change equation. “What’s in it for me?” pulls to meet the demands of its environindividuals towards the benefits of the future ment. Conversely, so too we must state, yet may not address the acknowledgeadapt to meet the demands of our inment of letting go of the current state, or the dustry. Processes, technology, behavtumult of the transition state. iors and structures that have served Last year, I was participating in a training us in the past may become obsolete session for change practitioners to gain deepRAD HR in the future. Because of our induser knowledge in facilitating the training of

BY KELLY PRAY try’s complexity, agility in change is a other practitioners. Our group began discussstandard requirement for those who ing ways to motivate teams and build change work in the healthcare field. Changes in healthresiliency when benefits may be hard to identify. Often we care in the last decade have included technolog- find ourselves having to lead teams through changes that ical advancements, shifting demographics in the negatively impact our teams – whether it be in process, patient population, new legislation and regulato- technology, behavior, or structure. After exploring how we ry requirements, modernized payment models, could expand on addressing “What’s in it for me?”, one of mergers and acquisitions of health systems and our colleagues bluntly added, “Give ‘em the WIIFM and the more. Change resiliency is a burden that each WIRM!” of us sign up for when seeking employment or Adding the layer of “What is required of me?” addresses service at a healthcare institution. the move through the transition state, the second piece to Change resiliency starts by acknowledging the process of change. How many times have you considered change to be a flip of a light switch – from current to future? Often, we lose sight of the fact that change is a process – that there are three states (current, transition, and future) we need to be mindful of. Change moves individuals from their current state into a transition state, in order to instill a better future.

Each transition requires its own release of the status quo, of what has been adapted to. Regardless of how individuals feel about the state they are in, barriers to resilience include the comfort of the current state and the fear of the unknown transitions.

A go-to tool in the change resiliency toolkit is addressing “What’s in it for me?” for individuals impacted by change.

Individuals will weigh the pros and cons of their current state with those that are identified in the future. By clearly articulating the benefits of the proposed future state, you both alleviate and accelerate individual adoption to the fu40

ICEMAGAZINE | MAY 2020

the change equation. The fear of the unknown often causes resistance to change, regardless of the scope or impact the change may have on an individual. By addressing “What is required of me?” leaders can help fill in the gaps that individuals may have in how the impending changes will impact them. By understanding what is required to effectively engage in the change, less becomes unknown, and fear diminishes.

Equally impactful as fear in transitioning through change is the power of comfort with the way things are. Regardless of how satisfied (or dissatisfied) individuals are in the current state, there is still comfort in maintaining the status quo. The third and final question to address the third state of change, the current state, is “Why?”. Reflect on January’s article that referenced Simon Sinek’s “Golden Circle.” Defining “Why”- why the change, why now, why me, will inherently get your team to begin to let go of the “what” it is that they’re executing on a day to day basis. Connecting individuals beyond what they are doing and how they should do it ADVANCING THE IMAGING PROFESSIONAL

is critical to building resiliency and productivity in times of change.

To be an effective leader in change means successfully navigating your teams through the three states of change: current state, transition state, and future state. By addressing the following three questions, you can set yourself and your team’s up for better chances of success in change: • Why? – Why should we be letting go of the current state?

• What’s In It For Me? (WIIFM) – What benefits or incentives are in place to instill a better future state?

• What Is Required of Me? (WIRM) – What is required of me from a knowledge, skills, resources, and ability standpoint in order to successfully navigate the transition state?

So in times of change remember- give ‘em the Why, the WIIFM and the WIRM. • KELLY PRAY is the enterprise change management lead at Children’s Hospital Los Angeles.

Source: https://blog.prosci.com/change-is-a-process

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ICEMAGAZINE

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INSIGHTS

DIRECTOR’S CUT

BY MARIO PISTILLI

COVID CRISIS I am not sure what the situation will be by the time this prints and reaches your hands. It is now March 25, as I sit to think about this.

The words are not coming easily as there is so much to do and so much uncertainty.

I, like many of you, am trying to balance work and life in ways I never really had to before. I am, of course, fearful for my own family and thinking of my constant exposure that I may then bring home. My son is in another state, in college, and staying at home in his apartment. I am constantly worried for him. Does he have enough food? Will he get sick and us not be there?

