Roadmap for a successful Office-Based Lab - Ziehm
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Roadmap for a successful Office-Based Lab Midwest Institute for Minimally Invasive Therapies, Chicago, IL, USA Case Study No 01
Transcript of Roadmap for a successful Office-Based Lab - Ziehm
Roadmap for a successful Office-Based LabMidwest Institute for Minimally Invasive Therapies, Chicago, IL, USA
Case Study No 011 JeffreyG.Carr,MD,"NavigatingtheRisingWatersinHealthcare:TheOfficeBasedInterventionalSuiteasanInnovativeModel,"GlobalVascular
Digest,April2015Issue,http://www.globalvasculardigest.com/april-2015-issue/navigating-the-rising-waters-in-healthcare-the-office-based-interventional-suite-as-an-innovative-model/
2 TheOutpatientEndovascularandInterventionalSociety–www.oeissociety.org3 TheZiehmVisionRFDHybridEditionrepresentsagroupofoptionalhardwareandsoftwarethatcreatesanoptionpackage
onthedevicenamedZiehmVisionRFD.4 ComparisonofconventionalØ12"imageintensifierand30cmx30cmflat-paneldetector
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Headquarters GermanyZiehm Imaging GmbH Donaustrasse 3190451 Nuremberg, GermanyPhone +49 911 2172 0Fax +49 911 2172 [email protected]
ItalyZiehm Imaging SrlVia Paolo Borsellino, 22 / 2442100 Reggio Emilia, ItalyPhone +39 05 22 61 08 94Fax +39 05 22 61 24 [email protected]
FinlandZiehm Imaging OyKumitehtaankatu 504260 Kerava, FinlandPhone +358 4 49 75 75 [email protected]
USAZiehm Imaging Inc.6280 Hazeltine National Dr.Orlando, FL 32822, USAToll Free +1 800 503 4952Phone +1 407 6 15 8560Fax +1 407 6 15 8561 [email protected]
BrazilZiehm Medical do BrasilAv. Roque Petroni Jr., 1089 cj 90404707-000 São Paulo, BrazilPhone +55 11 30 33 59 99Fax +55 11 30 33 59 [email protected]
FranceZiehm Imaging S.A.R.L.1, Allée de Londres91140 Villejust, FrancePhone +33 1 69 07 16 65Fax +33 1 69 07 16 [email protected]
ChinaZiehm Medical Shanghai Co., Ltd.Hongqiao New Tower CentreRm 06-07, 25 / F83 Loushanguan RoadShanghai, P.R. China; 200336Phone +86 21 62 36 99 03Fax +86 0 21 62 36 99 [email protected] SingaporeZiehm Imaging Singapore Pte. Ltd.7030 Ang Mo Kio Ave 5#08-53 Northstar@AMKSingapore 569880, Singapore Phone +65 6 39 1 86 00Fax +65 6 39 6 30 09 [email protected]
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D R . P A R A M J I T “ R O M I ” C H O P R A
Alternative care models
O F F I C E - B A S E D l A B S ( O B l s )
Dr. Paramjit “Romi” Chopra is an interven-tional radiologistwithover30years’experi-enceinthefieldofinterventionalradiologyandendovasculartherapy.ThestandardsforhisdailyworkweresetaftercompletinghismedicalstudiesandtraininginMumbai,India,followedbyhisfellowshipandresi-dencyatBrighamandWomen’sHospitalandHarvardMedicalSchoolintheUS.
After working extensively in academia and research,Dr.Choprabecameoneoftheyoungestheadsofaninterventionalradio-logydepartmentintheUS.Eagertosharehisexperience,heplacedgreatemphasisontrainingandintroducedawiderangeofeducationandresearchprogramsforstu-dents,colleaguesandresidents.Atthesametime,however,hewascommittedtokeepingthefocusfirmlyonpatientneedsatalltimes.
Dr. Chopra opened the Midwest Institute forMinimallyInvasiveTherapies(MIMIT)in2004.Asaninterventionalradiologyandendovas-culartherapypractice,MIMITspecializesin
minimallyinvasivetreatmentsforarterialdiseasesuchasperipheralarterydisease(PAD),uterinefibroiddisease(UFE),ve-nousdiseaseandmusculoskeletaldisease(spineinterventions).Blendinghiseasternrootsandextensivewesternexperience,Dr.Chopraunifiesthebestofbothworlds.Hisin-depthunderstandingofcomplexpa-tientconditionsisbackedbystate-of-the-arttreatmenttherapies,enablinghimtodeliverexceptionalpatientcareofthehighestquality.
