Instant diagnosis: The new ‘Prime Directive’ for the EDExpanded MRI safety requirements Zetta...

Dr. Mark Britnell: Denmark isn’t the only system U.S. could learn from p. 80

In this issueExclusive Q&As with:• Jason Cleckler, CEO of

Delta County Memorial Hospital p. 30• Donald McCormack, CEO of

Southwest Medical Resources p. 54

Industry sector reports:• ICU

Redesigning the department in the era of better outcomes and lower costs p. 40

• Mobile Medical The past, present and future of mobile imaging p. 44

Instant diagnosis: The new‘Prime Directive’for the EDp. 36

Your Industry Source for Health Care and Equipment CoverageDecember 2015

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• Annual physicist equipment surveys of advanced imaging equipment

• New shielding design requirements

• New ALARA review requirements

• New medical physicist qualification requirements

And there are many more...

• Expanded MRI safety requirements

HealthCareBusiness news I december 2015 3

CONTENTSDecember 2015

Visit DOTmed.com/news for breaking news daily, to comment on stories in this issue, to participate in surveys and more.

40

44

36

INDUSTRY SECTOR REPORTS

36EDThe use of CT in the emergency department has more than tripled

40ICURedesigning the department in the era of better outcomes and lower costs

44Mobile MedicalThe past, present and future of mobile imaging

FEATURES

52Transport LogisticsWhen do OEMs use special logistics and rigging companies, and when should you?

56Renting a Crane10 tips on making light work of heavy lifting

58Rural Health/Urban HealthWill the Save Rural Hospitals Act save rural hospitals?

62CharityBoston Marathon Jimmy Fund Walk reaches out to New England and beyond

64Year in ReviewLooking back at the best of 2015

THIS MONTH’S EXCLUSIVE Q&As

30Jason Cleckler, CEO of Delta County Memorial Hospital

54Donald McCormack, CEO of Southwest Medical Resources

Are YOU ready?As the leading accreditation services provider in the U.S., WEST PHYSICS knows these requirements in depth.

Not only will our team perform the required physics testing for your organization; our compliance experts will show you how to meet ALL of the new standards in the simplest & most cost-effective way.

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2015 Joint Commission Changes Are Here

3 0 3 3 9S u i t e 2 5 0 A t l a n t a , G A3 8 2 5 P a c e s W a l k S E

AlbuquerqueOrlando Kansas City Austin RochesterSeattleAtlanta Los Angeles Chicago Philadelphia Boston San Francisco

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8 6 6 • 2 7 5 • W E S T ( 9 3 7 8 )i n f o @ w e s t p h y s i c s . c o m

Just SOME of the new requirements are:

• Dose incident tracking & analysis

• Annual physicist equipment surveys of advanced imaging equipment

• New shielding design requirements

• New ALARA review requirements

• New medical physicist qualification requirements

And there are many more...

• Expanded MRI safety requirements

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Lauren Dubinsky

Chris BowenMark BritnellLisa ChamoffAine CrytsThomas DworetzkyJohn W. MitchellLee NelsonJill RathbunChristoph SitzerBipin Thomas

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David Blumenthal212-742-1200 Ext. [email protected]

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COLUMNS

6 Letter from the Editor

7 Top Online Stories

8 Letter from the Online Editor

8 DOTmed Online News

27 Upcoming Events

28 Hospital Spotlight Delta County Memorial Hospital

31 Cost Containment Corner

32 IT Matters Software-powered medical devices play an increasingly

central role in patient care

34 New Products Showcase

39 View from the Hill CMS issues final rules updating payment policies,

payment rates and quality provisions

43 Diagnostic Directions The Internet of Medical Things is transforming

personalized care delivery

75 This Month in Medical History The first successful kidney transplant

80 The Future of Health Care Denmark’s isn’t the only system U.S. health care could learn from

30

28

54

HealthCareBusiness news I december 2015 www.dotmed.com6

Turning the page…As 2015 comes to a close and everyone is looking forward to a better and brighter 2016 (fingers crossed), we’re going to dust off the old crystal ball and see what might be the major factors driving the health care space next year.

The biggest thing, of course, will be the ongoing digitization of health care. And not

just from an EHR, EMS, PACS, RIS perspective, but at every level. More and more medical devices will be able to talk to each other, and to the providers, making the continuum between diagnosis and treatment smoother, more efficient and effective. Personal medicine, personal monitoring, wearable medical devices and a new crop of ingestible devices that will let doctors track their patients in real time, will certainly be big in 2016. People will have more information to act and more control over their total health program as consumer technology keeps finding new ways to evolve into the next must-have health care app. Big data and cloud computing will also be dominant themes in the coming year, and cyber security issues will no doubt be a hot topic, below the radar and right on the radar. And, as they say, in 2016 it won’t be “if” there will be a major data hacking event, but when and where it will occur, how many people will be compromised, and what the ramifications will be.

Then there’s the continuing debate over the pros and cons of the Affordable Care Act (aka ObamaCare). It generated an exceptional

amount of smoke, but very little light in 2015. One camp of stake-holders is predicting quite sizable premium rate hikes, with many suggesting anywhere from 6% to 16%, depending on the state or region. Also expect to see some painful increase in deductibles. And as I write this, one of the headlines coming out of the health care industry was that mighty UnitedHealth was contemplating pulling out of the program in 2017. So there will be plenty of scrutiny of the ACA in 2016, and with what may be the wildest and woolliest presidential campaign ever, the ACA is one political football that’s going to be bouncing all over the place.

Dose reduction will, we confidently predict, continue to dominate diagnostic imaging discussions at radiology departments from coast to coast — particularly as the first XR-29 reimbursement cuts are slated to take effect in 2016. And with the inevitable implementation of more robust ERH systems and IT integration programs, the goal of documenting an individual’s lifetime exposures to X-ray will acceler-ate, with a particular focus on pediatric patients.

So those are most of the major trends to keep an eye on, and of course there will be some surprises along the way that will grab the headlines as well. And we’ll be commenting on them in the New Year as well — have a happy!

Robert GarmentExecutive [email protected]

Abass Alavi, MD, professor of radiology and director of research education in the Perelman School of Medicine at the University of Pennsylvania School of Medicine

Leonard Arzt, executive director, National Association for Proton Therapy

Norman E. Bolus, MSPH, MPH, CNMT, editor-in-chief, JNMT, director, assistant professor Nuclear Medicine Technology Program Clinical & Diagnostic Sciences Department, UAB School of Health Profession

Michael Friebe, PhD an affiliate professor at the Technical University Munich in Germany

Heidi Horn, vice president of SSM Health Care’s Clinical Engineering Service (CES) department

Jason Launders, medical physicist, ECRI Institute

Jill Rathbun, president, Galileo Consulting Group Inc.

Barbara G. Rebold, RN, MS, CPHQ director, Operations, ECRI Institute PSO

Katie Regan, clinical publishing manager, MD Buyline

Bipin Thomas, chairman, ICURO

Wayne Webster, principal, Proactics Consulting

Sharon A. VanWicklin, MSN, RN, CNOR/CRNFA, CPSN, PLNC, perioperative nursing specialist, Association of periOperative Registered Nurses (AORN)

Marty Zimmerman, president and chief executive officer of LFC Capital, Inc.

editorial advisory board

Letter from the Editor


Top online stories(October 16 - November 15)• UK researchers use PET technology to

cut radiation dose by 30 percent dotmed.com/news/27799

• Does screening mammo improve outcomes for breast cancer? dotmed.com/news/27638

• Using MR guided focused ultrasound to treat essential tremors dotmed.com/news/27667

• Deerfield Imaging (“IMRIS”) gets FDA nod for SYMBIS Surgical System dotmed.com/news/27763

M St. Mary’s Janesville Hospital to build $10 million radiation therapy facility dotmed.com/news/27565

• Proton therapy minus the gantry: P-Cure at ASTRO dotmed.com/news/27564

• Dramatic cuts to CMS radiation therapy reimbursement thwarted dotmed.com/news/27802

• Three studies presented at ASTRO to further define benefits of proton therapy dotmed.com/news/27530

M Gamma Medica and Marshfield Clinic partner for mobile MBI dotmed.com/news/27673

• New research underway after British woman found able to smell Parkinson’s dotmed.com/news/27598

• New wearable sensor patch accurately measures blood flow in real time dotmed.com/news/27721

• Cleveland Clinic and Candescent Health partner to transform radiology care dotmed.com/news/27635

• New database links patient Facebook posts to medical records for health insight dotmed.com/news/27757

• GE and SHINE produce pharmaceutical-grade Tc-99m dotmed.com/news/27816

• Walgreens chooses Epic as EHR provider dotmed.com/news/27800

Dr. Mark Britnell: Denmark isn’t the only system U.S. could learn from p. 80

In this issueExclusive Q&As with:• Jason Cleckler, CEO of

Delta County Memorial Hospital p. 30• Donald McCormack, CEO of

Southwest Medical Resources p. 54

Industry sector reports:• ED

The use of CT in the emergency department has more than tripled p. 36

• ICURedesigning the department in the era of better outcomes and lower costs p. 40

• Mobile MedicalThe past, present and future of mobile imaging p. 44

Instant diagnosis: The new“Prime Directive”for the EDp. 36

Your Industry Source for Health Care and Equipment CoverageDecember 2015

Subscribe to our Magazine and weekly Online News digest now.

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International institutions agree on standard for using MR to diagnose prostate cancer Posted online October 2, 2015 by Lauren Dubinsky

A new standard for evaluating MR im-ages to diagnose prostate cancer has been agreed upon by international radiological institutions and is now published in the journal European Urol-ogy. The new procedure reduces the over-diagnosis of insignificant cancers by up to 89 percent and assists in the diagnosis of up to 13 percent more life-threatening tumors than current procedures.

Ultrasound-guided transrectal biopsy is the current standard for prostate cancer diagnosis but it involves taking 10 to 12 prostate samples with an ultrasound-guided needle. The samples are then evaluated to determine if the patient has cancer and in many cases, the patients have non-cancer-ous swelling of the prostate or cancers that will most likely not cause harm.

Over the past few years, an imaging technique called multiparametric prostate magnetic resonance imaging (mpMRI) has gained interest for prostate cancer diagno-sis. Many studies have proven that mpMRI improves the detection of most of the harm-ful tumors so that fewer patients have to undergo a biopsy.

In addition to good quality images, good guidelines are also needed to iden-tify prostate cancer. In December 2014, draft global guidelines were released by the American College of Radiology (ACR), AdMeTech Foundation and the European Society of Urogenital Radiology based on a five-year project.

An early version of the Prostate Imag-ing and Reporting and Data System (PI-RADS) has been found to improve the

diagnosis of intermediate- to high-grade cancers. The new PI-RADS version 2 stan-dardizes mpMRI and simplifies the way the scans are acquired, interpreted and reported.

“Early results have shown that mpMRI is an enormous help in detecting signifi-cant cancers,” Jelle Barentsz, professor at Radboud University Medical Centre in the Netherlands, said in a statement. “But to allow more widespread use, standardization of image acquisition and interpretation is needed. The new PI-RADS protocols have the potential to bring real benefits to many patients, throughout the world.”

Going forward, mpMRI will be brought into the mainstream, which will involve ex-tensive training and education programs.Share this story: dotmed.com/news/27315

Have you ever used the Internet Ar-chive’s Wayback Machine? It’s a free tool that allows you to see Web sites as they ex-isted years ago. As a kind of Internet history museum, it provides some vaguely nostalgia-inducing insight into a simpler time when all Web sites kind of resembled Craigslist.

You can even look up DOTmed.com in the Wayback Machine and see what kind of layouts we were using back when George W. Bush was in office. Not surprisingly, our site has come leaps and bounds visually speaking — but there’s a more subtle and very recent change that would surely go unnoticed in a cursory glimpse through the archives.

The content on DOTmed HealthCare Business News online has nev-er been better. We are providing more thorough coverage on the most important breaking news of the moment than ever before, and we’re doing it with a growing network of reporters and industry analysts.

Our site traffic has increased by just about 50 percent compared to this time one year ago, so I know that many of you have already

taken notice. For those of you who haven’t, this is your written in-vitation.

And while I’m at it, there’s a new update to our site that would be noticeable in the Wayback Machine: we’ve rolled out a new tab on the navigation bar called “News By Topic” so, for the first time, you can see all the HCB News articles that matter to you, and none of ones that don’t.

If you’re interested specifically in news relating to MR business and research, you can have it all laid out on one page. The same goes for CT, ultrasound, proton therapy, health IT, radiation therapy and radiography.

We’re pretty excited about the modern layout and user interface on our Web site, but we’re even more proud of our substance. Come check us out, and let me know what you think.

Gus Iversen Online Editor [email protected] Twitter: @dotmedcom

Letter from the Online Editor

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Siemens Healthcare selects David Pacitti as new head of North America businessPosted online October 1, 2015 by Gus Iversen

In a statement from Siemens Healthcare, the company has just named a new leader for its North American business.After the announcement earlier this month that Greg Sorenson would be stepping down as CEO, it has now been revealed that David Pacitti, an industry professional with a background in sales and marketing, will be stepping in to fill his shoes.

According to the statement, Pacitti will be responsible for lead-ing the marketing, sales, service, and support functions for Siemens Healthcare in the U.S. with additional oversight of Canada, across the entire Healthcare portfolio including medical imaging, labora-tory diagnostics, therapy solutions, and services. He will be based at the U.S. headquarters in Malvern, Pennsylvania.

Pacitti comes to Siemens Healthcare from Abbott Vascular where he served as senior VP of U.S. commercial, sales, marketing and operations from 2013-2015. In this position, and as a member of the senior executive staff, he ran Abbott Vascular’s business in North America. Before that, Pacitti was VP of Abbott’s Commer-cial Operations from 2009-2013. He joined Abbott Vascular after spending 14 years at Guidant Corporation.Share this story: dotmed.com/news/27302

Focused ultrasound used to treat depression for first timePosted online October 8, 2015 by Aine Cryts

The world’s first treatment of a patient with severe depres-sion using focused ultrasound has been performed in Korea, according to the Focused Ultrasound Foundation. Dr. Rees Cosgrove, head of epilepsy and functional neurosurgery at Brigham and Women’s Hospital in Boston, told HCB News the patient was treated on Sept.19.

The beauty of using focused ultrasound to treat patients with severe depression is you don’t need to do an invasive surgery, said Cosgrove, who has been performing surgery on patients with psy-chiatric illness since the early 1990s.

Described by the Focused Ultrasound Foundation as a potentially powerful non-invasive approach for treating patients with depression that’s resistant to medical treatment, focused ultrasound is a non-radiation treatment that eliminates the risks of open neurosurgery.

The patient in Korea is part of a 10-patient clinical trial to deter-mine the feasibility and safety of MR-guided focused ultrasound to destroy a small amount of tissue deep within the brain called the anterior limb of the internal capsule. This study is led by Dr. Jin Wood Chang, a neurosurgeon at Yonsei University College of Medicine in Seoul, South Korea.Share this story: dotmed.com/news/27392

More than 200 lawmakers urge Congress to rethink proposed cuts to radiation therapyPosted online October 1, 2015 by Lauren Dubinsky

More than 200 bipartisan members of Congress wrote letters to CMS asking that the agency rethink the proposed cuts to radiation therapy reimburse-ment in the 2016 Physician Fee Schedule (PFS) Proposed Rule.

There were three letters signed by 40 U.S. Senators and 188 members of the U.S. House of Representatives.

Almost 65 percent of all cancer patients are treated with radiation therapy and al-most 40 percent of all radiation therapy is conducted in freestanding, community-based facilities, according to the Radiation Therapy Alliance (RTA). In its 2016 PFS Pro-posed Rule, CMS proposed reducing Medi-care payments to freestanding radiation therapy centers by six percent next year.

If the proposed rules are finalized, pay-ments for a course of prostate and breast cancer treatment will be cut by 25 percent and 19 percent, respectively. Physicians, soci-eties and patient advocate groups have been vocal about the effect that the cuts will have on access to care.

“By cutting payments to cancer care pro-viders, the government is putting at risk an important safety net for millions of Ameri-cans in need of radiation therapy — and, in turn, jeopardizing the health and well being of our nation’s most vulnerable patients,” Dr. Christopher M. Rose, chief technology of-ficer of Vantage Oncology, wrote in a recent article published in The Hill.

He went on to explain that the proposed rule will mean that freestanding centers will

now be paid at 80 percent of overall hospi-tal rates. “This is indefensible, even though the direct costs for the services, the quality of care, and the outcomes of the care are identical,” he wrote.

The cuts will be even more devastat-ing for the African-American community since there is a disproportionate number of prostate and breast cancers among that population. Thirty members of the Con-gressional Black Caucus wrote a letter that explained that African American men have a 2.4 times higher death rate for prostate cancer than white men, and African-Amer-ican women also have higher death rates for breast cancer.Share this story: dotmed.com/news/27300


Roberts Proton Therapy Center trials further define benefits of proton therapyPosted online October 20, 2015 by Gus Iversen

Clinical trials undertaken at the Roberts Proton Therapy Center at Penn Medi-cine are shedding new light on the value of proton therapy over conven-tional radiation for treatment of vari-ous cancers. Dr. James Metz, chair of the department of radiation oncology, pointed out that the facility’s contribu-

tions to defining the value of proton therapy are no coincidence.

“These studies are prime examples of that mission, providing the field with more data to help establish the effectiveness and clinical benefits of proton therapy in more cancers,” he continued.Share this story: dotmed.com/news/27530

Texas MakerHealth Space will facilitate the creation of care solutions by nursesPosted online October 2, 2015 by Thomas Dworetzky

Nurses, those too-often unheralded medi-cal device innovators, finally have a place to give their creativity free range. The Mak-erHealth Space, a joint effort of The MakerNurse project and The University of Texas Medical Branch at Galveston, Texas, has now opened its doors.

MakerNurse co-creators Jose Gomez-Mar-quez and Anna Young debuted their project at the New York Maker Faire last year.

The Texas facility is the first “makerspace” in the country for health care workers. One of the early users of the MakerHealth Space in the John Sealy Hospital described his experience in a You-Tube video made available by UTMB Galveston.

The makerspace has all the bits and pieces nurses have used for years, plus some state-of-the-art gadgetry, to create solutions to care dilemmas — adhesives and fasteners, such as Velcro and zip ties; textiles and electronics, in-cluding sensors and microcontrollers; and a range of tools, from pliers and sewing needles to 3-D printers and laser cutters.

The space has different workstations, each geared to different challenges, like fluid control or assistive technology.

A “selfie station” in the makerspace isn’t about ego. It lets creators of solutions docu-ment what they came up with so the tech-niques, technologies and knowledge can be documented, shared and used by others.

“The MakerHealth space at UTMB will help bring nurse-making to the forefront of health care innovation,” said David Marshall, Chief Nursing and Patient Care Services Officer at the UTMB Health System. “We know nurses have break-through ideas for improving health care. Providing them with the space, tools and materials to create these solutions, rather than outsourcing them to engineers and designers, just makes sense.”

All medical staff and health profession stu-dents will be able to use the space to devise ingenious solutions to practical care problems.Share this story: dotmed.com/news/27306

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Konica Minolta acquires ViztekPosted online October 1, 2015 by Lauren Dubinsky

Konica Minolta announced that it has completed the acqui-sition of digital software and hardware imaging solutions company, Viztek. Through the acquisition, Konica Minolta hopes to help its customers meet the demands of Meaningful Use in the new value-based payment model.

Primary imaging makes up 70 percent of all images acquired. The move toward value-based care is creating a need for primary imaging solutions that provide more economic value, clinical con-fidence and ease of use.

Viztek recently announced its new Exa platform for PACS, RIS and EHR systems that allows for access to images and information in any location. In 2015, the company experienced record sales for digital radiography and has since made advancements in wireless technology with dose-efficient software for pediatrics.

As part of the agreement, Viztek’s partner company, 20/20 Imag-ing LLC, will become Konica Minolta’s autonomous subsidiary. 20/20 Imaging is a provider of digital imaging, PACS and EHR solutions.

“Working together, our expanded portfolio and the track record of Viztek software innovation will enable us to successfully deliver comprehensive end-to-end solutions for all imaging needs,” David Widmann, president and CEO, Konica Minolta Medical Imaging, the Americas, told HCB News.Share this story: dotmed.com/news/27303

Dr. Jan Kimpen appointed CMO of Royal PhilipsPosted online October 5, 2015 by Lauren Dubinsky

Royal Philips announced that Dr. Jan Kimpen will become chief medical officer of the company on Jan 1. Kimpen was previously the chairman of the executive board at the Uni-versity Medical Center Utrecht (UMC Utrecht) in the Neth-erlands.

Philips believes that Kimpen will help the company grow in the health tech market. He will work with Philips’ global network of medical thought leaders to make sure that the company’s proposi-tions revolve around patient-centered care and clinical insight.

Kimpen joined UMC Utrecht in 1997 and later became the pres-ident of the board in 2009. In his role, he strengthened connections with the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital and the Netherlands Pediatric Oncology Center, and was behind the partnerships with Philips and Eidenhoven University of Technology.

Kimpen believes that collaboration is crucial to fostering innova-tion in health care. With his experiences in fostering partnerships in the public health care sector, he is confident that he can provide a strong foundation to broaden Philips’ cooperation agreements with a variety of public and private stakeholders in the industry.Share this story: dotmed.com/news/27333

UCLA not responsible for patient record release; attorney says case could set legal precedent Posted online October 2, 2015 by Lisa Chamoff

A California jury recently decided that the University of California, Los Angeles (UCLA) Health System was not responsible for the unauthorized release of a patient’s medical records, which an attorney says sets some precedent for similar cases.

The patient, Norma Lozano, had sued UCLA for $1.25 million after an assistant in the office of a UCLA-affiliated physician used the doctor’s access code and password to view Lozano’s medical records. The as-sistant, Alexis Price, allegedly took photos of the records and texted them to Lozano’s ex-boyfriend. Lozano later learned that the physician, Dr. John D. Edwards, had shared the login credentials with his office staff.

After reaching the verdict, a juror told

legal news Web site Law 360 that they couldn’t find UCLA responsible, and that its privacy protections are similar to those at other facilities.

Andrew Gantt, a partner in the business department of law firm Cooley LLP and a member of its Life Sciences Practice Group, said in a news release that the jury’s deci-sion “sets at least some precedent for limits on a plaintiff’s ability to recover in situations where an employee has authorized access to information but exceeds that authorized access to engage in activities that could be privacy or security violations.”

It came up in the trial that, usually in the case of celebrities, UCLA employs a second-ary layer of security that requires entering

a password a second time and specifying a reason for viewing the records. Gantt said this extra layer, called “break the glass,” might not have deterred Price from access-ing the records. Other security measures, such as a biometric authentication factor, may have prevented the breach in this case, but Gantt said such a system isn’t considered the industry standard.

Gantt said the U.S. Department of Health and Human Services’ Office for Civil Rights could find UCLA responsible in investigat-ing the case as a HIPAA violation. He urged facilities to train staff in HIPAA compliance, monitor access to patient data and address possible weaknesses.Share this story: dotmed.com/news/27304


University of Minnesota using 7T MR to bring the brain’s visual cortex into unprecedented focus Posted online October 5, 2015 by Gus Iversen

Using 7 Tesla MR techniques pioneered at the University of Minnesota’s Cen-ter for Magnetic Resonance Research, new insights are being gleaned at sub-millimeter spacial resolutions regarding the actual activities of the human brain.

Researchers from the University of Glasgow have taken those techniques and applied them to the complex interaction between what our eyes see — and how the brain perceives it and how the process that takes place in the visual cortex actu-ally occurs.

Previous research into the nature of this interaction has been limited by an inability to observe the contextual feedback of the vi-

sual cortex in an isolated layer of the system (versus all six cortical layers at once). The researchers from Glasgow said their break-through hinges on the fact that input from the retina is mapped out in the visual cortex.

The location from which light hits the eye has a corresponding region in the visual cor-tex where it is represented, a phenomenon the researchers liken to when light hits a specific portion of a camera’s sensor to form a pixel.