I am worried for my staff. How many will fall ill? How will they cope financially? I frankly worry about myself. Will I get really sick, and who will take care of my family if I do?

I am sure that each of us is facing so many challenges and in the face of all of this we must lead. We must lead bravely, calmly and strongly as others are looking to us for answers and for their own courage. Even if inside we are filled with our own stress and worry, outwardly we must continue for those that rely on us.

It reminds me of a leadership exercise I participated in this past summer. They took a small group of us to a local sailing class for the day to teach us to sail. We had no idea this was the plan for the day, we were not told ahead of time. We did not have a 42

ICEMAGAZINE | MAY 2020

chance to study beforehand nor were we given a list of things to prepare. I was partnered with two other people and none of us had ever sailed before. We started with some preliminary lessons on the dock. At the end of the lessons none of us had any clue what we just learned or how to apply it. We all entered our boat completely confused about wind directions and tacking and jibing were still foreign words to us.

The three of us got in the boat with our skipper and he explained step by step how to prepare the boat to leave and guided us out of the dock. With his guidance, we soon got out of the channel into open water and then he said, “OK, you all are going to sail the boat.”

We were terrified as we still felt like we had no clue. We each took a role – one person on the tiller to steer, one person on the line that controls the main sail, and one person on the two ropes that control the jib sail (the smaller triangular sail at the front).

The skipper gave us minimal directions and forced us to use the nautical terms that we had just learned and still didn’t fully understand. Every 15 minutes or so we had to switch roles and rotate our position on the boat. I wanted to admire the scenery of the beautiful Santa Monica Bay, but I was too busy trying not to screw up and pay attention to everything around me. He told us we needed to learn to feel the wind, but that was not happening for me. I never realized until now, how much I learned that day.

ADVANCING THE IMAGING PROFESSIONAL

• Sometimes we have to face things unprepared. Nobody was prepared for this. Trust in yourself and what you do know. Trust in your experience that even though you have never faced a viral epidemic, you know how to take care of people and you know how to lead people.

Most of all, what I learned through sailing, is that we have a tremendous capacity to learn quickly and adapt. You need to draw on that now.

• We need to rely on others. There is no way I could have sailed that boat on my own and I had to rely on others to do their parts. We all had to do this with the understanding that none of us fully knew what we were doing, but I was so focused on what I had to do that I had to trust them.

• Give people space to make mistakes. Just as you are struggling to navigate your role so is everyone else. I have been faced with many questionable judgement calls of others that do not fully understand what we do. Like directing my staff to wear non-MRI safe PAPR hoods WWW.THEICECOMMUNITY.COM

•

•

•

•

in the MRI suite. We need to have patience with each other.

Be a cheerleader. Each of us needed encouragement that day and it made the world of difference to have my boatmates tell me good job. Those around you need that right now, let those around you know you appreciate all they are doing when times are difficult.

Talk through your challenges. On the boat that day we were not ashamed to admit what we were struggling with. Ask your team, what it is they are worried about or struggling with and talk through it with them.

Tell the truth. Now is not the time to “fake it till you make it.” Now is the time to admit what you don’t know and to be honest. I don’t know what the future is going to bring, but I do know that we care about our patients and our staff and we are going to do everything we can to keep them all safe.

Stay positive. I know this is hard, but you need to stay positive.

When I took the tiller of the boat that day, having no clue what I was

doing, I knew that the other two people didn’t need me freaking out. We have to let our teams know that we are positive that we will get through this and focus in on our strengths and opportunities.

The bottom line is that this is the time that leaders need to just lead.

We are the captains of our respective ships with a boat full of people relying on us to guide them safelyhere to shore.

Photo caption and here and here and here andishere The wind is uncertain, andand thehere water and here and here and here perilous, but never-the-less the boat is still moving. We can either crumble and complain about the wind or be a good captain and trim the sails and keep sailing. So, to all my dear colleagues, your families and your respective teams, I wish you calmer waters ahead and all a chance to finally sit back and enjoy the scenery. • MARIO PISTILLI, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Children’s Hospital Los Angeles. He is an active member and volunteers time for ACHE and HFMA organizations. He is currently serving on the AHRA national Board of Directors. He can be contacted at mpistiili@chla.usc.edu.

