Healthcare Business News

The need for risk management p. 112 Your Industry Source for Health Care and Equipment Coverage April 2017

The OR Issue

Featuring our exclusive OR Equipment New Product Showcase p. 98

A lso in our Operating Room issue HOSPITAL BEDS • Can smart hospital beds replace patient monitors? p. 60 ENDOSCOPY • Assessing the adequacy of reprocessing common endoscopy devices p. 66 REPROCESSING • From FDA regulation to best practices p. 74 FOCUSED ULTRASOUND • Collaboration is fueling a changing landscape p. 84

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CONTENTS April 2017

THIS MONTH’S EXCLUSIVE Q&As 28

60

Dana Bledsoe, president of Nemours Children’s Hospital Orlando

32 John Flannery, GE Healthcare CEO

34 SGNA President Kristine Barman

FEATURES 42

66

C-arms Sector features innovation, new models and improvements in technology.

60 Hospital Beds Can smart hospital beds replace patient monitors?

66 Endoscopy The importance of assessing the adequacy of reprocessing common endoscopy devices.

74

84

Reprocessing From FDA regulation to best practices.

84 Focused Ultrasound Collaboration is fueling a changing landscape.

90 Operating Room/Year in Review The best stories from the past 12 months.

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

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3

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PUBLISHER

PRESIDENT CHIEF TECHNOLOGY OFFICER

EXECUTIVE EDITOR

EDITORIAL DIRECTOR

DOTmed.com, Inc. Philip F. Jacobus Matt Ulman Robert Garment Glenn J. Kalinoski

EDITORIAL

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COLUMNS

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Hospital Spotlight Nemours Children’s Hospital

30 IT Matters

CONTRIBUTING EDITOR Sean Ruck 212-742-1200 Ext. 218 sruck@dotmed.com

DAILY NEWS EDITOR

SENIOR REPORTER

CONTRIBUTING WRITERS

Gus Iversen Lauren Dubinsky Bruce Ackerman Lisa Chamoff Phillip P. Chan Maurice R. Ferre Jessica L. Foley Dennis Kelly Rich Krueger James Laskaris Chris Odom Jill Rathbun Bill Scott Bipin Thomas Dan Vukelich Thom Wellington

Using Big Data to Improve OR Efficiency

36 View From the Hill

CMS Requirements for Advanced Imaging Services

37

Cost Containment Corner

Growing Your Practice Through Patient Financing Options

40

Technology Advisor Focus on Millennials

50

C-arm Product Showcase

62

Hospital Beds Product Showcase

70

Endoscopy Product Showcase

78

Sterilizers Product Showcase

89 Purchasing Insights

Operating Room Buying Patterns

96

Infection Control in the Hybrid OR

98

OR Suite Product Showcase

112 The Future of Health Care

The Need for Risk Management

DESIGN

DESIGN DIRECTOR DESIGN CONSULTANT

Stephanie Biddle Oscar Polanco

SALES

SALES DIRECTOR David Blumenthal 212-742-1200 Ext. 224 dblumenthal@dotmed.com

KEY ACCOUNT Susan Minotillo

MANAGERS 212-742-1200 ext. 261 sminotillo@dotmed.com Connie Goon 212-742-1200 Ext. 289 cgoon@dotmed.com

ACCOUNT MANAGERS Colm Ford 212-742-1200 Ext. 241 cford@dotmed.com Michael Montes 212-742-1200 Ext. 217 mmontes@dotmed.com Press Releases If you have news regarding your company submit it to: pr@dotmed.com Article and Story Consideration If you have an article or feature story you would like the editor of HealthCare Business News to consider publishing, submit it to: news@dotmed.com Letters to the Editor Submit letters to the editor to: gkalinoski@dotmed.com Subscriptions For all subscription inquiries please email info@dotmed.com or visit dotmed.com/magazine Auctions If you want information about auctioning equipment on DOTmed.com, please call: 212-742-1200 Ext. 296, or email us at auctions@dotmed.com HealthCare Business News is published by DOTmed.com, Inc., 29 Broadway, Suite 2500, New York, NY 10006 Copyright 2016 DOTmed.com, Inc. All rights reserved.

DOTmedSM provides the HealthCare Business NewsSM to its registered users free of charge. DOTmedSM makes no warranty, representation or guarantee as to the accuracy or timeliness of its content. DOTmedSM may suspend or cancel this service at any time and for any reason without liability or obligation to any party.

All trade names, trademarks and trade dress contained herein belong to their respective owners and are used herein with the intent to represent the goods and services of their respective owners. If you think your trade name, trademark or trade dress is not properly represented, please contact DOTmed.com, Inc.

Letter from the Editor

The doctor won’t see you now This letter from the editor was written on the day that the Trump White House released its 2018 Fiscal Budget — March 16.

If you were paying attention that day, you noted some federal departments were winners, like Defense, Homeland Security and Veterans Affairs, and some were major losers, such as the EPA and the State Department.

But perhaps most surprising were the very significant cuts to America’s health care programs. Wasn’t making health care “great again” one of Trump’s rallying cries?

A quick surfing of the ’net that day came up with these reports, just a few among many: From Bloomberg News: “President Donald Trump is proposing big cuts to biomedical research as part of a budget to reduce discretionary spending at the Department of Health and Human Services by 23 percent.”

From NBC News: “[The Trump budget] would slash nearly $6 billion from the National Institutes of Health, which funds most basic medical research in the country … Trump’s plan would cut funding to medical and scientific research agencies and stall medical advances. ‘Cutting the funding in this way will have devastating and generation-long effects,’ said Dr. Clifford Hudis, CEO of the American Society of Clinical Oncology.”

From The Los Angeles Times: “… And the budget would slash more than $400 million in training programs for nurses and other health professionals.”

On top of that, the Congressional Budget Office (CBO) made these projections about the American Health Care Act (AHCA) — the program that “replaces” the ACA after it is “repealed”: “CBO estimates that, in 2018, 14 million more people would be uninsured under the legislation than under current law … following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026.”

Those all are pretty shocking numbers that affect real people. The good news is these are starting points and the numbers are sure to change. But as President Trump discovered for the first time a few weeks ago, in his own words, “health care is complicated.” Let’s hope our congressional representatives who have known that for a long time make wise changes to ameliorate some of the drastic implications of this legislation.

Robert Garment Executive Editor rgarment@dotmed.com

editorial advisory board 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 Professions

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

Katie Regan, Communications Manager, Children's Research Institute at UT Southwestern

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

Bipin Thomas, chairman, ICURO

Jason Launders, medical physicist, ECRI Institute Jill Rathbun, president, Galileo Consulting Group Inc.

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

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

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

Wayne Webster, principal, Proactics Consulting

www.dotmed.com/news

HealthCareBusiness Daily News Online Top trending headlines

Welcome to Our News Center daily news

online

When health care industry news breaks, you’ll read about it first at: dotmed.com/news Visit daily and sign up for our convenient weekly news digest.

As we went to print:

• Chicago health system doubles cancer detection rate with GE's automated breast ultrasound dotmed.com/news/story/36038

• Hitachi subsidiary wins $163 million DoD radiology contract dotmed.com/news/story/35970

M Siemens CEO stresses 'commitment to U.S. manufacturing' with Trump dotmed.com/news/story/36221

• Four trends emerged at HIMSS this year dotmed.com/news/story/35803

• Siemens' ARTIS pheno robotic C-arm gets FDA nod dotmed.com/news/story/36129

• New 3T Siemens MR adjusts itself for personalized imaging

in print Get a free subscription and sign up for the digital version of HealthCareBusiness News.

dotmed.com/news/story/35843

• GE acquires Monica Healthcare to expand its maternal and infant care portfolio dotmed.com/news/story/36100

• Scripps proton therapy center files for Chapter 11 bankruptcy protection dotmed.com/news/story/35917

• UCLA brings deep learning to interventional radiology dotmed.com/news/story/35992

• FDG PET/CT may yield benefits for staging lung cancer treatment, recurrence dotmed.com/news/story/35873

Subscribe to our Magazine and weekly Online News digest now.

M Philips partners with LabPON to develop massive digital pathology database dotmed.com/news/story/35940

• One dose of brachytherapy might be enough for prostate patients: study dotmed.com/news/story/35960

• Philips signs 15-year, $65 million strategic partnership with Phoenix Children's Hospital dotmed.com/news/story/35972

The need for risk management p. 112 Your Industry Source for Health Care and Equipment Coverage

• Can portable 3-D ultrasound of the eye quickly diagnose brain trauma?

April 2017

dotmed.com/news/story/36134 The OR Issue

Featuring our exclusive OR Equipment New Product Showcase p. 98

Also in our Operating Room issue

• Watson and MedyMatch partner to read trauma CTs in the ER faster dotmed.com/news/story/36130

HOSPITAL BEDS • Can smart hospital beds replace patient monitors? p. 60 ENDOSCOPY • Assessing the adequacy of reprocessing common endoscopy devices p. 66 REPROCESSING • From FDA regulation to best practices p. 74 FOCUSED ULTRASOUND • Collaboration is fueling a changing landscape p. 82

M Editor’s Choice Visit HCB Daily News online for breaking stories every day.

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Letter from the Daily News Editor

‘Nobody knew that health care would be so complicated’ A predictable pattern has emerged in how President Donald Trump’s cavalier attitude will be covered by the media: sympathetic outlets will try to read between the lines to figure out what he means, while critical outlets will painstakingly dissect the literal inaccuracies and contradictions in his comments.

A good example of this took place in February when, while addressing the repeal and replace plan for the Affordable Care Act, Trump mused, “Nobody knew that health care would be so complicated.” The ensuing headlines depended, of course, on where you got your news.

Among my friends and colleagues it was the same way. You’re either A) incredulous that the president of the United States could be so naïve about health care, or B) you appreciate the hyperbolic understatement in his comments and perceive them as an intentional bureaucratic wink.

In other words, you either subscribe to the Donald Trump school of loose talk or don’t. Pick your poison.

Obviously, health care is infinitely complicated and insurance is just one piece of the puzzle. Regulations intended to support patient

safety can inadvertently increase costs for hospitals, while legislation aimed at lowering costs may actually compromise safety.

It’s kind of a mess.

At HCB News, we’re seeing this with the CT dose standardization initiative, XR-29, which aims to cut reimbursement for facilities that do not meet certain criteria. There are seemingly minor elements in how XR-29 will be implemented that could have a major impact on the third-party equipment dealers and servicers who provide hospitals with equipment at a competitive price.

This is a topic we are going to be addressing in the coming weeks and months, so if you have any thoughts on the subject I would love to hear from you.

Politics aside, I think everyone who has ever set foot in a hospital probably shared a laugh when Donald Trump discovered how complicated health care is. Whether you’re laughing with him or laughing at him is a separate matter.

Thanks for reading.

Gus Iversen Online Editor giversen@dotmed.com Twitter: @dotmedcom

UCLA pilot study finds that eating grapes twice each day may reduce Alzheimer’s effects Posted online February 08, 2017 by Gail Kalinoski We’ve all heard an apple a day keeps the doctor away, but a new pilot study from researchers at the University of Los Angeles, California, has found that eating grapes two times a day may help keep the effects of Alzheimer’s disease at bay.

The research, results of a randomized, controlled study, showed that consuming grapes twice a day for six months protected against the decline of metabolic activity in Alzheimer-related parts of the brain, according to a story in Genetic Engineering & Biotechnology News. The UCLA researchers also found that the grape-enriched diet increased metabolism in other areas of the brain that aided in improvements in attention span and working memory.

The researchers published the results of 8

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their pilot study in Experimental Gerontology.

“The study examines the impact of grapes as a whole fruit versus isolated compounds and the results suggest that regular intakes of grapes may provide a protective effect against early decline associated with Alzheimer’s disease,” Dr. Daniel H. Silverman, lead investigator of the study, said in a prepared statement.

“This pilot study contributes to the growing evidence that supports a beneficial role for grapes in neurological and cardiovascular health. However, more clinical studies with larger groups of subjects are needed to confirm the effects observed here.”

The small pilot study focused on 10 randomly selected people — evenly split between men and women — with an average age of 72, who were suffering early memory

decline, according to the U.K.’s Mirror Online. They were randomly selected to receive either whole grape powder, the equivalent to 2.25 cups of grapes a day, or a polyphenol-free placebo powder that had similar flavor and appearance.

The research team measured cognitive performance at baseline and six months later. They used brain PET scans, also at baseline and after six months, to look for changes in the brain metabolism.

The results of this study showed that consuming grapes preserved healthy metabolic activity in the regions of the brain affected by early stages of Alzheimer’s disease. Those who had the placebo showed significant metabolic decline in the same regions of the brain.

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Is 4-D MR imaging ready to go mainstream?

Posted online February 02, 2017 by John W. Mitchell Researchers believe that the stunning images that can be produced with 4-D MR imaging are not only moving closer to becoming a reality on the front lines of medicine, but they can offer meaningful new solutions to serious medical problems.

“The strength of 4-D flow MR is its ability to help gain an understanding of complex situations,” Michael Markl, Ph.D., director of cardiovascular imaging research at Northwestern University, told HCB News. “For example, in congenital heart disease that cannot — or can only incompletely — be assessed with other imaging modalities.”