Dr. Chopra believesthepathtolong-termsuccessliesintreatingpatients’spirit,mindandbody–notjusttheirmedicalconditions.Hisinstitutehasgivenhimtheopportunitytocreateawell-thought-outenvironmentwherepatientsandtheirfamiliescanfeelcalm,gettheinformationtheyneedandbetreatedwithcutting-edgehealthcaretechnologies.
The man behind the Office-Based Lab
At Midwest Institute for Minimally Invasive Therapies (MIMIT), our goal is to help people live healthy and happy lives. We strive to educate and empower patients and their families to make a decision that is best for the patient. But we also have to run our office-based lab as a business to maintain fiscal responsibility for our business and staff.
Paramjit“Romi”Chopra,MD,FounderandMedicalDirectorofMIMIT,Chicago,Il,USA
Alternatives to traditional patient care are evolving in response to the world’s aging population. Gone are the days of diagnosis and treatment in a cold, sterile hospital setting. Across the United States, alternatives to hospi-tal practices are seeing substantial growth. Office-based labs (OBLs) are one such option. Also known as office interven-tional suites, OBLs are being opened by vascular surgeons, interventional radiologists and other physicians who have an interest in a delivery-care model that is patient centered in an office-based setting.
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Establishing the Office-Based Lab
S I X P I l l A R S O F S U C C E S S
pillars of success for the OBL6
Excellent patient satisfaction
Excellent patient care
Excellent employee satisfaction
Maintaining fiscal responsibility
Constant innovation
Systems to sustain the above 5 pillars
OBLs started to emerge over a decade ago.Today,thereareanestimated500labsacrosstheUnitedStates.¹MedicalassociationssuchastheOutpatientEndovascularandInterven-tionalSociety(OEIS),²aswellasphysicians,theindustryasawholeandpatients,allrec-ognizethevalueofOBls.However,openinganewoffice-basedlabisacomplexundertak-ingthatrequiresconsiderableplanning.Al-thoughentrepreneurshiprunsinDr.Chopra’sblood,hestillspentayeardevelopingasuc-cessfulbusinessplanandmetwithcolleagueswhohadopenedtheirownOBls,gainingvalu-ableinsightandguidancealongtheway.
This hands-on experience led him to identify six pillars of success for OBLs:–Excellentpatientcare–Excellentpatientsatisfaction–Excellentemployeesatisfaction–Maintainingfiscalresponsibility–Constantinnovation–Systemstosustainthese5pillars
Inordertobestmeettheserequirementsfromanimagingperspective,Dr.ChoprachosetheZiehmVisionRFDHybridEdition3C-arm.ThissystemofferedDr.Choprafea-turesmostcomparabletoafixedimagingroominahospitalbutwithoutthecostorcomplexity.Keyelementslikethelatestflat-paneldetectortechnologywithalargefieldofview,motorizationinallfouraxesandapowerfulgeneratorwereallfactorsinhisdecision.
AsthetechnologyofmobileC-armsliketheZiehmVisionRFDHybridEdition3pushesthelimitsofconventionalproceduresandfurtherrivalsfixedimagingequipment,OBlswillbecomemoresuccessfulandbeabletooffermoreexpandedprocuedures,whichattractsbothphysiciansandpatientstoapractice.ForthefutureofMIMIT,Dr.Choprasayshesees“growthandnewlocations,”andthecontinuedabilityinhisOBltoconnectwithpatientsonaperson-to-personlevel,whichhasbeenoneofhisguidingprinciplesinmedicinefromthestart.
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Dr. Chopra opened his first office-based labs in 2015.Forhim,itreallywasadreamcometrue.TheOBlgavehimtheoppor-tunitytotreatpatientsinahospital-likeenvironmentbutwiththesamephilosophythatshapedhisworkatMIMIT.
The initial labs were setup in three loca- tions,reinforcingDr.Chopra’scommitmenttotakehiscaretopatientsratherthanforc-ingthemtocometohim.Inlinewiththesixpillars,Dr.Chopraalsodevelopedasoundfinancialplan.Bymanagingthefin-ancesresponsibly,heensuresthattheOBlisn’tjustagreatplacetotreatpatientsbutthatit’salsoagreatplacetowork.Thisal-lowshimtoattractstaffhecanrelyonforhisdailyclinicalpractice.Heworkshandinhandwithanexperiencedteamthathasspentmanyyearsworkingwithhim.Dr.Chopraandhisteamvisitthethreelocationseveryweek,ensuringconsistentqualityofcareandstandardizedworkflowsatalllocations.