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INSIGHTS

ALWAYS ON! T

PACS/IT

BY MARK WATTS

he heavy toll of “always on” technology, emails, instant messages and texts — and the expectation that they’ll be responded to immediately — are driving workers to distraction. Are radiologists as focused as they need to be? Do technologists spend less than productive hours at work due to omnipresent social media vectors? Could this distraction lead to fatigue and burnout?

I drove my family to the Florida beach from Tennessee 14 years ago. As a corporate director I was recently given a Blackberry and felt connected to work. It was only when my son, at the time 5 years old, asked me an innocent question, “Can’t you just leave that (Blackberry) in the car?”

As a director we ask employees to “check your email daily.” From an operations standpoint this lets us document the transfer of knowledge and change. How quickly should employees respond to emails? In most workplaces the answer is “right away.” But scientific research is starting to suggest that managers need to recognize the effect that being “always on” has on employee stress and overall efficiency.

More than a decade after the smartphone’s introduction, researchers have been tracking and analyzing its impact — and that of its addictive nature on our brains.

In the book “The Distracted Mind: Ancient Brains in a High-Tech World” (The MIT Press, 2016), neuroscientist Adam Gazzaley and psychologist Larry D. Rosen reveal what happens in our brains when we get interrupted or self-distract and how that affects us behaviorally and psychologically.

The book explains how Internet-connected devices and expectations for immediate

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responses to communications degrade our attention, with implications not just for productivity but also for mental health and stress levels in the workplace.

The question is, what can radiology managers do to minimize unnecessary interruptions for their staff? Have you noted a fellow worker who is always “on their phone?”

Delay of service to “just check” for updates?

This is not as simple as locking up phones when an employee reports to work.

Managers want as much productivity as possible, of course, but they should be aware that when employees are interrupted by a communication such as email, instant message or text, it not only distracts their attention, but it can keep them away from the task they were engaged in for a substantial period of time. One study estimates that the resumption lag in getting back to the original task is nearly 15 minutes, on average.

In addition, when people return to the task, they have to reactivate the brain networks that were being used to address it which takes additional time and effort.

Ultimately, employees can do just as good a job as they would if they haven’t been interrupted, because they work more quickly than ever after the interruption.

But this comes at a cost: time delays, the need to use extra work hours to complete the interrupted tasks and additional stress.

Workers are being interrupted far too often and suffering far too much unnecessary frustration and anxiety as a result.

Researchers are just now starting to compile data on the impact of technology use on the brain, on sleep, on productivity and on learning. They have found strong negative effects in many cases. The research clearly indicates that the impact from so many interruptions on our mental and emotional functioning is vast and needs to be addressed.

ADVANCING THE IMAGING PROFESSIONAL

The majority of tech-induced interruptions that take place at work are self-generated, where employees are checking in, checking email and checking up on one another — without external direction. How can health care leaders help?

A general plan needs to be in place across the organization to help workers avoid this constant checking-in behavior. First, the health care system must implement policies on online communications. Some companies have a 7-to-7 rule, where communications sent before 7 a.m. or after 7 p.m. do not need to be answered until the workday begins.

Second, we have, over time, built up expectations that communications deserve priority over everything else and that we should address them immediately. We must start changing these expectations. One way is to set a workplace norm that digital communications should be dealt with in, say, 30 minutes, or whatever works. If a communication is vital, then it should be moved to a phone call or even a face-to-face discussion so that it gets addressed immediately.

Third, we have developed an almost Pavlovian response to incoming communications, which we have to quell.

Leaders need to consider a technique called a “tech break.” This means that you close down any websites on devices that are not relevant to work, including email and texting, and you set a timer on the phone for 15 minutes. You place the phone directly in your line of sight — but upside down to remove the flashing alerts from your line of sight — as a reminder that you’re still on tech break. When the alarm rings, you can check anything for one minute. Then you are “taking control of your own interruptibility.” This is critical to productivity, and managers should encourage their workers to do it.

After this is comfortable, start again.

This is a flexible plan, so it can be WWW.THEICECOMMUNITY.COM

longer than one minute, but it needs to be timed. You go 15 minutes without checking in and then increase it to 20 and then 30 minutes.

Implementing the tech-break strategy, along with technology-free hours and even technology-free zones in the office, will go a long way toward alleviating distraction.