In their study, the researchers showed subjects images, such as that of an automo-bile, but blocked out a portion of the image with a white square. In the high-definition high-resolution MR image, the absent part of

the car was represented in a quieted-down region of voxels in the MR representation.

In this fashion the researchers monitored and mapped out “feedback” and “feed-forward” communications between the six layers of the visual cortex, as the brain tried to infer what should have been in the place of the white square.

The researchers hope that by using MR to get a better understanding of how the visual cortex designs predictive models, they can shed new light on the feeling of unfamil-iarity that is typical for many mental health patients. Their research has been published in the journal Current Biology.Share this story: dotmed.com/news/27332



Siemens Biograph Horizon is smallest PET/CT yetPosted online October 13, 2015 by Gus Iversen

The 28th annual congress of the European Association of Nuclear Medicine (EANM) set the stage in Hamburg, Ger-many, for Siemens Healthcare to introduce a number of in-novations to their line of nuclear medicine products.

The Biograph RT Pro Edition, a new treatment planning PET/CT solution for radiation therapy, as well as a new version of the Bio-graph mMR software that reduces examination times and gener-ates better images in MR/PET, were among the products on display.

But the main draw from Siemens was an attractively priced premium PET/CT scanner, Biograph Horizon. The company stated the system will enable clinicians to serve a broader mix of patients and expand into new service lines without compromising on quality due to budget constraints.

It achieves that in part by being compliant with every commercially available PET tracer in oncology, neurology and cardiology. In addition, in order to visualize smaller lesions, the system’s 4 mm LSO crystals scintillate faster and have a higher light output, which allows for superior image quality and an optional Time-of-Flight functionality.

The Biograph Horizon is still pending FDA 510(k) clearance.Share this story: dotmed.com/news/27439

Increased CT usage in the ED is improving diagnosesPosted online October 14, 2015 by John W. Mitchell

A team of researchers at the Massachusetts General Hospital Institute for Technology Assessment have determined that a CT scan in the ED is, indeed, providing vital diagnostic in-formation to help doctors make the right decision about a patient’s condition.

The study, published online in the journal Radiology, was conducted at four academic medical centers and involved nearly 1,300 patients. Nearly 250 ED physicians participated in pre- and post-CT surveys.

The research team discovered that after CT, physicians frequently changed their diagnosis. This included changes of patient diagnosis in 51 percent of cases involving abdominal pain; 42 percent in cases involving chest pain/shortness of breath; and 24 percent in cases involving headache.

While the study did not factor in risks from radiation exposure or the cost of a CT scan, the findings offer important guidance for physicians.

According to the study, the use of CT in the ED has tripled in the past 20 years. The study was designed to provide a broad look at CT use in the ED across multiple diagnoses.Share this story: dotmed.com/news/27457

Study: half of all late-stage lung cancer patients are over-treated with radiation by oncologistsPosted online October 6, 2015 by John W. Mitchell

Radiation oncologists are over-treating nearly half of all Stage 4 lung cancer pa-tients, according to a study published in the Journal of the National Cancer Institute.The study also found that up to one-third of patients are receiving more than 25 radiation treatments, well beyond the established protocol of 15 treatments or less.

“The results were surprising,” Dr. Mat-thew Koshy, lead author and a radiation on-cologist at the University of Illinois Hospitals & Health Sciences System, told HCB News. “Less than 15 treatments is the protocol that has been validated in 14 randomized clinical trials.”

Such treatments, which reduce pain and improve quality of life, are considered palliative for terminal patients. Additional

treatments beyond the established protocol add costs, mean needless trips to treatment centers and can cause radiation toxicity and difficulty swallowing.

“The study showed that privately insured patients were 40 percent more likely than other patients to receive more than the rec-ommended 15 radiation treatments,” Koshy said. The study also revealed that patients treated in community cancer centers with-out ties to academic hospitals were more likely to be over-treated.

“Physicians might tend to over-treat pri-vately insured patients because services are billed and reimbursed per-fraction, creat-ing a financial incentive to overt-reat,” said Koshy. He added that it is possible these pa-tients may also be over-treated because they

are considered better candidates for a more positive outcome.

The study included a review of 47,000 pa-tients who received palliative care from 2004 to 2012. Other members of the research team included physician experts from: the University of Chicago; the University of Texas MD Anderson Cancer Center; Yale Univer-sity; and Rush University Medical Center.

Koshy said that patients almost always rely on the recommendations of the attend-ing oncology team in receiving treatment.

“The best way to eliminate this [problem]would be continued education of radiation oncologists, highlighting the importance of shorter fractionation schedules for palliative thoracic radiation therapy,” Koshy concluded.Share this story: dotmed.com/news/27336


Kentucky Trailer rolls on with acquisition of Smit Mobile Equipment in an ‘exact match’Posted online October 6, 2015 by Gus Iversen

Kentucky Trailer announced the acqui-sition of Smit Mobile Equipment Com-pany, a leading European provider of advanced mobile medical trailers and relocatable solutions.

Smit comprises two separate business units: Smit Mobile Medical B.V. in the Neth-erlands, and Smit Mobile Equipment (UK) Ltd., based in the United Kingdom. By bring-ing both units (as “Smit”) under the umbrel-la of Kentucky Trailer, the company hopes to expand its mobile medical footprint with an eye on international markets.

For Charles Ducas, senior vice president of sales and marketing and GM of specialty vehicles for Kentucky Trailer, the two com-panies were an “exact match” involving business partnerships going back over two

decades (namely, between Smit and Bob Bachman, president of Advanced Mobility by Kentucky Trailer).

“We’re investing to build a platform and business model that’s going to provide glob-al solutions to both our OEM and our shared medical service providers,” Ducas told HCB News, referring to the company’s primary customer base.

“As a company that traces its roots back to 1750, it is very exciting for Smit to become part of a company that has its own long and accomplished history, that shares our dedication to excellence in all aspects of product design, manufacturing and customer service. We are excited to combine the strengths of our businesses and capitalize on the significant opportu-

nities resulting from this transaction,” said Gerben Smit, president and CEO of Smit, in a statement.

For Kentucky Trailer, this acquisition fits in with a 10-year plan of balancing organic growth with new acquisitions, according to Ducas. The merging with Smit also provides the company with what he called, “a very effective base to service Europe and other parts of the world.”

Last year, Kentucky Trailer completed the acquisition of Advanced Mobility & Shelter Technologies LLC, which could be seen as a first step toward this current announcement.

The company is currently undergoing expansion into a new 75,000-square-foot facility to triple its manufacturing space.Share this story: dotmed.com/news/27359



Total-body PET scanner being developed with $15.5 million from NIHPosted online October 1, 2015 by Aine Cryts

For the first time, we’ll be able to use a total-body PET scan-ner to image the entire body at once, Dr. Simon Cherry, pro-fessor of biomedical engineering at the University of Califor-nia (UC) Davis, told HCB News.

Cherry is leading a National Institutes of Health (NIH)-funded initiative to build the world’s first total-body PET scanner.

The scanner has the ability to image the body more quickly and to subject patients to less radiation while they’re being scanned, said Cherry. The new technology will impact pharmaceuticals re-search and the treatment of chronic diseases such as diabetes, in particular.

Cherry’s research team at UC Davis has been awarded a $15.5 million grant by the NIH High-Risk, High Reward Program. Ac-cording to the university, this is one of eight given in the NIH’s transformative research category in 2015. The five-year grant is administered by the National Cancer Institute.

With a total-body PET scanner, Cherry said patients can be im-aged within 15 to 30 seconds — as opposed to the 10 to 20 min-utes required today, when PET scanners can only image parts of the body at a time.Share this story: dotmed.com/news/27455

Minority women more likely to have aggressive breast cancer, inferior carePosted online October 16, 2015 by Lee Nelson

“The findings weren’t surprising,” Lu Chen, the author of the study, told HCB News. She is a researcher in the Public Health Sciences Division at Fred Hutchinson Cancer Research Center in Seattle.

“But our study was to see how these disparities vary from cancer subtypes.”

Many studies in the past have illustrated that African-American, Hispanic white and American Indian women had a higher prob-ability of being diagnosed at advanced stages of breast cancer than other women. They are also less likely to obtain the recommended treatments and more likely to die from the disease.

Chen’s study found that non-Hispanic white women were more likely to have smaller tumors and more likely to have the less ag-gressive subtypes of breast cancer compared with African-American women. African-American women were more likely to have large tumors and to have the more aggressive breast cancer. Plus, 40 to 70 percent were more likely to be diagnosed at stage 4 of all sub-types of breast cancer.

Hispanic white women were 30 to 40 percent more likely to be diagnosed at stage 2 and/or stage 3 across all breast cancer subtypes.Share this story: dotmed.com/news/27478

Colorectal cancer screening too aggressive for certain people despite family history: researchersPosted online October 7, 2015 by Lauren Dubinsky

It can be very frightening to lose a rela-tive to colorectal cancer. There is always that fear that you will get it, too. But does that mean that you need to have aggressive screening for the disease the rest of your life even when you are older?

Some researchers are saying “no,” de-spite guidelines to the contrary.

“When you get to be 65 years old, you don’t need to undergo a colonoscopy every five years if you only have history with one family member,” Dr. Chyke Doubeni told HCB News. He is chair of the department of Family Medicine and Community Health at the Perlman School of Medicine at the Uni-versity of Pennsylvania, Philadelphia.

“If you have had a colonoscopy every five or 10 years, and had several of them in a row that have all been negative, you can take a break for a while. And most likely it doesn’t matter what your family history is once you get older,” he adds.

In an editorial published in the journal Gastroenterology, Doubeni, along with Rob-ert Fletcher of the Department of Population Medicine at Harvard Medical School, wrote their thoughts and suggestions in the context of a new study published in that issue. The research followed 144,768 men and women aged 55 to 74 for 13 years to figure out each of their risks of the disease in light of their history of colorectal cancer in a first-degree relative.

“The accumulated evidence shows that the risk of colorectal cancer diagnosis in pa-tients associated with having a family his-tory of the condition becomes progressively smaller with increasing age, as does the as-sociation between family history and death from colorectal cancer,” Doubeni wrote in the editorial.

Doubeni still agrees wholeheartedly that screening is the most effective way to reduce your risk of dying from the disease.

“Screening has prevented 500,000 deaths from the 1980s to 2010. It’s really effective — and the technology has gotten better with more tests available,” he says.Share this story: dotmed.com/news/27361


Could this super tiny linac revolutionize radiation therapy in dealing with brain tumors?Posted online October 7, 2015 by Lisa Chamoff

A team of scientists has built a proto-type for a miniature particle accelerator with a single module that is 1.5 centime-ters long and 1 millimeter thick, which could enable new diagnostic imaging and radiation therapy techniques.

The researchers, part of the Hamburg-based Center for Free-Electron Laser Science — a joint enterprise of DESY, the Max Planck Society and the University of Hamburg — presented the prototype in the journal Na-ture Communications.

The prototype, which was set up in DESY scientist Franz Kärtner’s lab at the Massachu-setts Institute of Technology (MIT), uses tera-hertz radiation instead of radio frequency structures, which the scientists say has the potential to miniaturize the entire accelera-

tor by at least a factor of 100.“The compact accelerator we are build-

ing enables the construction of very bright and potentially fully coherent X-ray sources, which also enable new medical diagnostic imaging techniques, like phase contrast im-aging; and also, potentially, new radiation therapy techniques like image-guided small tumor radiation therapy and micro-beam ra-diation therapy for brain tumors,” Kärtner, a professor at the University of Hamburg and at MIT, as well as a member of the Hamburg Centre for Ultrafast Imaging, told HCB News.

For the prototype, the physicists used a type of electron gun to fire fast electrons into an ac-celerator module that was tailored to be used with terahertz radiation, which was fed into the module, further accelerating the electrons.

The prototype was able to increase the energy of the particles by 7 kiloelectronvolts, accord-ing to the scientists. While not a particularly large acceleration, the experiment demonstrat-ed that the principle works in practice, said co-author Arya Fallahi of CFEL, in a statement.

“The theory indicates that we should be able to achieve an accelerating gradient of up to one gigavolt per meter,” Fallahi said in the release. This is more than 10 times what can be achieved with the top conven-tional accelerator modules currently avail-able, the scientists said. Plasma accelerators could produce higher accelerations, but the scientists said this experimental technology requires much more powerful lasers than the ones needed for terahertz accelerators.Share this story: dotmed.com/news/27370


Ex-dentist no longer smiling as court shuts down his home-use medical laser businessesPosted online October 8, 2015 by Thomas Dworetzky

A South Dakota ex-dentist is no longer smiling over his home-use laser business that sold the devices through private membership associations.

Chief Judge Jeffrey Viken, in the U.S. Dis-trict Court for the District of South Dakota, has now granted the U.S. Food and Drug Ad-ministration a permanent injunction against 2035 Inc. and Robert “Larry” Lytle, doing business as QLasers PMA and 2035 PMA.

Lytle told Black Hills Fox News, “Obviously the impact on me isn’t as important as is the impact that it’s having on those people that have found success with using the laser. Over the 15, 17 years that the laser’s been in pro-duction, we’ve never had one single com-plaint about the laser hurting somebody.”

The former dentist reported that he is thinking of appealing the decision. The or-der also put a $10,000-a-day price tag for any violations of the injunction.

Lytle, as a dentist in Rapid City, South Da-kota, began selling lasers for the purposes of treating “cancer, cardiac arrest, HIV/AIDS, diseases and disorders of the eye and ear, venereal disease, and diabetes,” according to The Rapid City Journal.

The court noted that QLaser’s label claims it can treat “tendonitis, arthritis, burns, and any pain or inflammation... speed bone re-pair... help repair damaged DNA... repolarize damaged cell walls.” It also states that it is a “multiorgan cell-re-energizer... [and is] prov-en effective and beneficial for healing, and

to benefit inflammation or disorders of all internal [organs], and the treatment of any unknown condition,” according to Vice’s Motherboard.

Lytle explained to the Journal in 2014, when the DOJ legal fireworks began, that 2035 PMA and QLasers PMA are both pri-vate membership associations.

The injunction blocks both the manu-facture and distribution of “QLaser devices, which have not received FDA approval,” ac-cording to the Journal.

The FDA had okayed two QLaser devices for providing temporary relief of pain associ-ated with osteoarthritis of the hand, but not any other medical conditions.Share this story: dotmed.com/news/27392


Apple’s ResearchKit enables research studies for autism, epilepsy and melanomaPosted online October 16, 2015 by Lauren Dubinsky

Apple announced that its ResearchKit, which turns the iPhone into a medical research tool, is allowing new research studies to be conducted on autism, epilepsy and melanoma. Since it was launched six months ago, over 50 researchers and more than 100,000 participants have contributed to the open source framework.

After receiving permission from the iPhone users, researchers have access to data from the Health app including weight, blood pressure, glucose levels and other data captured by third-party devices and apps. They also have access to the accelerometer, micro-phone, gyroscope and GPS sensor to gain information on the user’s gait, motor impairment, fitness, speech and memory.

Researchers and developers that use ResearchKit are continually creating new modules, active tasks and custom surveys. The Active Task module allows the researchers to obtain more targeted data with the iPhone’s advanced sensors.

Over the past six months the researchers have developed tasks to study tone audiometry for hearing loss, reaction time through delivery of a known stimulus to a known response, a timed walk test, the speed of information processing and working memory, and a mathematical puzzle used for cognition studies.Share this story: dotmed.com/news/27490


InSightec’s ExAblate can spare uterus during fibroid treatment as FDA grants labeling changePosted online October 9, 2015 by Lauren Dubinsky

InSightec announced that the FDA has approved the relabeling of the ExAblate system to treat women with symptom-atic uterine fibroids who want to spare their uterus and maintain fertility. ExAb-late can now be used for both women who are “family complete” and those who still want to conceive.

ExAblate combines focused ultrasound and MR technology to non-invasively treat uterine fibroids. High intensity focused ul-trasound (HIFU) waves are used to heat and destroy the fibroid, and the MRI is used for treatment planning, real-time thermal moni-toring during treatment and post-procedural assessment.

The relabeling was approved based on a study that involved 118 patients who con-

ceived after ExAblate treatments.“This is a major breakthrough in the

treatment of symptomatic uterine fibroids,” Dr. Haywood Brown, chairman of obstetrics and gynecology at Duke University School of Medicine, said in a statement. “Gynecolo-gists can now offer patients a treatment that is not only noninvasive and uterus sparing, but with the new labeling, this treatment is also an option for women who are not fam-ily complete.”

The FDA also approved the next genera-tion of the ExAblate system. The new ver-sion provides physicians with greater control of and more flexibility in treating uterine fibroids with a clearer 3-D view of the treat-ment as it’s happening.

“The combination of InSightec’s next

generation system and the expansion of our labeling, brings new benefits to treating physicians and women alike, as we can now serve a larger cohort of patients,” Ramya Singh, vice president of Americas at InSight-ec, said in a statement.

Thousands of patients have been treated with ExAblate around the world. More than 70 peer reviewed papers have demonstrated that the procedure is safe and effective in treating uterine fibroids, with up to three-year follow-up, according to InSightec.

ExAblate was first approved by the FDA to treat symptomatic fibroid tissue in 2009 and this has been the second labeling adjust-ment since then.Share this story: dotmed.com/news/27398


Nestle Health Science to create $70 million technology center focusing on nutritional therapy Posted online October 12, 2015 by Thomas Dworetzky

Nestlé Health Science is going to create a $70 million Nestlé Product Technology Center (NPTC) at the New Jersey Center of Excellence in Bridgewater, N.J., dedi-cated to developing innovative nutri-tional solutions.

“This investment reflects our commit-ment to leading the development of inno-vative nutritional therapies that change the course of health for people and patients in the U.S. and globally,” Nestlé Health Science CEO Greg Behar said in a state-ment. “The new facility will house the lat-est technologies and people in the field, uniting our R&D and business teams in a region with strong life-science activity; it will enhance and accelerate the quality and speed to market of Nestlé Health Science’s

innovations that improve nutritional status and health outcomes.”

Nestlé Health Science, established four years ago, focuses on the role of nutrition in health care, so vital in many diseases and health challenges.

The NPTC in Bridgewater will focus on applied research and innovative product de-velopment, sensory perception, engineer-ing, and provide technological know-how in packaging, according to the company.

The new center is scheduled to open in 2016.

The impact on local health care business was stressed by New Jersey Lt. Gov. Kim Guadagno. “In the industry that Nestlé is in, it’s a door opener, quite frankly,” the state’s top official for economic development told

NJ BIZ about the new 180,000-square-foot headquarters and research and develop-ment facility in Bridgewater.

Nestlé Health Sciences has been in the news recently with a number of other deals. In September it entered into a deal for exclu-sive rights to Lipid Therapeutics’ LT-02 com-pound (phosphatidylcholine), a novel barrier function therapy for patients with mild-to-moderate ulcerative colitis (UC).

In addition, The Nestlé Institute of Health Sciences SA signed a research collaboration agreement in September with AC Immune SA to develop a sensitive, minimally invasive Tau diagnostic assay for early Alzheimer’s dis-ease using Nestlé’s proprietary multiplexed ultrasensitive antibody technology platform.Share this story: dotmed.com/news/27414

RadNet acquires Diagnostic Imaging Group LLCPosted online October 16, 2015 by Lauren Dubinsky

RadNet Inc., provider of outpatient imaging services, announced that it has acquired Diagnostic Imaging Group LLC (DIG) for about $56.7 million. The deal will provide RadNet with about $70 million of additional revenue per year, according to the company.

DIG was founded in 1985 and its headquarters is located in Hicks-ville, Long Island. The company owns and runs 17 imaging centers in Brooklyn, Queens, the Bronx, Manhattan and Nassau County, and employs over 600 people who conduct more than 750,000 imaging procedures each year.

With the addition of DIG’s facilities, RadNet now runs 56 facilities in New York City and in Rockland and Nassau Counties. Including its facilities in northern New Jersey, RadNet operates 74 facilities in the greater New York Metropolitan area.

RadNet believes that it will bring “efficiencies and new expansion opportunities” to DIG by being able to service DIG’s referring physi-cian communities and patient populations more effectively.

RadNet’s main markets are California, Maryland, Delaware, New Jersey, New York and Rhode Island and it owns and operates 293 outpatient imaging centers. The company employs a total of about 6,300 workers including affiliated radiologists and full-time and per diem technicians and employees.Share this story: dotmed.com/news/27491



St. Mary’s Janesville Hospital to build $10 million radiation therapy facilityPosted online October 201 2015 by Gus Iversen

When St. Mary’s Janesville Hospital in Rock County, Wiscon-sin, opened in early 2012, it did not offer radiation therapy to cancer patients, although such a service was always in the hospital’s plans.

The expansion will allow for a single-story, 8,750-square-foot area at the hospital’s Dean Clinic on the campus’ southwest side (where cancer patients now receive chemotherapy and surgical oncology). It will house new computer imaging equipment and the state-of-the-art, 26,000-pound linear accelerator — which is designed, as hospital officials said, “to administer radiation therapy to cancer patients with pinpoint accuracy.”

“A cancer diagnosis is tough enough and the last thing you want to have to do is go to multiple facilities for treatment,” Eric Thornton, vice president of operations at the hospital, who is also the project manager overseeing the expansion, told HCB News.

Thornton said that St. Mary’s wanted to offer what it believed to be the most effective treatment possible to complete the exist-ing array of cancer services, and considered Varian Medical System’s TrueBeam linac to be the “cutting edge” in radiation oncology care.Share this story: dotmed.com/news/27565

University of Texas MD Anderson installs first MR-guided linear accelerator in the U.S. Posted online October 13, 2015 by Lauren Dubinsky

The University of Texas MD Anderson Cancer Center, Elekta and Philips have partnered to install the first high-field, 1.5 Tesla MR-guided linear accelerator (MR linac) in the U.S. The system is expect-ed to begin operating for research purposes early next year.

MR linacs capture detailed MR images of tumors and surrounding normal tissue dur-ing radiotherapy procedures. The images are used to help clinicians evaluate the therapy while it is occurring, which can potentially lead to better outcomes.

Philips chose to build its 1.5 T MR into the system because it believes it provides the best balance between image quality and spatial in-tegrity. A representative from Philips told HCB

News it’s very challenging to combine a high-field MR system with a high-performance lin-ear accelerator, but the company developed novel designs for the MR magnets and gradi-ent coils to overcome any problems.

MD Anderson renovated its existing ra-diotherapy vault earlier this year and on Aug. 1, Elekta started delivering and installing the components. They recently completed the final step successfully, which involved raising the MR magnet up to its operational field strength.

At the end of 2014, Elekta and Philips installed the world’s first MR linac at the University Medical Center Utrecht (UMC Utrecht) in the Netherlands. To date, they have successfully conducted all proof-of-

concept tests on the system and all perfor-mance specs have been met or exceeded.

In 2012, Elekta and Philips established a re-search consortium of leading radiation oncol-ogy centers and clinicians to further the devel-opment of MR linac. The consortium includes UMC Utrecht, MD Anderson, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital. Sunnybrook Health Sciences Centre, The Froedtert & Medical College of Wiscon-sin Cancer Center, The Institute of Cancer Re-search and The Christie NHS Foundation Trust.

Elekta is anticipating delivery of MR linacs to the first commercial purchases in 2018, and by 2019 it expects to have about 75 sys-tems installed around the world.Share this story: dotmed.com/news/27440

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First physician-owned proton therapy center purchases second system in JacksonvillePosted online October 15, 2015 by Lisa Chamoff

A Florida proton therapy facility, which opened six months ago, announced this week that it is installing a second, more technologically advanced system, allowing the center to treat even more complex cancers.

The Ackerman Cancer Center (ACC) in Jacksonville, Florida, treats 25 to 30 patients per day, mostly with head and neck cancers. The new machine, the MEVION S250i, has a pencil beam scanning technology. Dr. Scot Ackerman, radiation oncologist and medical director of ACC, said the technology, which is newer than the conventional passive scat-ter technology, is ideal for treating larger tu-mors located near the spinal cord and other organs. The majority of ACC’s patients have

cancers affecting the larynx, tongue and base of the skull.