Markl has been working on 4-D MR imaging for more than a decade. Most

recently, the American Heart Association cited the technique in its journal Circulation: Cardiovascular Imaging, for its potential in predicting the risk of stroke in atrial fibrillation patients. Afib patients account for up to 30 percent of strokes every year.

Cardiologists who are trained to see the heart working in real time through a variety of imaging techniques — from MR to echo scans — can also watch complex blood flow unfold over time with 4-D MR flow.

“Compared to other MR tests, 4-D flow is very easy to perform ... compared to standard techniques that often require multiple 2-D measurements during breath-holding,” explained Markl. He added that 4-D MR offers new information that is not easily op-

tioned or impossible to assess with other diagnostic tests, such as time-resolved 3-D blood flow though all four cardiac chambers and valves, acquired in a single scan.

In addition to being useful, 4-D MR images are rich and beautiful. One of Markl’s graduate students recently took top honors in an annual scientific image contest with a still submission of a 4-D MR image.

According to Markl, several significant steps were achieved in the past one to two years to advance the 4-D modality, including adoption of a consensus statement on the clinical use of 4-D flow MR by leading academic groups in the field.

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New PET radiotracer for prostate cancer found to be safe and effective

Dense breast MR protocol showing promise at Seattle radiology center

Posted online February 03, 2017 by Lauren Dubinsky

Posted online February 08, 2017 by Lauren Dubinsky

In the latest issue of the Journal of Nuclear Medicine, researchers have confirmed that a new PET radiotracer for diagnosing primary and metastatic prostate cancer is safe and effective.

The gallium-68-labeled peptide BBN-RGD agent targets both the gastrin-releasing peptide receptor and integrin αvβ3. Unlike single-receptor targeting, dual-receptor targeting allows for tumor contrast when either or both receptor types are expressed.

"This approach is better than targeting a single receptor," Dr. Xiaoyuan Chen, senior investigator of the study, told HCB News.

"In other words, the sensitivity of detection is improved [over] other radiotracers."

The study involved 13 patients with prostate cancer. Four were newly diagnosed, nine received therapy and five were healthy volunteers.

They found that Ga-68-BBN-RGD PET/CT was able to detect 20 bone lesions in seven patients with primary prostate cancer or after radical prostatectomy. The patients with bone metastases didn't necessarily have an elevated prostate-specific antigen level.

Since no adverse events were reported during the procedure and at the two-week follow-up, Ga-68-BBN-RGD was deemed safe.

Chen noted that this is a better result than bone scanning with the most common radiotracer used today, technetium-99m-MDP. Share this story: dotmed.com/news/35278

A new Abbreviated Breast MR protocol that improves cancer detection in women with dense breasts is now available in the Pacific Northwest. The exams will be offered at Via Radiology in north Seattle.

“We know that the earlier the detection of breast cancer, the better the survival rate and the less debilitating and costly the treatment is. Breast MR can pick up very early stage cancers,” Dr. Craig Hanson, president and CEO of Via Radiology and medical director of Seattle Breast Center at UW Medicine/Northwest Hospital & Medical Center, told HCB News.

Currently, MR is only recommended for screening women who are at high risk for breast cancer because it’s an expensive test to perform. Hanson is hoping that the Abbreviated Breast MR protocol will change that.

“We have distilled the very important part of breast MR for screening purposes only,” said Hanson.

A study published in the Journal of Clinical Oncology in August 2014 found that the acquisition time for AB-MR is three minutes compared to 17 minutes for conventional breast MR. In addition, the diagnostic accuracy of AB-MR was equivalent to that of conventional breast MR, and detected an additional 18.2 per 1,000 cancer cases.

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Siemens’ PETNET to manufacture investigational tau imaging agent Posted online February 13, 2017

by Lauren Dubinsky Cerveau Technologies recently signed an agreement with Siemens’ PETNET Solutions that grants the company the right to manufacture its investigational tau imaging agent.

The [F-18]MK-6240 PET agent is currently under evaluation for imaging neurofibrillary tangles in the brain. NFTs that are made up of aggregated tau proteins are known as the pathologic hallmark of certain neurodegenerative diseases including Alzheimer’s disease.

The pharmaceutical company Merck initially developed [F-18]MK-6240 and then signed a license agreement with Cerveau last month for the global development and commercialization of the imaging agent.

Cerveau plans to initiate a Phase III clinical trial in early 2018. As part of the new agreement, PETNET will manufacture [F-18] MK-6240 clinical trial material at select radiopharmacies in the U.S. with the possibility of expanding into additional locations.

PETNET has over 50 PET radiopharmaceutical drug manufacturing facilities and dispensing nuclear pharmacies worldwide. The CEO of the company, Barry Scott, stated that its large network of radiopharmacies will be needed to support the availability of [F-18]MK-6240.

Early studies conducted by Merck scientists found that [F-18]MK-6240 has a high specificity and selectivity for NFTs. It also has “favorable physicochemical properties and in vivo pharmacokinetics that warranted clinical investigation as a potential PET neuroimaging agent.”

“There is a critical need for sensitive biomarkers for diagnosis and monitoring of tau pathology in neurodegenerative diseases, to allow for more appropriate staging of disease states, and measuring the effect of candidate disease-modifying therapeutics,” Darryle Schoepp, vice president discovery at Merck Research Laboratories, said in a statement in January.

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GE gets FDA nod for CT spectral imaging to improve visualization Posted online February 15, 2017 by Christina Hwang GE Healthcare announced the FDA clearance of GSI Xtream on Revolution CT, the first volume spectral CT technology designed for better visualization and simplified workflow.

The new technology improves the detection of small lesions and can differentiate between tissue with similar densities better than conventional CT systems, while

reducing metal artifacts and working with image-viewing software.

“The workflow has been designed to be similar to a single energy acquisition with faster image reconstruction, clinical identifiers and direct transfer to PACS,” Sonia Sahney, premium CT global product marketing manager, told HCB News.

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Siemens Healthineers signs $100 million-plus, five-year lab partnership deal in Turkey Posted online February 06, 2017 by Thomas Dworetzky Siemens Healthineers has landed a fiveyear contract with a pair of new Turkish hospitals expected to be worth more than $108 million, based on the anticipated test volumes.

Over the period, it is expected that over 90 million patients will be served.

“This project combines our expertise in equipping laboratories with our service portfolio. It is a milestone for us and, at the same time, also a proof point for how we enable our customers to meet their current challenges and to excel in their respective environments,” Bernd Montag, chief executive officer of Siemens Healthineers, said in a statement. “We have developed a customized solution for our partner DiA and the Turkish Ministry of Health that will compre-

hensively support their clinical business.”

The hospitals were built and are run as a public-private partnership between DiA Holding and the Turkish Ministry of Health.

“It was important for us to have a partner that not only came with enough experience in the hospital environment, but also was strong on technical innovation,” said Hakan Adanalı, director of clinical support services at DiA. Healthineers will run all medical labs in multiple disciplines, including biochemistry, microbiology, hematology, immunology, emergency, genetics, pathology and pointof-care testing.

The company will also design the labs, provide equipment, consumables and service and maintenance. It will also handle

Toshiba Medical wins $828 million DLA radiology contract Posted online February 07, 2017 by Thomas Dworetzky Toshiba American Medical Systems has won a contract worth as much as $828 million for radiology systems, accessories and training from the Defense Logistics Agency.

The Tustin, California, company was awarded the deal after a competitive process in which a total of 27 responses were received by the agency, according to a statement.

The firm-fixed-price, indefinite-delivery/indefinite-quantity contract is for five years, set to end Feb. 2, 2022. It has one five-year option.

The radiology systems will be used by the Air Force, Army, Navy, Marine Corps and federal civilian agencies.

Toshiba Medical will be changing its name during the length of the contract. Toshiba Medical Systems Corp. will become “Canon Medical Systems Corp.” on or about the beginning of 2018, according to the company.

The Toshiba medical unit went to Canon in March 2016, and the deal officially closed in December of that year.

In December 2015, Toshiba’s MR portfolio was the first to meet network security guidelines laid out by the U.S. Department of Defense, according to a company release.

At that time, stated the company, it “received authorization to operate (ATO) with the U.S. Air Force for its entire MR portfolio.”

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technical staffing.

The plan is part of the ongoing government restructuring of the health care system started in 2003, according to Siemens.

According to the Turkish government, the Bilkent health campus is the biggest health care project ever built from scratch in the country. It has almost 3,800 beds, a hotel, congress center and commercial area.

Beginning in mid-2018, more than 10,000 medical staff will be responsible for nearly 25,000 patients there on a daily basis.

The new hospital in Mersin will hold about 1,300 beds, and went operational at the end of January 2017.

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Researchers establish national dose levels for 10 common adult CT exams Posted online February 27, 2017 by Lauren Dubinsky When radiation dose isn’t proportional to patient size, patient exposure inevitably runs the risk of exceeding — or falling beneath — the amount necessary for good image acquisition. A two-year study published in the journal Radiology used the world’s largest CT dose index registry to establish national CT dose levels based on patient size.

Previous national diagnostic reference levels (DRLs) only provided one value per exam based on a standard-size phantom that represented an average patient. But Kalpana M. Kanal of the University of Washington School of Medicine and her colleagues realized that CT protocols need to be optimized for the wide range of patient sizes.

The American College of Radiology launched its Dose Registry Index in 2011, and by 2016 it expanded to include 30 million-plus exams from over 1,500 facilities. Kanal and her team evaluated more than 1.3 million registry exams that were conducted in 2014 at 538 health care facilities in the U.S. DRLs and achievable doses were developed for 10 of the most common adult CT exams. For head exams, the team used lateral thickness to determine patient size, and water-equivalent diameter was used for neck and body exams.

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Siemens gets FDA nod for budget-friendly MAGNETOM Sempra 1.5T MR Posted online February 13, 2017

by Lauren Dubinsky Siemens Healthineers announced that the FDA has cleared its MAGNETOM Sempra 1.5T MR, a system designed for radiology practices and small- to medium-sized hospitals that need to keep operating costs low.

The scanner utilizes three Day optimizing throughput (Dot) workflow engines (for brain, spine and large joint exams) so that clinical cases can be adjusted for each patient. Together, those procedures add up to roughly 75 percent of the average MR imaging volume, which means exams can be conducted faster and repeat scans can be avoided more often.

Patients with MR-safe metallic hip and knee implants can undergo MAGNETOM Sempra exams and most scans — including brain scans — can be completed in 10 minutes.

The system also employs Eco-Power technology which monitors and controls the magnet-cooling helium and can reduce energy consumption by up to 30 percent, compared to the system’s normal mode. Zero Helium boil-off technology is offered as a supplementary feature to help facilities avoid helium refills by preventing evaporation.

“Siemens Healthineers is pleased to offer the MAGNETOM Sempra, an MR system designed to address the needs of radiology practices, smaller hospitals and other providers in delivering high-quality patient care in a cost-effective manner,” said Murat Gungor, vice president of Magnetic Resonance at Siemens Healthineers North America, in a statement.

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Philips signs 15-year, $65 million strategic partnership with Phoenix Children’s Hospital Posted online March 08, 2017 by Lauren Dubinsky Royal Philips has signed a $65 million long-term strategic agreement with Phoenix Children’s Hospital, one of the largest children’s hospitals in the U.S. “The doctors and researchers at Phoenix Children’s Hospital often create solutions on site that can address the specific needs of these young patients,” Brent Shafer, CEO of Philips North America, told HCB News. “We

look forward to working further with Phoenix Children’s to create solutions that can scale and improve global pediatric care.”

These on-site solutions include life-size models of patients’ hearts and other organs that can be used to plan surgeries via the pediatric care provider’s advanced 3-D printing lab.

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Is Medtronic readying medical supply business for sale?

Posted online February 03, 2017 by Thomas Dworetzky Medtronic seems to be looking to unload its medical supply business.

The company inherited most of the assets potentially on the block in its Covidien purchase, first announced in 2014. The business markets a wide variety of supplies including needles, catheters, monitoring equipment and medical instruments.

The cash-and-stock transaction was valued when it closed on Jan. 26, 2015, at approximately $49.9 billion, based on Medtronic’s closing stock price of $75.59 per share on that day.

While still in its initial stages, the present plan could result in the sale of a unit worth upward of $5 billion, unnamed sources told Bloomberg News.

Medtronic has, so far, had no comment on possible deals, although sources have

told the news agency that possible buyers have been alerted by the company.

No word yet as to whether plans call for a single big sale or multiple deals breaking up the supply business into smaller units.

Earnings for the business under consideration were about $500 million.

At the time of the Covidien acquisition Omar Ishrak, chairman and CEO of Medtronic, said that it brought together “the extensive and innovative capabilities of both Medtronic and Covidien with an underlying objective to solve health care’s biggest challenge — expanding access and improving clinical outcomes, while lowering costs.”

Even when the deal happened, it seemed that the “commodity” medical supply business was an unlikely fit with much of the

higher-technology Medtronic business, such as pacemakers and neurostimulators.

Beyond that, these types of medical supplies were a relatively small part of Covidien’s overall market share, accounting for only $1.6 billion of 2014 annual sales of $10.7 billion, according to the Minneapolis/St. Paul Business Journal.

Many of these types of supply offerings were brought under Medtronic’s patient monitoring and recovery unit. Overall, that unit had fiscal 2016 revenue of $4.3 billion.