The common thought is that millennials want to be connected and think they can multitask effectively, even when scientific studies show that’s not the case. Meanwhile, older people were more distractible than younger adults and have more issues with task switching and multitasking. Regardless of a person’s age, nobody multitasks all that well. Making rules for different people due to age doesn’t make any sense.

One way my research has influenced me personally is that when we found a major impact of late-night technology use on sleep problems, I stopped using my phone and tablet one hour prior to bedtime. Instead, I

“single task” by watching TV. The move from film to PACS, the move from phone to smartphone and the development and training of the current human brain has impacted our ability to focus and complete radiology tasks in the same manner we did 15 years ago. Photo caption here and here and here and and and here If we consider the here results ofhere an “aland here and here and here ways on” brain and workplace, I hope you see it is time we retrain ourselves to turn off and enjoy the sounds of the waves at the beach. • MARK WATTS has over 20 years as an imaging professional with vast expertise in imaging informatics and IT issues. He has served in many roles in both hospitals and industry as a health care vice president, imaging director and IT consultant.

His knowledge and experience in the convergence of IT and imaging has made him a sought after author, speaker and consultant. He has authored a textbook on informatics and was a pioneer in the adoption and development of PACS and VNA technologies.

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INSIGHTS

WHEN LIFE CHANGES IN A MOMENT T

here is an old to motivate employees who proverb, a curse may be feeling overworked or really, that goes underappreciated. But this cursomething like “May you rent series of events is bringlive in interesting times.” ing people back to this core We are currently managmission in ways that are both ing a global health crisis self-sacrificial and heroic. that has impacted every There are physicians, clinione of our lives in ways cians, technologists and clerical we would never have staff putting their own safety DEPARTMENT/ imagined only months and, in many cases, the safety ago. Our hospitals are OPERATIONAL ISSUES of their families at risk to meet full, we lack some basic the needs of the sick. There are

BY JEF WILLIAMS tools and equipment to support engineers and staff deliver safe care, our personal lives who are ensuring that equipment and ecosyshave been disrupted by social distanctems are running effectively and kept clean and ing practices, for many of us our work sterile. What an opportunity we have to apprehas changed from office to home, or ciate these people who have always understood from regular to extended and weekend there is a mission to support but may have never hours. Yet in the midst of this chaotic, expected a time would come that so much would and tragic, situation there are some be required – and they persevere in ways that lessons we’re learning that help us cope inspire us all. Their actions also remind us that and may perhaps live long beyond the there is often a reason that certain phrases get latest novel coronavirus. over-used like “patient care,” and that’s because

WHY WE DO THIS An oft used colloquialism heard in the halls and conference rooms in health care is “it’s all about patient care.” This is used as a way to rally consensus or recalibrate focus when dealing with all of the peripheral activities that support patient care and delivery. It is used to justify expenses related to new equipment, to reduce the impact of a negative return on investment (ROI) related to a technology or operations project, and even 46

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it’s what matters most.

THINKING ADAPTIVELY There are many long-standing policies and practices in health care. It’s widely known that change happens slowly in health care. The implementation of EHRs notwithstanding, most innovation and implementation of rapid change is often met with a level of resistance. There are human factors related to change and the discipline of organizational change that contribute to this, ADVANCING THE IMAGING PROFESSIONAL

but there many other factors as well.

In a time of crisis, we often must learn to adapt – and quickly – to meet the problem with what must be done to remediate that problem. We are seeing some very interesting changes being adopted during this time that may ultimately change some of the ways we provide care.

The value of telemedicine has risen exponentially as people look for ways to isolate and reduce transmission.

While the tools for providing remote physician consulting have been available for years, the adoption curve has proven disappointing for many. Issues related to reimbursement, certification and even HIPAA seemed unsurmountable especially with smaller hospitals and groups. Now there are reduced barriers to adoption with widely used tools such as Skype and Zoom along with policies changing to allow doctors to practice across state lines (or allow for local state certification of the practice to suffice regardless of patient location). Imagine how this, if it persists, will improve our ability to meet patients in the way that best meets their needs.

BUT WHAT ABOUT ME Our lives have changed since early March 2020. We no longer have the ability to enjoy a night out at our favorite restaurant, bowling at our favorite alley and have a beer at our favorite local brewery. Kids activities, including school, have ceased indefinitely and we’re balancing education, exercise and entertainment while still managing full-time jobs – many of which are more demanding than ever before. Our household has shifted from planning events and trips to making book lists, TV series and online yoga. Perhaps there is a silver lining with this nearly dissociative shift in habits and routines – that it brings new perspectives and opportunities.