“It allows us to provide intensely modulated proton therapy, which allows us to be a little more precise than passive scatter proton therapy,” Ackerman told HCB News.

Ackerman said the facility had always planned to invest in a second system, and already has the foundation and other in-frastructure in place to install it. They plan to begin construction on the second pro-ton therapy bunker next year. The MEVION S250i is not yet FDA approved, but Acker-man said they expect it to receive approval by 2017, when they will be ready to use it to treat patients.

Back in April, the Florida center was only the second facility to begin clinical operation with the MEVION S250.

The outcomes have proven the worth of the center’s investment, Ackerman said. ACC is the first physician-owned cancer cen-ter to offer proton therapy, which targets cancer cells more precisely than traditional radiation therapy, resulting in less damage to surrounding tissue.

“We always knew that, inherently, pro-ton therapy would allow us to treat patients more safely,” Ackerman said. “We’re seeing that. We’re seeing our patients tolerating the treatment better. We think [the invest-ment] is worth it based on our outcomes.”Share this story: dotmed.com/news/27460

New microscope imaging device may cut uncertainty from brain tumor surgery Posted online October 15, 2015 by Lauren Dubinsky

“There is a lot of ambiguity and judgment that goes on in the practice of brain tumor surgery,” Dr. Daniel Orringer, the University of Michigan Health System neurosurgeon piloting the technology, told HCB News. “The hope is that we will be able to eliminate some of that guesswork and make the process of taking out a tumor more of a quantitative process and a more data driven process, rather than something that relies on the physician’s own judgment.”

Orringer and his colleagues are currently working on a second-generation version of the SRS microscope, which they hope to keep close to the operating table once complete. Surgeons can insert a fresh tissue sample into the device, which will immediately generate microscopic images to determine if more surgery is need-ed to remove the tumor, or if the entire lesion has been removed.

The team developing the SRS microscope intends to make it roughly the size of a microwave and more affordable than any of the current imaging technologies used for this purpose, such as intraop-erative MR. Orringer believes that the technology will be of more inter-est to surgeons if the cost and space-capacity barriers are eliminated.Share this story: dotmed.com/news/27477


More work needed for wider implementation of Choosing Wisely recommendations: studyPosted online October 12, 2015 by Lauren Dubinsky

Additional interventions are needed for Choosing Wisely recommendations to be used more widely in general practice, according to an article published online in JAMA Internal Medicine. Researchers analyzed seven clinical services and found significant declines for only two of them.

The researchers evaluated the frequency and trends after the launch of the earliest Choosing Wisely recommendations in 2012. They used medical and pharmacy claims from Anthem-affiliated Blue Cross and Blue Shield health care plans for about 25 million members.

Most notably, the use of imaging for headaches went down from 14.9 to 13.4 percent and cardiac imaging for members who don’t have a history of cardiac condi-tions declined from 10.8 to 9.7 percent. Antibiotic use for sinusitis decreased mod-erately from 84.5 to 83.7 and use of pre-operative chest X-rays and imaging for low back pain stayed high.

The researchers also found that there were increases in a couple of the services. The use of nonsteroidal anti-inflammatory drugs for patients with hypertension, heart failure or chronic kidney disease increased from 14.4 to 16.2 percent and human papil-loma virus testing for women under 30 years old went up from 4.8 to 6 percent, despite recommendations.

The Choosing Wisely campaign’s goal is to get physicians, patients and other health care stakeholders to think about and discuss the overuse of health care resources in the U.S. Over 70 lists of about 400 recommen-dations of frequently used medical proce-dures have been compiled.

According to the researchers, the small changes in utilization mean that more in-terventions are going to be required for broader implementation of the recommen-dations. These could range from data feed-back, physician communication training,

systems interventions, clinician scorecards, patient-focused strategies and financial in-centives.

In a related commentary, Dr. Ralph Gon-zales and Dr. Adithya Cattamanchi of the University of California, San Francisco wrote

that delivery systems and clinician groups should develop and test strategies that aim to reduce the use of low-value treatments and diagnostics.Share this story: dotmed.com/news/27422

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ASTRO: follow-up by advanced practice nurses after head and neck cancer treatment improves care Posted online October 16, 2015 by Lauren Dubinsky

Research was presented at the American Society for Radiation Oncology’s (ASTRO’s) 57th annual meeting showing that radia-tion therapy and chemoradiation therapy treatments can cause side effects includ-ing short- and long-term pain or difficulty swallowing, tooth decay, bone pain, nau-sea, fatigue, mouth sores and sore throat, resulting in infection risks and complica-tions that may lead to unplanned emer-gency room visits or hospital admissions.

The researchers compared the occur-rence of adverse events among 25 high-risk head and neck cancer patients who received post-treatment care at an APN-led, acute-rehabilitation-focused clinic with adverse events among 24 head and neck patients

who received standard follow-up care.The researchers considered patients to be

at “high risk” if they had limited social sup-port, lived in a nursing home, needed mul-tiple hydrations during treatment, received a second course of stereotactic body radiation therapy (SBRT) and/or had a feeding tube.

All of the patients were treated with in-tensity-modulated radiation therapy (IMRT) or SBRT techniques. Radiation therapy alone was administered to 22 patients and the other 27 patients received radiation therapy with concurrent chemotherapy.

They found that patients in the APN clinic group were seen twice as often as the patients who received standard care. The patients in the standard follow-up group were seen at

four to six weeks after treatment and then at three months after treatment. The patients in the APN clinic group were seen at two to four weeks after treatment and then every two to four weeks until their symptoms stabilized.

Out of all of the patients, 18 experienced adverse events a total of 26 times. Out of the 18 who visited the emergency room or were admitted to the hospital, six were un-dergoing frequent follow-up care through the APN-led clinic.

In addition, only 16.7 percent of pa-tients in the APN clinic group who were only treated with radiation therapy experienced adverse events versus 60 percent in the stan-dard follow-up group.Share this story: dotmed.com/news/27503

Royal Philips strengthens partnership with Amazon Web Services Posted online October 1, 2015 by Lauren Dubinsky

Royal Philips announced that in order to further its goal to create an ecosystem for new types of connected and per-sonalized digital health solutions, it has strengthened its partnership with Amazon Web Services (AWS).

The Philips HealthSuite digital platform analyzes and stores 15 petabytes, or 15 million gigabytes, of patient data that is gathered from 390 million imaging studies, medical records and patient inputs. Philips is now using AWS IoT, which is a new platform that makes it easy for devices to connect to AWS services, to expand the connectivity and capabilities of HealthSuite.

One of the ways AWS IoT will support HealthSuite is with sup-port of the growing elderly population. Remote monitoring tech-nologies for seniors are becoming increasingly popular and by adding AWS IoT to the HealthSuite device cloud, it will be easier to acquire, process and act upon data from those devices.

Philips’ HomeSafe Medical Alert system, which provides fast access to response associates by pushing a button, and can auto-matically call for help if a fall is detected, may be expanded with other new devices on the market. Devices like that will help clini-cians respond to deteriorating health conditions at an earlier stage.Share this story: dotmed.com/news/27406



Are physician-scientists becoming an endangered species with the workforce growing older? Posted online October 14, 2015 by Lauren Dubinsky

Physician-scientists play an important role in the development of better health care because of their unique familiarity with different sides of the health care spectrum — but some experts fear these unique experts are rapidly disappear-ing. According to a recent commentary pub-lished in The Journal of Clinical Investigation, an action plan is needed to stem the tide.

“Medical research improves our ability to diagnose, treat and prevent human diseases,” Dr. Dianna Milewicz, lead author of the com-mentary and director of the division of medi-cal genetics at The University of Texas Health Science Center at Houston, told HCB News. “The physician-scientist plays a unique role in medical research in that they can provide the

link between the patients and the laboratory.”There has been a significant increase in

the average age of physician-scientists and in the amount of time it takes them to receive their initial grants. In 1980, a physician-sci-entist was usually around 35 years old when receiving an independent National Institutes of Health grant, but in 2011 they were typi-cally 45 years old.

Only 14,000 of the almost 1 million phy-sicians in the U.S. identified research as their main focus, according to a survey conducted by the American Medical Association. The amount of physician-scientists is stable right now since the older ones are working longer, but the workforce may still experience a de-cline in the near future.

Milewicz believes that the time for action is now. In her commentary she wrote that lessons from the M.D.-Ph.D. training and postgraduate training need to be applied, the time to inde-pendence needs to be shortened by five years, there needs to be greater diversity and numbers in training programs, and Physician-Scientist Career Development offices need to be estab-lished at medical centers and universities.

She believes that instead of waiting for the federal government to solve our prob-lems, the academic community needs to solve its own problems. She urges them to address those goals by collaborating with the NIH and national clinical specialty and medical organizations.Share this story: dotmed.com/news/27454

Using hyperpolarized diamonds, researchers ‘light up’ early cancers on MRPosted online October 19, 2015 by Thomas Dworetzky

Physicists at the University of Sydney’s ARC Centre of Excellence for Engineered Quantum Systems have found a method to use nanodiamonds to better find early-stage tumors, according to a university statement. The research appeared in the journal Nature Communications.

“We knew nanodiamonds were of interest for delivering drugs during chemotherapy because they are largely non-toxic and non-reactive,” said team leader Professor David Reilly.

His team of physicists tackled the tough problem of utilizing these tiny diamonds to “light up” cancerous tumors before they could grow to be a threat to life.

“We thought we could build on these nontoxic properties realizing that diamonds have magnetic characteristics enabling them to act as beacons in MRIs. We effectively turned a pharmaceutical problem into a physics problem,” he said.

Reilly and his colleagues focused on figuring out how to “hyperpo-larize” the tiny synthetic gems — that is, how to align the atoms inside a diamond to make a signal detectable by an MRI scanner.

The team will next focus on testing the new technology on mice, and if that works well, move ahead to clinical trials.Share this story: dotmed.com/news/27480



Trice and FUJIFILM SonoSite develop imaging-sharing portable ultrasound Posted online October 6, 2015 by Lauren Dubinsky

Trice Imaging and FUJIFILM SonoSite have partnered to create a new porta-ble ultrasound device called iViz. It’s em-bedded with Trice’s medical image sharing, collaboration and routing platform, Tricefy, which allows physicians to quickly share im-ages with patients and colleagues for refer-rals and consultations.

“Most of the imaging devices in the market today don’t have any encryption on them,” Asa Nordgren, CEO and co-founder of Trice, told HCB News. “It’s a challenge to use them outside hospital networks.”

Ultrasound images are often faxed to other hospital networks, but that can be a very inefficient and time-consuming pro-

cess. Nordgren believes that embedded communication modules are the future of ultrasound technology and will become as common as having Wi-Fi and email embed-ded on a computer.

Technology like this is also useful for many underserved markets in Africa and Asia that don’t have enough physicians to diagnose patients. The nurses and com-munity health workers in those areas can conduct the exams and send the images to physicians in remote locations.

“There are so many markets in the world that are underserved when it comes to imag-ing in general,” said Nordgren. “Their imag-ing is not like we have it over here.”

Trice and FUJIFILM SonoSite recently worked together on a project in Morocco that used portable ultrasound units with 3G connectivity to provide early detection and treatment for the major causes of maternal mortality. They wirelessly transmitted 575 exams to clinicians, which led to a reduction in costs per patient and a decrease in time from two weeks to 24 hours per diagnosis.

Trice and FUJIFILM SonoSite demonstrat-ed the technology at the Health 2.0 confer-ence in Santa Clara, California, during a ses-sion on care delivery platforms for provider media.Share this story: dotmed.com/news/27357

FDA orders duodenoscope makers to conduct safety studies for infection fightPosted online October 7, 2015 by Thomas Dworetzky

Everyone involved in modern medicine knows that medical scopes can be lifesaving tools. But improperly used or cleaned they can also be deadly — as recent duodenoscope-transmitted infection incidents have clearly shown.

To shed light on this challenge, the U.S. Food and Drug Admin-istration (FDA) issued an order to the three manufacturers of these sophisticated scopes marketed in the U.S.: Start using post-market surveillance to get better insight into the way these devices are re-processed in the real world.

“This is a significant step in the effort to combat infections spread through duodenoscopes. The FDA has undertaken an in-depth inves-tigation into the factors that may play a role in infection transmission associated with duodenoscopes, and is now requiring manufacturers to study the devices in the clinical setting where they are being used,” said Dr. William Maisel, deputy director for science, and chief scientist at the FDA’s Center for Devices and Radiological Health, in a statement.

Olympus America Inc., Fujifilm Medical Systems, U.S.A. Inc. and Hoya Corp. (Pentax Life Care Division) presently market duodeno-scopes sold in the U.S.

They have 30 days to get their plans for such surveillance to the agency.Share this story: dotmed.com/news/27363

Hospital in India among first to purchase Varian’s VitalBeam Posted online October 7, 2015 by Lauren Dubinsky

The Chirayu Medical College and Hospital (CMCH) in India is now one of the first cancer treatment centers worldwide to purchase Varian Medical Systems’ new VitalBeam platform.

To date, 10 platforms have been ordered in India, Germany and the U.S.

VitalBeam has many of the same advanced capabilities as Var-ian’s flagship platform, TrueBeam, including RapidArc, which can shape radiation dose very precisely and perform treatments in two to four minutes. However, VitalBeam cannot perform radiosurgery like TrueBeam.

VitalBeam is available with low-dose megavoltage imaging that uses the accelerator beam for image guidance and respiratory gating for motion management. It also has a streamlined treatment console with a user-friendly graphical interface and guidance system that walks the users through the most difficult treatments.

CMCH is planning to use VitalBeam to treat head and neck, brain, pancreatic and other abdominal malignancies. “They are serving a large area so they’re excited about having this highly capable plat-form,” Surekha Karudapuram, manager of Treatment and Imaging Solutions Marketing at Varian, told HCB News.

VitalBeam received FDA approval in May. Good Samaritan Hospital in Corvallis, Oregon, is currently the only hospital in the U.S. with an installation.Share this story: dotmed.com/news/27377


Upcoming Events

27th Annual IHI 2015 National ForumPresented by: Institute for Healthcare ImprovementLocation: Orlando World Center Marriot, Orlando, Fla.Dates: December 6 – 9 Years in Existence: 27Average attendance: +5,500Who should attend: Frontline staff, quality professionals, safety professionals, nurses, physicians, medical and health profession students, leadership including Board Mem-bers, administrators, nurse practitioners, physicians’ assistants, researchers and pa-tients and patient advocates

Surgical Services Summit 2015Presented by: DecisionHealthLocation: Wynn, Las VegasDates: December 9 – 11 Years in Existence: 2

Who should attend: Perioperative/clinical nurse managers, VPs and directors of sur-gical suites, OR, surgical services, infection control supply chain, compliance and quality managers

IMSH 2015Presented by: Society for Simulation in HealthcareLocation: San Diego Convention Center,San DiegoDates: January 16 – 20Years in Existence: 16Who should attend: Nurses, laboratory managers, technicians, simulation, coordina-tors, education specialists, trainers, research scientists, pharmacologists

2015 7th Annual Winter Hip & Knee CoursePresented by: International Congress for Joint Reconstruction

Location: Vail Cascade, Vail, Colo.Dates: January 14 — 17Years in Existence: 8Average attendance: +200Who should attend: Orthopedic surgeons, sports medicine, orthopedic nurses, ortho-pedic technologists, orthopedic physician assistants

2015 NAEMSPPresented by: National Association of EMS PhysiciansLocation: Manchester Grand Hyatt,San DiegoDates: January 14 – 16Years in Existence: 31Average attendance: +600Who should attend: Physicians, paramed-ics, nurses, administrators, educators, re-searchers and key EMP personnel

www.dotmed.com

Hospital Spotlight: Delta County Memorial Hospital

HealthCareBusiness news I december 201528

Delta County Memorial HospitalLocation: Delta, ColoradoYear founded: 1915Number of beds: 49 + 9 clinicsNumber of employees: Approximately 600CEO: Jason Cleckler

Noteworthy distinctions: 100 years in busi-ness this year; New chief financial officer — previous CFO served 11 years prior to retire-ment; working on regional collaboration to form an ACO; clinic acquisition in addition to starting an urgent care clinic; substantial in-crease in numbers of patients seen in DCMH emergency room

Specialties: General surgery, orthopedic sur-gery, primary care (including internal medicine practice), oncology and rheumatology

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HealthCareBusiness news I december 2015 29HealthCareBusiness news I december 2015 29

1. DCMH Exterior Photo 2. National Wear Red Day — for heart health3. Stork’s Landing, the hospital’s Labor and

Delivery Dept., welcomes a new baby4. OR (Operating Room) team prepares for sur-

gery in one of the surgical suites at DCMH5. Dr. Steven Berstein, radiologist, with breast

imaging study, DCMH Radiology Dept.6. DCMH celebrates 100 years of serving Delta

County families. The first hospital was in a house.

Recent developments: Transitioned from a county hospital to a hospital system last year. Delta Pediatrics moved into new offices and si-multaneously changed its name to DCMH Prima-ry Care — Pediatrics. Delta Family Physicians, a well-respected 30-year-old Delta-based medical clinic, transitioned into DCMH Family Medicine. Delta County Memorial Hospital opened DCMH Urgent Care directly across from the hospital campus in December of 2014. In 2015, the hos-pital laboratory was reaccredited by the College of American Pathologists. Surgical site infection rate for 2014 was 0.19 percent, a decrease from 0.3 percent the previous year and well below the national average of 2 to 2.5 percent.

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HealthCareBusiness news I december 2015 www.dotmed.com30 HealthCareBusiness news I december 201530

Hospital Spotlight

Jason Cleckler has built his capabilities as a CEO from the ground up. His past experience serves him well today to iden-tify problems and opportunities for staff and patients. We took some time to learn more about him, as well as the facility he heads.

HCB News: How did you get involved in health care?

JC: I got involved in the early ‘90s. I start-ed as an RN. I began my career in inpatient psychiatry for many years. I taught at the University of Colorado and changed direc-tion to become an ER trauma nurse, then ICU. From there, I took a path into admin-istrative.

But the big reason I got involved was that I was very interested in science and psychia-try, so nursing combined those. I think the biggest factor, however, was that I had a cousin who was an RN, and very influential, telling me about the career and benefits, and how she could make a difference. So looking back, I feel it was a very good deci-sion back in the ‘80s when I first made it.

HCB News: How did you get involved in Delta Hospital?

JC: I’ve been here a little over seven years. I was working in the ICU in a neighboring hospital. Then an opportunity opened to be the trauma nurse coordinator, to be involved in process and quality improvement.

HCB News: How long have you been CEO?

JC: A little over three years. Prior to that, I managed trauma, then was an ER director, and then chief clinical officer for about two years.

HCB News: Are there any recent de-velopments you’d like to highlight?

JC: The biggest changes have been fo-cused on creating a larger network to provide access for patients, in part, by employing more physicians. We opened several new primary care clinics and brought some new ones on to create that network. Small rural standalone hospitals are being purchased by larger sys-tems, so we’ve focused on regional collabora-tion with other hospitals in our region. We’ve moved down the path of creating an ACO. There are three other hospitals in our region, and it may sound strange, but the more we work together, the more we can remain in-dependent through increased collaboration and sharing of resources. Hospitals that were formally competing are working together to make each other stronger and more viable.

HCB News: How has staffing been? Are you finding any areas just don’t have enough people entering the field?

JC: I think that there have been several areas that have been challenging. One is hiring primary care physicians — because we’ve tried to hire ones that also do OB. So finding the right person, and someone who fits into our community, can be challenging. Rehab and speech therapy has been hard. With nursing we’ve done pretty well. We have a nursing school about 35 miles north. But within nursing, finding someone within OB has been a challenge. Another challenge has been internal medicine physicians.

HCB News: What attracts staff to Delta Hospital?

JC: We’re appealing due to our location. We’re in a beautiful area, with nice weather, outdoor opportunities. The community is primarily farming and ranching, with about 20 wineries in the area. It’s a rural lifestyle, low crime, low pollution, but close enough to a metropolitan area for shopping.

At the hospital itself, we’re very focused on a team approach and every employee, no matter their role, has a say in where the hos-pital is going. Employee engagement is truly paramount to the success of the hospital. In order to improve the patient experience we need to improve the employee experience. So employee engagement and running a transparent organization has made us able to attract and retain employees.

HCB News: What is your patient mix?JC: Our typical payor mix is [primarily]

Medicare and Medicaid. Age range is across the board, certainly leaning toward a retire-ment community. But really, what we see is a mix.

HCB News: How has the ACA impact-ed your facility?

JC: ACA has been a mixed bag. Some things have been good for us and some have been challenging. The state of Colorado was one of the states that decided to expand Med-icaid, so we have more people, and it’s been challenging providing services on the low end of reimbursement. But we’ve been proactive. We’ve been able to increase services and serve more patients. Because we’ve been proactive and doing advanced planning, we will be in a better place once we adjust. Share this story: dotmed.com/news/27817

Q&A with Jason ClecklerCEO of Delta County Memorial Hospital

By Sean Ruck


Cost Containment Corner

If you listen to real news radio on any given day, there’s usually mention of the stock performances, averages and the ups and downs of the economy. Somewhere in that information will be men-tion of job growth. There may also be men-tion of it being an “employer’s market” or a “job seeker’s market.” That topic — the employer versus employee — is an impor-tant one to focus on.

While it’s understandable that a job mar-ketplace suffering from high unemployment could be considered an employer’s market — they have a larger pool of applicants to pick from, that group also knows there’s greater competition, so it may not negotiate as aggressively — it should be understood that the employer isn’t necessarily a clear winner. There may, in fact, not be a winner.

First, consider — you’ll be taking a chance on an unknown. How much effort will be required to get to know the poten-tial employee before making the decision to bring them on board? How much profit will be lost for each day you’re without? How many customers will be disappointed with the experience they’ve had with your under-staffed organization?

Next, if you’re replacing and not ex-panding staff, consider what you may be losing. Even if the new hire is a good hire, how long will it take to get to the level of institutional knowledge your departing employee would be taking away? Even things as simple as knowing where to find files or reports can save countless hours — and you know the adage and formula… time equals money.

There’s also the risk of potential burnout among your remaining staff as they struggle to pick up the work added to their list.

So what’s a company to do? The an-swer is easy — match the value of the

employee with the value of the benefits (salary, health insurance, profit sharing, flextime, etc.). The answer is easy, but the background work can be challenging. It requires a careful look at the actual ex-penses of each program you’re running and the expectations of the profitability or value from the position you’re encouraging someone to stay in.

Make sure to balance the costs of increas-ing benefits against the other costs you’ll encounter with a new hire — the upfront costs of attracting talent is a starting point. So, online job postings, paying a placement firm or talent agency, any costs for adminis-trative work involving adding new people to existing plans — things add up quickly. And keep in mind the increase to employee bene-fits doesn’t necessarily carry a dollar amount. For instance, a 2009 study conducted by SuccessFactors, a group that explores em-ployee retention and other like-issues, says key factors in driving a nurse away from a job include lack of recognition for a job well done, lack of direction and support from upper management and low collaboration with co-workers. All these things could cost money to address, but some investigation on a facility’s part is likely to turn up low-cost or no-cost solutions.

Fortunately, there is an incredible amount of information available via studies from or-ganizations and industries of every stripe that will help you to determine your employ-ee’s value and your compensation packag-es, to determine if the two are compatible. In fact, in a decade-old survey of 610 CEOs by Harvard Business School, the cost of a new hire can often be substantially higher than retention. According to the report from that survey, the average typical mid-level manager takes about six months to reach their break-even point — that is, the point

where the money a company invests in the employee is at the same value level as the return the employee is giving.

Smart companies get to that break-even point much faster by working to put pro-cesses into place to help the new hires get up to speed faster. Those smart companies would have also exhausted all other options that would have precluded requiring a new hire. If it was a question of a raise, for ex-ample, would bumping up the salary of the on-staff employee break the bank? If it takes roughly six months for a middle manager to hit the break-even, but the previous em-ployee was at that point — or even worse, if they were strong drivers of profitability, then you may have lost six months of profit. For specialties like health care, which require specific, focused skills and technical knowl-edge, the break-even point might be even further out. A number of studies on the cost of nurse turnover give estimates at (an ad-mittedly wide-ranging) $22,000 to $64,000 per nurse. And losing two nurses goes be-yond doubling that number if you keep in mind the previously mentioned problem of the additional workloads and stress on re-maining staff.