CMS announced it will provide reimbursement for leadless cardiac pacemakers, thus giving heart failure patients broader access to Medtronic’s Micra Transcatheter Pacing System.

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MIT researchers develop alternative to gadoliniumbased MR contrast agents

Toshiba Medical Systems announces new name, bright future forecast

Posted online February 16, 2017 by Lauren Dubinsky

Posted online February 01, 2017 by Thomas Dworetzky

Researchers at the Massachusetts Institute of Technology have developed an alternative to gadolinium-based contrast agents for MR exams. The new iron oxide nanoparticles may be safer for patients with impaired kidney function.

About one-third of the 60 million MR procedures performed annually use contrast agents that usually contain gadolinium, according to MIT. Studies have shown that in rare cases gadolinium can cause a potentially fatal condition called nephrogenic systemic fibrosis.

Recent research has shown that gadolinium can accumulate in the brain, but to date it hasn’t been proved to cause any harmful effects. The FDA is investigating whether this build up in the brain is harmful.

The MIT researchers found that similar MR contrast can be produced with small iron oxide nanoparticles that have been treated with a zwitterion coating. Zwitterions are molecules that have areas of positive and negative electrical charges that cancel out and make them neutral.

Some contrast agents generate negative or dark areas in the MR image and others produce positive or light areas. The agents that produce light areas contain gadolinium, and iron oxide particles have mostly been used as dark contrast agents.

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Toshiba Medical Systems Corp. will have its name changed to Canon Medical Systems Corp. on or about the beginning of 2018, according to the company.

The megadeal that saw Canon buy the group from Toshiba appears to be having the desired effect, bolstering its bottom line.

Canon just forecast operating profit to climb 11.4 percent for the full year. That’s the first upward movement for revenue in three years, according to a Reuters report, which noted it was “bolstered by earnings from a medical equipment unit it bought from Toshiba Corp. last year.”

The forecast, which called for a $2.3 billion rise, was in line with analyst estimates, according to Thompson Reuters.

Rumors had swirled that Canon might ride to Toshiba’s rescue again and put money into its chip business. But Canon CFO Toshizo Tanaka said at a 2016 earnings news conference in late January that such a deal would be “difficult,” according to the Japan Times.

His reasoning is in line with the $6 billion Toshiba Medical buy. He said that Canon is undergoing a “major strategic transition” away from its mainstay businesses toward new ones, specifically medical equipment.

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Will PET and SPECT become ‘go-to’ imaging methods for the brain?

Posted online February 24, 2017

by Lauren Dubinsky Dr. Robert S. Miletich, interim chair and professor at the Jacobs School of Medicine at the University at Buffalo, believes that nuclear medicine will one day be as important to neuroscience as it is to cardiology.

“Nuclear neurology is an emerging medical subspecialty,” he told HCB News. “My anecdotal experience has been that once clinicians have seen what nuclear neurology can do for them in the care of their patients, they expand their use of it.”

PET and SPECT could potentially improve the detection and treatment of many brain disorders including Alzheimer’s disease, traumatic brain injury and autism. Miletich is studying brain scans obtained from 16,000 patients that range from juveniles to the elderly.

In clinical practice, he already uses these modalities to image brain tumors, TBI, epilepsy, transient ischemic attack, dementia, Parkinson’s as well as depression, anxiety disorders and schizophrenia.

“Diseases or illnesses always affect the physiology and function of the brain. Anatomic changes, though, do not always happen with disease,” he said. “A good example is traumatic brain injury wherein CT or MRI are often unremarkable, but SPECT is clearly abnormal.”

The main hurdle is that many physicians lack expertise in interpreting nuclear neurology images. That’s largely because brain function is complex and the number of potential diseases that can cause a particular neurologic disorder is larger.

Miletich and other physicians proficient in nuclear neurology are beginning to train younger physicians. Because of that, he expects that the adoption of PET and SPECT will increase for neurological applications.

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Researchers are developing an army of tiny MR-powered robots to deliver cancer drugs Posted online March 09, 2017 by Lauren Dubinsky Imagine tiny robots, called microsurgeons, that physicians can steer through blood vessels to deliver cancer drugs. Researchers at the University of Houston and Houston Methodist Hospital are working on making that a reality.

The team is developing imaging technology, control algorithms, ultrafast computational methods and human-machine

immersion methods to harness the power of an MR scanner. MR will be used to both provide imaging and steer the .5-to-2-millimeter robots through the body.

Even the fastest MR systems on the market are too slow for this procedure and have a time lag before the information is available.

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Hospira’s infusion business sells for $900 million Posted online February 08, 2017 by Gail Kalinoski Medical device maker ICU Medical Inc. completed its acquisition of Hospira Infusion Systems from Pfizer Inc. and paid about $900 million, less than the $1 billion first announced in October.

The business includes IV pumps, solutions and devices that, when combined with the company’s existing businesses, make San Clemente, Calif.-based ICU Medical one of the world’s leading “pure-play” infusion therapy companies.

“We are pleased that Hospira Infusion Systems is now part of ICU Medical and welcome our new Hospira colleagues to the ICU team,” Vivek Jain, ICU Medical chairman and CEO, said in a prepared statement.

“We look forward to working together to

continue providing quality, innovation and value to our clinical customers worldwide.”

The Hospira Infusion Systems product line complements ICU Medical’s existing business, to create a company with a complete IV therapy product portfolio from solutions to pumps, to non-dedicated infusion sets. ICU Medical said the acquisition also significantly enhances its global footprint and platform because it now holds industryleading positions in key segments and has access to the full U.S. infusion marketplace with a “compelling product portfolio.”

Pfizer acquired Hospira Infusion Systems in September 2015 as part of a $15.5 billion purchase of parent company Hospira Inc., which was described as the world’s leading

Hologic acquires aesthetics company Cynosure for $1.65 billion amid market growth Posted online February 15, 2017 by Lauren Dubinsky Hologic signed an agreement to acquire the medical aesthetics company Cynosure for approximately $1.65 billion. It will purchase all of Cynosure’s outstanding shares for $66 each in cash.

Cynosure has a portfolio of over 20 products for noninvasive body contouring, hair removal, skin revitalization and women’s health. The products are sold through direct sales and distributors in 130-plus countries.

The company launched the world’s first FDA-cleared laser treatment for noninvasive body contouring, SculpSure. It also owns a carbon-dioxide laser for women’s health called MonaLisa Touch.

Cynosure raked in $433.5 million in 2016 and reported top-line growth in 28 consecutive quarters. About 60 percent of the company’s business comes from physicians outside the traditional areas of plastic surgery and dermatology, with a significant focus on OB/ GYN applications.

The global medical aesthetics segment is worth more than $2 billion and is expected to grow at a low double-digit rate over the next few years. The aging population is taking an interest in aesthetics and physicians are looking to increase their cash-based procedures.

The aesthetics segment is not “subject to reimbursement risks, making it less cyclical,” Margaret Kaczor, analyst at William Blair, told Reuters.

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provider of injectible drugs and infusion technologies and a global leader in biosimilars.

Last May, Pfizer began taking bids for Hospira Infusion Systems. At that time it was thought that by selling off the pumps and devices unit, Pfizer would have a more “pureplay” drugs unit for a potential spinoff.

In October, Pfizer and ICU Medical entered into a definitive agreement for the sale of the Hospira unit calling for ICU Medical to pay $1 billion in a cash-and-stock deal.

But The Street reported that ICU Medical reduced the upfront cash component of the agreement and added an earnout provision, reducing the sale price to about $900 million.

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Global MR systems market to reach $7.52 billion by 2021 Posted online February 22, 2017 by Lauren Dubinsky The global MR systems market was valued at $5.45 billion in 2016 and is expected to hit $7.52 billion by 2021, with North America and South America leading the charge, according to a new Technavio report.

A major driver of the market is the development of MR-compatible pacemakers, which are allowing providers to utilize cardiac and breast disease imaging techniques that cannot be performed when implanted devices contain ferromagnetic material.

MR imaging is primarily used for diagnosing disorders in the central nervous system and to guide radiosurgery for intracranial tumors and arteriovenous malformations. The global MR systems market for brain and neurological disorders is expected to reach $2.61 billion in four years.

The market is highly competitive for manufacturers, so many have gotten involved in strategic partnerships, mergers and acquisitions. In March, GE Healthcare partnered with Columbia University Medical Center to advance MR research.

In May, Siemens Healthineers partnered with Case Western Reserve University and University Hospitals Case Medical Center to further develop MR fingerprinting.

PET/MR hybrid imaging systems are becoming more popular as applications in breast and prostate cancer have been developed. A University of Michigan study published in July found that PET/MR improves the accuracy of image-guided prostate biopsies.

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Konica Minolta jumps into secure enterprise imaging at HIMSS with Exa Posted online February 23, 2017

by John W. Mitchell Konica unveiled its new Exa Enterprise Imaging Platform at HIMSS 2017.

It is the only server-side rendering diagnostic zero footprint universal viewer for DICOM and non-DICOM images — which Andrew Horning, Konica Minolta cardiology product manager, told HCB News offers myriad benefits.

“Exa does not push large files — data is not in motion, no pre-fetching is required,” Horning said. “The server does all the work and it’s instantaneous — similar to how Gmail operates.”

With a minimum five-pixel monitor, Exa will view any angle and make measurements with speed.

The platform also has an app for mobile viewing, although it does not provide measurement capability.

Physicians will appreciate the view customization. Horning said that doctors would see only what they want to see when they log in.

“We have respected physician workflow on the platform,” he said. “We’ve figured out how to make complicated stuff, including cardiology echo and stress studies, simpler on the Exa platform.”

Exa also allows managers to assign parameters to the workflow. If, for example, a physician cannot read a study or a result in a preset time limit, the manager can set up rules to send the test to another physician to interpret. The system also allows for tie-in billing, syncing with EHRs and scheduling platforms.

According to Konica Minolta, the new collaborative workflow platform provides hospitals and imaging centers the ability to view images across departments and facilities. It also functions as a vendor-neutral archive (VNA) for central storage of images.

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Philips partners with LabPON to develop global digital pathology database Posted online March 07, 2017 by Lauren Dubinsky Royal Philips has partnered with a pathology lab in the Netherlands called LabPON to create the largest digital pathology database of annotated tissue images in the world.

Using the database, the partners hope to develop deep learning algorithms to inform future tissue assessments.

“Deep learning focuses on the devel-

opment of advanced computer programs that automatically understand and digitally map tissue images in considerable detail.

The more data available, the more refined the computer analysis will be,” Peter Hamilton, group leader of image analytics at Philips Digital Pathology Solutions, said in a statement.

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Majority of recent health data breaches were an inside job as focus remains on external threats: report Posted online February 16, 2017 by John W. Mitchell According to a recent analysis by patient protection analysis experts at Protenus, insiders committed 58.4 percent of patient health record privacy violations in January 2017 — a figure well above the 43 percent for all of 2016.

While external hacking of medical records garnered most of the attention last year, insider violations are a much bigger problem.

Another concern is that hospitals are often exceeding the 60-day period required by the government to report such breaches.

“In 2016, the headlines were dominated by external threats [26.8 percent of incidents],” Robert Lord, co-founder and CEO at Protenus, told HCB News. “While this is a perennial challenge, the severity of the delay between breach and detection [607 days]

in the case of malicious insiders was deeply troubling and quite surprising.”

Lord said his company, in collaboration with databreaches.net, provides a monthly assessment of data breaches affecting health care data, whatever the source of the breach or origin of the data. They also provide an annual report.

The January Breach Barometer report included nearly 400,000 compromised patient records involving 31 incidents. The two companies gather their information from publicly reported databases, and other events reported in the media.

“The Breach Barometer ... helps hospital leadership better prioritize budget line items to help mitigate their breach risk,” said Lord. “It also arms privacy and security

teams with information to help justify the resources they need to help better protect an organization from an array of threats to their patient data.”

According to Lord, awareness about internal threats is generally less publicized.

“We believe that 2017 will be the year of insider breach awareness. Insider threats need focus and action now,” Lord stressed. “It’s time to ensure the trustworthiness and appropriateness of access to clinical systems.”

Outside hacking remains a concern. According to the Protenus website, there were 12 hacking incidents in January affecting more than 145,000 records. One of the incidents was unusual, in that there was no ransomware or ransom demand.

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New 3T Siemens MR adjusts ACR says CMS and FDA itself for personalized imaging approval is required for thirdparty XR-29 compliance Posted online March 01, 2017 by Lauren Dubinsky Siemens Healthineers’ new high-end 3T MR system, Magnetom Vida, was launched at the University Hospital Tübingen in Germany.

It’s the first system equipped with the company’s BioMatrix technology, which adjusts the system to fit the different anatomical and physiological aspects of each patient.

“We want to generate standard and consistent, reproducible clinical outcomes with our MR systems,” Dr. Christoph Zindel, senior vice president of MR at Siemens, said at a press conference. “The challenge is that when you are looking around we find that we are all different in many aspects — shapes, physiology and so on.”

Siemens spent over five years developing the BioMatrix technology. The Magnetom Vida with BioMatrix was first installed at the University Hospital Tübingen and has been undergoing clinical trials since December 2016.

The BioMatrix sensors in the table automatically track patients’ respiratory patterns to determine their ability to hold their breath during the exam, making it especially useful for asthma patients.