Finding new ways to achieve similar outcomes requires creativity. Most of WWW.THEICECOMMUNITY.COM

our jobs can be defined by the 80/20 rule: 80% of what we do is the same and 20% is new or different. Most thrive in routine related to process, location and outcomes. Right now, most of us have at least two, if not all three, of these things disrupted. We are working in ways we hadn’t planned, but still have a job to get done. It’s easier for some than others, but to welcome creativity into our world can help us meet the demands in ways we hadn’t considered all while showing us what’s important and causes us to prioritize the things that matter most. It’s likely that a number of people who are now working from home may never go back to the office. Even the way we schedule personnel and utilize resources may be forever changed. And, while none of this in any way lessens the awful circumstances of the virus, maybe it can be considered a sliver of light.

We currently have no idea when this wave of tragedy will subside or when life as we knew it will return to normal. Perhaps this is a watershed moment, not unlike 9/11, where we will be adopting a new normal. Maybe we will be different after this. It’s possible some things we took for granted will go away, or old routines will be replaced by new activities or ways to do our job. While this isn’t the time to figure that out, we must be prepared for what is to come. Right now, the focus of everyone I work with in hospitals around North America are rightly focused on keeping systems running, staff supported and supplies stocked – all for the purpose of caring for patients. Please know, for those on the front lines, we are here to support you and consider you our modern-day heroes. As Samuel Johnson put it, “Great works are performed not by strength, but by perseverance.” May we all persevere. • JEF WILLIAMS, MBA, PMP, CIIP, is a managing partner at Paragon Consulting

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INSIGHTS

CORRECT BILLING FOR EXTENDERS N CODING/BILLING

BY MELODY W. MULAIK

on-physician practitioners (NPPs), such as physician assistants (PAs) and nurse practitioners (NPs) may be able to perform and bill for services independent of a physician. However, radiology practitioner assistants (RPAs)/registered radiology assistants (RRAs), who are frequently referred to as physician extenders, require physician supervision at all times. These individuals play a valuable clinical role in many organizations, but it is important to ensure that you are billing compliantly for their services.

The Centers for Medicare and Medicaid Services (CMS) requirements for supervision of diagnostic tests are found in the Medicare Benefit Policy Manual, Chapter 15, Section 80. There are 3 levels of supervision: general, direct and personal. All interventional procedures are not classified as diagnostic tests so they are listed as â&#x20AC;&#x153;concept does not apply.â&#x20AC;? This means that the procedure should be billed under the provider who is authorized to perform the procedure.

By current American Medical Association (AMA) and CMS guidelines this is limited to physicians and NPPs previously designated above.

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Historically, diagnostic procedures performed by RPA/RRAs that require personal physician supervision were covered only if the physician was in the room with the extender throughout the procedure. This now varies depending on state law and scope of practice regulations.

The supervision guidelines listed in the Medicare Benefit Policy Manual apply to all sites of services and are not limited to physician offices and independent diagnostic testing facilities (IDTFs). CMS clarified in the 2009 and 2010 Final Rules for the Medicare Outpatient Prospective Payment System (OPPS) that diagnostic and therapeutic services performed in a hospital outpatient department must be provided under physician supervision, and the required level of supervision for a diagnostic test is that which is indicated in the Medicare Physician Fee Schedule (MPFS). This guideline applies to outpatient departments within the hospital as well as remote departments.

Even with the recent changes, CMS ADVANCING THE IMAGING PROFESSIONAL

LOOKING TO PURCHASE OR SELL AN MRI, PET/CT, CT, OR X-RAY? guidelines and state scope of practice statutes may not permit a health care professional to perform all services for which he or she has been trained. For example, many RPA/RRAs receive training to perform procedures that are listed by Medicare as requiring personal supervision. Because of Medicare’s supervision rules, RPA/RRAs are not allowed to perform and bill for these studies unless a supervising radiologist is in the room during the performance of the entire procedure. The changes apply only to diagnostic tests.