To top all the troubles off, there’s no guar-antee the situation won’t repeat itself after the new hire builds his or her value through the knowledge and skills they acquire while working for you.

However, the solution doesn’t need to be as extreme as that introduced by Gravity Pay-ment’s CEO Dan Price, where he announced that the minimum wage of any employee at his 120-person company would be $70,000 (he took a pay cut from $1.1 million to that same $70,000 to help fund the change). But there does need to be a solution introduced. It’s just smart business. Share this story:dotmed.com/news/27848

Avoid an excessive level of nursing staff turnoverBy Sean Ruck


IT Matters

Software-powered medical devices play an increas-ingly central role in patient care. For many of the software applications that run on these devices,

FDA classification is, or will soon become, a mandate — and vendors that get ahead of this now will be better positioned than those that have to rush to catch up. That said, the requirements may not be easy for many vendors. Even to achieve FDA Class 1, the tier reserved for low-risk devices and applications, requirements include annual registration with the FDA, careful product labeling and use of marketing language, and a number of security and privacy mandates.

These last two areas may trip vendors up who have never before encountered the many layers required to protect the personal health data that will pass through their apps. It’s a significant undertaking that will side-track — and ultimately sideline — the unpre-pared vendor. The good news is that an ap-plication designed to comply with the HIPAA Security and Privacy Rule has a notable head start for some FDA Class 1 domains. This, in turn, can be accomplished to a great extent by hosting your application within a health care-exclusive, HIPAA-compliant data center.

Access to managed services at a manageable operating expenseMany health care organizations and the ven-dors who serve them are turning to “cloud” managed services partners for a broad set of security and privacy services. These ser-vices are typically delivered within a top-tier data center, by professionals in health care

IT security and privacy. The many services they offer can span from an initial risk as-sessment of the current IT infrastructure that houses your applications, to privacy impact and software development life cycle assess-ments, to ongoing, managed hosting of this infrastructure within a cloud environment that exceeds HIPAA, GAPP and other security and privacy controls.

Note that the investment in this fortress-like environment was made by someone else. All of its capabilities and assets, from data hosting to professional IT expertise, is available on a pay-as-you-go model, much like a monthly utility bill. In other words, vendors pay only for what they need. In the case of making medical software secure and private to FDA and HIPAA standards, this can include services where there is considerable overlap between the two sets of controls.

Both FDA Class 1 and HIPAA address con-figuration management, for example, which assures (among other responsibilities) that vendor-supplied credentials are changed to unique passwords. This is routine work for managed data services experts, who can also facilitate other change-driven activities, such as a secure transition of valuable data to new systems and integration of multiple databases.

Monitoring and physical environmental se-curity are another two areas where FDA Class 1 and HIPAA converge. Managed data ser-vices in the cloud can include real-time moni-toring, intrusion detection and prevention, data encryption and regular scans to detect new compliance risks. As for physical security, few commercial buildings are more secure in these modern times than a top-tier data center, from perimeter security to biometric authentication requirements for internal staff.

The security and privacy mandateThere are a number of reasons — all good ones — why software companies would willingly jump through the necessary hoops to obtain FDA classification. Large integrat-ed health networks increasingly need FDA classification for the applications they use to make medical decisions. It makes life a lot easier for them, especially from a legal standpoint, if these apps are cleared for FDA approval. Health care is also entering an unprecedentedly collaborative era, with a proliferation of joint projects concerned with testing new innovations and technologies. The market for a promising new product could be bigger with FDA classification.

It should be emphasized, however, that vendors need to secure their applications re-gardless of whether or not they obtain FDA classification. Adherence to security and pri-vacy will only grow in importance as hackers increase their targets to include medical de-vices and medical device software. But instead of taking this on themselves — a daunting feat — vendors can turn to a cloud partner who has made this a core competency.

Chris Bowen is founder and chief privacy and security officer at ClearDATA. He is a certified information privacy professional, certified information systems security profes-sional and certified information privacy technologist. ClearDATA provides HITRUST CSF-certified HIPAA-compliant cloud com-puting used by more than 300,000 health care providers to store, manage, protect and share their patient health information and critical applications. Share this story: dotmed.com/news/27720

How the cloud fast-tracks FDA Class 1 security and privacy for health care applicationsBy Chris Bowen

TOGETHER FOR BETTER HEALTH.Learn more at Conserus.com.

For years they’ve been telling us to imagine the possibilities. With the Conserus™ suite of solutions, the possibilities have finally arrived. Conserus offers a range of products that helps orchestrate interoperability among existing systems and specialists while helping to simplify the transition from volume- to value-based care. With comprehensive solutions like Image Repository, Clinical Data Exchange, Workflow Intelligence, Enterprise Worklist and Quality Workflows, we can help you connect your entire enterprise, putting valuable information in the right hands, in the right place, at the right time. With Conserus, the possibilities are more than imaginary — they’re here.

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To view these products online, visit dotmed.com and enter DM27832 into the search bar. Have a new product? Email your press release to [email protected]. For a chance to be included in the New Products Showcase, include a high resolution shot of the product.

Consumer Mobile App to Simplify Healthcare RecordsTo provide patients with a one-stop destination for all of their medi-cal records, Medfusion — a patient engagement platform dedicat-ed to facilitating the relationship between doctors and patients — has developed a consumer mobile application — Medfusion Plus.

Via a download on the App Store and Google Play, iOS and Android device users can now aggregate and access their health-care records onto their mobile devices. The information is pulled via Continuity of Care documents (CCD) from the patient portals and includes laboratory results, immunizations, medication lists, allergies, as well as appointments.

Medfusion Plus, which also provides an application program-ming interface and is available on the Apple Watch, will continue to evolve with a significant roadmap ahead for the developers.

Diagnostic Suite for IQon Spectral CTRoyal Philips announced that its IQon Spectral CT now has in-creased potential thanks to a new diagnostic suite approved for the U.S. market.

By providing spectral capabilities within traditional CT appli-cations, the Spectral Diagnostic Suite may unlock a new level of flexibility and clinical utility for the workhorse imaging modality. It may also reduce repeat imaging, as incidental findings can be explored in greater depth with the spectral data sets.

The visual and analytical benefits of the Spectral Diag-nostic Suite can be tapped into from a variety of different settings. According to a statement from Philips, the spectral data can be viewed from a reading room, a PACS system, or a remote location.

The IQon Spectral CT system itself received FDA approval in November of 2014.




New Full-field Digital Mammography System Siemens Healthcare recently announced the FDA has cleared the Mammomat Fusion mammography system.The system features a new generation cesium-iodide detector — an innovative, layered configuration of the photo diodes within the detector that enables more efficient utilization of the radiation dose. The result: high image quality at a patient dose that is at or below the range of other full-field digital mammography systems, with an even lower dose delivered in cases where the patient’s breast thickness exceeds 50 mm. And the system’s large image matrix of 23x30 cm makes the Mammomat Fusion the right choice for screening various breast sizes.

Patient Relationship Management SolutionSalesforce recently launched its first industry product built specifically for health care. Sales-force Health Cloud is a cloud-based, patient relationship management solution. It helps providers build stronger, one-to-one relationships; make smarter care decisions; and connect with their patients anywhere, on any device. It features a Today screen with alerts to caregivers on timely patient issues; Patient Profiles and Timeline views that provide a central view of a patient’s history and easy-to-read clinical data for providers; Private Communities that allow care coordinators to collaborate and assign tasks across a caregiver’s network; and Salesforce Shield, a set of built-in features that allow providers to manage, audit and archive patient data.

Patient Monitoring SystemQualcomm Incorporated announced that Capsule, a wholly owned subsid-iary of Qualcomm Life, Inc., has received FDA 510(k) clearance of SmartLinx Vitals Plus, a patient monitoring system that integrates vital signs monitor-ing and clinical documentation into one scalable platform. SmartLinx Vitals Plus, part of Capsule’s SmartLinx Medical Device Information System™, is a powerful alternative to traditional low acuity monitors. It provides new functionality in a single platform that allows hospitals and other health care facilities to streamline user authentication, patient identification, vitals mea-surement and clinical documentation by integrating vital signs modules and components directly to the SmartLinx NeuronTM 2 mobile clinical computer.

High Intensity Focused Ultrasound Prostate Ablation DeviceSonaCare Medical, LLC announced that it received de novo clearance from the U.S. Food and Drug Administration (FDA) to market the Sonablate® 450 in the U.S. for the ablation of prostate tissue. Sonab-late® is the first High Intensity Therapeutic Ultrasound (HITU) device to receive FDA regulatory authorization for prostate tissue ablation.


Over the past 20 years, the use of CT in the emergency department (ED) has more than tripled, but it’s not clear what effect it has on physicians’ diagnoses. Since CT comes with a high cost and radia-tion dose, it’s important to know how useful it really is.

“It’s more of an issue of whether the risk-benefit calculus is the right one,” says Dr. Pari Pandharipande, director of the Massachusetts General Hospital Institute of Technology Assessment. “That is a source of ongoing policy dialogue in the health care community regarding CT.”

Pandharipande and her fellow research-ers decided to investigate what effect CT has on ED physicians’ diagnoses and man-agement decisions. Over the course of 15 months, they assessed CT use at four U.S. academic medical centers.

The ED physicians participating in the study evaluated patients with abdominal pain, chest pain/shortness of breath and headaches, and filled out a survey after their initial evaluation that gauged their confi-dence in their diagnoses, and another survey after receiving results from the CT exam that asked if their initial diagnosis changed.

After 245 physicians completed both surveys for 1,280 patients, the researchers found that after CT, the physicians’ initial di-agnoses changed for 51 percent of patients with abdominal pain, 42 percent of patients with chest pain/shortness of breath and 24 percent of patients with headache. In addi-tion, CT helped them either confirm or rule out alternative diagnoses 95 to 97 percent of the time for all indications.

“We always want to try to get rid of un-necessary tests — it’s better for people not

to have tests that they don’t need,” says Pandharipande. “With this study, we had fairly pronounced results in terms of chang-es in physician decision-making before and after CT.”

Though CT led many physicians to change their diagnoses, that doesn’t pre-clude the need to constantly get better at trying not to order studies patients don’t need, she adds. The proportion of patients who had diagnoses that changed can either be viewed as a large number or it could be viewed as having a lot of room for improve-ment, says Pandharipande.

The use of CT in the ED will likely con-tinue to increase because of the unique window it offers into a patient’s health. The risks associated with the technology will also remain, but manufacturers are working to lessen them.

Industry Sector Report: ED

By Lauren Dubinsky

ED: Is the cost of CT justified?

The Aquilion ONE


Faster scans and lower doseIn trauma situations, ED physicians must make decisions fast without sacrificing ac-curacy. Also, health care reform is demand-ing that they take into account quality and costs more than ever before.

Memorial University Medical Center (MUMC) in Savannah, Georgia, has over 95,000 emergency visits and almost 3,000 trauma patients per year. When it had to update its CT systems in 2011, the facility decided to install Toshiba’s Aquilion ONE CT.

One of the major concerns about using CT is the radiation dose. To address that, Toshiba built its Adaptive Iterative Dose Re-duction 3D (AIDR 3D) technology into the system, which has been shown to lower ra-diation exposure by up to 75 percent com-pared to traditional filtered back projection reconstruction.

With the technology, MUMC was able to maintain lower dose for any patient shape and size without compromising image qual-ity. It was especially useful for pediatric pa-tients because of the harmful effects that radiation can have on children.

Many of the other major manufacturers offer iterative reconstruction technology for their CT systems. Philips Healthcare has its iDose 4 iterative reconstruction technique, GE has its ASiR dose reduction technology and Siemens has its ADMIRE technology.

ADMIRE, which is Siemens’ third-gen-eration iterative reconstruction technology, makes images appear as though the patient has received 100 percent dose, despite the fact that the dose has been significantly re-duced, says Christine Ziemba-Landon, CT product manager at Siemens.

“Even though we have reduced the ra-diation dose upfront, ADMIRE allows us to clean that image up, reduce artifacts and give them the appearance of a really nice image,” she adds.

To significantly reduce the dose, ADMIRE is combined with Siemens’ Stellar Detector, X-CARE and CARE kV technologies. “The industry is saying, ‘You need to reduce ra-diation,’ and the only way you can do that is by using dose reduction features,” says Ziemba-Landon.

When patients with metal prosthetics

or gunshot-wound victims with bullets in-side their body require CT exams, physicians usually have to accept that the image qual-ity will suffer. The metal artifacts can hide anatomical structures that the physicians need to see.

However, Toshiba’s Single Energy Metal Artifact Reduction (SEMAR) technology min-imizes the streaks and artifacts on images that metal objects cause. MUMC was able to provide more information to the radiolo-gists, which led to more accurate diagnoses and better overall outcomes for the patients.

The Aquilion ONE can perform a cardiac CT in one rotation or .35 seconds, compared

to standard CTs that can do that in five to six seconds. In addition, it provides 16 cen-timeters of coverage compared to typical scanners, which only cover four centimeters.

Time equals brainCT is not only making strides inside of the hospital — it’s also starting to be used in am-bulances for stroke patients. The trend origi-nally started a few years ago in Germany, but it is now making its way to the U.S.

Cleveland Clinic, The University of Texas Health Science Center at Houston (UTHealth), Mercy St. Vincent Medical Cen-ter and the University of Colorado Hospital


Industry Sector Report: ED

are a few of the institutions leading the way with this concept. Cleveland Clinic deployed its first mobile stroke unit in June 2014 equipped with Neurologica’s CereTom mo-bile CT scanner.

The unit looks like an ambulance on the outside, but inside it is equipped with a por-table CT scanner and a staff made up of a paramedic, critical care nurse, CT technolo-gist and EMS driver. The CT is used to image the patient’s brain and determine whether the stroke is caused by a blood clot or rup-tured blood vessel.

If a blood clot is the cause, the medical team can administer the intravenous tissue plasminogen activator (tPA) within three hours to try to break up the clot and that may improve the chance of recovery. TPA is currently underutilized since mobile stroke units are not yet the standard of care and only a small portion of patients arrive at the ED within three hours of the time they were last known to be well, according to the Mas-sachusetts Department of Health and Hu-man Services. UTHealth’s mobile stroke unit is also equipped with the CereTom CT. At the American Stroke Association’s International Stroke Conference 2015 in March, UTHealth reported that it was able to administer stroke treatment within 10 to 18 minutes of arrival and that over the course of nine weeks, two patients per week were treated with tPA and 40 percent were treated within the first hour from onset.

Mobile stroke units are equipped with portable CTs because of their small footprint, but Siemens Healthcare has a mobile stroke unit currently in production that is equipped with its SOMATOM Scope CT, which re-ceived FDA approval in September 2014. Even though it’s not a mobile system, it only requires 130.2 square feet of space.

“The idea behind it is that you can po-tentially eliminate spending time in the ED in situations where time plays a critical fac-tor in positive outcomes,” says Dena Bob-bett, product manager of neuroradiology and emergency department CT marketing at Siemens. “You could go straight to CT if you wanted to get a neuro perfusion study or you could go straight to the angiography suite.”

Nearly automatic ultrasoundJust like CT, ultrasound is also making its way into ambulances. Last year, six emergency vehicles in the Dallas and Forth Worth met-ropolitan areas deployed Samsung Electronic America’s PT60A ultrasound to diagnose trauma, internal bleeding, acute abdominal pain and cardiac arrest.

During a trial that started in July 2014, the emergency vehicles made 91 emergency calls by October. In one case, a patient was experiencing abdominal pain and the para-medics used the PT60A and found the pa-tient’s liver was bleeding.

The paramedics transmitted those im-ages, in real time with Trice Imaging’s mo-bile encryption and image management sys-tem, to the hospital and the staff was able to make sure the right specialists would be available when the patient arrived.

For point-of-care ultrasound systems used inside of the hospital, there is a trend toward a fit-for-purpose ultrasound de-signed specifically for the emergency space. Ultrasound systems are also being designed specifically for the critical care and anesthe-sia fields.

With traditional ultrasound, a clinician’s job is to get an image that is so compelling that it influences another physician to do something. But with point-of-care ultra-sound, the physicians’ only job is to convince themselves.

“They both care about image quality and they both care about seeing well, but their purposes are quite different,” says Paul Mullen, general manager of point-of-care ultrasound at GE Healthcare. Industry ex-perts believe that hand-held, pocket-sized ultrasound systems will eventually replace stethoscopes in the ED. A few of the sys-

tems on the market are GE’s Vscan, Siemens’ ACUSON Freestyle, Philips’ Lumify and Son-oSite’s iViz.

When patients show up in the ED with very low blood pressure, the physicians are usually worried about them surviving. When the physician uses the point-of-care ultrasound to image the patient’s heart, it might be determined that the left ventricle is slightly small.

The physician would then lift the patient’s leg to allow the blood to flow out of the leg and into the inferior vena cava vein, which should then fill the left ventricle. If it does, the physician will see a nice cardiac response and give fluids to the patient to deal with dehydration.

“You need to completely change the workflow of the ultrasound machine and show that you can facilitate this quick train

of thinking,” says Mullen. “The imaging happens nearly automatically — it doesn’t have to be perfect, but it has to be nearly automatic because no one wants to take the time to push buttons.”

Mullen believes that point-of-care ultra-sound will replace other modalities like CT or MR when imaging pediatric patients in the ED. Because of the harmful effects radiation may have on children, hospitals are looking to avoid exposing them to it.

Point-of-care ultrasound will also re-place other modalities when speed is a major priority. For example, resuscitation is a case where there is no time to perform a CT exam.

“I think that where possible we are go-ing to ultrasound, instead of using radiating technology for the care of the most vulner-able patients we have,” says Mullen.Share this story: dotmed.com/news/27963

‘You need to completely change the workflow of the ultrasound machine and show that you can facilitate this quick train of thinking. The imaging

happens nearly automatically — it doesn’t have to be perfect, but it has to be nearly automatic because no one wants to take the time to push buttons.’


View from the Hill

On Oct. 30, 2015, the Centers for Medi-care & Medicaid Services (CMS) issued final rules updating payment policies, payment rates and quality provisions for services furnished under the Medi-care Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS) and Ambula-tory Surgical Center (ASC) Payment Sys-tem for services performed on or after Jan. 1, 2016. There are several policies in the final rules that are of interest to the imaging community.

Regarding the Medicare Physician Fee Schedule (PFS), one of the most anticipated policies was how CMS would take the next step regarding the implementation of the Appropriate Use Criteria program for the ordering of advanced medical imaging ser-vices. CMS is implementing the first com-ponent of this program in this PFS final rule with comment period by establishing which organizations are eligible to develop or en-dorse appropriate use criteria (AUCs), the evidence-based requirements for AUC de-velopment and the process CMS will follow for qualifying provider-led entities.

A focus in the proposed rule was CMS’ definition of “provider-led entities” (PLEs), or those organizations that would be eligible to develop or endorse AUCs, because of the concern that radiology benefits manage-ment companies could get into the pro-gram. CMS proposed a definition as “includ-ing national professional medical specialty societies or an organization that is comprised primarily of providers and is actively engaged in the practice and delivery of healthcare (for example hospitals and health systems).” However, in the final rule, CMS opted to ap-ply a definition under which a PLE means “a national professional medical specialty soci-ety or other organization that is comprised primarily of providers or practitioners who, either within the organization or outside of the organization, predominantly provide di-

rect patient care.” One of CMS’ rationales for this finalized definition is to allow the opportunity for third parties to collaborate with PLEs to develop AUC.

CMS is also modifying its proposal to re-quire that the multidisciplinary team that a PLE uses for AUC development must include at least 7 members, including:• At least one member with expertise in the

clinical topic related to the criterion; • At least one member with expertise in im-

aging studies related to the criterion; and• At least one primary care physician repre-

sentative. The final rule also had CMS confirming

that the agency will not finalize criteria for identification of qualified Clinical Decision Support (CDS) mechanisms, through which physicians would consult with applicable AUC, until after the end of the CY 2017 rule-making cycle. Therefore, CMS indicated that it will NOT require that ordering phy-sicians consult with AUC during CY 2017, as required under the Protecting Access to Medicare Act (PAMA) of 2014. CMS sug-gested that it expects to have the initial list of CDS mechanisms available for review by summer 2017.

Another important area in the MPF rule for imaging was the list of procedures that had been identified and proposed for review as “misvalued” services. CMS finalized 103 of the 110 proposed “high expenditure” codes for review. Among the codes that were re-moved were two ultrasound codes and one nuclear medicine code, leaving 26 remaining imaging codes on the final list. The majority of these 26 codes are MRI and X-ray procedures. For these 26 procedures, CMS will begin mis-valued code reviews, with changes to Relative Value Units proposed as early as next year’s — 2017 — MPFS proposed rule.

Regarding the Hospital Outpatient De-partment Prospective Payment System, CMS finalized its proposal to restructure the Am-bulatory Payment Classifications (APCs) for

imaging services, reducing the number of imaging APCs from 54 to 25. This means that the payments are less granular and less specific to an individual procedure’s costs.

In finalizing this proposal, CMS did make one structural change by adding one addi-tional APC for nuclear medicine, in order to separate Positron Emission Tomography (PET) services from other services in other APCs. CMS also agreed to move 38 out of 114 com-menter-requested individual codes (many X-ray and ultrasound) from one APC to another.

To understand the effect of this APC grouping change, a hospital outpatient de-partment needs to look at the new payments assigned to the imaging procedures that they perform and determine the volume of each procedure in a single year. This would allow a hospital outpatient department to understand the impact of this proposal to its overall Medi-care revenue — do the procedures that are “winners” offset those that are experiencing reductions in payments for CY 2016?

To read more about the Final 2016 Medi-care Fee Schedule Rules and to check the addendum for payment amounts for indi-vidual imaging procedures, please visit the following CMS Web sites:

https://www.cms.gov/Medicare/Medi-care-Fee-for-Service-Payment/Physician-FeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1631-FC.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

https://www.cms.gov/Medicare/Medi-care-Fee-for-Service-Payment/HospitalOut-patientPPS/index.html

About the author: Jill Rathbun is manag-ing partner at Galileo Consulting Group in Arlington, Virginia. She will be commenting for HealthCare Busi-ness News on issues of

interest to health care professionals.Share this story: dotmed.com/news/27964

Time to prepare for next yearBy Jill Rathbun


By Lauren Dubinsky

A typical patient room in an intensive care unit (ICU) is filled with anywhere from 50 to 100 pieces of medical equip-ment that are manufactured by differ-ent companies and rarely communicate with each other. That’s becoming an issue now that health reform is demanding better outcomes and lower costs.

The Johns Hopkins University School of Medicine announced plans in late October to redesign how medical devices in the ICU communicate. Companies will work to de-velop a health IT solution that gathers data

from different monitoring equipment and identifies important trends that can help physicians prevent injuries and complica-tions.

Johns Hopkins will provide the clinical expertise and Microsoft will provide tech-nologies including its Azure cloud platform and services and software development ex-pertise. Azure works by collecting and in-tegrating data from different devices and providing critical analytics, computing, da-tabase, mobility, networking, storage and Web functions.

Microsoft will also help Johns Hopkins improve its Project Emerge, which aims to redesign the ICU workflow, culture and technology by bringing together clinicians, systems engineers, bioethicists, human fac-tors specialists, patients and their families. The project revolves around a tablet applica-tion that coordinates and integrates all data from monitoring equipment and informa-tion systems.

The tablet app also includes a harms monitor that keeps track of hundreds of tasks for each patient and categorizes them into seven sections. It monitors which preventive tasks were performed and alerts ICU staff to situations when patients might be at risk.

Johns Hopkins and Microsoft are plan-ning on starting pilot projects in 2016.

Cerner Corporation has also done work to enable the devices in the ICU to com-municate with its CareAware Critical Care solution, which automates the whole ICU

ICU: Innovations are leading to better patient outcomes

Industry Sector Report: ICU

Siemens’ SOMATOM Scope


including data from medical devices and patient records. It’s a vender-neutral tech-nology that enables interoperability among medical devices, health care applications and EMR platforms and then aggregates the data so that it can be displayed in a single view.