The BioMatrix tuners help to avoid rescans and improve the quality and reproducibility of whole-body diffusion. For example, during cervical spine exams it uses intelligent coil technology to automatically set the optimal scan parameters based on the patient’s anatomy.

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Posted online March 01, 2017 by Gus Iversen A new update to the ACR’s guidelines for achieving NEMA XR-29 compliance from third-party solutions could spell good news for Medic Vision, one of a handful of companies offering CT add-on software to meet the standards.

While the requirement has been somewhat ambiguous for thirdparty solutions, the new update specifies that these CT upgrades must be FDA-cleared and approved by CMS to be valid.

That leaves Medic Vision’s SafeCT-29 as the only third-party XR-29 solution on the market — at least for now.

“The medical imaging community has been waiting for clear guidance since the XR-29 standard became effective in 2016,” said Eyal Aharon, CEO of Medic Vision, in a statement. “We’ve advocated for clarity surrounding the XR-29 compliance guidelines that were too vague and raised concerns among CT operators and vendors.

These updated guidelines not only provide clarity, but ensure adherence to the highest standard for patient safety,” he added.

Scanner OEMs like Philips, Siemens and GE have established upgrade pathways for many of their CT scanners to ensure compliance — but older models are being left behind, as well as the majority of PET/CT systems.

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ACS and Johns Hopkins aim to cut surgery stays in half and improve care with $16 million study Posted online February 13, 2017 by John W. Mitchell The American College of Surgeons and Johns Hopkins Armstrong Institute for Patient Safety and Quality are looking for 750 hospitals that are willing to radically shake up the way they deliver surgical care.

The two organizations are undertaking an initiative with $4 million in startup money from a government quality agency with up to $16 million in total funding possible over the next three years.

The Enhanced Recovery After Surgery (ERAS) protocols achieved 30 to 50 percent shorter surgical recovery times, improved safety and lowered costs in more than 20 countries, according to an article published in the Journal of the American Medical Association Surgery.

“To achieve these outcomes, practices with-

in a facility need to change,” Michael Rosen, Ph.D., associate professor of anesthesiology and critical care medicine at Johns Hopkins, told HCB News. “Changing behavior in any organization is difficult, and doubly so for complex technical organizations, like surgical services.”

To achieve such a change in surgical outcomes, the participating hospitals will have to make a five-step cultural change using ERAS protocols. This requires engaging front line, hands-on caregivers to think critically about the way they do their work and make evidence-based changes. Some of the examples cited in the JAMA article included: changes in overnight fasting; eliminating or early removal of drains and tubes; getting patients up on their feet sooner; and changes to nutrition on the day of the operation.

“This translates to better care for the patient,” Dr. Clifford Ko, director of the Division of Research and Optimal Patient Care at ACS, told HCB News. “We know that changing culture is paramount to improving quality of care. We have multiple examples of hospitals participating in the American College of Surgeons Quality Programs that have improved their culture and then improved their surgical outcomes.”

The project is funded and guided by the Agency for Healthcare and Research Quality — part of the Department of Health and Human Resources — and has led several highprofile, evidence-based health delivery initiatives aimed at reducing hospital-acquired infections and improving patient safety.

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Philips unveils Access CT at ECR Posted online March 03, 2017 by Lauren Dubinsky Royal Philips unveiled its latest CT system, the Access CT, at the 2017 European Congress of Radiology in Vienna. It’s designed for facilities that want to establish or improve their CT imaging capabilities at a reasonable cost.

Health care organizations are becoming increasingly cost-conscious as they face reimbursement cuts, patient populations that can’t afford to pay medical bills and inefficiencies with growth and expansion.

“It’s always important that an imaging solution provides the right answer, the first time, but especially so for health care organizations that rely on a scanner to cover a wide breadth of patient needs within a more limited budget,” Kees Wesdorp, business group leader of diagnostic imaging at Philips, said in a statement.

The system can do a lot more than just routine imaging. Philips added advanced applications to the console so that it can be used for brain perfusion, lung nodule analysis, vessel analysis and virtual colonoscopy.

The iFlow console workflow platform offers features that automate the tasks of the technologist. That could help providers maintain, and even expand, their referral base.

The iDose4 reconstruction algorithm helps to personalize image quality based on a specific patient’s needs while maintaining a low radiation dose.

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Siemens Healthineers eyeing U.S. IPO debut Posted online February 14, 2017 by Thomas Dworetzky Siemens Healthineers may wind up publicly listed in the U.S. and not Europe.

This would let the German industrial giant take advantage of higher valuations than found in Europe for its $15 billion health care business.

“We don’t have a final view on this yet, but we are looking at it very closely,” Reuters reported Joe Kaeser, CEO of Siemens AG, told Euro am Sonntag.

The move is part of the major refocusing of the company. “I can imagine a future in which we give investors the opportunity to invest not just in the companies Siemens Healthineers or Siemens-Gamesa renewable energy, but also in a high-performing digital

industry business,” he told the weekly.

He also advised that there might be a dividend boost for shareholders on the way.

“We have just raised our profit guidance for 2017 and have increased our dividend three years in a row. I wouldn’t end such a streak for no reason,” he stated.

Healthineers might go public in late 2017, as HCB News reported in late January, when sources told Reuters that bankers were being contacted to help with the IPO. “Goldman Sachs will very likely emerge as one of the global coordinators of the Healthineers IPO,” an unnamed source told Reuters at the time.

“Health care is one of the most attractive businesses, if not the most attractive

we have in the company,” Kaeser said when announcing the spinoff of Healthineers in 2016.

The move had been in the works since 2014, when Siemens created the health care component as a “company within the company.” This set up an entity able to respond quickly to the enormous changes in the global health care market.

“The public listing is now the next step in further strengthening Siemens Healthineers in Siemens for the future,” he stated, stressing that the move came during a period when the Healthineers already held “a leading position” and the company had boosted its market share.

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Using SPECT to differentiate Alzheimer’s disease from late-onset depression

New tomosynthesis technique may eliminate need for 2-D mammo

Posted online February 16, 2017 by Lauren Dubinsky

Posted online February 22, 2017 by Lauren Dubinsky

Alzheimer’s disease and depression present with similar symptoms, making it difficult to tell the disorders apart. A study published in the Journal of Alzheimer’s Disease found that SPECT imaging is capable of making the correct diagnosis.

About half of individuals with late onset depression show signs of cognitive impairment and 9 percent to 65 percent of patients with dementia also have depression, according to the researchers.

“These disorders have very different prognoses and treatments and being able to improve diagnostic accuracy can improve outcomes for some patients,” Dr. Daniel G. Amen, lead researcher and psychiatrist, said in a statement.

Depression is usually diagnosed with a tool called Beck Depression Inventory, in which the patient answers a series of questions. But the researchers argue that the inventory reveals no statistically significant difference between those with depression and cognitive disorder compared to those with either condition.

Amen and his team recruited 4,541 individuals for the study — 847 were diagnosed with dementia, 3,269 with depression and 425 with both disorders. They then had each participant undergo brain SPECT exams.

The data reveal that those with cognitive disorders had reduced blood flow in multiple areas of the brain compared to those with depression.

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Digital breast tomosynthesis (DBT) in conjunction with fullfield digital mammography (FFDM) has been shown to improve cancer detection, but performing both exams means additional radiation exposure for the patient. Researchers at Christiana Care Health System developed a DBT technique that may eliminate the need for FFDM. The s2D mammography technique uses breast tomosynthesis images to create a synthesized 2-D compilation image, effectively collapsing down to a 2-D image, which is similar to the one that would be generated by mammography.

“The reason this is potentially practice-changing is that the replacement with an s2D image has a significant radiation dose reduction and decreased time of breast compression,” Dr. Jacqueline S. Holt, director of breast imaging at the health system, told HCB News.

Holt and her team studied 78,810 screening mammograms performed from 2011 to 2016. In the study group, 32,076 were screened with mammography, 30,561 with tomosynthesis and mammo and 16,173 with the s2D synthesizing technique..

They took note of the recall rate, cancer detection rate and the positive predictive value, which is the ability to predict whether an image-detected abnormality is malignant.

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Cut catastrophic infusion pump dosing errors by more than half with integrated software Posted online February 20, 2017 by John W. Mitchell Findings from a multi-hospital white paper study demonstrate that potentially catastrophic dosing errors (PCDE) are sharply reduced with an integrated pump dosing solution. ICU Medical Inc., which conducted the study, found a 52 percent decrease in PCDE and a 156 percent increase in participation in drug library (dosing) compliance when such systems are installed.

“Human error associated with inaccurate medication, dose, concentration, and incorrect patient are common errors found in health care,” Candida Arvelo, MBS, BSN, clinical director, Integration at ICU Medical Inc. told HCB News. “Synergies between infusion device safety software and EMR/CPOE systems significantly reduce the risk of these errors by ensuring accurate order transfer

and a checkpoint with infusion safety software, intended to mitigate human error.”

The study was conducted at three community hospitals ranging from 50 to 350 beds. The facilities had installed ICU Medical’s smart infusions system and medication safety software products. The average installation cost, according to Arvelo, is about $120,000 per hospital, plus some licensing fees. While these technologies have been around for a while, implementation has been slow.

“The greatest barrier to adoption has been the slow uptake of awareness of this technology among clinical leaders. There has also been very little published on outcomes associated with adoption, or cost benefits that will support adoption,” said Arvelo.

The study reviewed more than half a mil-

lion programing sequences. The primary outcome showed the impact of clinical integration of infusion devices with the EMR on reducing serious, preventable medication errors. All three metrics — incidence rate, compliance and variability of severity — improved at each individual hospital. There was also a large and statistically significant reduction in the variability in the severity of individual PCDEs When analyzing data month by month over the study period, the reduction in PCDEs clearly pivoted around the “go-live” date of ICU Medical’s client hospitals, and is sustained after integration. The clinical team that conducted the study included a doctor of pharmacy and a medical doctor.

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Most patients have no clue if their doctor is receiving industry payments Posted online March 09, 2017 by John W. Mitchell A new study addresses the concern that widespread acceptance of payments and gifts could tempt physicians to make decisions that are not in the best interest of their patients.

By cross-referencing information from a publicly available open payments data set from 2014 with a short online survey of adults, the researchers found that 65 percent of patients had, in fact, visited a doctor who accepted medical industry payments — but only 5 percent know if their doctor had received payment.

In addition, only 12 percent of patients were aware that details of such payments were publicly available and only 45 percent of survey respondents were aware that such payments even existed.

Since 2013, under the auspices of the ACA, pharmaceutical and medical device manufacturers are required to report gifts and payments to health care providers.

“The findings are important because they tell us that the reach of industry payments at the patient level is much more extensive than we had previously thought, and they tell us that more should be done to inform patients,” said Genevieve Kanter, Ph.D., one of the authors and assistant professor in the Department of Health Management and Policy at Drexel University.

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ECRI executives, chief nursing informatics officer make case at HIMSS for IT patient safety leadership Posted online February 27, 2017 by John W. Mitchell Two executives from ECRI and a health system chief nursing informatics officer made the case to HIMSS attendees that hospital informatics staff must move from the help desk to the medical floor to keep patients safer.

“IT has to become visible to leadership and staff in designing workflow and information aggregation systems to improve patient safety. That’s the word we’re trying to get out at HIMSS this year,” Ronni Solomon, JD, executive vice president and general counsel, told HCB News.

She led a panel discussion with Bill Marella, executive director of ECRI, and Patricia Sengstack, RN-BC, chief nursing informatics officer at Bon Secours Health, titled “Journey

to Patient Health: Where We’ve Been and How Health IT Can Help.”

Marella announced that ECRI has released eight new safety practices as part of a Health IT Safe Practices initiative. These standards are part of the ongoing work of the Partnership for Health IT Patient Safety that formed in 2013. The recommendations cover a wide range of improvements. These range from standardizing patient identifiers, patient attributes, and distinguishing information across screens, as well as implementing monitoring systems to detect identification errors.

To drive the need home for such safety changes, Solomon asked for a show of hands of how many in the audience had an IT safety program in their hospital. Only a

few in attendance responded.

“IT has the ability to hardwire safety into hospital systems to hold the gains we’ve made in safety [and make further improvements],” said Marella. “IT must synthesize the data and put it front of people who can take action.”

As an example, he cited one hospital leadership team they worked with last year that used the transparency of such data to share hundreds of cases of patient care errors that had been retained in risk management and not shared.

“In God we trust, all others bring data,” said Sengstack. “A famous quote on mistakes instructs that we have to learn from all mistakes because we won’t live long enough to make them all ourselves.”

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Scientists cut contrast in angiography using miniature particle accelerator

F-18-fluciclovine PET/CT better targets radiotherapy for recurrent prostate cancer

Posted online March 07, 2017 by Lisa Chamoff

Posted online March 08, 2017 by Lauren Dubinsky

Using a miniature particle accelerator that produces more precise X-rays, scientists in Germany were able to perform angiography using at least a third of the amount of contrast while still retaining image quality.

While more research is needed before patients can be imaged with this technology, it has the potential to avoid complications from contrast agents in those with kidney problems.

The scientists, from the Department of Diagnostic and Interventional Radiology at the Klinikum rechts der Isar, working with the chair of biomedical physics at the Technical University of Munich (TUM), used monoenergetic X-rays, which were generated by the Munich Compact Light Source (MuCLS).