There are multiple considerations including, but not limited to, state scope of practice, payer requirements and supervision considerations. It is important not to confuse supervision guidelines with billing requirements. The bottom line is that no physician may bill Medicare separately for diagnostic tests performed in a hospital outpatient setting by a radiologist extender unless an exception applies. Either the NP/PA is a credentialed individual that bills under their own provider number, the RPA/RRA is allowed to perform designated procedures under direct supervision or there is no claim generated for the professional component. • MELODY W. MULAIK, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is

LOO

K NO FURTHE

R.

GE • TOSHIBA • SIEMENS • PHILIPS Give us a call at 213-276-8209 (844-PMIM-MRI) or visit www.pmimagingmgmt.com

the president of Revenue Cycle and Coding Strategies Inc.

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INSIGHTS

MANAGERS:

EMOTIONAL INTELLIGENCE

BY DANIEL BOBINSKI

PLEASE THINK LIKE TRAINERS B

efore I share a few stories, let me first state that my formal education is how to create training from scratch on any subject. A good training designer first identifies the expected results of a training, then the behaviors needed to get those results. From there, the designer identifies the knowledge, skills and attitudes required for someone to display the needed behaviors. Once all that is done, training is developed and delivered.

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With that backdrop, letâ&#x20AC;&#x2122;s look at a few workplace stories.

Tom was a technical trainer for 20 years.

He was respected by his companyâ&#x20AC;&#x2122;s employees, as evidenced by how much they enjoyed his training. On class evaluations, Tom received the highest scores out of all the technical instructors in his company.

Sophie was a great waitress. How do I know? Many who had the pleasure of being served by Sophie would ask to be seated in her section on return visits. In fact, people talked about going to the restaurant so ADVANCING THE IMAGING PROFESSIONAL

they could have, “The Sophie experience.”

And then there’s John, consistently his company’s number one salesperson. His customers loved him, and his company enjoyed great success because of John’s exceptional sales skills.

Tom, Sophie and John were all stellar employees. Why do I bring them up? Because each of them were promoted, but none of them performed well in their new positions.

This phenomenon is commonly referred to as, “The Peter Principle,” based on a 1969 book by the same name. Essentially, “The Peter Principle” states that employees promoted based on their current levels of success will eventually reach a level where they are no longer successful. Or, as the book put it, they get promoted to a place where they are incompetent.

Tom was an exceptional classroom trainer, but he didn’t understand how to create training from scratch nor how to manage other people. As a result, when he was promoted to a team that oversaw training development for his company, Tom felt like a cork in the ocean. It got so bad that the vice president overseeing the department gave Tom six months to “figure it out” or he’d be gone.

The situation was similar for Sophie.

After her manager quit, the restaurant’s owner thought Sophie would be an inspirational replacement. He believed she would know how to train others to do what she did. Unfortunately, Sophie struggled in her managerial duties, including managing and motivating employees.

John’s sad tale is a story I’ve often told. When a company promotes its best salesperson to sales manager, the company has made two mistakes.

First, they’ve lost their best salesperson, and second, they’ve hired a mediocre sales manager. This is because the skills required of a sales manager are quite different from that of a salesperson, and rare is the individual who can excel at both.

WWW.THEICECOMMUNITY.COM

This article is for anyone who manages or oversees other people, and the message is this: managers and leaders must think like trainers who design training. Such a person identifies the objectives to be reached, the behaviors needed, and the knowledge, skills and attitudes required to get there.

Stated another way, managers and leaders must pay attention to the skills needed for success in each position they manage. Then, if someone in a position is not performing at needed levels, the manager or leader must identify what’s getting in the way of success and work to make it right.

For example, whenever a performance problem exists, several questions must be asked. Does the problem stem from outdated procedures or policies? Is the problem related to personnel, such as a personality clash?

Or, does it stem from a lack of clear goals or a lack of capability?

In all cases, it’s the responsibility of the person in the supervisory capacity to either adjust policies or procedures, or equip people with the knowledge and skills they need to get a job done.

By all means, avoid doing what Tom’s vice president did, telling Tom to, “figure it out.” With Tom being as experienced as he is, if he could have figured it out, he would have done so.

A WELL-WRITTEN JOB DESCRIPTION IS VALUABLE For optimal performance management, supervisors and those they supervise should meet 1:1 every two or three months. The main purpose of such meetings should be to review the four or five most important and urgent projects for each person.