In August, Cerner and Hospira an-nounced an agreement to advance the inte-gration of IV and EMR technology. Through the agreement, Hospira will connect its infu-sion pumps to the EMR at the point of care and add functionality for devices connecting to CareAware.

Remote ICU monitoringIt’s well-known in the industry that there is a shortage of staff in the ICU. In addition, critical care costs in the U.S. are as high as $80 billion to $100 billion per year and the demand for critical care services is grow-ing more rapidly than the supply of these services, according to the Society of Critical Care Medicine.

Many hospitals including the Mayo Clinic and Saint Luke’s Health System in Missouri believe that electronic ICUs (eICUs) are the solution to the problem. Vital signs, medica-tions, blood test results, X-rays and other data from bedside monitors are sent to a central workstation so the ICU staff can re-motely monitor each patient.

The staff can also monitor and speak to patients with high-quality cameras and audio monitors that are installed in the pa-tients’ rooms. In addition, computer systems continuously analyze the data and alert staff if a patient is deteriorating.

A University of Massachusetts Medical School study investigated the impact that Philips Healthcare’s eICU Program had on almost 120,000 critical care patients across 56 ICUs, 32 hospitals and 19 health systems over the course of five years.

The researchers found that 26 percent of the patients were more likely to survive in the ICU, they were discharged from the ICU 20 percent faster and 16 percent were more likely to survive hospitalization and be discharged.

Addressing ventilator issuesVentilator induced lung injury (VILI) is a ma-jor problem in the ICU — 24 percent of all patients who are mechanically ventilated will develop VILI for reasons other than acute lung injury and acute respiratory distress syndrome.

“Those ventilator-induced injuries are reportable and are a huge focus for custom-ers to make sure they are on top of proper weaning, and managing the ventilating of their patients in the ICU,” says Kathy Forde, product manager of Life Care Solutions at GE Healthcare.

GE’s CARESCAPE R860 ventilator, which received FDA approval in July, was designed to address that issue. It’s equipped with lung protection tools that make sure that the dif-ferent zones of the lung receive the treat-ment they need.

With the CARESCAPE R860, clinicians can measure lung volume, possible lung recruitability, the capability of the lung al-veoli to open and titrate the right pressure in the lungs after exhalation. Its breathing trial mode helps clinicians determine which patients don’t require further ventilation, as

HealthCareBusiness news I august 201542

prolonged mechanical ventilation can cause complications.

Ventilators cause 50 percent of alarms and patient monitors cause the other 50 per-cent in the ICU, says Forde. GE has a tool on its central workstation that enables clinicians to print reports of the alarm traffic and man-age the alarm settings by bed.

“What you see is one or two patients are usually the offenders for alarms and their alarms may be set inappropriately or maybe they are appropriate and the patient is hav-ing a lot of arrhythmias,” says Forde.

As the elderly population in the U.S. grows, the strain on the ICU is also growing. “You think about the growing elderly popu-lation who are so frail and malnourished and that is a lot of the patients who end up in the ICU on a ventilator these days,” says Forde.

About 40 to 50 percent of patients in the ICU are malnourished, according to a study in the New England Journal of Medicine.

Traditionally, the dietitian tries to esti-mate a patient’s caloric needs or metabol-ic heart rate, which involves calibrating a cart, figuring out how to get it in line with the ventilator’s breathing circuit and wait-ing until the patient is in a steady state to measure.

The CARESCAPE R860 can measure the patient’s energy expenditure and tell the clini-cian exactly how many calories are required. It’s important to get the exact amount be-cause if patients are overfed, they retain car-bon dioxide and can’t be weaned off, and if they are underfed they lose muscle mass and are more prone to infection pressure sores.

If patients get the calories needed they leave the ICU in a much healthier state. “The patient has a better outcome and financially

we are saving millions of dollars for our facili-ties,” says Forde.

In 90 days, The Jewish Hospital — Mercy Health saved almost $9,000 per ICU patient by using the CARESCAPE R860 to track pa-tients’ nutritional status. Since there was a 28 percent decrease in the amount of time the patients needed to be ventilated, the hospital estimated it will be able to save $5 million per year.

CT in the ICU?If ICU patients need a CT exam, they will usually have to be transported to the radiol-ogy department, since many ICUs are not equipped with a CT. But now that a new CT that only requires 130.2 square feet of space is on the market, that may change in the near future.

Siemens Healthcare’s SOMATOM Scope CT received FDA approval in September 2014. To date, no hospitals have installed the CT in their ICUs, but Siemens believes that it’s something they should look into be-cause of the staff coordination and patient safety benefits.

“It’s very dangerous to move a patient that is that ill because there are so many chances of things getting unhooked or wires or IVs coming loose,” says Karol Nguyen, product manager of the SO-MATOM Scope CT.

At least three staff members — a respira-tory therapist, ICU nurse and patient trans-port personnel — need to work together to transport an ICU patient to the radiology department. Eliminating that would help hospitals cut costs.

“There is a cost associated with the staff-ing that is involved in the care supporting

that patient, because the three staff that you are using for that hour to transport that pa-tient could have been doing other things,” says Nguyen. “If something were to happen to that patient as they were being moved and their safety is compromised, there is a cost there, too.”

Treating with lightWhen caring for patients in the ICU, lighting may not be the first thing to come to mind, but research has shown that it plays an im-portant role. Philips Healthcare’s HealWell health care lighting incorporates light into the treatment of critical care patients.

“When you look in ICUs, the lighting is horrible. You have these really industrial lights and it’s more like a machine room than a hospital atmosphere,” says Carla Kriwet, CEO of patient care and monitoring solu-tions for Philips. “We are working on light-ing, which is not just more comfortable, but also part of the treatment process.”

Lighting plays an important role if pa-tients need to be calmed down due to fear or delirium, or if they need to be activated. The HealWell lighting system is automati-cally controlled based on algorithms that are linked to the patients’ monitors.

The German Heart Institute in Berlin is currently piloting HealWell in its ICU. It’s helping to support natural sleep rhythms by mimicking the natural light patterns outside, and it also helps relieve stress.

HealWell is not yet available in the U.S., but many facilities in other parts of the world have it installed. The Altona Children’s Hos-pital, Asklepios Clinic and Berhmannsheil Buer Clinic, all of which are in Germany, and University Medical Center in the Netherlands are a few of those facilities.

Now more than ever, hospitals are search-ing for solutions that help them achieve bet-ter outcomes and lower costs. Since one solution is not going to do the trick, the ICU has to be redesigned with that goal in mind.

Ventilators that provide exact measure-ments, smaller CTs that can fit inside a closet and lighting that contributes to the healing process are all pieces of the puzzle.Share this story: dotmed.com/news/27965

Industry Sector Report: ICU

‘There is a cost associated with the staffing that is involved in the care supporting that patient, because the three staff that you are using for that hour to transport that patient could have been doing other things. If something were to happen to that patient as they were being moved and their safety is compromised, there is a cost there, too.’


Diagnostic Directions

The Internet of Medical Things (IoMT) is the network of wireless medical de-vices and applications that connect with health care systems through real-time computing power. It is a unifying platform that addresses the “Internet of Things” needs for the medical industry. Examples of IoMT include remote monitoring of patients with chronic conditions; tracking patient medi-cation orders and the location of patients admitted to hospitals; and patients’ wear-able devices, which can send information to caregivers. Infusion pumps transmitting data in real time to clinicians’ dashboards and hospital beds rigged with sensors measuring patients’ vital signs are medical devices accel-erating the deployment of IoMT technology.

By 2020, experts predict that more than 20 billion everyday objects will be able to capture, receive and share data via a vast, interconnect-ed global network linked together by inex-pensive sensors and cloud computing power. Health care laws like the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that protects the privacy and security of patient data, and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 which supports the cre-ation of national health care infrastructure, are among the strong factors in the growth and development of a secured infrastructure for IoMT.

The Need for an IoMT PlatformThe health care industry is in need of an Internet of Things platform delivering con-sumer-centric care with an integrated set of health care services from the providers, payers, medical device manufacturers and pharmaceutical/life sciences companies. All these entities in the health care value chain are shifting from a product-centric view to a consumer/patient view. The consumer is in the middle of it all, no longer the product. IoMT plays a pivotal role in bringing the care team together to improve patient engage-ment across the continuum of care.

The HITECH Act and new policies for the meaningful use of patient care data now allow for increased monitoring of the patient at home that is beyond an off-the-shelf wearable. Health care needs to go where the patient is. The hos-pital or exam room is no longer the boundary. It’s about creating the ecosystem around the patient. How do you bring technology capabili-ties to the patient to get the biometric data and functional status on a real-time basis when they are not in the hospital or at their care provider? This is what is driving the need for an IoMT plat-form that can connect with the patient and collect data for meaningful clinical decisions.

Several major industry groups and gov-ernance bodies have emerged to establish standards-based guidelines and security for connected health technologies such as sen-sors, remote monitoring devices, tablets and smartphones, and gateways, as well as net-worked and cloud solutions. Continua is an international not-for-profit industry group and the leading organization promoting global technology industry standards to de-velop end-to-end, plug-and-play connec-tivity for personal connected health. Con-tinua’s design guidelines, based on global industry standards and test tools, enable more efficient, standardized development, and create new market opportunities for interoperable personal health devices and services used to collect and relay vital health information and education.

Consumer-centric Design ApproachCurrently, the main issue for medical device manufacturers is the ability to design and build IoMT as part of the product design and devel-opment cycle. Companies such as Amazon, Nike and Uber have shaken up the competi-tive landscape by raising the bar on consumer expectations. They don’t just provide useful products and services, they create unique experiences that people love. They do it by applying a user-centered perspective that un-earths opportunities to create products and

services that delight and empower customers.It is important to launch smart wireless

medical devices for IoMT that can be used by patients without any setup or learning curve. The medical device companies have to design every product with user experience and personalization in mind. The devices are going to be increasingly used by patients at home in an unsupervised environment. The device must work the moment the pa-tient gets it, with no setup, no assembly, no downloads and no syncing required. The device should be used in the exact same way as the regular, non-connected version of the device, so it’s simple for the user. The bat-tery in these devices should last for multiple months without needing to be recharged.

The IoMT is transforming the way medi-cal devices are used for delivering person-alized care. Patients will be the group that ultimately decides which devices will be adopted, so we must always remember to design these devices and tools for patients above all else. It is also remarkable that IoMT is getting much more established with wide adoption of connected devices in the health care industry. The future is focusing more on a network of smart medical devices, and health care is adopting IoMT platforms with an aim to improve personalized care overall.

About the author: Bipin Thomas is a renowned global thought-leader on consumer-centric health care transfor-mation. Thomas is an editorial advisory

board member of DOTmed HealthCare Business News and chairman of ICURO, a consumer-centric digital care outcomes research and management organization, where he is redefining personalized care delivery by connecting all stakeholders in the emerging health care ecosystem. Share this story: dotmed.com/news/27966

The Internet of medical thingsBy Bipin Thomas


Dow R. Wilson, President & CEO, Varian Medical Systems (left), and Dr. Arkadi Stolpner, founder, DTC.

Industry Sector Report: Mobile Medical

Upon returning home from World War II, Ian Smith, a first generation Austra-lian-American, partnered with Westing-house (then an X-ray manufacturer) to bring medical care to Cuba’s United Sug-ar Workers Union. Upon fulfilling delivery of 36 multiphasic mobile health clinics in 1949 for $600,000, the mobile imaging marketplace was born.

Smith’s company, Medical Coaches, has remained in business ever since. In the ‘70s, when CT was emerging as a costly and de-sirable new modality, Medical Coaches was preoccupied with business in Iran, leaving room for new competition to enter the do-mestic mobile imaging market.

Ellis & Watts out of Ohio and Calumet Coaches out of Illinois were among the first big competitors to meet that need. “That really started the boom of the mobile high-end screening business,” says Geoff Smith, president of Medical Coaches and son of Ian Smith.

Over the next decade or so, a handful of successful companies emerged and today most competitors in the mobile imaging market can trace their roots, in one way or another, to that bygone era when CT (and later MR) were new, and relatively exotic.

Shared Medical Services emerged out of northern Minnesota in 1980. Founder John

Arington’s success followed a similar path-way of expansion, adding MR to CT, as well as bone densitometry.

In 1983, Alliance HealthCare was found-ed as a mobile CT provider. Today it claims to be the largest provider of advanced outpa-tient diagnostic imaging services in the U.S.

Medical Imaging Centers of America (MICA) was another highly successful com-pany to rise up in this era. The company’s vice president and chief financial officer, Ray Stachowiak, used his knowledge and experience to start his own company, Shared Imaging, which has enjoyed over 20 years of success, and credits it largely to a footprint that allows it to provide flex-

The past, present and future of mobile imagingBy Gus Iversen

A mobile trailer from Shared Imaging


ible solutions to a diverse customer base. In 1995, Jim Gallagher joined the company and remained for 13 years before setting out on his own with LG Medical, a mobile imaging company.

In the early ‘90s PET started to gain ground as an imaging modality and was fol-lowed by PET/CT. It was around that time that Bob Bachman, formerly of Calumet Coaches, set out to start AK Specialty Ve-hicles with his business partner, Larry Sod-omire, which they sold to OshKosh in 2006. After that, Bachman and Sodomire started Advanced Mobility.

John Vartanian had been a service en-gineer for a number of companies before starting Medical Imaging Resources (MIR) in 1992.

All the while, Medical Coaches continued plugging away at its own mobile imaging business and it was relatively smooth sail-ing until the recession in 2008. The industry underwent drastic changes as revenue de-creased, trailer manufacturing fell off and new legislation called for a restructuring of the business model.

Today, acquisitions are hinting at new signs of life. In May, MIR was acquired by Oxford Instruments Healthcare, and last year, Kentucky Trailer purchased Advanced Mobility, a move Bachman says gave his

company the balance sheet and capacity to competitively leverage its knowledge of the industry.

In October, the newly formed Advanced Mobility by Kentucky Trailer acquired SMIT, a leading European provider of mobile medi-cal trailers. What led to the sudden increase in market activity? Bachman calls that the million-dollar question.

Rural hospitals and the ACAWhen advanced mobile imaging took off in the ‘70s and ‘80s, it was driven by the expense and scarcity of CT and MR. Today, an abundance of fixed installations and an evolved refurb market have eliminated a lot of those original market drivers. In rural ar-eas, however, a shared system can still seem like a logical solution.

Dale Hockel, chief operations officer of

Alliance HealthCare, says the lower patient volume in rural communities make them an ideal candidate for shared mobile ser-vice. “This is more viable than having the system sitting around not being utilized,” he says.

“I would say there has been an increase in activity from shared service providers. A few have recently bought multiples from us,” says Smith, with Medical Coaches, referenc-ing Cleveland Clinic as a hospital system that utilizes both fixed and mobile MR systems.

There are also significant capital expense benefits to not having fixed site installations, which bring their own unique demands for space and shielding. “As an alternative, I can buy [an MR] and plug it in and turn it on and be up and running,” says Vartanian. “That’s a lot easier than building the whole room, taking delivery of the system and rigging ev-erything in.”

“The way health care is moving, rural hospitals are taking the hardest hit in many ways,” says Juan Rocha, vice president of field operations at Shared Imaging. The company was founded in the interest of serving rural areas, but currently finds the demand for trailers to be strongest in metro-politan business.

“There is some growth simply because the population has increased, but most of that takes place in cities. People are leav-ing rural areas for work in city centers,” says Vartanian. He speculates that the business of mobile routes has no more room to expand for shared rural services.

For Oxford, the interim business is thriv-ing. As for the fixed-state units, Vartanian says people are becoming familiar with the

An early Brake Shoe X-ray mobile unit from Medical Coaches.


When advanced mobile imaging took off in the ‘70s and ‘80s, it was driven by the expense and scarcity of CT and MR. Today, an abundance of fixed

installations and an evolved refurb market have eliminated a lot of those original market drivers. In rural areas, however, a shared system

can still seem like a logical solution.


rules of the Affordable Care Act, and con-sequently entrepreneurial business is begin-ning to reemerge. “If you’re renting a build-ing, you don’t want to invest $300,000 into a room you don’t even own, so you say, ‘You know what I’ll do? I’ll bring a mobile in.’”

Mobile MR leads the wayMost mobile imaging companies agree that MRs are the most highly sought units on the market. Meanwhile, hospitals with smaller budgets are still keeping mobile CT units ac-tive, and some more advanced hospitals are turning toward nuclear imaging with PET/CT, or MCT.

For Oxford, Siemens and GE are the most highly sought MR system manufac-turers. As for PET/CT, “We have three trail-ers and we are not building into that space because it doesn’t seem to be growing,” says Vartanian.

There is some speculation that as PET/CT continues to expand its capabilities on the research front it will begin to gain greater ground among clinicians, but whether or not that shift has created any new market demand is a matter of some debate.

For Advanced Mobility, which works more directly with the OEMs than with the hospitals, the adoption of PET/CT has been apparent. “GE and Siemens both brought mobile PET/CT products to market last year and we have built several of each and have orders for several more,” says Bachman.

“Philips has had a good run again this year with a 70 cm-bore MR product, [Inge-nia] and hopefully the OEMs will continue to follow those paths of upgrading new sys-tems with different modalities,” he added.

In addition to the primary modalities, Medical Coaches has recently delivered a few Hologic bone densitometry units and is also doing a fair amount of mammography units, according to Geoff Smith.

Medical Coaches has also recently sold a few breast screening units that utilize CT. “There is a cup in the table where the breast goes in and CT will spin around it,” says Smith, adding that the image quality is extremely detailed, allowing for improved accuracy for biopsies.

The first mobile molecular breast im-aging vehicle is currently traveling around Wisconsin between five Marshfield Clinic Health System hospitals. The imaging allows secondary screening for women with dense breasts for whom traditional mammography is not always conclusive.

The mobile molecular breast imaging system is called the LumaGEM and is man-ufactured by Gamma Medica. Philip M. Croxford, the company’s president, says the system is small and light enough that install-

‘If you’re renting a building, you don’t want to invest $300,000 into a room you don’t even own, so you say, ‘You know what I’ll do? I’ll bring a mobile in.’ ‘


ing it on a trailer was less complicated than it would be for more cumbersome modalities.

Getting the OEMs to play ball“The fleets are aging, getting miles, rust-ing, hitting walls and getting damaged — a lot of stuff gets worn out and gets thrown away at some point,” says Vartanian. Oxford refurbishes some of those trailers back to their original specifications in order to get them back on the market with more modern technology.

Shared Imaging’s Rocha points out the engineering and regulatory hurdles that the manufacturers face in putting systems on wheels as a major deterrent, but if the mar-ket demand continues to grow, he specu-lates they may have to devote more energy to meeting it.

“Around 2002 the whole market was putting out about 200 systems per year, but around 2009 that dropped to 10-12 units per year for the entire industry” says Bach-man. “If we can get 50 or 60 new-build units in the U.S. market next year, that would be a good year.”

“The mobile industry has changed be-cause it’s extremely expensive to get into the business,” says Geoff Smith. “Not only the cost of having the right people and develop-ing the designs, but you also need certifica-tion and a lot of the vendors now just don’t do certifications anymore.”

Vartanian says the current output is a “trickle” compared to what it was nine or so years ago. The recession had everything to do with that, and as other countries have increasingly recognized the value of mo-bile imaging, the domestic fleet has further thinned.

For Philip Jacobus, the president of DOT med.com and Owen Kane Holdings, as well

as a board member of Diagnostic Treatment Centers in Russia, the international demand for mobile trailers represented a unique busi-ness opportunity. He says that between 2003 and 2014 he shipped over 100 mobile MR units to Russia.

“If there was a mobile trailer out there for sale, we would buy it, refurbish it and reuse it in Russia,” says Jacobus. “However, as a result of the problems in Ukraine, the sanc-tions in Russia, and the lower price of oil, that market has dramatically dropped off.”

“Mobiles are being dispersed from our country, going out all over the world, and not being replaced by the manufacturers right now — which all adds up to more demand than supply,” says Vartanian.

As the trailers in the U.S. grow older, they present new challenges. “In some cas-es you have to upgrade the trailer to meet new weight distributions or other different requirements,” says Rocha. “In a case like that you have to either go through the ex-pense of refurbishing the unit or else buy a new trailer.”

If the trailer still meets Department of Transportation requirements and satisfies clinical needs, however, Shared Imaging has programs to get the vehicles back in top form and looking good, which is a legitimate

consideration in the era of patient satisfac-tion ratings.

“We do a lot of refurbishing of existing units, the fleets that are owned and main-tained by Alliance HealthCare and Insight Im-aging,” says Bachman of Advanced Mobility, adding that his company rarely ventures into the broker market, but will refurbish for a cus-tomer who chooses to go in that direction.

Advanced Mobility by Kentucky Trailer has just acquired an additional 75,000 square feet of manufacturing space, which is as clear an indication as any that they fore-cast a changing of the tide. “When OEMs re-ceive orders from hospitals, we work behind the scenes to make sure we’re designing and building a product that supports their prod-uct most efficiently and works the way it’s supposed to,” he says.

Vartanian points out that their sales are based on volume, as evidence that the OEMs are unlikely to get back into mobilizing in earnest. “The old model of three hospitals buying in 100 percent for a five-year route — that business model is dying because the manufacturer still has to sell to an operator.”

A new era for mobile CT?Geoff Smith contrasts the current regulatory atmosphere with that of years gone by. “The Odelca 70mm X-ray for chest imaging was around for probably 15-20 years because nobody was developing anything better,” he says.

While few hospitals can make the case for having the most advanced technology available, new dose monitoring legislation like XR-29 is raising the bar on minimum re-quirements. For facilities that don’t step up to the new standards, reimbursement gets cut.

‘If there was a mobile trailer out there for sale, we would buy it, refurbish it and reuse it in Russia. However, as a result of the problems in Ukraine, the sanctions in Russia, and the lower price of oil, that market has dramatically dropped off.’

‘In some cases you have to upgrade the trailer to meet new weight distribu-tions or other different requirements. In a case like that you have to either

go through the expense of refurbishing the unit or else buy a new trailer.’



amstcorp.com

Mobilizing your medical mission with globally progressive, innovative engineering solutions and technologies. Advanced Mobility and Smit Manufacturing B.V., certified by all OEM partners to manufacture and recondition MRI, PET/CT and CT environments.

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Rocha calls XR-29 a “driving force” in the mobile imaging field. He anticipates some hospitals will take this opportunity to re-evaluate the distribution of their as-sets and perhaps continue long term with shared or trailer-based systems originally intended as interim.

For Advanced Mobility, getting the mo-bile CT market rolling again has been a topic of serious consideration. “Right now most of the CT is going in refurb trailers and we’re trying to figure out how to bring a lower priced new CT trailer to market within the next several months,” says Bachman. The challenge is in making a mobile CT economi-cally viable.

“We can’t put a $400,000 CT scanner in a $400,000 trailer, so we’re working on a lower price new-build CT trailer,” he says. As hospitals look for ways to mitigate the cost impact of adhering to standards like XR-29,

an affordable mobile solution could be a wel-come alternative.

“It’s a factor you cannot ignore,” says Hockel. Ensuring that a facility is updated and compliant with dose standardization will increasingly impact not only the quality of equipment being utilized by providers, but the quality of the CTs being offered in the mobile market.

“With health systems, the industry is continuing to create partners and solutions to provide the most patient-focused and economical model possible,” says Hockel. “There is an opportunity and a window that mobile solutions provide within that context, and it’s crucial to bring technological ad-vancements into the mobile environment.”Share this story: dotmed.com/news/27967

‘With health systems, the industry is continuing to create partners and solutions to provide the most patient-focused and economical model possible. There is an opportunity and a window that mobile solutions

provide within that context, and it’s crucial to bring technological advancements into the mobile environment.’