The MuCLS, considered the world’s first mini-synchrotron, was introduced at TUM in 2015.

Their research was recently published in Nature Scientific Reports.

“The energy of the X-rays of a compact synchrotron can be adjusted more precisely to an ideal ratio of image quality and dose, compared to a conventional X-ray tube spectrum,” Elena Eggl, chair of biomedical physics at TUM and the paper’s lead author, told HCB News. “A dose reduction appears feasible because low-energy Xrays are spared.”

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CT, MR and nuclear medicine bone scans are conventionally used to guide and monitor targeted treatment for recurrent prostate cancer, but researchers at the Winship Cancer Institute of Emory University may have found a better alternative.

Preliminary results in a three-year study that found fluorine-18-fluciclovine PET/CT can improve radiotherapy targeting were published in the March issue of The Journal of Nuclear Medicine.

“F-18-fluciclovine PET/CT will have an increasing role for treatment planning in radiotherapy, and study is ongoing to further define its utility in guiding and planning radiotherapy in the post-surgery recurrent prostate cancer setting,” Dr. Ashesh Jani, professor of radiation oncology at the institute, and Dr. David M. Schuster, associate professor of radiology and imaging services, told HCB News via e-mail.

Jani, Schuster and the rest of the team had 96 patients undergo initial treatment planning based on results from standard CT or MR abdominopelvic imaging. To better define the tumor-target area and modify treatment planning, 45 of the patients underwent abdominopelvic F-18-fluciclovine PET/CT exams.

They found that including F-18-fluciclovine PET/CT information in the treatment planning process leads to notable differences in the target areas that receive radiotherapy. In addition, they didn’t observe any increase in toxicity.

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ACR and other groups urge Congress to pass CT colonography act Posted online March 03, 2017 by Lauren Dubinsky The American College of Radiology and other physicians and patient groups are strongly urging Congress to pass the CT Colonography Screening for Colorectal Cancer Act that would provide Medicare coverage for the procedure.

CT colonography, also known as virtual colonoscopy, uses CT or MR imaging to generate a 3-D image of the interior lining of the colon and rectum. It’s much less invasive than a standard colonoscopy procedure.

The United States Preventive Services Task Force assigned an “A” grade to CTC under the Affordable Care Act and requires private insurers to cover the procedure with no copay. However, Medicare refuses to provide coverage.

CMS covers colorectal screening for average risk individuals age 50 and older using fecal occult blood testing, sigmoidoscopy, colonoscopy and barium enema. The agency stated, “Neither the Medicare law nor the regulations identify the CTC test as a possible coverage option under the colorectal cancer screening benefit.”

U.S. Hispanics are more likely to die from colorectal cancer than those in many Central and South American countries, yet only half of that patient population age 50 and older gets screened. African-Americans also have lower screening rates and a higher death rate for colorectal cancer.

“We need more Medicare-covered options, including CT colonography, to increase Hispan-

ic screening rates and save lives,” Dr. Elena V. Rios, president and CEO of the National Hispanic Medical Association, said in a statement.

This is not the first time patient and physician organizations have spoken out about this.

In August 2016, the ACR, Colon Cancer Alliance, Colon Cancer Coalition and Prevent Cancer Foundation called on CMS to cover CTC. They cited a 2015 study published in the journal Abdominal Imaging that found that screening Medicare patients with CTC would reduce colorectal cancer screening costs by 29 percent.

In addition, former president Barack Obama received a CTC in 2010 to screen for colorectal cancer.

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GE Healthcare to relocate hundreds of jobs to downtown Chicago from Barrington Posted online February 27, 2017 by Thomas Dworetzky The Chicago footprint of GE Healthcare continues to expand.

It has announced that it will move an undisclosed number “in the hundreds” from its Barrington, Illinois, facility to the Windy City, according to The Chicago Tribune.

Plans call for the shift to begin in the third quarter of 2017.

“More and more, you really want to be in an area where it’s not just your employees,” GE Healthcare CEO John Flannery noted. “The fundamental premise of this move is to increase the intensity of our investment in the digital platform and do it in downtown Chicago, where we think there’s a really top-tier technology ecosystem.”

There are 600 workers there at present, made up of the management of GE Healthcare and its Transportation Group’s Digital Solutions personnel.

This latest move will up that number above 1,000. The Chicagodestined jobs are mostly in the IT and software fields.

There are no plans to reduce jobs as part of the relocation, according to the CEO. If anything, it will be the reverse. “I think, net-net, we’re going to be adding jobs on the digital side of things here,” he said.

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HealthCareBusiness Daily News Online > dotmed.com/news

Royal Philips’ ElastQ Imaging receives FDA approval for use with EPIQ ultrasounds Posted online March 01, 2017 by Lauren Dubinsky Royal Philips announced that its ElastQ Imaging capability received FDA clearance for its EPIQ portfolio of ultrasound systems.

It can simultaneously image tissue and evaluate stiffness, which is critical for diagnosing liver conditions.

“The use of ElastQ Imaging shear wave elastography reduces, and in some cases avoids, the need for conventional liver tissue biopsies,” Vitor Rocha, ultrasound business leader at Philips, told HCB News. “This is beneficial to both clinicians and patients by

reducing the wait time associated with tissue biopsy and providing a more comfortable, less costly experience for patients.”

In 2013, 29 million people in the European (EU) region suffered from a chronic liver condition and more than 30 million Americans had liver disease, according to the International Liver Congress.

Conventionally, those patients would be subject to a liver biopsy to determine the stage of liver disease and damage done.

The noninvasive ultrasound approach means forgoing the needles that are used

for liver biopsies.

The ultrasound exam results are also available immediately, which can help to alleviate anxiety patients might feel as they await test results.

According to Philips, its ElastQ Imaging shear wave elastography has a larger field of view than competitor solutions.

It also color codes the quantitative assessment of tissue stiffness, provides real-time feedback and intelligent analysis and quantitatively measures with multiple sample points.

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Siemens Healthineers unveils its global Digital Ecosystem platform at HIMSS

Published study questions the benefits of IV fluids in contrast agent procedures

Posted online February 21, 2017 by Lauren Dubinsky

Posted online February 28, 2017 by Lauren Dubinsky

Siemens Healthineers launched its Digital Ecosystem global platform at the HIMSS Conference & Exhibition. On one platform, users have access to data, applications and services from health care providers and manufacturers around the world.

“We believe that digitalization and the associated networking of health care providers is essential for the transformation to value-based health care. Big data needs to become smart data,” Dr. Arthur Kaindl, head of digital health services at Siemens, said in a statement.

Through the platform, experts can link to and communicate with peers worldwide to share knowledge. Health care providers have access to Siemens’ expertise in almost all clinical areas including health care data security.

Users also have access to aggregated data that can be used for a variety of different applications. For example, the predictive analysis tools can spot trends that can help improve diagnoses and guide therapy decisions.

Digital Ecosystem is designed with an application programming interface, so application developers, device manufacturers and data providers can contribute to the platform. The companies can develop, market and offer their applications and technologies on the platform.

Arterys, Dell EMC, SecondOpinions.com, Stroll Health, SyntheticMR, 3D Slicer, TMC, USARAD and Viewics have already agreed to become partners.

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Intravenous hydration is intended to protect patients’ renal function during contrast-enhanced procedures, but it actually may be harming them.

Those were the findings of a new study published in The Lancet.

Used in a wide range of medical procedures such as a CT scan or angiogram, approximately 75 million doses of contrast agents are administered globally each year, according to a study published in Mayo Clinic Proceedings.

These contrast agents can cause acute kidney injury, also known as contrast-induced nephropathy, in some patients. Those with already poor renal function are at a higher risk, which accounts for about 10 percent of the global population.

Clinicians attempt to minimize damage by administering additional fluid intravenously to these high-risk patients during the procedures. This requires patients to be hospitalized for one or several days, which can dramatically increase procedural costs.

Researchers from Maastricht UMC+ in the Netherlands spent two years evaluating 660 patients with poor renal function. About half of the patients received intravenous hydration before the contrastenhanced procedures.

They found that the rate of acute decrease in renal function was practically the same in both groups. In fact, 5.5 percent of the patients who received additional fluids experienced complications, including heart problems.

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Upcoming Events ASIPP 2017 Annual Meeting

ASBrS 2017 Annual Meeting

Presented by: American Society of Interventional Pain Physicians Location: Caesars Palace, Las Vegas Dates: April 20–22 Years in Existence: 19 Who should attend: Medical professionals in the fields of anesthesiology, physical medicine, psychiatry and neurology, PMR, emergency medicine, fellows of interventional pain practice.

Presented by: American Society of Breast Surgeons Location: Bellagio, Las Vegas Dates: April 26–30 Years in Existence: 18 Average attendance: +1,400 Who should attend: General surgeons, surgical oncologists, plastic surgeons, radiologists, medical oncologists and allied health professionals.

ASNR 2017 Annual Meeting

AATS 2017 Annual Meeting

Presented by: American Society of Neuroradiology Location: Long Beach Convention and Entertainment Center, Long Beach, Calif.

Dates: April 22–27 Years in Existence: 55 Who should attend: Neuroradiologists and neuroradiology-affiliated professionals.

Presented by: American Association of Thoracic Surgery Location: Hynes Convention Center, Boston Dates: April 29–May 3 Years in Existence: 97 Who should attend: Cardiothoracic surgeons, nurses, physician assistants, surgical assistants and perfusionists, and physicians in related specialties such as cardiothoracic anesthesia, critical care, cardiology, pulmon-

ology, radiology, gastroenterology, thoracic oncology and vascular surgery.

2017 ARRS Annual Meeting Presented by: American Roentgen Ray Society Location: Hyatt Regency, New Orleans Dates: April 30–May 5 Years in Existence: 117 Average attendance: +3,000 Who should attend: Radiologists and radiology-affiliated professionals.

SGNA 44th Annual Course Presented by: Society of Gastroenterology Nurses and Associates, Inc. Location: Morial Convention Center, New Orleans Dates: May 7–9 Years in existence: 44 Average attendance: +2,000 Who should attend: GI nursing professionals, including staff nurses, nurse supervisors, administrative professionals, researchers, technicians, educators.

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Hospital Spotlight: Nemours Children’s Hospital 1

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Nemours Children’s Hospital Location: Orlando, Florida Year founded: The hospital opened in October 2012. It is a part of Nemours Children’s Health System, which spans five states and more than 50 care locations. It was started in 1940.

Number of beds: 100 Number of patients/year: 2,733 inpatient admissions in 2016 Number of employees: 1,600 CEO/President’s name: Dana Bledsoe is president of Nemours Children’s Hospital. David Bailey, M.D., is the president and CEO of Nemours.

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Noteworthy distinctions: In December 2016, Nemours Children’s Hospital was named a Top Children’s Hospital by the Leapfrog Group. This elite distinction is awarded to hospitals nationwide that meet the toughest standards for safety and quality. Only nine children’s hospitals in the country received the honor in 2016. It was the second time in its four years of operation that the hospital earned the recognition.

In October 2016, the Florida Hospital Association honored Nemours with an Innovation of the Year in Patient Care Award. It recognized Nemours CareConnect, a new approach to telehealth that brings board-certified pediatricians into homes, schools and hospitals.

In 2015, Press Ganey Associates Inc. recognized Nemours with the Guardian of Excellence Award.

The honor came after Nemours performed in the 95th percentile or above in performance in patient experience.

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Specialties: • Interventional radiology • Cardiac surgery • Sports medicine • Neurology • Hematology/Oncology

1. Every physician in the Nemours Emergency Department (ED) is board-certified in pediatric medicine. And most kids are seen by a doctor within 10 minutes of arrival.

2. The common area outside the Nemours Children’s Hospital operating rooms is one of the most soothing areas of the hospital. It is next to one of two rooftop gardens at the hospital.

3. Located inside Nemours Children’s Hospital, the Clinical Logistics Center is staffed by paramedics who remotely track the vitals and alarms of each inpatient child 24/7. The paramedics stay in constant contact with the care teams and act as an additional set of eyes and ears.

4. Children have a chance to select the color of the overhead lighting in the inpatient rooms, making Nemours Children’s Hospital a colorful place at night and giving patients a sense of control over their environment.

5. When Nemours Children’s Hospital opened in October 2012, a group of kids raced through a “wall” of silly string to enter the hospital for the very first time.

Recent developments: In June 2016, Nemours launched the Nemours Cardiac Center in Florida, which is led by the world-renowned pediatric cardiothoracic surgeon, Dr. Peter Wearden. He and his team of more than 100 pediatric cardiac specialists are organized around the unique concept of the integrated practice unit, which has been shown to improve outcomes for patients. Every member of the cardiac team from the surgeon to the anesthesiologist and intensive care physician only treat pediatric cardiac cases.

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Hospital Spotlight

Q&A with

Dana Bledsoe President of Nemours Children’s Hospital Orlando

By Sean Ruck

Since our patients are too young to vote, we have to be their advocates. It’s important to ensure they don’t experience a deterioration of access to care.

For this month’s installment of Hospital Spotlight, we spoke with Dana N. Bledsoe, president of Nemours Children’s Hospital Orlando to learn about the unique challenges medical professionals face and the special focus they have when caring for young patients.