As basic as it sounds, a great place to start is with job descriptions, or JD’s for short. And yes, JD’s are valuable even at senior management levels.

After 30 years of consulting in companies of all shapes and sizes, I’d say the most underused tool in business is job descriptions.

Unfortunately, even when JD’s do exist, they are often misused. As a general guideline, a well-written JD should identify between five and 15 duties, and each duty should have between five and 15 tasks. And, to be useful, they should be integral to performance management efforts.

Quarterly performance management meetings don’t need to be long.

Half an hour is fine, and discussion should revolve around goals and identifying actions needed to get past obstacles to achieve those goals.

Also, check to see if a person’s JD has changed. Why? Because JD’s serve as a focus for action, and a manager or leader should be coordinating his or her team so everyone is rowing in the right direction.

As we saw in Tom’s, Sophie’s and John’s stories, none of that happened.

In closing, let me offer some great questions to ask when performance problems exist.

Are the problems caused by other personnel? If not, are policies or procedures getting in the way? If not, do problems exist because someone doesn’t have needed knowledge or skills to do the work?

If a person needs training, funds may need to be authorized. Connections may need to caption be made.

One Photo here andofhere and here andprinciples here and here the most important for and here and here and here and here anyone who supervises others is this: Ensure the people working for you have what they need to do their jobs.

It’s thinking like a training designer. What objectives do you need to reach? What conditions do you need to create so you get there? • DANIEL BOBINSKI, M.Ed. is a bestselling 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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SCRAPBOOK

AMSP Winter Meeting

2

1. The AMSP Winter Meeting was set at the picturesque, luxury Renaissance Aruba Resort & Casino.

2. (Pictured from left to right) Manny and Ruth Roman, John and Joni Krieg, and Megan Cabot enjoy a beautiful al fresco Welcome Reception.

3. AMSP annual meeting attendees are seen prior to boarding a private charter to Renaissance Island, where everyone enjoyed a phenomenal dining event to cap off the week’s meeting.

4. MedWrench’s Ben Calibrating also enjoyed some fun in the sun!

5. AMSP President Richard Hollis led member round tables and introduced associate members as they presented to the association members.

6. Aruba was a beautiful backdrop for the AMSP Winter Meeting.

7. John Krieg and the ICE sales team had the opportunity to discuss the importance of print, digital and social media advertising with AMSP members. Collectively, all involved are looking forward to a new partnership to help promote this association and individual members.

8. AMSP members had the opportunity to network prior to enjoying a wonderful dinner during the Welcome Reception. •

3

T

he annual Association of Medical Service Providers (AMSP) Winter Meeting was held March 9-11 on the beautiful Caribbean island of Aruba. Over 20 industry suppliers of products and services from all over the United States gathered and conducted presentations to directly address the company owners of AMSP.

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ADVANCING THE IMAGING PROFESSIONAL

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AMSP

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ICEMAGAZINE | MAY 2020

ADVANCING THE IMAGING PROFESSIONAL

SPONSORED CONTENT

MEMBER PROFILE

PREFERRED DIAGNOSTIC EQUIPMENT SERVICE INC.

BY ERIN REGISTER

equipment lines such as Siemens, Canon, Fuji, AMX, Hitachi MRI, Shimadzu, Ziehm, OEC, RadPro, Quantum and more.

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referred Diagnostic Equipment Service Inc. (PDES) has been a family-owned and operated company since its establishment in 1992 as a quality, cost-effective alternative for servicing radiology equipment.

“PDES has earned a solid reputation as an asset to the diagnostic industry,” said Bobbie Human, PDES Office Manager. “PDES has experienced steady growth and success, serving a large customer base in the Southern California region, including the counties of Los Angeles, Riverside, San Bernardino, San Diego and Orange.”

Human’s husband, Richard Hollis, is the CEO and owner of Preferred Diagnostics Equipment Service Inc. Preferred Diagnostics Equipment Service is a member of the Association Medical Service Providers (AMSP), the premier national association of independent service and products providers to the healthcare technology industry.

ICE magazine learned more about PDES in a recent interview with Human and Hollis.

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Q:

How does PDES stand out in the medical imaging field?

Hollis: For the past 20 years, we have been providing quality, cost-effective alternative service for Children’s Hospital of Los Angeles. As soon as the equipment they purchase from OEMs comes off of warranty, they move the service to us.