Every system and process in the OBL is optimized;thisincludesconnectingevery-thingandeveryoneoverthecloud.Thissavesmoneyeverydayandopensupfurtherprocessoptimizationpotentialwithinhisteamandworkflows.Thesesavingsalsotranslateintorealbenefitsforpatientsintheformofshorterwaitingtimes,shorterhospitalstays,fasterreferralcommunicationandbetterclinicaloutcomes.
Overall, the OBL has increased patient com- fort and convenience.IthasgivenDr.Chopragreateradministrativeoversightandallowedhimtodevelopbetterschedulesfordoctorsandotherstaff.Hebelieveshecanworkmoreeffectivelyoutsideofahospitalenviron-ment.“Thisismyoffice,”saysDr.ChopraaboutMIMIT."Itrytothinklikepatientswhoarelookingforhelp.Wecangivethemthishelp,butevenmoreeffectivelyandinamorepersonalenvironment,”headds.
TA K I N G T H E N E X T S T E P
Running a successful Office-Based Lab
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Forward thinking with a mobile hybrid OR in an Office-Based Lab
Z I E H M V I S I O N R F D H y B R I D E D I T I O N
When it came to choosing imaging equip- ment,Dr.ChopraknewthatsuperiorimagingdeviceswouldbethemostimportantsuccessfactorforhisbusinessasboththeMIMITandtheoffice-basedlabsspecializeinminimallyinvasivetreatments.Afterashortevaluationperiod,MIMITselectedZiehmImagingasitsvendorofchoice.Inthewordsofthefounderandmedicaldirector,Dr.Chopra:“WesawthatZiehmImagingisthetechnologyleaderinmobileimaging.”
MIMIT chose the Ziehm Vision RFD Hybrid Edition3,apowerful25kWmobileC-arm,whichismorethancapableofmeetingtheneedsofDr.Chopra'schallengingproce-dures.BecausetheZiehmVisionRFDHybridEdition3utilizesasquareflat-paneldetectorof30cmx30cm,Dr.Chopracouldseeroughly50percentmoreimageinformationwith-outdistortioncomparedtoaconventionalroundimageintensifier(II).4Theexceptionalcontrastresolutionoftheflat-paneldetectorgivesDr.Chopratheabilitytovisualizeeventhesmallestdetailsofanatomy,helpingtominimizeriskandpatientcomplications.
Maximum uptime was also critical for Dr. ChopraandthestaffatMIMIT.ZiehmImagingoffersanestablisheddirectserviceorganiationwithtailoredservicesolutionsand24/7technicalphonesupportintheUS.TheZiehmVisionRFDHybridEdition3givesMIMITtheflexibilitytodeliverthebestimagequalityatanylocationandatanytime.
Easy setup and reduced operating costsarekeyfactorsinbothahospitalsettingandoffice-basedlab.TheZiehmVisionRFDHybridEdition3canbesetupinanyroomwithoutanyspecialadaptationsorprepa-rationsandhasacompactfootprint.Inad-dition,theZiehmVisionRFDHybridEdition3providesauserinterfacewithsimplecon-trolsandeasyaccessbetweenfrequentlyusedfunctionslikefluoro,digitalsubtrac-tionandroadmapping,whichspeedsuptheclinicalworkflow.Featuringthelatestimagingtechnologies,theC-armisacom-prehensivemobilesolutionenablinghybridproceduresinoffice-basedenvironments.
Ziehm Imagings' innovative flat-panel technology allows us to perform various minimally invasive procedures demonstrating great anatomical detail that was only available in fixed labs. It is a game changer for us to provide better outcomes with same-day services in our OBLs.
JorgeArellano,R.T.(R)ChiefTechnologist,MIMIT
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Quality patient care
C A S E R E P O R T
A 68-year-old woman presented withsevereperipheralarterialdisease(PAD)andhasbeenaheavycigarettesmokerforoveradecade.Shehadpreviouslybeentreatedatanotherhospital,wheredoctorsimplantedabaremetalstentinthesuperficialfemoralartery,andwasnowcomplainingofseverepainatrestinherlowerleftextremity.Shehadalsohadastentplacedinhercommoniliacartery,whichmadeitdifficulttotreatthesuperficialfemoralartery(SFA)fromtherightcontralateralcommonfemoralartery.
A previous arteriogram showed extensiveocclusionoftheentireleftsuperficialfemoralarteryandproximalpoplitealartery.Thetreatmentoptionswereafemo-ropoplitealbypassorrevascularizationoftheSFAviapoplitealarteryaccess.Dr.Chopradecidedtoperformacompleterevascularization.