HCB News: What inspired you to get involved in health care?

DB: My first experience in the health care field occurred in high school. I was a nurse’s aide in a local nursing home. From there, I went on to nursing school and during my pediatric rotation I was inspired by a 3-yearold. There was a situation where her family couldn’t be with her and when she was being discharged, she looked up at her mom and told her she had named the stuffed animal she had with her “Dana.” It was over. I was hooked. Looking back, I don’t know if I realized the impact that you can have on a child or a family at their most vulnerable time, but I appreciate it now.

HCB News: How long have you been with Nemours?

DB: Two years in June that I have been an employee and I’ve worked with Nemours for a number of years prior to that.

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HCB News: What attracted you to a job there?

DB: Without a doubt, it was the extraordinary people with both talent and passion.

It’s also the culture of excellence and the commitment to deliver an extraordinary experience to patients and their families.

HCB News: What type of management style is practiced there?

DB: It’s largely participatory with an entrepreneurial spirit that comes with a new organization. It’s part of envisioning how everything comes together to serve our patients.

HCB News: What do you think attracts other employees?

DB: I think in addition to the people and culture, there’s excitement about having the opportunity to build new programs from the ground up. It’s almost a once-in-a-lifetime opportunity.

HCB News: Why do patients and their families choose you?

DB: One of the things patients and families tell us is the experience they have here.

That goes back to the culture. We’re committed, without fail, to partnering with the families to make them part of the care team.

The outcome of that commitment is reflected in our Press Ganey Guardian of Excellence award for maintaining a 95th percentile rating in patient experience.

HCB News: How did the implementation of the ACA impact your facility and are the current questions surrounding the ACA causing problems or concern?

DB: I would say it’s a volatile time in health care. We’re all in a situation where we need to be part of the solution to shape what the future looks like, but no one has the answers right now. We also look to partner with our government to figure out solutions. Since our patients are too young to vote, we have to be their advocates. It’s important to ensure they don’t experience a deterioration of access to care.

HCB News: What are your hospital’s key areas of focus and has that changed over the past few years, or do you believe it will be changing in any way?

DB: One key area we currently focus on that will remain a priority is the development and advancement of programmatic offerings. We will continue to bring in new services such as pediatric interventional radiology. There are only 100 pediatric www.dotmed.com/news

Nemours Children’s Hospital opened in Orlando in October 2012, becoming Florida’s third freestanding children’s hospital. It is a part of Nemours Children’s Health System, which includes locations in five states and cares for 350,000 children a year.

fellowship-trained interventional radiologists in the country and we have three. We will continue to build on this internationally recognized program.

Another area we’re highly focused on is telehealth. We were the first pediatric system to launch a telehealth app. I’ve personally used it as a mother, so I can talk about it from both sides. We also use telehealth technology to support our hospital partners. Additionally, we partner with schools to back up the school nurses. It’s wonderful technology and allows for keeping children and their families as close to home as clinically safe.

HCB News: Is there any state-of-the-art technology — either medical equipment, or health IT technology at Nemours — that you’d like to talk about?

DB: A thoughtful and novel approach is our hallmark clinical logistics center, staffed by paramedics 24/7. The eyes of our team have access to monitors connected to patients in our hospital and our sister hospital in Delaware. All of this is connected to the EMR. Visitors from all over the world come to see how it works and how it might help their facilities. It has been open more than four years now.

HCB News: Do your patients ever inspire changes in your facility?

DB: There’s probably a number of things they have inspired. The one that immediately comes to mind is the prom we hold for our patients. Gowns are donated, a makeup artist comes in and does their makeup, there’s a red carpet and great music. We want children to have the chance to experience their prom and we do what we can to make it happen.

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IT Matters

Using big data to improve OR efficiency and margins

By Rich Krueger

Today’s high-tech OR has benefited enormously from technological advancements in peer industries.

Bulky CRTs have been replaced with sleek, touchscreen LCDs, incandescent lighting with LEDs and surgical booms are made from lightweight carbon fiber instead of steel. Surfaces are coated with antimicrobial surfaces to lower infections, and the overall design and workflow takes into account the latest understanding of both provider and patient ergonomics.

Yet the planning and management of these ORs still rely on methods used 20 years ago. ORs are both the most expensive and most lucrative locations in many hospitals, so it is crucial that OR block time be optimally allocated to surgeons, practices and departments to maximize throughput and minimize waits, while still leaving enough headroom to fit in emergency cases. Most hospitals manage this, at best, with manual spreadsheets, and at worst, based on historical experience.

Applying today’s management science to hospital operations requires data. Many hospitals have only recently computerized, partially as a result of the incentives associated with the American Recovery and Reinvestment Act of 2009.

The availability of both data and tools has created the opportunity for real innovation in perioperative management. Cloud-based operations planning and management platforms enable health care leaders to transition from being reactive to being proactive in managing the OR in a way that best utilizes this shared resource while also taking into account the specific institution’s culture and policies.

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can manage OR resources, from “federated departments” to “centrally controlled.” In the former, each surgical department or practice is given an allocation of OR block time and is responsible for ensuring they meet target utilizations. Within the department or practice, they can sub-allocate the blocks in any manner they see fit. As long as departments or practices meet their target utilization, they retain their OR blocks. If they exceed target utilization, they may gain additional blocks, and if they fall below target, they risk losing them. In all scenarios, the department or practice fully plans and manages their allocated OR blocks.

Centralized control is the opposite. A hospital OR committee manages all blocks down to the individual surgeon level. The OR committee has full visibility into all block operations and sets the policy that is used to manage block allocation as well as evaluate whether or not the OR blocks have been utilized successfully.

Key aspects of both models are transparency and accountability. Whether it is the individual surgeon or the practice or department, unused blocks need to be re-allocated to where they are more likely to be utilized in a way that is consistent and fiscally responsible. Before the availability of data and operations planning and management tools, OR committees simply didn’t have access to such important insights.

Decisions were often made on first-hand experience, seniority and/or political influence.

Given the very high operational expense of running an OR and the impact on downstream resources, a 1 to 2 percent increase in utilization or surgical volume can add millions to the annual operating margin or revenue.

EMR vendors or Excel spreadsheets can provide a basic reporting capability, but they lack the flexibility, policy sensitivity and ”what-if” scenario capabilities of specialized vendors. Hospitals need to instill a framework

of accountability that transparently allocates OR time, staff and surgical beds according to the case activity, demand and policy.

Other key elements are usability and verifiability. Some larger hospitals have invested in data operations, hiring staff to compile reports and even run basic predictive analytics to gain a basic set of insights. These reports are used by OR committees to help make decisions, but don’t take into account the level of complexity that often exists. The accuracy of these reports, and the inability to reproduce them, is often questioned by providers, creating data skepticism and diminished influence in driving critical change. With the average annual operating expense of a single OR costing $2 million to $3 million, this inaction has significant consequences on a hospital’s or health system’s financial performance.

A robust operations planning and management platform can account for complexities that exist in these environments. It allows all stakeholders from executives to surgeons to OR staff to quickly validate the raw data and easily follow it through each step of any recommendation in real time so that conclusions are defensible and actionable.

The opportunity for data and health care operations planning and management tools to modernize hospital and health system operations goes far beyond OR block time.

By bringing in data on bed placement and length of stay and combining it with simulation and what-if modeling capabilities, hospital leadership can understand the impact of inpatient surgical demand on beds, create centers of excellence and build staffing structures with more precision.

About the author: Rich Krueger is president and CEO of Hospital IQ, provider of a cloudbased operations planning and management platform.

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Build bridges with like-minded peers, forward-thinking experts, and industry leaders as we work together to transform healthcare at SIIM 2017!

Learn how imaging informatics can improve patient-centered care Take home ready-to-implement tools and templates for increasing productivity Map out enterprise imaging governance and workflows Walk the exhibit hall to learn about new concepts and solutions Let SIIM equip you with enterprise imaging strategies to implement transformation in your organization.

Register before May 3 and save $100! Special rates available for SIIM Institutional Members.

Executive Perspective

Q&A with

John Flannery GE Healthcare CEO

By Gus Iversen

The health care industry converged on Orlando, Florida, for the annual HIMSS conference this past February. The event brought together hospital executives, tech startups, medical manufacturers and physicians with a common goal: discovering the latest and greatest in health IT. In an exclusive interview, John Flannery, CEO of GE Healthcare, gave HCB News a wide-angle perspective on what HIMSS means for his company, and how he views GE’s role in the rapidly evolving world of health IT. HCB News: What kind of message did GE Healthcare convey at HIMSS17?

John Flannery: One of the impressions people came away with from our HIMSS discussions — and frankly, our RSNA discussions as well — is that radiology and informatics are merging together.

I certainly see a path down the road where these aren’t two separate ideas and two separate shows, and it’s really the interplay of the equipment and the data and the analytics and how those combine to produce better clinical and economic outcomes. Our equipment business is aligning digitally with our IT business, so these things are becoming one and the same.

Second, General Electric has developed an industrial IoT (Internet of Things) platform called Predix. This is a multi-billion dollar investment that we’re leveraging across the verticals inside of GE. Our par32 HealthCareBusiness news

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ticular aspect of that is GE Health Cloud.

At HIMSS, we presented about 20 different workflow and workstation products across ambulatory care, financial management, clinical operations, etc. We rolled out 13 apps at the show, five of which are commercially available and the rest are coming out very soon. These apps are all about leveraging analytics for better clinical or economic outcomes.

an outcome-based solution. We’re not a gadget company or a box company or a narrow software company. We’re focusing on outcomes for our customers.

The health care industry has been behind other industries in applying data and analytics to the field. What we’re witnessing now is the dawn of a new era in health care, driven largely by digital-based data and analytics.

HCB News: So these apps will exist on the GE Health Cloud?

JF: Yes. Think of GE Healthcare’s Predix platform as similar to an iTunes. That’s the easiest analogy. We will be putting up a number of our own applications which we’re developing now alongside several clinical and academic partners, but we envision the vast majority of these apps will come from third-party developers using the platform and bringing new analytics to our customers.

At GE Healthcare, we’re spending about $500 million over the next few years on digital. We’ve got 5,000 software engineers today and that number is growing.

It’s about 10 percent of our total workforce.

With regard to our discussions at HIMSS, we announced an outcome of one of our more robust applications, DenialsIQ, which is a tool that unearthed $2 billion worth of savings for our customers.

We’re constantly trying to drive this to

HCB News: How do the challenges of software development compare with the challenges of device development?

JF: Historically, hardware development was a fundamentally longer cycle. A lot of major changes in hardware would be twoor four-year engineering and development cycles.

The challenges were technical in nature, physics in nature, trying to solve an engineering problem with a belief that if they could produce that technical solution, then the market would want that product.

Software is very much the opposite. It starts with defining the problem. What is the customer trying to solve? What information are they trying to ingest, analyze and derive conclusions from? You start off already understanding the problem, understanding the solution, understanding the value proposition.

Also, the development cycles are faster.

While it takes significant investment to get www.dotmed.com/news

the platform up and running, once you have that, it’s a rapid process of saying, “Hey, I’m going to drop a denials application in here, drop a revenue cycle application in here, drop a patient contact application in here.”

HCB News: In health care, would you say we’re in an era where software analytics are trying to catch up with devices? Or are devices and analytics developing in equal partnership?

JF: It’s fair to say that we’ve been in a catch-up cycle on the software side as an industry, where the hardware was generating significant amounts of information that was fundamentally going unused. In that regard, we’re harnessing the data and analytics capabilities that the hardware has already enabled for a number of years.

For example, with UCSF, we are codeveloping an application to look at lung screening images, and very quickly — through analytics and pattern recognition — the algorithm sorts through the images and identifies what’s normal, so that the radiologist can focus on what’s abnormal.

So you start to automate with the hardware as it is today, but ultimately these things will start to move forward together.

A lot of our software engineering research is around making the scanner image acquisition itself more automated, using AI to, maybe, position the patient differently.

So there’s a lot of software development on the actual device.

I think you have to start looking at these things as a broader ecosystem, which is, could I have sophisticated scanners on a very distributed basis moving images up to the cloud? Can I process them on the cloud? Where do the reports go? You have to start looking at this whole environment together — how the equipment, the cloud, the customer, the end user and the patient will all connect.

HCB News: That ties in with the notion of these industry events sort of merging into something more singular.

JF: I think we’ll look back in a short pe-

riod of time and say, “I really can’t believe that’s how we did this.” Especially on the clinical side, where people are still looking at images in a darkroom and trying to determine a diagnosis.

I think we’re really at a massive inflection point and I’ve seen that in the two years that I’ve been in the business, how fast it is changing.

“Great, we needed to digitize and not have paper, we needed the ability to consume information from different sources, but we haven’t turned it into a productivity tool.”

That’s the next generation that we’re seeing now with solutions like DenialsIQ. We’re taking the inert digital input and turning it into productivity, improving departmental workflow, improving billing, and so on.

The health care industry has been behind other industries in applying data and analytics to the field. What we’re witnessing now is the dawn of a new era in health care, driven largely by digital-based data and analytics.

HCB News: What are the areas where software still has the biggest unmet potential?

JF:We are just scratching the surface of what it can mean on clinical diagnosis.

Automation of reading, improving the accuracy of reading, speed, cost, the ability to provide remote access to radiology. We have lots of activities in emerging markets where they just don’t have the infrastructure for radiology.