Advanced Mobility by Kentucky TrailerAdvanced Mobility and Smit Mobile Equipment B.V. by Kentucky Trailer is the mobile medical division of Kentucky Trailer. Our innovative new designs, engineering and manufacturing of new domestic and global ISO 9001:2008 certified MRI, PET/CT and CT medical units has made us the approved vendor by GE, Philips, Siemens and Toshiba serving the largest health care modalities for diagnostic and treatment providers worldwide. Let us help you start mobilizing your mission. Visit www.amstcorp.com or www.smit.eu.

La Boit Specialty Vehicles / “Medical Express”La Boit Specialty Vehicles introduces a new 26’ Mobile Medical Unit (Class-C) called the “Medical Express” and includes an option for a Digital X-Ray System, and designed for private Primary Health care providers. Also designed for Mobile Concierge Medicine that caters to the increasing demands and needs of today’s Baby Boomers!

Featherlite TrailersPut your medical solutions in motion. From mammogram to radiology to dozens of other versatile medical trailer platforms, discover how Featherlite Trailers can put your team in motion. Featherlite provides a comprehensive range of mobile solutions for the healthcare industry. We feature lighter, more durable aluminum trailers and truck bodies customized to your exact needs.

Medical Coaches Inc.Medical Coaches Inc., established in 1949, is a privately held, highly specialized manufacturer of custom mobile units that are ISO 9001 compliant. They have delivered thousands of mobile units to 110 countries and all 50 states, specializing in MRI, PET/CT, CT, mammography, dental, television, health screening and other modalities. They are certified to work with all major manufacturers (Siemens, General Electric and Philips).

Industry Sector Report: Mobile Medical Vehicles

DOTmed asked the leading mobile medical vehicle manufacturers to submit up to three of their products to be featured in this section. To learn more about these mobiles and see other models not shown, please visit: www.dotmed.com/mobile

DOTmedNEWEQUIPMENTGUIDEMOBILE MEDICALVEHICLES



Matthews Specialty VehiclesMatthews Specialty Vehicles is the nation’s premier specialty vehicle manufacturer. Since 1992, we have been the leader in the design and manufacture of purpose-built specialty vehicles. Our vehicles can be found serving private sector organizations, law enforcement agencies, governments and military organizations across the U.S. and around the world. Our brand hinges on our demonstrated durability, reliability, high-quality and overall customer satisfaction. If it’s got to be Mobile, Make it a Matthews! www.MSVehicles.com

Siemens Healthcare / Siemens Mobile MRI Complete, flexible mobile imaging solution combining Siemens’ MAGNETOM scanner technology with a dedicated trailer from Siemens-certified trailer manufacturer. Option of mobile-ready operation available for four Siemens 1.5T MRIs: MAGNETOM Espree, a 70 cm open bore system with Tim (total imaging matrix) technology; MAGNETOM Avanto, a short-bore system with Tim and Dot (day optimizing throughput) technology; MAGNETOM ESSENZA, an ultrashort, lightweight system with Tim technology; and MAGNETOM Symphony, a short-bore IPA (integrated panoramic array) RF system.

Modular DevicesSince 1987, Modular Devices Inc. has been the industry leader in interim Cath & Vascular Labs, with the largest in-stock inventory of systems available. Our interim lab fleet includes both Mobile Lab trailers and larger Modular Lab buildings with a variety of equipment configurations - including Cardiac Cath, Peripheral Vascular and CT Scanner systems. All leases include the industry’s only 24/7 service support program & applications training.

Siemens Healthcare / SOMATOM Scope Mobile CTNew mobile CT imaging vehicle designed to bring low-dose CT lung imaging to areas of need, including rural and remote settings. No commercial driver’s license (CDL) required to drive vehicle, which is ready to scan within minutes of parking and includes diesel generator and high-speed wireless connection. Patients can enter vehicle by stairs or wheelchair lift and watch videos prior to exam via installed TV/DVD player. Patient is scanned on Siemens’ SOMATOM Scope CT system using low-dose lung imaging protocol. Customer has option to customize vehicle’s exterior.


By Christoph Sitzer

The original equipment manufactur-ers (OEMs) of imaging equipment have long recognized that rigging and instal-lation are not part of their core business. In the past, OEMs’ service departments were in charge of delivering and installing new medical equipment, as well as handling emergency service calls and troubleshooting equipment problems. Because service calls take priority over routine installations, com-pletion delays caused by service call interrup-tions often upset the routine of performing rigging and mechanical installations.

As the pressure to reduce installation delays increased, while at the same time the demands on skilled OEM technicians to spend more time servicing equipment also increased, the OEMs started to look for outsourced solutions for their installation projects. They reached out to technical and

logistics service providers. Those specialized service providers have trained technicians on staff and are experienced in handling and shipping highly sensitive and valuable medical equipment via truck, air or sea. Ad-ditionally, these logistics companies could be seamlessly integrated into the overall project management with hospitals, general contractors and the OEMs of the medical equipment.

The technicians of service and logistics companies are specialized in certain systems (CT, MR, general X-ray, cardiography, PET, SPECT) and complete installations every week. Given the high frequency of installa-tion projects, these technicians have acquired a higher level of expertise and perform more efficiently than those who complete installa-tions at a much lower rate. Most often, the technicians are either factory trained or have

passed an OEM-audited internal training program. They are also more likely to have the correct tools available and the unique knowledge base to utilize the tools.

Since the installation is part of a highly complex supply chain of medical equipment from the factory to the hospital, these service and logistics companies have skilled profes-sionals onboard. They have the experience to effortlessly navigate both domestic and international logistics, including customs clearance and DOT regulations.

The overall project management/coor-dination of an installation is often under-valued, but it is critical for the success of the project. This is another area where the service and logistics company experts im-prove the process and outcome of any in-stallation. In cooperation with the hospital, general contractor and project managers

When do OEMs use special logistics and rigging companies, and when should you?

Feature: Transport Logistics


of the OEM, they define rigging paths for MRs, CTs and other heavy equipment. These logistics experts have access to industry networks and can obtain the right crane equipment and experienced rigging crews, proper forklifts and even obtain the required city permits, all while maintaining a focus on the project schedule. During the installa-tion process, they provide constant project updates to the appropriate parties and swiftly intervene if delays occur

Outsourcing installation to a service and logistics company is not always the least expensive solution. However, the end result is almost always a safe and efficient installation with minimal interruption to a hospital’s normal operations — a key element in today’s “patient-focused” environment.

For a moment let’s also discuss how important the customer satis-faction or the customer’s experience is in the overall project. There is no magic formula for this, however, in a very competitive marketplace, the slightest differences between imaging vendors are highlighted by the customer, based on their positive or negative experiences. If it is an efficient and professionally-handled project, the stakeholders have less to worry about, and confirm that they have made the right equipment purchase decision. So what value do you put on excellent customer satisfaction? If the business goal is to secure repeat business or enhance the customer’s experience, then one has to make sure the very best logistics vendors are contracted to handle the job.

When it comes to de-installation and relocation of used medical equipment, including de-installation for resale, the experience gained by logistics companies that work with OEMs provides expertise that can help make even the most difficult de-installs go smoothly. In ad-dition, they carry extensive insurance coverage that is compliant with market standards.

In many cases, the particular system and its components require special transportation devices and frames for de-installation, and specialized logistics companies will have these items. Far too often, extensive and costly damage occurs due to negligence and lack of ex-perience with various systems, especially Biplane, CT or MR systems.

One thing to remember when you are arranging to hire a de-installation logistics company is ask your colleagues in your region for referrals. And start early. You don’t want to begin looking for a de-installer the same week you want the job done. Send plenty of photographs of the equipment and its location to prospective de-installers so they can see what the job might entail. Get quotes from several companies, but don’t go by price alone — a lowball offer might be attractive but could cost you dearly in the end.

Here are questions about your special logistics provider you want answered:• Do they have experience working in the health care environment?• Do they have dedicated cross functional teams? (multi-modalities)• Do they have dedicated rigging/mechanical teams?• Do they use qualified professional third-party riggers, when needed?• Do they offer site visits prior to project start?• Do they have a quality management system in place?

(“ISO Certification”)

• Do they have their own tool management system?• Do they have proper property and casualty insurance?• Have you visited their facility? Is it clean and organized?• And always ask for references.

Once you choose your de-installer, set a firm date to have the job done. Be aware that for equipment like CTs and MRs, it may take more than one day to remove the machine. Also make sure everyone at your facility who should know, does know about the de-install. The facility manager needs to communicate with the imaging department, security, the maintenance staff, etc., so no one is surprised when the job starts. The machine should be decommissioned and ready to be removed before the logistics company arrives.

The above overview of service and logistics companies should provide food for thought when deciding on service providers for instal-lation and de-installation projects in your hos-pital system.

Christoph Sitzer is the CEO of Hegele Logistic, in Wood Dale, Illinois.Share this story: dotmed.com/news/27968



There is a lot to consider before bring-ing any new piece of equipment home to the hospital. This is especially true when you’re preparing to rent a temporary or per-manent mobile MRI, CT or PET/CT system. HealthCare Business News spoke with Don-ald McCormack, the chief executive officer of Southwest Medical Resources, to get an idea of what to expect when you’re expect-ing a mobile unit.

HCB News: How far ahead should you plan to rent a mobile unit?

DM: In the past, they were readily avail-able when you needed them, but in this last year we’ve seen a significant change in demand. Back in 2008, there were several mobile companies building trailers, and now there are very few and their capacity is much lower than it was back then. You need to be doing a rental as far in advance as possible.

The real solution here is to have a Rolodex with numerous companies who can provide these services to you to really get an answer. Two or three months is the minimum time if you’re looking for a long-term production. In our company, I need 90 to 120 days to build a mobile solution to suit.

HCB News: Do you need a special lo-cation for the mobile unit?

DM: There are three ways to go about this. The most preferred, when you have a mobile that you’re going to use for an ex-tended period of time, is a concrete pad that’s poured specifically for the use of mobiles. For short-term interim needs, it is perfectly acceptable to use an asphalt lo-cation, five or six parking spots that are set aside. But, it’s really important to note that they’re going to put steel plates underneath the landing legs of the mobile to disperse the weight and that there will be damage to the asphalt, especially if it’s a really hot environment. The mobile provider will never

take responsibility for this and you will end up with some parking lot damage if it’s really hot. An interim solution to that is a pad for each wheel.

The last one that is the least desirable, but has been used for short-term solutions, is having compacted dirt. This is only good in arid climates and it’s only for really short-term solutions.

HCB News: What are the power re-quirements?

DM: Depending on the type of mobile that you’re going to be putting in place, it’s always 480/three-phase power as the maxi-mum, and 200 amps is the maximum need.

The power requirements are typically a Rus-sellstoll connector for a mobile unit. That’s a four- or five-wire [connection] and the OEMs decide which one they’re using. That four- or five-wire connection can be adapted. So, if you’re putting one in your facility, it’s bet-ter to have a five-wire Russellstoll connector than to use an adapted connection to go down to the four-wire for the mobile if you get one that’s a four wire.

The other way the power is hooked up is by hardwiring the trailer into the facility, but you have to be aware and make sure that you get a licensed electrical contractor and/or certified staff of the facility.

The last, and least desirable, is a genera-

tor. This should only be considered as a tem-porary solution. I’ve had situations in which the generator was as expensive as the mo-bile unit.

HCB News: What are the state, coun-ty and city regulatory requirements?

DM: It’s important to note that a lot of states require Certificates of Need, and this is typically related to demographics of the local area and utilization rates. So, a lot of times, if you have the demand, you can get past the Certificate of Need, especially for a mobile interim solution. But, if it’s going to go any time longer than that, you’ll have to get a Certificate of Need.

What to do before the ‘new baby’ arrives(The baby, in this case, is a mobile medical trailer)By Lisa Chamoff

Back in 2008, there were several mobile companies building trailers, and now there are very few and their capacity is much lower than it was back

then. You need to be doing a rental as far in advance as possible.


There [may also be] health department and/or Housing and Urban Development codes. Make sure that the trailer you’re getting comes pre-certified for whatever local health department and/or HUD stick-ers you might need. There are insurance requirements by the mobile provider that some states and counties require. You show proof of it and you have to have it up and mounted.

HCB News: Are there security con-cerns?

DM: The trailers usually come with locks on the doors and underneath the belly boxes. The technologists should be locking up the trailers when they leave them, every time they go inside the facility. It is a pain, but it should be done. We’ve had situations in which people have taken up residence inside of our equipment be-cause it was left open.

It’s common to set up barriers to keep cars and trucks from getting too close to the equipment. When the rented equipment is in your facility, you’re responsible for it, so damage from somebody backing into it can cause trouble.

On the MRI side, it is necessary to keep some distance from the magnet, especially on some of the older systems, in order to keep the quality of the images coming out of it as good as possible. A three- to eight-foot barrier is common. Newer technology needs no more than 3 feet.

HCB News: Are there wear and tear concerns, and should a facility be wary

of any unanticipated expenses associ-ated with the rental?

DM: It’s common to see additional charg-es for abnormal wear and tear, so be very careful here. Make sure your personnel are very aware if there is a deposit. It’s common for the personnel that are using the mobile to go, ‘Hey, this is just a temporary thing’ and not take care of it, and it can cost you a lot of money.

HCB News: What can be done to help make the patient experience better?

DM: If you’re doing something more

permanent, [I’ve seen] grass settings around them, picnic benches set up around them, planters, ramps leading up to them.

You can even pull one inside, so you don’t even know you’re in a mobile. (If) there’s a service entrance at the back of the building where you have a roll-up door, the mobile pulls in and parks and then there’s this hood that extends the hallway and connects it to the side of the building, so you never actually walk into a mobile. Share this story: dotmed.com/news/27969

It’s common to set up barriers to keep cars and trucks from getting too close to the equipment. When the rented equipment is in your facility, you’re responsible for it, so damage from somebody backing into it can cause trouble.



When your facility is planning to install a piece of equipment (such as a large air conditioning unit) that requires a mo-bile hydraulic crane, keep in mind that renting a crane is only part of the job.

You also need a rigger. The rigger is the person (or people) who will put the straps, chains and cables in place that make the “lift” or “pick,” as it is called in the trade, possible. Riggers can also do the many other tasks needed to be accomplished, based on

complexity and nature of the job.Depending on your region of the country,

some crane rental companies will also pro-vide the rigging crew, but that’s usually not the case in most big cities.

“When you need a crane, you really need a rigger and a crane, and I’d look for a rig-ger first,” says Michael Ahng of LaGrange Crane Service. “They can take a lot off your plate. They get involved in all aspects of a job, not just the lift.

“If windows have to come out or doors removed to provide access for the installa-tion, however, that’s not the rigger’s job. The facilities management department at the hospital is responsible for things like that.”

That’s just one example where you need to plan ahead and determine who should do what. Don’t assume you know what the crane operator’s and the rigger’s responsi-bilities are. Ask direct questions, and if nec-essary, get the answers in writing. Also, be aware of local union regulations and jurisdic-tions. Sometimes simply turning on an elec-trical switch, if not done by a union member, can have them shut your job down.

Start early to avoid problemsAccording to Ahng, the biggest problem when renting a crane is that “the hospital doesn’t plan far enough ahead when it comes to renting the crane. They get everything else in place and then call the crane company and riggers last. You don’t want your crane rental to be a last-minute decision.”

Communication is the key. If you’re installing an A/C unit, you need to let the HVAC company that’s going to hook up the system to your facility’s plumbing know when the “pick” is scheduled, and if that date changes, let them know. Let the crane company and rigger know, too.

We can’t say it enough: communication is the key.

“When you’re renting a crane,” John Cereghino of JC Duggan says, “that’s a high-risk operation, so get your insurance broker involved at an early stage. Make sure they require both the crane company and the rigger to have the correct property and casualty limits for the risks the job entails. This is critical. And that ballpark would be limits from $2 million to $10 million.

“You also want a clear line of responsi-bility. Suppose you want to save money by renting the crane yourself, instead of having the rigger do it, which means he’ll mark it up. Then suppose there’s an accident and something is damaged or broken. Whose responsibility is it? The crane company? The rigger? It’s not always clear. In fact, it’s almost never clear in those situations, and you don’t want to face that dilemma.”

How to make renting a crane an uplifting experience10 tips on making light work of heavy liftingBy Robert Garment


You want a qualified rigger handling your equipment, and a qualified rigger possesses a certificate that attests to that. Ask to see it. The same goes for the crane operator. All legitimate crane operators are licensed, so make them prove it.

You also want to get multiple bids on your job.

“But as we all know,” Ahng notes, “shopping just on the basis of price alone is never a good idea. A low bid may mean the company might try cutting corners and that could result in major problems.”

What size crane do I need?The size and type of crane you need will be de-termined, primarily, by the gross weight (and possibly the shape) of the unit being lifted. The other important factor is the distance the load has to travel from the pivot point of the crane to the area where it’s being installed. This will determine the length of the crane’s boom. It’s best to rely on the recommenda-tion of the crane company and/or the rigger regarding the right crane for your job. It’s also good to get several quotes. Then you can see and compare the different mobile cranes you are offered and ask informed questions.

Cranes always need travel permits. They’re all overweight, and many have those “wide load” tail signs which restrict the roads they can travel on. Ahng says, “the travel permit will map out the route the crane must take to reach your facility, and these permits

cost money. If you change the installation date and neglect to alert the crane company, re-booking it is going to be a costly mistake.”

The following are the top 10 tips for renting a crane:1. Spend the time to get competitive bids on

the project. Engage your crane companies and invite them to perform a site survey.

2. Book your crane in advance. The last thing you want to do is not have the crane avail-able on the date your equipment is being delivered.

3. Involve the site facilities team on the plan-ning and coordination of the crane pick. They are vital to making sure that areas are clear and cordoned off.

4. If possible, plan your crane pick during normal working hours, Monday through Friday. Premium-time picks can cost a lot of money, and many times there are costly minimums associated with them.

5. Have a plan for rigging the equipment and have the proper rigging equipment on site for the project. Many crane com-panies can provide the rigging for the lift, but keep in mind they may not hook up the rigging to the equipment.

6. Coordinate the transportation of your equipment to the project site. Make sure you are not waiting around for the truck with the unit being installed to show up.

7. Inquire with the local municipality about permits. Some cities require permits for

closing sidewalks, parking lanes and traf-fic lanes. Some will just require proper notice.

8. If windows, doors, or walls have to be re-moved to provide access, remember that’s not the rigger’s job, it’s yours, and make sure it’s done in advance.

9. Communication is key. Keeping every-one aware of what is going on is vital to having your project and crane pick go smoothly.

10. Always get references on both the crane company and rigger you want to hire.

Keeping these things in mind can help you avoid unexpected costs and help your project go off without a hitch. The most im-portant item is to get your crane company involved at the beginning stages of the proj-

ect and keep them informed as you progress through the planning stages to the actual “lift” date.

Michael Ahng is project manager at LaGrange Crane Service in Hodg-kins, Illinois. John Cereghino is vice president at JC Duggan Inc., in Brooklyn, New York.

Share this story: dotmed.com/news/27970

Michael Ahng

John Cereghino


Joann Anderson

Priya Bathija

Maggie Elehwany

Ellen Kugler

Michael Lutes

John Raffoul

By Lisa Chamoff

In the early 1990s, White Memorial Medical Center, a 353-bed, not-for-prof-it teaching hospital in East Los Angeles, was struggling and the leadership was contemplating putting the facility up for sale. What ended up breathing life back into White Memorial was the Disproportion-ate Share Hospital (DSH) program, which covers the cost of providing care to unin-sured patients.

The hospital, in an area where close to half the residents live below the poverty line and which provides $26 million worth of free or uncompensated care per year, is again in

uncertain times, with the expected reduction of Medicare DSH payments by $22.1 billion through 2019, according to the American Hospital Association.

“That really harms the inner-city hospi-tals because we live and die by that money,” says John Raffoul, White Memorial’s presi-dent and chief executive officer.

For both urban and rural facilities, it’s death by a thousand cuts — there are also 2 percent Medicare sequestration cuts, created in 2013 after the country went over the “fiscal cliff,” and readmis-sion penalties, in which hospitals with the

highest readmission rates lose 3 percent of each payment, and which impact ar-eas with a larger number of impoverished residents more acutely. A number of stud-ies, including one published recently in the journal JAMA Internal Medicine, have shown that socioeconomic factors have more of an impact on readmissions than hospital performance.

“Patient characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmis-sion risk between patients admitted to hos-pitals with higher (versus) lower readmission

Will the Save Rural Hospitals Act save rural hospitals?

Feature: Rural Health/Urban Health


rates,” wrote the authors of the JAMA study. “Hospitals with high readmission rates may be penalized to a large extent based on the patients they serve.”

There is some hope on the horizon. In March, the Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 was introduced in both the U.S. Senate and the House of Representatives. The legislation would require the Centers for Medicare and Medicaid Services (CMS) to take the socioeconomic status of patients served by the hospital, as well as the propor-tion of patients eligible for both Medicare and Medicaid, into account when assessing readmission penalties.

“CMS has the ability to address that,” says Ellen Kugler, executive director of the National Association of Urban Hospitals, which has endorsed the bill.

Raffoul says the leadership at his hospital has been aiming to reduce costs and im-prove care to soften the impact of the cuts.

Last year, they brought in a consulting firm to find efficiencies, reducing labor and sup-ply costs and finding $10 million in savings by looking at the hospital’s revenue cycle. The hospital also formed a committee that is looking at ways the facility can improve care for patients with hip and knee issues and reduce cases of sepsis. The hospital partners with outside groups, including home health care agencies and hospice care, to reduce readmissions. Raffoul says the facility has cut its infection rates in half and won a series of awards.

“We’re proud of the things that we’re doing despite the fact that we’re facing all these cuts,” Raffoul says.

But even in spite of the gains White Me-morial has made in the last 20 to 30 years, there is always the worry that the amount of the cuts, and the speed at which they are being implemented, will propel the facility back into uncertainty.

“We are thankful we have been able to

survive these cuts,” Raffoul says. “I can tell you that looking forward, unless some of these initiatives are frozen or taken off the table, we will be put in the same spot in the next few years.”

Continued rural closuresRural hospitals face many of the same chal-lenges as facilities in large metropolitan areas — DSH and other cuts to reimbursements also impact rural facilities — though limited access to public transportation and a popu-lation that tends to skew older, and that is less financially secure because of losses in manufacturing jobs, also hurt.

A lower population also hurts rural facili-ties, even with the transition from volume- to value-based reimbursement, says Joann Anderson, president and CEO of South-eastern Health, a nonprofit health system in Lumberton, N.C., that runs a 452-bed facility with acute care, intensive care and psychiatric services.


Feature: Rural Health

Compared to an urban facility that may treat 100 patients for a similar issue, a rural hospital with one bad outcome is more likely to be penalized, Anderson says.

“The way the value is being measured is the percentage of patients with expected outcomes,” Anderson says. “That scale is difficult for us.”

The picture for rural hospitals is similar to last year, with hospitals closing at a rapid pace. Some say this is due to a number of states blocking the Medicaid expansion offered under the Affordable Care Act, though many agree that other factors have combined to make it a particularly tough climate. The North Carolina Rural Health Research Program has estimated 57 rural hospital closures from January 2010 to the present nationwide.

Maggie Elehwany, vice president of government affairs and policy at the Nation-al Rural Health Association, says the situation has only gotten worse in the last year, and estimates there are more than 280 hospitals on the verge of closure.

“What we are seeing is finally a greater recognition of the problem,” Elehwany says.

In July, U.S. Rep. Sam Graves, R-Mis-souri, introduced the Save Rural Hospitals Act. The legislation would essentially re-move the cuts and penalties that hit ru-ral hospitals particularly hard — among other things, it would eliminate Medicare sequestration cuts for rural hospitals, elim-inate rural Medicare and Medicaid DSH reductions and delay the application of penalties for failure to achieve meaningful use with electronic health records. It would also eliminate the requirement for doctors to certify that a Medicare patient will be

discharged or transferred to another hos-pital within 96 hours, which is a condition of payment.

The bill, which is currently with the House Subcommittee on Health, would also reverse cuts to federal reimbursement of bad debt for critical access hospitals and rural hospitals, which has a big impact on these facilities.

“There have been studies done on the impact bad debt alone is having on rural hospitals,” Elehwany says. “We know those cuts have had a horrific impact on rural providers.”