Richard Hollis (left), CEO and owner of Preferred Diagnostics Equipment Service Inc., with his wife and PDES office manager, Bobbie Human.

Q:

What are some services and products PDES offers?

Human: Some of the services we offer are new equipment sales, easy financing, refurbished equipment sales, room upgrades, service contracts, PM contracts, installations, de-installations, room plans and technical support.

Hollis: Because of the laws here in California, we are locked out of most new equipment sales in the hospital market, so we focus on our service business.

PDES specializes in the services of

Q:

What has been your company’s biggest accomplishment?

Hollis: I would think that one of our biggest accomplishments is that we moved Hoag Hospital from analog to digital imaging.

Q:

What is on the horizon for your company?

Hollis: This year, we are going to expand into the veterinarian market. • LEARN MORE about Preferred Diagnostic Equipment Service Inc. by visiting Pdiagnostic.net. You can also reach CEO Richard Hollis by calling 951-340-0760 or emailing rhollis@pdiagnostic.net.

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“Don’t let yesterday take up too much of today.”

– Will Rogers

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[QUOTE OF THE MONTH]

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ADVANCING THE IMAGING PROFESSIONAL

Science Matters

PCR test detects tiny trace of DNA Polymerase chain reaction (PCR) is a sensitive lab test – common in medicine and other fields – that makes millions or billions of copies of DNA for analysis from a tiny sample.

After a microbe enters a person

2 Later, person

gives cheek swab sample to lab* * Timing depends on how fast specific virus spreads in body

1 Virus enters

person’s body and immediately invades cells, makes copies of its DNA or RNA

subjects sample to PCR that is set up to amplify a known piece of the virus’ genetic material

no evidence of virus’ genetic material, result is negative

A second negative result is regarded as a definitive test

In everyday life, a person sheds small bits of DNA This evidence may yield usable DNA: • Skin or mouth lining cells left on cigarette butt

Preparing PCR sample

Test vial

• Follicle at base of a hair NIST

Source: US Centers for Disease Control and Prevention; US Federal Bureau of Investigation; London School of Hygiene & Tropical Medicine; TNS Photos Graphic: Helen Lee McComas, Tribune News Service

WWW.THEICECOMMUNITY.COM

If PCR produces

One negative result does not rule out infection totally; test may be run again or another part of sample used

If suspect left behind some DNA

• Trace of dried blood, even if old and degraded

the sought-for genetic material, result is positive; indicates person is infected

SCIENCE MATTERS

VIRUS CELL

3 Lab

If PCR produces

‘Primer’ tells test what to look for PCR simply amplifies DNA or RNA in sample A “primer,” or short piece of DNA, is used to tell the test what to amplify To test for viral infection, a section of that virus’ DNA is used as a primer In a criminal investigation, a primer is chosen for comparison to large forensic DNA databases – or to DNA of a single suspect

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INDEX

ADVERTISER INDEX AHRA p. 14 Injector Support and Service p. 4, IBC

Association of Medical Service Providers (AMSP) p. 54

Ampronix, Inc. p. 2

Richardson Electronics Healthcare p. 41

KEI Medical Imaging p. 35 Sodexo CTM p. 27

MedWrench p. 5 Technical Prospects p. 23

ULTRASOUND QA & TRAINING PHANTOMS

Carolina Medical Parts p. 15 www.carolinamedicalparts.com

DIAGNOSTIC IMAGING & SURGICAL SOLUTIONS

Multi Diagnostic Imaging Solutions Back Cover

ACCURATE• DURABLE• RELIABLE • Multipurpose •Small parts • Doppler flow •ABUS

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• Endoscopic •Contrast detail •Custom design •Training

TriImaging Solutions p. 9

ATS LABORATORIES A CIRS COMPANY

900 Asbury Ave• Norfolk, VA 23513 www.atslaboratories-phantoms.com • Email: admin@cirsinc.com Phone: (800) 617-1177 ISO 13485:2016

ATS/CRIS p. 49

MW Imaging Corp. p. 3

W7 Global LLC p. 15 Diagnostic Solutions p. 47

PM Imaging Management p. 49

Webinar Wednesday p. 34 Entech p. 35

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Preferred Diagnostic Equipment Service Inc. p. 55

ADVANCING THE IMAGING PROFESSIONAL

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