When it comes to mobility and collaboration, I’d say we’re a little more advanced and gaining traction. That’s another area that we see evolving quickly — the ability to move images around and read them on your laptop, at home on your iPad, the ability to convene a tumor board virtually, versus having all the clinicians in the same physical place, the ability to take a scan in Seattle and shoot it to your friend in Boston to get input.

A third thing I’ll mention is that there’s been big development of software on the operational side of the business (EHR, EMR), but the general consensus has been,

HCB News: Looking ahead to the next few months, can you clue us in on anything we can expect to hear from GE Healthcare?

JF: On one level you’re going to hear more of the same: more clinical partnerships. We developed a digital command center for Johns Hopkins University that has tremendous traction. We know exactly what we want to do, we’re putting a huge amount of resources on it and we’re riding on the back of GE, so we’re not going to veer left or right. We’re going to be stepping on the gas even harder.

We will also continue to partner with other leading academic institutions and health systems, like UCSF and BCH, targeting key disease states, inefficient processes and care areas, to build a library of deep learning algorithms.

Looking further ahead, by 2020, we will have hundreds of apps in the GE Health Cloud, enabling insights that will truly transform health care.

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SGNA

Q&A with

Kristine Barman SGNA President

By Sean Ruck

The Society of Gastroenterology Nurses and Associates will hold its annual course May 7-9 in New Orleans. With the date fast approaching, HealthCare Business News reached out to President Kristine Barman to learn a little of her history in health care and about the latest news from the society.

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

KB: I was interested in health care ever since I was a little girl. When I’d visit my grandparents on the upper peninsula of Michigan and my grandfather got a cut, he would come find me and say I was the best at putting on a Band-Aid. I loved taking care of him. Later, when I attended college, the two majors that didn’t require a foreign language were engineering and nursing, so that helped to direct things, too.

HCB News: How did you get involved with SGNA? KB: When I first started my career, I was working at a small community hospital in Florida when they opened a new department — endoscopy. They were looking for volunteers to staff the new department, and while it didn’t come with a pay raise, it did come with educational opportunities. A friend of mine invited me to join her at the local SGNA regional society meeting, which was the perfect place to get my education. I also found the networking to be invaluable.

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HCB News: Why should others consider joining?

KB: Joining SGNA is just so beneficial.

You get so much back for every hour invested. It’s the best place to learn about best practices, and for me the annual meeting is like going to a family reunion.

HCB News: What have been the main initiatives you’ve championed as president?

KB: The main message during my presidency is to invest in yourself and inspire others. When you invest in yourself professionally, you get so much in return for your practice and the greater GI nursing community. You also are able to share with others and ”pay it forward” in terms of sparking passion in your colleagues. SGNA has always, and will continue to have, provided the resources to our members in order to be successful, and safe practitioners and patient advocates.

HCB News: What are the biggest challenges facing your members today?

KB: One challenge is to stay current with technology advancements, and continue with training on new procedures and new accessories. We want to provide safe patient care and serve as patient advocates. It is important to be educated on how the new technologies will impact patients and what kind of complications we need to observe for. The GI community is doing things we never imagined we could do with a scope

and it all definitely requires extra training to understand our roles and patient safety.

HCB News: What items top your members’ wish list?

KB: Our members want to be informed on industry news and what is new in the GI community. SGNA promotes our scholars and fellows in research directed in the areas where our members need information to define and support their practice.

HCB News: Do you anticipate any big changes in the role SGNA plays in coming years?

KB: I think SGNA will continue to be a voice and resource for GI nursing, and our role continues to grow. We’ve worked with partners including the CDC and FDA, which is making SGNA an even stronger advocate for our patients.

HCB News: Do you anticipate the repeal of the ACA will impact members, and if so, how?

KB: Working in a large teaching institution, I personally didn’t notice a lot of change when the ACA was introduced, so I’m not sure how much impact the repeal would have for my workplace specifically. I think it is too early to tell in regard to the repeal, but SGNA will always support legislative efforts that increase access to screening and care. SGNA has been part of the initiative to have 80 percent of the population get screened by 2020. www.dotmed.com/news

HCB News: What’s your prediction for how the field of gastroenterology will change in the next 10 years?

KB: I think that as technology advances, there may be different tests that will be less invasive. Probably some new diagnostic that can provide screening. It’s possible that we could have someone send in a stool sample and get it analyzed to let them know if they should take the next step and get a colonoscopy.

HCB News: There have been debates about screening turning up a lot of results that may not become cancerous if left untreated. Is that still a big topic?

KB: The focus has shifted over the years.

Today, we’re looking for flat polyps which are harder to find, but more likely to turn into cancer. Fortunately, our equipment has improved to better assist in finding these polyps.

HCB News: Are there enough gastroenterology professionals working

today? Is that trending up or down?

KB: We don’t have comprehensive data, but nursing has always interested those people attracted to caring. Today, not everyone plans to stay in the same career over the course of his or her life. People don’t hesitate to go back to school to acquire the knowledge they need to change careers. But even in our field, there are more mature students willing to make a career change into nursing.

being used. Our Infection Prevention Champions program is still evolving and improving in terms of releasing the newest information to our members. Our guidelines are being reviewed and updated. Our fellows and scholars programs and research are pointing us forward.

SGNA will continue to serve nurses and practitioners not only in the hospital setting, but beyond in places like inflammatory bow-

We’ve worked with partners including the CDC and FDA, which is making SGNA an even stronger advocate for our patients.

HCB News: Are there any other developments you’d like to discuss?

KB: It’s an exciting time in terms of gastroenterology. Many new technologies are

el disease practices and ambulatory centers.

We are a home to all GI professionals, and we are very proud to be GI. Share this story: dotmed.com/news/36161

The SGNA Infection Prevention Champions Program is your way to A.I.M. for best practices.

Participation in the Infection Prevention Champions Program is an ideal way to meet annual CMS requirements, identify areas for improvement, and build a strong relationship with infection prevention risk managers.

Learn more and sign up at www.sgna.org/InfectionPrevention.

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View from the Hill

CMS implements AUC requirements for advanced imaging services

By Jill Rathbun

On Nov. 15, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2017 Medicare Physician Fee Schedule (MPFS) final rule.

In this final rule, CMS continued the process of implementing the policy requirement whereby providers would have to consult applicable Appropriate Use Criteria (AUC) prior to ordering advanced diagnostic imaging services, including MRI, CT, PET and nuclear cardiology. CMS also finalized the priority clinical areas that will be used to measure so-called “outlier professionals” in this CY 2017 final rule. These outlier professionals would then be subjected to prior authorization requirements for at least two years if they were in the top 5 percent of physicians whose ordering of advanced imaging did not meet the AUC guidelines.

In the CY 2017 final rule, CMS also stated that it is planning to finalize all remaining elements of this program during the CY 2018 Medicare Physician Fee Schedule rulemaking process. The proposed rule for CY 2018 should be released for comment in early July 2017. CMS anticipates that this will allow the AUC consultation requirement to be in place starting Jan. 1, 2018.

In implementing this new policy requirement, CMS selected a list of provider-led entities that applied to CMS stating they could provide one or more AUCs for use by physicians to comply with the law’s AUC consultation requirements starting Jan. 1, 2018. The following are the organizations that were selected as of June 1, 2016: 36 HealthCareBusiness news

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• American College of Cardiology Foundation • American College of Radiology • Brigham and Women’s Physicians Organization • CDI Quality Institute • Intermountain Healthcare • Massachusetts General Hospital, Department of Radiology • National Comprehensive Cancer Network • Society for Nuclear Medicine and Molecular Imaging • University of California Medical Campuses • University of Washington Physicians • Weill Cornell Medicine Physicians Organization CMS must also identify and publish a list of qualified clinical decision support (CDS) mechanisms (electronic software) that could be used by ordering professionals to consult with the applicable AUC. Many CDS mechanisms can be seamlessly embedded within an electronic health record. CMS will announce the CDS mechanisms that have been selected by July 1, 2017. This will give providers in offices, hospital outpatient departments and ambulatory surgical centers time to obtain a system and become familiar prior to Jan. 1, 2018.

CMS finalized an initial list of priority clinical areas, defined as clinical conditions, diseases or symptom complexes, and associated advanced diagnostic imaging services on Nov. 15, 2016. The diagnosis codes that were used to describe the proposed priority clinical areas can be found on the CMS AUC program web page. The list of clinical priority areas includes: • Coronary artery disease (suspected or diagnosed) • Suspected pulmonary embolism • Headache (traumatic and nontraumatic)

• Hip pain • Low back pain • Shoulder pain (to include suspected rotator cuff injury) • Cancer of the lung (primary or metastatic, suspected or diagnosed) • Cervical or neck pain Once the AUC program requirements start on Jan. 1, 2018, Medicare will no longer pay claims for technical component or professional component reimbursement to rendering providers for advanced imaging services in the Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Prospective Payment System, unless the ordering physician has consulted with an AUC before making the order.

Ordering professionals that CMS has identified as “outliers” with low rates of AUC adherence relative to their peers on the priority clinical areas identified above based on the previous two years of data will be required to obtain prior authorization from CMS before advanced imaging orders can be furnished starting Jan. 1, 2020. No more than 5 percent of the ordering physician population can be deemed an outlier.

To learn more about the CMS implementation of the AUC program, please visit the CMS web page on the Appropriate Use Criteria Program. Or read the section in the CY 2017 Final Rule for the Medicare Physician Fee Schedule at Federal Register / Vol. 81, No. 220 / Tuesday, Nov. 15, 2016 / Rules and Regulations, pages 80403 — 80428.

About the author: Jill Rathbun is managing partner at Galileo Consulting Group.

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Cost Containment Corner

Growing your practice through patient financing options

By Dennis Kelly

Trust and security Given recent events, there has been quite a bit of consumer distrust in the financial services industry. For this reason, it’s important to make sure that you partner with a financing platform that offers substantial customer service processes, has significant funding partners and a secure network.

Some recommended questions you can ask potential partners include: • How many customers they have and have they been able to successfully fulfill the promises they’ve made?

• How many consumers have they helped with financing options?

• And from a security standpoint, how is their IT infrastructure set up?

There have been many recent advancements in the health care industry for which most practitioners are left utterly confused and overwhelmed when trying to decide which will most help their health care practices grow.

One path to growth can be simple: offer your patients the ability to finance your services.

Whether it’s plastic surgery, orthodontia, cosmetic dentistry or infertility treatments, elective procedures can be quite taxing on the wallet. Many patients considering treatments and procedures that aren’t covered by insurance are looking for the best ways to cover the costs.

While it’s by no means a panacea, the solution for many patients could be the availability of financing with a fast and easy application and approval process, terms that fit the patient’s financial situation and immediate funding to your practice. This allows patients to get the care they need now, with the ability to spread manageable payments out.

Working with a financing partner takes all the financial risk off of your practice, both simplifying the process and improving your practice’s efficiency, but you need a partner. Think of it like making a referral to a specialist, only more so. You don’t have the resources to provide your own financing services, but you don’t feel comfortable handing your patients off to just any finance company. You need a partner you can trust with products and processes you understand and support.

What should you look for in a financing partner?

Speed and efficiency No longer does a patient have to head to the bank, deal with piles of paperwork and/ or wait days on end for a decision. Financial technology has provided the opportunity for your team to offer patients financing within seconds. Some companies offer financing via mobile apps, which allows paperless applications with near-instant approval decisions.

Fast payments Don’t get involved with any financing partner that doesn’t provide immediate funding.

For you, there should be nothing to worry about except the actual procedure. Knowing the payment has been taken care of should be table stakes.

Financing today can be fast, easy, paperless and stress-free for both patients and practitioners. For practitioners interested in growing their businesses, financing may be the most surefire way to both increase revenue and improve efficiency.

About the author: Dennis Kelly is an experienced health care executive whose career spans over 37 years in health care devices and services.

He is the president of GreenSky Patient Solutions, LLC. Share this story: dotmed.com/news/35914

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Payment Management

Reducing rejected claims with better patient data processes

By Bruce Ackerman

Just as health care providers and the public were getting used to the many changes brought about by the Affordable Care Act, more upheaval is on the horizon.

Even before the new administration was officially sworn in, Congress leveraged the budget reconciliation process to begin the process of rolling back many of the ACA’s provisions. As the new administration moves to take action, impassioned partisan debate and public commentary about ACA repeal make it clear that the transition to replaced or repaired health care laws won’t

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be quick and painless. While it seems likely that a systemic overhaul will take months, if not years, it’s time to accept that major changes are on the way for health insurance infrastructure and mandates. Specifics have not yet been determined, but it’s safe to predict that providers will feel even more pressure on their bottom line.

According to CMS figures for 2015, annual U.S. health care costs surpassed $3 trillion, accounting for 17.8 percent of GDP. The federal government sponsored 28.7 percent of total expenditures. Pending reforms are aimed squarely at control-

ling those costs. Estimates vary, but the general consensus is that approximately one-third of these costs can be chalked up to fraud and administrative waste, and that doesn’t include the amount of time and frustration patients spend correcting erroneous medical bills.