The National Rural Health Association worked with Congressional offices to help get the bill introduced. The main solutions, Elehwany says, are stopping the various cuts in Medicare and figuring out a new model for rural hospitals.

“We haven’t developed a model since 1997 with critical access hospitals,” Elehwa-ny says.

A Senate bill introduced in June by Sen. Chuck Grassley, R-Iowa, would designate critical access hospitals, or a hospital with a maximum of 50 beds in a rural community, as a rural emergency hospital, meaning the facility would have to provide 24-hour emer-gency medical and observation care.

“It’s really targeted at those small strug-gling rural hospitals that have a small inpa-tient volume,” says Priya Bathija, senior associate director of policy for the American Hospital Association. “It will be interesting to see how it moves forward. We think that these ED proposals are a step in the right direction, but it’s not a “one size fits all” so-lution for rural hospitals.”

The American Hospital Association re-cently created a task force on ensuring ac-

cess to health care in vulnerable communities that is exploring other models. Anderson, of Southeastern Health, is one of the task force members. While the AHA task force is in the early stages of its work, Anderson says her organization has been taking proactive steps to avoid becoming a vulnerable rural hospital. Southeastern Health has expanded its clinics to more rural communities, so travel is less of an issue for patients, opened same-day clinics for people who can’t make a set appointment and also offers telemedicine services, though that comes with increased costs that many rural facilities may struggle with.

Southeastern Health has also partnered with Campbell University, a private univer-sity in Buies Creek, N.C., to create an osteo-pathic medicine program with the goal of addressing physician shortages, which is an issue in rural areas. They now have 40 stu-dents training through the program, as well as 25 residents who have graduated from other programs helping to start a residency program in family and emergency medicine.

“Our goal is to try to infuse physicians in the area through that training program,” Anderson says. “We believe if they are trained in a rural community they will stay in a rural community.”

Being a member of the Coastal Carolina Health Alliance, a network of nine hospitals, also helps. The alliance reduces costs with group purchasing and collaborative educa-tional offerings.

“It’s difficult, particularly if you’re not as-sociated with a larger institution,” Anderson says.

There are also initiatives not connected to reimbursement, including providing com-munity education on diabetes and other common health issues, and partnering with local churches, which are very important in rural communities. There are 13 churches in Southeastern Health’s communities involved in health education; one church even takes breaks from services to allow worshippers to exercise.

“There’s no payment for that, but we believe we’re helping the community [by teaching them] that they can impact their own health,” Anderson says.

‘We are thankful we have been able to survive these cuts. I can tell you that looking forward, unless some of these initiatives are frozen or taken off the table, we will be put in the same spot in the next few years.’


The organization is seeing results from its efforts. In the past five years, after opening up access to primary care clin-ics in more remote locations, emergency room visits have gone down by 12,000 per year, from 80,000 to 68,000 visits. They are also beginning to see admissions reduced because of disease management through primary care.

Some facilities are already creating new models of delivering care. In July 2014, the Carolinas HealthCare System Anson in Wadesboro, N.C., created a new model, which HCB News reported on last year. They built a new hospital, cutting the number of inpatient beds from 52 to 15 and keeping the emergency department. While the new facility still offers surgical procedures, as well as radiology, laboratory, pharmacy and other inpatient services, the big difference is that there is now a patient-centered medical home that is embedded

within the ED. The aim is to provide pri-mary care and cut down on costly and un-necessary ER utilization.

Michael Lutes, a senior vice president with Carolinas HealthCare System, says the health system’s experiment has paid off. ER visits at the new facility were down 6 percent in the first year, while visits to the primary care medical home were up 101 percent, from 5,100 visits to more than 10,300 visits (there had previously been a standalone primary care office before the switch, though it was not connected to the ED). Lutes compares this to the greater Charlotte, N.C., market, where ED visits were up 7 percent.

The system has also recognized the cor-relation between mental health and many chronic diseases, having therapists see pa-tients in an outpatient setting, in the ER and at the medical home.

While the Carolinas HealthCare Sys-

tem’s new model might not be workable in every market, it could be something that some health systems can look to for inspi-ration.

“I think this model could work in most rural communities, but you have to have the resources and we’re fortunate to be part of a health care system that has [resources such as] telemedicine,” Lutes says. “It’s a challenge for most rural hospitals if they’re not part of a health system. But, from a care perspective, it’s the right model for rural communities.”

While Lutes declined to reveal specifics about the hospital’s financial picture, he says the model is financially feasible.

“It’s a financially sustainable model that allows us to pursue our mission,” Lutes says. “If we were operating under our previous model, it would not be financially sustainable.”Share this story: dotmed.com/news/27971


By Aine Cryts

As they do every year, many of them toughed it out for the 26.2 miles from Hopkinton, Mass., to Boston. Unlike the more than 30,000 runners who converge on Massachusetts every April to run in the Boston Marathon, these 9,000 walkers weren’t in pursuit of their fastest time — or a gold medal.

On Sept. 27, participants in the Boston Marathon Jimmy Fund Walk laced up their walking shoes to raise money for Boston’s Dana-Farber Cancer Institute, which treats all forms of adult and pediatric cancers and describes itself as a leader in innovative can-cer research. Raising more than $100 mil-

lion during its 27-year history, the Boston Marathon Jimmy Fund Walk raises the most money of any single-day walk in the nation, according to Dana-Farber.

“[The walk] energizes me to build rela-tionships with such passionate people, who care about doing good,” said Zach Black-burn, assistant vice president of the Boston Marathon Jimmy Fund Walk. “They’re walk-ing in honor of a loved one or a colleague, or for themselves.”

Participants don’t have to walk all 26.2 miles of the Boston Marathon route to par-ticipate. They can also choose from a 13.1- mile route, a 5-mile route or a 3-mile route.

The Jimmy Fund, which organizes the walk each year, traces its history to 1948 and a patient named Einar Gustafson — the original “Jimmy” — who was a 12-year-old patient of Dr. Sidney Farber, founder of Dana-Farber. During his treatment, Gus-tafson (who was given the name “Jimmy” to protect his identity) wanted a TV in his room at Dana-Farber so he could watch the Boston Braves, his favorite baseball team.

The original “Jimmy” was interviewed on a national radio program called “Truth or Consequences,” which was broadcast from his hospital room. At the end of the show, listeners were asked to send money so

Communities making a difference for local hospitals

Feature: Charity


Gustafson could buy a TV. He got his TV — and listeners also sent more than $200,000, which led to the start of the Jimmy Fund.

The money raised by the Boston Mara-thon Jimmy Fund Walk goes in equal parts to research and patient care, according to Blackburn. The walk attracts support from New England and beyond. People around the country can donate to the Boston Mara-thon Jimmy Fund Walk by visiting www.jim-myfundwalk.org/give.

This year’s walk was expected to raise more than $8.2 million by Oct. 31.

Raising awareness about breast reconstruction after breast cancer surgeryA lot of people think about the color pink during the month of October, which is breast cancer awareness month, said Dr. Carolyn De La Cruz, assistant professor of plastic surgery at the University of Pittsburgh School of Medicine and chair of Breast Re-

construction Awareness (or “BRA”) Day Pittsburgh.

What most people don’t think about is breast reconstruction after breast cancer surgery. That’s precisely the reason that De La Cruz decided to get involved in BRA Day USA about four years ago. Since then, BRA Day Pittsburgh has raised about $20,000. A portion of that money goes to support BRA Day USA, whereas the remainder is used lo-cally for education and awareness events.

Organized on a national level by the American Society of Plastic Surgeons and the Plastic Surgery Foundation, BRA Day USA provides an opportunity to educate commu-nities around the country about the ability to reconstruct the breast after total mastecto-mies due to a breast cancer diagnosis, said De La Cruz.

If you’ve had to lose your whole breast, it’s harder to get on with things, she said. Still, only 20 percent of women fully under-stand their breast reconstruction options,

according to BRA Day USA. “Women think they’re vain [to consider breast reconstruc-tion]. Women in general learn to live with it. That’s women’s nature,” said De La Cruz.

BRA Day Pittsburgh 2015, which took place at Pittsburgh’s Andy Warhol Museum on Oct. 21, featured an art show with man-nequin busts created by local artists, some of whom are breast cancer survivors. The event included performances by a modern dance and live music ensemble called the Attack Theatre, and the Pittsburgh Dance Company. Money was raised from tickets purchased for the event and the sale of mannequins.

As Robert F. Kennedy once put it, “The purpose of life is to contribute in some way to making things better.” Maybe it’s creating a piece of art or attending an event — or adding mileage to your walking shoes. How-ever you can help further the mission of your local hospital, it’s time to contribute.Share this story: dotmed.com/news/27972


Best of the Year

Best of 2015Welcome to the best of 2015! Every year, HealthCare Business News provides a rundown of award recipients from top health care associations. If an association you belong to isn’t highlighted in the following pages, let us know and we’ll consider them for inclusion in next year’s issue.

Share this story: dotmed.com/news/27875

ACR

AAMI

ACR Gold MedalThe American College of Radiology’s highest honor, the ACR Gold Medal, is awarded annually to radiologists, radiation oncologists, medical physicists and other scientists for their distinguished and extraordinary service to the ACR or to the discipline of radiology.

Dr. Carl R. Bogardus Jr., FACR, of the Stephenson Cancer Center and University of Oklahoma describes his introduction to radiation oncology as love at first sight. He appreciates the opportunity the specialty affords him to both delve into physics and spend time with patients. From teaching to private practice, business to consulting, Bo-gardus’ interests and abilities range widely. In his 48 years of membership and service to the ACR, he has been a member of the Board of Chancellors (1985–1992), serving as

secretary (1987–1991) and president (1991–1992). He served as president of ASTRO and ACR simultaneously. Bogardus is adamant that the ACR has shaped his career and insists many of his accomplishments would have been impossible without the College.

Alongside his work in the ACR, Bogardus has devoted most of his career to developing the Radiation Oncology Coding and Nomenclature System, which he feels will be his most lasting contribution. In 2000, he started ONCOCHART electronic medical record, now one of the primary software programs used for management, documentation, charge capture and compliance in radiation oncology. He is also the author of 65 articles and eight textbook chapters and has developed several other software programs specific to radiologic oncology and billing.

The AAMI Foundation’s Laufman-Greatbatch AwardThis is AAMI’s most prestigious award. Named after two pioneers in the field — Harold Laufman, M.D. and Wilson Greatbatch, Ph.D. — this highly regarded award honors an individual or group that has made a unique and significant contribution to the advance-ment of health care technology and systems, service, patient care or patient safety.

Candidates must demonstrate a significant, singular, and global impact on the ad-vancement of patient care or patient safety through the advancement, development, enhancement or creation of a specific medical device, technology, system or service.

This year, the award honored Dr. Masakazu Tsuzuki, professor emeritus, The University of Tokyo; and former president of the Japanese Society of Medical Instru-mentation.

Tsuzuki received the award due to his role as a pioneering figure in health care technology in Japan. As a leader of JSMI, he has helped build ties with AAMI, participating in the AAMI Annual Conference & Expo for 25 consecutive years. His peers have praised him for his championing the use of standards around the world. Tsuzuki has authored or co-authored more than 450 scientific papers during his career.


AHRA

AHRA Gold AwardThe award is the highest honor AHRA can bestow upon its members. It is given to members who have made significant contributions to the association and, thus, to the profession of health care administration. Nominations for the Gold Award come from the membership, and any member may nominate a candidate. All members of AHRA are eligible for award consideration.

Paul Dubiel has been an active member of the AHRA since 1993, earning his CRA and achieving Fellow status in 2011.

Dubiel’s commitment to the association and to advancing the profession of medical imaging is obvious. Dubiel’s volunteer career began in 2000 with the Member Greets a Member Program, followed by the Audioconference Task Force in 2005 and the Image

Advisory Council three years later. Dubiel was one of the initial members of the Product Development Committee from 2008 to 2009, and served as chair from 2010 to 2013. Dubiel has also served as a mentor, volunteered onsite during multiple annual meetings, and served on the Expanding Excellence Campaign.

Radiology management is where Dubiel has truly excelled as a volunteer. Dubiel has served on the Editorial Review Board since 2010 and has been Editor-in-Chief since 2012. Dubiel’s written contributions are numerous, including three Radiology Manage-ment Editorial award winners: “Thinking Strategically About Imaging Capacity and Capital” (Jan/Feb 2006), “Preparing for a JCAHO Survey: Utilization of Imaging Specific Tracers” (March/April 2007) and “Finding and Mentoring the Next You” (2013 Supplement Issue, July-August 2013). In addition to his work with Radiology Management, Dubiel was an editor for Financial Management in Radiology (2nd Edition) and conducted a peer review for Basic Imaging Management: A Reference Manual. In 2010, Dubiel was a moderator for the “Career Ladders” Round Table Discussion at the annual meeting. At the 2005 annual meeting, Dubiel was a co-presenter for “Planning Long-term requirements for Diagnostic Imaging Capacity and Capital.”

ARRSThe ARRS Gold Medal The ARRS Gold Medal is the American Roentgen Ray Society’s highest honor, awarded to recipients for distinguished service to radiology. Three recipients were named this year.

A native of Melbourne, Australia, Paul A. Bottomley is a pioneer in the develop-ment of MRI technology. While earning his Ph.D. in physics at Nottingham University, he worked on one of the three original projects that launched MRI technology and performed the initial work on radiofrequency field and power deposition in human MRI. Bottomley was a member of visionary Raymond Andrew’s group which, along with that of Peter Mansfield, built the first MRI system producing radiographic-quality images of the human wrist. After completing his Ph.D., he adapted MRI for spatially localized spectroscopy (MRS) for Johns Hopkins University, using surface coils to demonstrate metabolite depletion and reversal in regional myocardial ischemia.

Bottomley later joined the General Electric Research Center in Schenectady, N.Y., which built the first high-field whole-body MRI-MRS system, overcoming problems

of coil design, radiofrequency penetration and signal-to-noise ratio. In addition to these and countless other achievements, Bot-tomley has published approximately 180 peer-reviewed papers and holds nearly 50 patents. He is an International Society for Magnetic Resonance in Medicine (ISMRM) fellow and gold medal recipient, and a General Electric Gold Patent and Coolidge Fellowship awardee.


Best of the Year

ARRS

William G. Bradley, Jr. is professor and chairman of the department of radiology at the University of California, San Diego. He earned a Bachelor of Science degree at the California Institute of Technology and a Ph.D. at Princeton University, and completed his medical training at the University of California, San Francisco. He was an ISMRM president and has received its two highest honors for his research: gold medal and honorary member. Dr. Bradley has also received gold medals from the Radiological Society of North America (RSNA) and the American College of Radiology (ACR).

Bradley first became involved in MRI at the University of California, San Francisco, in the late 1970s, translating the physics of MRI for other radiologists. His subsequent research has focused on MRI of flow phenomena, hemorrhage, stroke and normal pressure hydrocephalus.

Bradley has served as a member of the board of trustees of the RSNA Research and Education Foundation, and as chairman of its fund development committee. Dr. Bradley also served on the ACR board of chancellors, chaired the ACR Commission on Neuroradiology and MRI, and served as ACR vice president. He is a member of the governing boards of the International Society for Strategic Studies in Radiology, the Association of University Radiologists, the Academy of Radiology Research and the Academy of Radiology Leadership and Management. Bradley has published more than 200 papers, 54 chapters and 21 textbooks.

Melvin M. Figley Fellowship in Radiology Journalism Jadranka Stojanovska is an assistant professor of radiology at the University of Michigan, specializing in thoracic and cardiovascular radiology. Dr. Stojanovska has taught and been invited to present at medical conferences in eastern and western Europe and the United States and has served as a reviewer for many organizations and medical journals, including the National Institutes of Health Patient-Centered Outcomes Research Institute, the Journal of Thoracic Radiology, Acta Radiologica and the Journal of Cardiovascular Imaging.

James A. Brink is radiologist-in-chief at Massachusetts General Hospital (MGH) and is the Juan M. Taveras professor of radiology at Harvard Medical School. He earned a Bachelor of Science degree in electrical engineering at Purdue University and his M.D. at Indiana University before completing his residency and fellowship at MGH. Brink joined the faculty of the Mallinckrodt Institute of Radiology at the Washington University School of Medicine, where he rose to the rank of associate professor be-fore joining the faculty at Yale University. He served as chair of the Yale Department of Diagnostic Radiology and then returned to MGH in his current position.

Brink is a fellow of the American College of Radiology (ACR), and the Society for Computed Body Tomography/Magnetic Resonance and is past president of ARRS. He serves as vice chair of the ACR board of chancellors and as scientific vice president for

the National Council for Radiation Protection and Measurements. He is the recipient of several honors, including the Radiological Society of North America Editor’s Recognition Award for Reviewing with Distinction (twice) and the Society of Computed Body Tomography Cum Laude and Moncada awards.

Brink has broad experience in medical imaging, including utilization and management of imaging resources, and has particular interest and expertise in issues related to the monitoring and control of medical radiation exposure.


Lee F. Rogers International Fellowship in Radiology Journalism Donna Taylor is a consultant radiologist at Royal Perth Hospital and a clinical associate professor at the University of Western Australia School of Surgery. An experienced researcher, teacher, author and presenter, Dr. Taylor serves on the university’s Clinical Radiology Research Committee and is an associate editor for the Journal of Medical Imaging and Radiation Oncology.

ASRT

Jean I. Widger Distinguished Author AwardThe award honors the best peer-reviewed articles published in ASRT’s scientific journals. The award is named after longtime Radiologic Technology editor Jean I. Widger.

Melissa P. Culp, B.S., R.T.(R)(MR); James R. Barba, M.A., R.T.(R); and Melissa B. Jackowski, Ed.D., R.T.(R)(M), are the winners of the Widger award for their article “Shield Placement: Effect on Exposure.” The article appeared in the March/April 2014 issue of Radiologic Technology.

Culp is a faculty member of the University of North Carolina at Chapel Hill with an interest in radiology’s contribution to sustain-able global health initiatives.

Barba is a former lab director for the UNC — Chapel Hill radiologic science program, who retired in January 2014 after more than 40 years in the profession.

Dr. Jackowski is the competency management development specialist at Siemens Medical Solutions USA, Inc., CX USA Educa-tion Services.

Their study measured radiation exposure to determine ideal shield placement to protect bone marrow that is not in the primary beam during knee imaging. The study reinforced the notion that shielding should be used in conjunction with collimation, to reduce exposure as much as possible.

ARRS


Best of the Year

ASRT

ASTRO

ASTRO Gold MedalASTRO’s Gold Medal, first awarded in 1977, is bestowed annually on up to three ASTRO members who have made outstanding contributions to the field of radiation oncology, including work in research, clinical care, teaching and service. Including the 2014 awardees, only 75 of ASTRO’s more than 10,000 members have received the Gold Medal award.

Candidates must be nominated by one active member of ASTRO and receive letters of support from two additional active members of ASTRO, detailing the nominee’s impact on the advancement of radiation oncology. Nominees may be from any of the scientific disciplines represented in ASTRO, including radiation oncology, biology and physics.

Carl R. Bogardus, Jr., M.D., FASTRO, has been an ASTRO member since he at-tended his first meeting of the American Club of Therapeutic Radiologists during the Radiological Society of North America annual meeting as a resident in training in 1960, and is professor, clinical director and vice chairman of the Department of Ra-diation Oncology at the University of Oklahoma Health Sciences Center in Oklahoma City. He is the only person to have served as both president of ASTRO (1989-1990) and the American College of Radiology (1991-1992). He led countless meetings with policy leaders and colleagues to develop the process of care for radiation oncology services and the subsequent treatment planning, simulation, treatment devices, dosimetry calculations, and physics procedure codes that are billed today as separate and distinct clinical services. His concepts of care and reimbursement, as detailed in

Harold Silverman Distinguished Author AwardThe award is named in honor of radiation therapist Harold Silverman, an advocate for accreditation of radiation therapy educational programs. This award also honors the best peer-reviewed articles published in ASRT’s Radiation Therapist.

Patricia Sledge Brewer, M.P.A., R.T.(R)(T); Terrence J. Ravine, Ph.D., M.T.; and Sarah E. Bru, M.S., M.T., are the winners of the Silverman award for their article “Risk of Patient Infection From Heating Appliances Used to Produce Thermoplastic Immobilization Devices.” The article appeared in the Fall 2014 issue of Radiation Therapist.

Brewer has more than 30 years of radiation therapy experience, has a master’s degree in public administration and is the radia-tion therapy program director for the University of South Alabama in Mobile. Dr. Ravine has taught anatomy and physiology at the University of South Alabama for more than 10 years, and his work experience includes more than 20 years working in or directing clinical laboratory facilities in the public and private sectors. Bru has degrees in medical technology and instructional design, as well as 21 years of experience in the clinical laboratory, including work in microbiology, clinical chemistry, instruction and supervision.

Their study assessed whether appliances used to heat water for fabricating immobilization devices in the clinic carry microor-ganisms that present risk of disease transmission. Forty-two percent of surfaces tested positive for potentially harmful bacteria.


ASTRO

Carl M. Mansfield, M.D., Sc.D. (Hon.), FASTRO, has been a member of ASTRO since 1970. When he retired from a nearly 50-year medical career in 2002, he was as-sociate director of the Greenebaum Cancer Center and chairman of the Department of Radiation Oncology at the University of Maryland. His career included the positions of professor and chairman of the Department of Radiation Oncology at the University of Kansas Medical Center in Kansas City; professor and chairman of the Department of Radiation Oncology and Nuclear Medicine at Thomas Jefferson University Hospital in Philadelphia; and associate director of the Division of Cancer Treatment, Diagnosis and Treatment Centers Radiation Research Program at the National Cancer Institute.

Mansfield is considered a pioneer in intraoperative radiation therapy (IORT) for early stage breast cancer. He produced a seminal 1983 report comparing periop-

erative and intraoperative (Iridium -192) breast implants that laid the groundwork for much of the continuing research in this field today. His work also led to advances in the conservative management of breast cancer through breast irradiation and local brachytherapy. This method of treatment excised the tumor without removing the entire breast. Mansfield served as primary or co-author on more than 200 original publications and more than 30 original abstracts. He has also written a book on breast cancer and was editor of two radiation therapy textbooks.

Mansfield earned an undergraduate degree in chemistry from Lincoln University, a medical degree from Howard University, and an Honorary Doctor of Science degree from Lincoln University. In addition to his post-doctoral fellowship at Middlesex Hospital, he was the Chernicoff Fellow in Pediatric Radiation Therapy at Jefferson Medical College Hospital from 1964-66 and served another year at the Meyerstein Institute of Radiotherapy at Middlesex Hospital Medical School in 1972-73.

James B. Mitchell, Ph.D., FASTRO, has been an ASTRO member since 1985 and is currently branch chief of the Radiation Biology Branch of the National Cancer Institute at NIH. Mitchell was recognized as a Fellow of ASTRO in 2009 and served as the vice chair of the Radiation Biology Committee and on ASTRO’s Scientific Committee, among numerous other roles. His more than 40-year career as a preeminent radiobiologist includes work in the Department of Radiation Oncol-ogy at Vanderbilt University Hospital, the Department of Radiology and Radiation Biology at Colorado State University and the National Cancer Institute at NIH. Mitchell advanced in his roles at the NCI, beginning in the Radiobiology Section of the Radiation Oncology Branch (ROB). He became branch chief of the Radiation Biology Branch in 1993, and he has served as administrative acting branch chief

of ROB on three occasions, a total of six years, during his distinguished NCI tenure. Mitchell’s achievements include his role as a teacher and leader in the field of tumor biology and the development of novel radia-tion protectors and sensitizers. He also assisted in the development of photodynamic therapy for clinical cancer treatment in the ROB at the NCI. Together with his colleague, Dr. Murali Krishna, he has worked toward the development and testing of novel in vivo imaging platforms for the non-invasive determination of tissue hypoxia and metabolism.

his “User’s Guide for Radiation Oncology,” provided the stepping stones that have created the documentation for many of the technical and scientific advances in the field. Bogardus was recognized as a Fellow of ASTRO in 2006.