The left popliteal artery (P3 segment) wasaccessedusingamicropunctureneedleunderultrasoundguidance.AwireandcatheterwerepassedthroughtheocclusionoftheSFAallthewayintotheiliacarteryand,fromthere,intotheaorta.Anintra-vascularultrasoundwasperformedoftheentirepoplitealartery,superficialfemo-ralartery,commonfemoralarteryandtheiliacarteries.
The external iliac artery hadastenosisgreaterthan75%.TheSFAandproximalpoplitealarterieshadheavycalcificationandextensiveplaque.Asaresult,alaseratherectomyoftheentireSFAwasperformed.ThiswasfollowedbyanangioplastyoftheentireSFAandpoplitealarteryusinga6mmx20cmballoon.TheentireSFAwasthencoveredwitha6mmx15cmSUPERA®peripheralstentsystem.
The external iliac artery stenosiswastreatedwithintravascularultrasound,angioplastyandbare-metalstentplacement.Thepatientreceived5,000unitsofheparinintravenouslyduringtheprocedure.Thepoplitealarterysheathwasremovedandhemostasisofthepoplitealarteryaccesssitewasachievedthroughmanualcompression.
At the end of the procedure thepatienthadpalpable2+pulsesinthedorsalispedisartery.Intherecoveryroom,thepatientstatedshehadcompleterelieffromthepaininherlowerleftextremity.
Popliteal artery access under ultrasound, chronic total occlusion crossed through previously placed stents with guide wire
Angiogram through popliteal artery sheath, occluded previosly placed stents and extensive collaterals
Post artherectomy of stent placement. Left superficial artery residual stenosis is 0 %.
Laser artherectomy performed in-stent restenosis
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Roadmap for a successful Office-Based LabMidwest Institute for Minimally Invasive Therapies, Chicago, IL, USA
Case Study No 011 JeffreyG.Carr,MD,"NavigatingtheRisingWatersinHealthcare:TheOfficeBasedInterventionalSuiteasanInnovativeModel,"GlobalVascular
Digest,April2015Issue,http://www.globalvasculardigest.com/april-2015-issue/navigating-the-rising-waters-in-healthcare-the-office-based-interventional-suite-as-an-innovative-model/
2 TheOutpatientEndovascularandInterventionalSociety–www.oeissociety.org3 TheZiehmVisionRFDHybridEditionrepresentsagroupofoptionalhardwareandsoftwarethatcreatesanoptionpackage
onthedevicenamedZiehmVisionRFD.4 ComparisonofconventionalØ12"imageintensifierand30cmx30cmflat-paneldetector
Zieh
m Im
agin
g is
con
stan
tly
impr
ovin
g it
s pr
oduc
ts a
nd r
eser
ves
the
righ
t to
chan
ge t
he s
peci
fica
tion
s w
itho
ut n
otic
e. P
rese
nted
dat
a ar
e su
bjec
t to
tole
ranc
es. C
ount
ry s
peci
fic
data
and
opt
ions
may
app
ly.
Headquarters GermanyZiehm Imaging GmbH Donaustrasse 3190451 Nuremberg, GermanyPhone +49 911 2172 0Fax +49 911 2172 [email protected]
ItalyZiehm Imaging SrlVia Paolo Borsellino, 22 / 2442100 Reggio Emilia, ItalyPhone +39 05 22 61 08 94Fax +39 05 22 61 24 [email protected]
FinlandZiehm Imaging OyKumitehtaankatu 504260 Kerava, FinlandPhone +358 4 49 75 75 [email protected]
USAZiehm Imaging Inc.6280 Hazeltine National Dr.Orlando, FL 32822, USAToll Free +1 800 503 4952Phone +1 407 6 15 8560Fax +1 407 6 15 8561 [email protected]
BrazilZiehm Medical do BrasilAv. Roque Petroni Jr., 1089 cj 90404707-000 São Paulo, BrazilPhone +55 11 30 33 59 99Fax +55 11 30 33 59 [email protected]
FranceZiehm Imaging S.A.R.L.1, Allée de Londres91140 Villejust, FrancePhone +33 1 69 07 16 65Fax +33 1 69 07 16 [email protected]
ChinaZiehm Medical Shanghai Co., Ltd.Hongqiao New Tower CentreRm 06-07, 25 / F83 Loushanguan RoadShanghai, P.R. China; 200336Phone +86 21 62 36 99 03Fax +86 0 21 62 36 99 [email protected] SingaporeZiehm Imaging Singapore Pte. Ltd.7030 Ang Mo Kio Ave 5#08-53 Northstar@AMKSingapore 569880, Singapore Phone +65 6 39 1 86 00Fax +65 6 39 6 30 09 [email protected]
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