Bogardus earned his Bachelor of Arts degree from Hanover College, Hanover, Indiana, and his medical degree at the University of Louisville School of Medicine. He served his residency in therapeutic radiology at Penrose Cancer Hospital in Colorado Springs, Colorado. His fellowship in radiation therapy and radiation physics was at the Mallinckrodt Institute of Radiology at Washington University School of Medicine, St. Louis.


Best of the Year

Medical Practice Executive of the Year Award This award recognizes a medical group practice executive who has demonstrated, within the last three years a noteworthy achievement of exceptional leadership and management proficiency to enhance strategic and operational effectiveness of health care delivery in his or her practice and community.

Jan Vest is the true definition of a medical group practice executive who has dem-onstrated exceptional leadership, management proficiency and operational effective-ness of health care delivery in his practice and community within the last three years.

An MGMA member since 1995, Vest has more than 20 years of experience lead-ing medical practices, and pledging himself to connecting patients and doctors. He is the chief executive officer of Signature Medical Group, a multi-specialty physician

group with 146 physicians practicing in St. Louis, Kansas City and southwest Missouri. Since joining Signature Medical Group in 2001, Vest has committed himself to improving the delivery of health in that area through excellence in service and clinical care.

MGMA

The Harry J. Harwick Lifetime Achievement AwardThis award is the highest recognition bestowed by MGMA. It goes to an individual who has made nationally recognized contributions to health care administration, delivery and/or education in his/her career, advancing the field of medical practice management.

An MGMA member since 1996, Alan Beason has worked in medical practice management for more than three decades. Beason began work for Cardiovascular Consultants in 1995 and is responsible for the growth of the practice, increasing the number of staff from five physicians in one hospital to 11 cardiologists and four mid-level providers with 65 supporting staff serving five hospitals.

Beason develops education for medical practice administrators and executives on effective leadership in health care organizations. He has been an invaluable resource for MGMA, having served as the MGMA representative to the United Healthcare

National Physician Advisory Committee, the MGMA Southern Section and the Louisiana MGMA Board.

RSNA

Dr. Hedvig Hricak, M.D., Ph.D., Dr.h.c., is internationally renowned for her ex-tensive research and clinical expertise in genitourinary and gynecologic oncologic imaging. Her pioneering work in MRI and MR spectroscopic imaging of prostate cancer and MRI and CT of gynecological cancers helped lay the groundwork for genitourinary and gynecologic oncologic imaging as we know them today. Dr. Hricak was RSNA President in 2010.

Hricak, a native of Zagreb, Croatia, earned a medical degree from the University of Zagreb in 1970. She came to the U.S. two years later, completing her radiology residency at St. Joseph Mercy Hospital in Pontiac, Michigan, in 1977, followed by a fel-lowship at Henry Ford Hospital in Detroit, where she served as a senior staff member.

She served from 1982 to 1999 as professor of radiology, radiation oncology and gynecology and, eventually, as head of abdominal imaging in the Department of Radiology at the University of California, San Francisco. In 1999, she assumed her current position as chair of the Department of Radiology, Carroll and Milton Petrie Chair, Memorial Sloan Kettering Cancer Center, New York.

RSNA Gold Medals In a tradition that originated in 1919, Gold Medals are presented each year to individuals who have rendered exemplary service to the science of radiology and who have received unanimous approval by the RSNA Board of Directors. Gold Medal awards are RSNA’s highest honor. This year the organization recognized three individuals.


RSNA

She also holds a senior position within the Molecular Pharmacology and Chemistry Program at the Sloan Kettering Institute and is a professor at the Gerstner Sloan Kettering Graduate School of Biomedical Sciences, as well as a professor of radiology at the Weill Medical College of Cornell University.

Hricak received her Ph.D. (Dr. Med. Sc.) from the Karolinska Institute in Stockholm, Sweden, in 1992, and in 2005 became the first woman to receive an honorary doctorate in medicine (Dr.h.c.) from the Ludwig Maximilian University of Munich in its 500-year history. She was appointed to the RSNA Board of Directors in 2002 as liaison for publications and communications. Prior to her Board appointment, Dr. Hricak served as chair of RSNA’s Public Information Advisory Board and as a member of other RSNA public information committees.

She has authored or co-authored 18 books, more than 450 research articles, reviews and editorial articles, and more than 130 book chapters. She is an associate editor and editorial board member of numerous premier medical journals, serving as an associate editor of Radiology from 1985 to 1993 and a consultant to the editor of Radiology from 1993 to 1997.

Hricak is a member of the National Academy of Medicine (formerly the Institute of Medicine) and has served on the Scientific Advisory Board of the National Cancer Institute and the Advisory Council of the National Institute of Biomedical Imaging and Bioengi-neering. Throughout her career, Dr. Hricak has worked to promote international collaboration and has helped to create international training programs to improve imaging practice and research, particularly in developing countries.

In recognition of her international outreach efforts, research and visionary leadership, Hricak has received many awards, including the Marie Sklodowska-Curie Award from the American Association for Women Radiologists, the Beclere Medal of the International Society of Radiology, the Howard M. Pollack Medal of the Society of Abdominal Radiology, the Katarina Zrinska Croatian Presidential Award and the gold medals of the International Society for Magnetic Resonance in Medicine (ISMRM), the Association of University Radiologists, the Asian Oceanian Society of Radiology and the European Society of Radiology.

Hricak was awarded fellowships by the American College of Radiology, the ISMRM, the Society of Uroradiology, the International Cancer Imaging Society and the American Association for the Advancement of Science. She is a member of the Russian Academy of Science and the Croatian Academy of Sciences and Arts, and is an honorary member or fellow of 15 national radiological societies from around the globe.

One of the most highly respected educators in radiology today, Dr. Robert A. Novel-line, M.D. has become internationally known for his expertise in emergency radiology.

Along with establishing one of the nation’s first emergency radiology residency/fellowship programs in the early 1980s, Novelline, a professor of radiology at Mas-sachusetts General Hospital and Harvard Medical School, has trained hundreds of students and junior staff members, and is a founding member of the American Society of Emergency Radiology (ASER).

Born in Boston, Novelline received his medical degree from Boston University School of Medicine and completed his radiology residency and fellowships in both vascular/interventional radiology and radiology education at Massachusetts General Hospital. Much of Novelline’s early research and many of his publications dealt with therapeutic

intravascular infusion therapy, therapeutic embolization and angioplasty.Novelline’s dedication to radiology education began early in his career. He served as director of both the Harvard Medical School

Core Clerkship and the Advanced Radiology Clerkship at Massachusetts General Hospital between 1975 and 2012. In 1977, Novel-line was named assistant professor of radiology at Massachusetts General Hospital and Harvard Medical School, moving up the ranks to his current position as professor in 1996.

In 1982, he was appointed director of the newly formed Division of Emergency Radiology at Massachusetts General Hospital — a position he held until 2012. Novelline shaped the course of emergency radiology on a number of fronts. He installed one of the first CT scanners in an emergency imaging division, pioneered research on CT diagnosis of trauma and acute non-traumatic emergencies, and reported on new CT techniques for diagnosing appendicitis, diverticulitis and urinary tract stones.


Best of the Year

RSNA

A renowned clinician and researcher, Dr. Steven E. Seltzer, M.D., has forged a legacy as a passionate educator committed to teaching and mentoring radiology students and junior faculty to fill the leadership roles so critical to the specialty’s future.

Born in Philadelphia, Dr. Seltzer received his baccalaureate and medical degrees from the University of Pennsylvania and completed his radiology residency at the Peter Bent Brigham Hospital in 1980. He joined the Brigham and Women’s Hospital/Harvard Medical School staff directly afterward, and remained on staff for his entire career. From 1984 to 1997, Seltzer served as co-director of abdominal imaging and director of CT at Brigham and Women’s Hospital. Since 1997, Seltzer has held his current position as chair of the Department of Radiology at Brigham and Women’s

Hospital and the Philip H. Cook Professor of Radiology at Harvard Medical School.From 1984 to 1997 as department chair, Seltzer worked with founding director Ramin Khorasani, M.D., M.P.H., to establish

the Center for Evidence-Based Imaging at Brigham and Women’s Hospital in 2002. The unique multidisciplinary translational research center offers diversified funding sources, including research grants from the National Institutes of Health and the Centers for Medicare & Medicaid Services, among other institutions.

Seltzer, who served on the RSNA Health Policy and Practice Committee from 2000 to 2002, is active in numerous radiology organizations and served as president of the AUR, the Academy of Radiology Research (ARR) and the Society of Chairs of Aca-demic Radiology Departments. Seltzer was elected to fellowship in the American College of Radiology in 1997. He was awarded the AUR gold medal in 2004.

Seltzer currently serves as chair of the Coalition for Imaging and Bioengineering Research, created by the ARR. His other honors include the 1981 Teacher of the Year Award from the Brigham and Women’s Hospital Department of Radiology and numerous Editor’s Recognition Awards from Radiology.

Seltzer has published over 130 peer-reviewed research manuscripts in journals including Radiology, Academic Radiology and the American Journal of Roentgenology.

Among the founding members of ASER in 1987, Novelline led the effort to revise, expand and disseminate the National Curriculum in Emergency Radiology, a major focus of ASER. In 1998, he founded the Alliance for Medical Student Educators in Radiology. Novelline has served the Association of University Radiologists (AUR) in many capacities, including as president in 2012.

Novelline served initially as co-author and later as author of the landmark 1988 book, “Squire’s Fundamentals of Radiology,” used by medical schools throughout the U.S. and abroad. Another textbook co-authored in 1993 by Dr. Novelline, “Radiology of Emergency Medicine,” still serves as the definitive reference textbook on emergency radiology.

Novelline has published over 150 original reports or reviews and has served on the editorial boards of journals including Radiol-ogy, Emergency Radiology and Investigative Radiology, and as a manuscript reviewer for Academic Radiology, American Journal of Radiology and The New England Journal of Medicine. He is a sought-after speaker who has lectured nationally and interna-tionally on emergency radiology and radiology education, and has held more than 50 visiting professorships around the world.

Amid his extensive RSNA history, Novelline served as the first RSNA co-chair of the RSNA-American College of Radiology Public Information Website Committee, and oversaw the successful launch of RadiologyInfo.org. Novelline also served on the RSNA Refresher Course Committee from 1997 to 2006, serving as chairman from 2003 to 2006, and as director of the Emergency Radiology Track from 1997 to 2002. He has also served on the RSNA Public Information Advisors Network since 2005. In 2007, Novelline was named the RSNA Outstanding Educator.

Other accolades include the 2004 Association of Program Directors in Radiology’s Achievement Award, the 2012 Alliance for Medical Student Educators in Radiology Excellence in Education Award and the 2013 Sustained Excellence in Teaching Award from Harvard Medical School. Novelline received the ASER gold medal in 2000 and the AUR gold medal in 2015.


SIIM

Roger A. Bauman, MD AwardThe Roger A. Bauman, M.D. Award is presented for the best student paper each year at the annual meeting. This award was named to honor Dr. Bauman’s distinguished career in radiological informatics research and practice, and his status as Founding Editor of the Journal of Digital Imaging.

Dr. Peter Chang’s early research success has focused on developing medi-cal software that integrates computer vision and machine learning tech-niques to analyze radiology images. His work has been recognized on the na-tional level including the 2015 Roentgen Resident Research Award, and the 2014-15 Introduction to Academic Radiology Award (RSNA/ARRS). In addition he has authored multiple papers, patents, abstracts, presenta-

tions and book chapters. The Roger A. Bauman Award was presented for his paper, “Fully Automated Quantitative Scor-ing of VASARI Glioma Imaging Features Demonstrates High Interobserver Agreement with Expert Neuroradiologists.” Chang completed his undergraduate and medical school training at Northwestern University, graduating summa cum laude and inducted into the Alpha Omega Alpha medical honor society for excellence in scholarship and service. He is currently completing his radiology residency at Columbia University’s New York Presbyterian Hospital.

Most Downloaded PaperAuthor: Donald K. DennisonTitle: “PACS in 2018: An Autopsy” Vol 27:1Dennison has worked in the medical imaging informatics industry for over 14 years. Currently serving as a consultant, he is a speaker and panelist on topics ranging from medical imaging record interoperability, integration of imaging data within the EMR, enterprise imaging, multi-facility integration and others. He has published articles and eBooks on patient identity management, VNAs, PACS and enterprise viewers. Den-nison currently serves on the board of directors and various committees of the Society for Imaging Informatics in Medicine (SIIM) and chairs the ACR Connect committee for the American College of Radiology (ACR).

Best Paper AwardAuthors: Brian Kolowitz, Gonzalo Romero Lauro, James Venturella, Veli-yan Georgiev, Michael Barone, Christopher Deible and Rasu Shrestha Title: “Clinical Social Networking — A New Revolution in Provider Communication and Delivery of Clinical Information across Providers of Care?”Brian J. Kolowitz is director and principal architect of the Next Generation Imaging program at UPMC Enterprises responsible for all program, product and research activi-ties. Research within Next Generation Imaging includes application of machine learn-ing techniques supported by natural language processing technologies to contextual-ize health information according to disease state and progression. Additional focus includes the value quantification of individuals and systems on patient outcomes. He

has worked in health care information systems for over 10 years leading the design and implementation of UPMC innovations including the SingleView application which was awarded Information Week’s #1 Healthcare Innovation Award. In addition to his professional experience, he is an accomplished academic holding adjunct assistant professor positions at the University of Pittsburgh and University of Maryland. He holds a Doctor of Science degree in Information Systems from Robert Morris University, Masters of Business Administration and Masters of Science in Management of Information Systems degrees from the University of Pittsburgh and a Bachelor of Science degree in Computer Engineering from Penn State University. Kolowitz was the recipient of the Journal of Digital Imaging Best Paper of 2014 award for his research on application of social networks to health care information systems.


Best of the Year

SNMMI

Georg Charles de Hevesy Nuclear Medicine Pioneer AwardEach year, SNMMI presents the Georg Charles de Hevesy Nuclear Medicine Pioneer Award to an individual for outstanding contributions to the field of nuclear medicine. De Hevesy received the 1943 Nobel Prize in chemistry for his work in determining the absorption, distribution, metabolism and elimination of radioactive compounds in the human body. His work led to the foundation of nuclear medicine as a tool for diagnosis and therapy, and he is considered to be one of the fathers of nuclear medicine. SNMMI has given the de Hevesy Award every year since 1960 to honor groundbreaking discov-eries and inventions in the field of nuclear medicine.

Michael E. Phelps, Ph.D., is the Norton Simon Professor, chair of the department of molecular and medical pharmacology, and the director of the Crump Institute for

Molecular Imaging at the University of California, Los Angeles (UCLA).Phelps earned Bachelor of Science degrees in chemistry and mathematics at Western Washington State University, and a Ph.D.

in chemistry at Washington University. Phelps’ innovations have changed the face of radiology. He invented the PET scanner and, with colleagues, developed a minia-

turized preclinical PET scanner, microPET. He led a national effort — with the help of the U.S. Congress and the White House, along with medical schools across the United States — to gain U.S. Food and Drug Administration approval and reimbursement for PET molecular imaging diagnostics. His efforts resulted in federal and private insurance coverage for PET in cancer and in Alzheimer’s, Parkinson’s, epilepsy and cardiovascular disease.

Phelps has published 780 peer-reviewed scientific articles and four textbooks. He has been awarded more than $360 million in grants and has received such prestigious awards as the George von Hevesy Prize, the Enrico Fermi Presidential Award presented by President Clinton, the General Motors Cancer Research Kettering Prize and the World Molecular Imaging Society 2012 Gold Medal Award. He chaired the 1983 Nobel Symposium in Stockholm and presented the American College of Physicians keynote address at the 2007 Nobel Symposium.

Phelps was one of the three founders and a member of the board of directors of CTI Molecular Imaging (acquired by Siemens in 2005). He is a cofounder and chair of the board of Momentum Biosciences LLC (MoM), a biotech incubator that provides facilities, services and funding for startup and early-stage companies for UCLA and Caltech faculty. He is also one of the founders and the board chair of Sofie Biosciences, an MoM company.

Paul C. Aebersold AwardThe Paul C. Aebersold award is named after a pioneer in the biologic and medical appli-cation of radioactive materials and the first director of the Atomic Energy Commission’s Division of Isotope Development. The award recognizes outstanding achievement in basic science applied to nuclear medicine and was first presented in 1973. The SNMMI Committee on Awards selects the recipient.

Dr. David W. Townsend obtained his B.Sc in Physics from Bristol University and his Ph.D. in Particle Physics from the University of London and was a staff member for eight years at the European Centre for Nuclear Research (CERN) in Geneva, Switzerland. In 1980, Townsend joined the faculty of Geneva University Hospital as a physicist in the Department of Nuclear Medicine. He has worked on PET instrumentation development

since the early eighties, and designed and built the first rotating partial ring PET scanner using BGO block detectors. In 1993, Dr. Townsend moved to the University of Pittsburgh as an associate professor of radiology and senior PET physicist. He was co-director of the Pittsburgh PET Facility from 1996-2002, and became professor of radiology in 2000. In 1995, Townsend was principal investiga-tor on the first proposal to design and build a combined PET/CT scanner. The PET/CT scanner, attributed to Townsend and Dr. Ronn Nutt, then president of CPS Innovations, was named by Time Magazine as the medical invention of the year 2000. In recognition of his work on PET/CT, Townsend received the 2004 Distinguished Clinical Scientist Award from the Academy of Molecular Imaging, and the 2008 Nuclear Medicine Pioneer Award from the Austrian Society of Nuclear Medicine. In 2006, he was elected a Fellow of the IEEE and in 2009 received an honorary doctorate from the University of the Mediterranean, Marseille, France. He shared with Nutt the 2010 IEEE Medal for Innovations in Healthcare Technology.

This Month in Medical History

In 1954, Richard Herrick had just returned home to Massachu-setts from serving in the Coast Guard. But instead of enjoying his homecoming with friends and family, Herrick was hospitalized with kidney disease. At the time, the diagnosis meant his days were numbered.

But before the 23-year-old Herrick could even begin to accept his fate, his doctor, Dr. David Miller, thought of the research being done by a group of physicians and scientists at a hospital and the Harvard Medical School nearby. The group was work-ing to figure out how to transplant healthy kidneys into individuals who suffered from organ failure. In fact, the physicians were looking for a po-tential candidate just like Herrick for the first procedure — the patient hap-pened to have a twin brother.

Herrick was lucky to have Miller as his physician. After all, many medi-cal professionals were vocal skeptics of the physicians researching organ transplantation. One doctor went as far as calling the group at Harvard “a bunch of fools” for their interest in the effort. These “fools” were led by Dr. Joseph Murray, a young sur-geon and professor at Harvard Medi-cal School.

Upon graduating from medical school, Murray was drafted and spent World War II working at a hospital in Pennsylvania. That’s where he first worked on transplanting skin tissue on many burn victims and spent a lot of time thinking about tissue rejection. His experience showed him that skin grafting rejection was nearly non-existent when the transplant came from a patient’s relative.

After the war, Murray returned to Massachusetts to work with an enthusiastic doctor studying kidney transplantation at the Surgi-cal Research Lab at Harvard Medical School. Much progress was made, but the potential for the body rejecting a transplanted organ as a foreign object was an outstanding problem. However, Murray hypothesized that transplanting organs between twins would avoid this issue, as his experience with skin tissue transplants had shown.

By the mid-1950s, Murray and his team believed that a suc-cessful operation would be technically feasible. Two days before Christmas in 1954, Richard Herrick was brought into one of the op-erating rooms at the Peter and Bent Brigham Hospital (now known as Brigham and Women’s Hospital). The surgery took about five and a half hours. As Murray predicted, Herrick’s body did not re-

ject his twin’s organ, and he lived for eight more years. After the successful surgery, Murray went on to perform nearly 20 other kidney transplanta-tions among other twins.

Although Herrick’s operation went well, Murray and his team still faced the problem of organ rejection among non-related patients. The physicians tried various strategies, such as X-rays and drugs to suppress the immune system to prevent the body from rejecting the new organ. For years, nothing the physicians tried worked, but Murray was en-couraged to continue searching for a solution by the hospital’s clinical staff and leadership.

In 1962, the physicians finally had a breakthrough. Murray’s team part-nered with Burroughs-Wellcome, a company that developed Imuran, a drug aimed at helping the body ac-cept an organ transplant. The drug was successfully tested on a patient

named Mel Doucette, who received a kidney donation from a stranger. The drug paved the way for additional research and other organ transplantation procedures.

Murray’s pioneering research and work earned him a 1990 Nobel Prize in Physiology or Medicine. Later, Murray told a relative that he believed he didn’t really have to work to win the Nobel Prize — he was just doing what was right for his patients.

Thanks to the perseverance of Murray and his team, nearly 17,000 Americans safely undergo a kidney transplantation proce-dure every year. The organ can come from an unrelated, or even a deceased donor, and add years to another person’s life. Share this story: dotmed.com/news/27973

The first successful kidney transplantation procedure

Dr. Joseph Murray



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The U.S. health care debate has taken an unexpectedly global turn in recent weeks, sparked by favorable comments made by presidential candidate and Ver-mont senator Bernie Sanders toward Denmark’s system. The ensuing coverage has highlighted the strengths of some Euro-pean models of universal coverage, whether that be through mandated private or single-payer government coverage.

After spending the last six years working in 60 countries’ health systems, I see time and again the value in looking international-ly for solutions to the problems facing health care today. Every country has something to teach and something to learn, and while the U.S. pays more than any other nation, yet still leaving 10 percent of people uninsured, there are several ways in which it leads the world, too. U.S. research and development dwarfs that of other countries, producing more breakthroughs, more blockbusters and more Nobel prizes than any other. For those with the ability to pay, the quality of care in top U.S. hospitals is without equal.

Denmark’s system has much indeed to recommend it, having achieved strong re-gional integration of health and care services and, with its single-payer system, kept year-on-year health care spending growth at half the U.S. rate over the last 10 years. However, with waiting times creeping steadily up in recent years and a somewhat inflexible state-

led approach, it is far from the whole story.In my recent book I outline 12 compo-

nents of different countries’ health systems that, if they were combined, would give something approaching “perfection.” Look-ing through these, several systems stand out as sources of inspiration for the U.S.

While U.S. health care can be very good episodically, it can be poor on integration across the continuum of care. This matters because not only do patients feel treatments are being “done to” rather than “done with” them, disintegration and disempow-erment create enormous financial waste. Just look at the 30 percent of medicines prescribed in the U.S. that never get taken by patients, costing an estimated $290 bil-lion every year. The ultra-lean Indian hospital chain Narayana started taking aside patients’ main caregivers while they are recovering from surgery and training them in post-op-erative care, including supervised work on the wards. They’re finding lower readmis-sion rates and a much greater confidence on the part of patients and caregivers to follow treatment plans and look after themselves. We could also look to developments in Sin-gapore, where around half the population now has access to their medical records on-line, and regularly use them to track their health and manage their care.

Parts of the U.S. are rapidly embracing accountable care, bringing payers and pro-

viders together to incentivize prevention of disease rather than reactive medicine and over-treatment. Promising new partnerships and models of care are developing, but sev-eral countries have been doing this for a lot longer. Israel’s health care system is delivered by four insurers that also run hospitals, pri-mary care clinics and even nursing homes. The largest payer-provider, Clalit, has been going since 1911, with integrated electronic records since 2001. It has used this data to develop sophisticated methods of predict-ing which patients are in need of additional, targeted support to keep them well.

Finally, with some of the most expensive health care professionals in the world, the U.S. should look to countries that are using other cadres to tackle the challenges of age-ing and chronic disease. For example, Japan is using its postal workers to check up on elderly citizens during their rounds, and Aus-tralia has trained its police officers in respond-ing to people with mental health problems.

While health systems around the world differ enormously, the challenges we face are remarkably similar. The U.S. continues to teach the world much about great health care, but it also has much to learn.

Dr. Mark Britnell is chairman and partner, KPMG Global Health Practice, and author of “In Search of the Perfect Health System.”Share this story: dotmed.com/news/27974

Denmark’s isn’t the only system U.S. health care could learn from

Denmark’s isn’t the only system U.S. health care could learn from

By Dr. Mark Britnell

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