The continuous pressure to increase the efficiency of the increasingly complex and competitive U.S. health care system impacts everyone involved. After years of rising out-of-pocket costs and frustrating transactions with insurance companies, health care consumers are demanding bet-

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ter options and more accountability. Providers are burdened by regulations, health IT implementations, increasing patient loads and insurance-related processes.

Many insurance companies struggled to make a profit in the individual market.

To make it through the looming challenges, health care organizations need to keep a sharp focus on optimizing operations and administrative systems.

Rejected claims are a significant drag on bottom lines and productivity. Hospitals, clinics and private physician offices lose money by failing to capture reimbursements for services rendered and by spending extra staff time correcting and resubmitting claims. The California Nurses Association found in 2011 that the state’s insurers denied 26 percent of all claims the previous year. Similarly, the National Health Insurer Report Card shows top insurers deny claims at rates ranging from 11 to 27 percent.

The Academy of Family Physicians recommends that providers ensure that no more than 2 percent of their claims are denied, but the industry average is closer to 10 percent. Insurance experts agree that most of these denials are not due to coding errors or issues of patient eligibility. Rather, many claims are denied simply due to inaccurate or incomplete patient information: basic demographics, Social Security numbers and insurance plan numbers. Offices are often too short-staffed to resubmit claims, or fail to do so within the allowed time frame — essentially leaving money on the table. Even when claims are successfully resubmitted, the additional time and work protracts the revenue cycle, disrupts cash flow and cuts into profits.

In a pressure-cooker environment that leaves little margin for error, providers can deliver better customer service and reduce rejected claims by improving administrative processes. Automated intake procedures, digital data capture and identity verification are an essential first step. The Council for Affordable Quality Healthcare (CAQH) has estimated that full adoption

of electronic transactions (reducing manual administrative processes) could save U.S. health care billions of dollars per year and millions of hours each week.

Capturing accurate patient data and porting it efficiently into digital records systems goes a long way toward producing clean claims and avoiding rejections.

Advanced ID scanning and verification solutions increase the speed and accuracy of data entry, cutting down the amount of time patients spend waiting in line and filling out redundant forms. Front desk staff has more time to focus on caring for the patient and providing a better overall customer experience.

Automated patient registration processes using self-service kiosks or desktop or mobile card scanners can be integrated with EHR systems and other databases to ensure that patient data is up to date and verified. Scan-and-verify solutions significantly reduce errors in patient records and claims submissions while saving hundreds of keystrokes per intake. Submitting claims electronically significantly reduces the time between a patient’s appointment and the insurance company’s receipt of claim for that service. However, the efficiency of electronic processing is totally dependent on the accuracy and completeness of data initially fed into the system. Many practices are deploying ID scanning, verification and autofill technologies to quickly capture and integrate high quality demographic and insurance data from each patient.

Identity verification solutions also tackle the scourge of identity theft and insurance fraud, issues that may be compounded during the ACA repeal-and-replace transition.

There will likely be some degree of upheaval as insurance providers join or leave the new system. Employers and individuals may change insurance plans more frequently as they navigate new options and obstacles.

Providers will have to focus resources on responding to regulatory and funding changes. If they can handle the administration of patient accounts more efficiently, the overall transition burden will be eased.

A confluence of factors is reshaping health care into a more consumer-driven industry. Early federal reform proposals recommend shifting funding to health care savings accounts in order to give individuals more choice and control regarding insurance plans. As patients pay more out of pocket, they are more likely to choose providers based on price and value. The quality of their care and their experience as a customer will become more influential, compelling providers to control costs and optimize services.

Leading providers are adopting best practices from other consumer-driven businesses, including cloud platforms and services that automate, record and analyze patient data. Analytics-driven solutions can help providers improve treatment, comply with regulations, integrate with third-party systems, manage revenue and assess risks.

Health care is inherently a dynamic, complex and high-stakes industry. As high profile, controversial government reform agendas put the industry on the hot seat yet again, health care administrators have to prepare for an uncertain future. As exigencies bear down from many directions, sustaining cash flow and maximizing revenue are fundamental to thriving through transition. Manual processes, patient data errors and high rates of rejected claims can be addressed with readily available technology solutions. Building stronger operational foundations today will enable your organization to develop the capabilities and resilience you’ll need for tomorrow’s challenges.

About the author: Bruce Ackerman is executive vice president of global sales for Acuant, a leading provider of data capture and verification solutions.

Share this story: dotmed.com/news/36164

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Technology Advisor

Millennials are the new target

By Bipin Thomas

It was always the baby boomers who dominated the health care demographic landscape — one of the top audience targets of opportunity.

The post-war crowd still represents a substantial slice of the population in the U.S. But baby boomers are no longer the largest cohort. Millennials (age 18-34) are now the largest generation, reaching 75 million in the U.S., and one of the most sought-after consumer crowds. But millennials are nothing like quiet and compliant baby boomers. In health care, millennials have higher expectations and are more demanding than previous generations.

Winning new millennial patients requires a different approach. The following are some of the significant distinctions to reach and retain this target audience.

Digital access is the new driver More than any other group, millennials own, use and rely on the digital devices, mobile applications and the Internet throughout the health care continuum.

They rely on Internet information. Millennials look online for health information, to make and manage appointments, to pay bills and to communicate with the office.

Patient reviews are a significant criterion in physician selection. In choosing a doctor, millennials’ preferences are guided by opinions posted on government sites, reports from friends and family and sites such as Healthgrades, Consumer Reports and Yelp. Millennials expect physicians to value their time. Convenience is the new currency. A research report by the Health Industry Distributors Association (HIDA) reveals “the leading cause of provider dis-

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satisfaction among millennials is being unable to get laboratory results during the same visit.”

Millennials have high expectations and demand more from their providers. They expect fast and efficient care, according to HIDA research. Facilities should be modern, comfortable and have up-to-date equipment and technology. And while they’re waiting, they expect to find comfortable chairs, snacks and beverages.

You probably have just one shot at connecting. This is a generation that has grown up expecting and finding nearly immediate answers online. They are likely to form strong opinions quickly. And, good or bad, they are prepared to share their opinions quickly and online. Millennials want convenience more than an ongoing provider relationship. Almost half of millennial respondents in a recent Salesforce survey said they had no personal relationship with their primary care physician. The cost of health care is important to millennials. The FAIR Health survey indicates that this group is most likely to price check, comparison shop and to ask about costs in advance of services.

The millennial demographic group is an attractive business target, but one that is significantly different from what most providers and hospitals have reached in the past. This is a group that has higher expectations and is more critical than other generations. And successfully marketing to this group — reaching and retaining them as new patients — requires a more accommodating, patient-centered approach in the digital world.

Ripe for virtual care delivery Rising demand by consumers for virtual health care services is putting more pressure on providers and payers to expand

delivery options for on-demand health services. For those millennials who have received care virtually, the reasons they cited most often for seeking virtual care are greater convenience than traditional in-person health care services, familiarity using technology to manage their health and curiosity to try virtual health.

Provider endorsement of the technology is crucial. Millennials would be even more likely to try virtual care if encouraged by a physician or a health care payer.

Technology-enabled services will be equally important as traditional in-person services, allowing the modern patient to choose when and how they receive health care services. Given evolving attitudes toward virtual care, making virtual health a priority could be a boon for provider organizations that are resource- and finance-constrained.

As more millennials take control of their health care in the digital age, provider organizations have to change the business models to offer meaningful choices for health care access and virtual care delivery.

About the author: Bipin Thomas is a renowned global thought-leader on consumer-centric health care transformation.

Thomas is a board member of HealthCare Business News magazine and strategic advisor to HealthTap. Thomas is a senior executive at Flex, where he is launching new business models by connecting all stakeholders in the emerging health care ecosystem. Thomas is a former senior executive at Accenture and UST Global, where he implemented strategic digital initiatives across the care continuum, including providers, payers, medical device manufacturers, pharmaceutical and life sciences, federal and state health agencies.

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C-arms

C-arm sector features innovation, new models, improvements in technology

By Lisa Chamoff

While the mobile C-arm market has seen a small but continuous demand for image intensifiers, flat-panel detectors, specifically with CMOS technology as an alternative to amorphous silicon detectors, are driving new releases.

GE Healthcare’s OEC Medical Systems, one of the last manufacturers to solely offer the older technology, last year released its first C-arm with a flat-panel detector, showing that times are definitely changing.

Here’s a guide to what’s new in the space.

GEMSS SPINEL 12HD C-arm

GEMSS North America GEMSS North America is releasing two new C-arm models this year. The first, coming out in the second quarter of 2017, is a 12-inch version of the company’s Spinel 3G, a nine-inch image intensifier.

Both units run on the new CX View 3.0 software, which came out in the middle of last year.

The company is also hoping to get FDA clearance for the 12HD, its flat-panel detector. The 12HD will have a 15.3-inch flat-panel detector, a larger arc and an armmounted control panel that swivels from side to side.

The larger field of view will be beneficial for vascular labs and orthopedic and urology practices, says Gary Kohler, vice president of sales and marketing for GEMSS North America.

“That’s really the high-end flagship,” Kohler says.

“We felt that there’s still a good market for image intensifiers without a doubt, but there is more need that we have noticed for a larger field of view. That’s why we’re adding the 12-inch and flat-panel, because that’s where things are headed.”

All of its systems are sold through a network of 74 independent dealers covering all 50 states and Puerto Rico.

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C-arms

Hologic InSight FD Genoray ZEN-7000

Hologic In March, Hologic debuted an update to its InSight software that creates a low-dose mode, which gives a 50 percent lower dose than the current system, says Laura DiGangi, the company’s associate product director of global marketing.

The low-dose mode decreases the frame rates to 15 frames per second with clinically equivalent imaging, according to DiGangi.

“By definition, mini C-arms are low dose,” DiGangi says. “As vendors start applying dose reduction technology, the conversations do come up more often.”

The software, InSight v.6.1, is available for new systems, with an upgrade available for current customers.

The company offers two C-arm models, the InSight 2, an image intensifier, and the InSight FD, with a CMOS flat-panel detector, initially released in 2012.

“The focus is on image quality and creating a less intrusive system,” DiGangi says. “They’re being operated more by orthopedic surgeons and their team, versus radiology staff, and they’re looking for us to create ways to use it independently. They want more control and an easier-to-use system, so it can be used by their staff without a ton of additional training.”

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OEC Elite MiniView

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Genoray Genoray released the third generation of its main C-arm, the ZEN-7000, as a pre-order in December. The company made several image-related improvements, which make the system faster and more customizable, says Jae Perez-Kim, C-arm sales specialist and Genoray manufacturer’s representative with Complete Medical Services.

One big change is the addition of a 2-terabyte, archive-dedicated hard drive that

is separate from the operating system. This is ideal for facilities that use their EMR system only, without a dedicated picture archive system, such as a PACS system.

“If you don’t have a PACS system, this is a good alternative,” Perez-Kim says. “You can store your images and view them years later.”

The new version of the ZEN-7000 also has a remote diagnostic system.

“Typically, when the machine goes down,

you have to send someone out to open it and test the board,” Perez-Kim says. “This reduces downtime.”

The company positions itself as an affordable digital alternative.

“Instead of paying for the name, you’re able to get a state-of-the-art, fully digital system with the same features and power for a fraction of the cost,” says Dave Orlando, vice president of the C-arm division at Complete Medical Services.

OEC Medical Systems In September, OEC Medical Systems, a wholly-owned subsidiary of GE Healthcare, received clearance to sell its OEC Elite CFD, with a CMOS flat-panel detector, in Europe, Japan, Australia and New Zealand. The OEC Elite CFD is the company’s first full-size, flatpanel C-arm.

Dan Strauch, chief marketing officer for GE Healthcare, says the company was waiting until the technology was perfected before stepping into the flat-panel arena.

Company officials felt that flat-panel detectors based on amorphous silicon were not superior to image intensifiers for the mobile imaging environment.

“We stayed with image intensifier technology longer than others,” Strauch says.

“People were very satisfied and it met all of their needs. We needed a compelling reason to make that change. We believe with the CMOS technology, the flat-panel technology will meet the image quality expectations of the user, particularly in difficult-to-image situations.”

In August, the company introduced the OEC Elite MiniView, also with a CMOS flatpanel detector. The mini C-arm is meant for use in hand and foot surgeries.

Because it has a low dose, the Elite MiniView can be used in an office environment, as the dose level may not require a shielded room, Strauch says. Improvements include one lock button, instead of several different locks, when a physician places a patient’s hand or foot directly on the detector.

“Sometimes it’s just thinking through the challenges with our customers,” Strauch says.

A new level of image quality you would not expect from a mobile C-arm.

Taking care of your X-ray imaging needs.

“Can I really use a mobile C-arm for cardiac applications?”

With our specially developed heart program, powerful generators and flat-panel technology our C-arms provide best results in the most demanding procedures.

“How can I gain intraoperative confidence in spinal procedures?”

Ziehm Vision RFD 3D helps avoid revision surgeries. With an edge length of 16 cm it offers a 3D dataset to confirm the correct implant position in just 3 minutes.

Find out more: www.ziehm.com

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C-arms

OrthoScan FD Pulse with 24-inch monitor

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OrthoScan The company is promoting the second edition of its OrthoScan FD Pulse, launched in early 2015. It’s the first and only mini C-arm with pulse fluoroscopy, says Travis Prikryl, vice president of surgical sales for OrthoScan, with the option of 30, 15 and 7 1/2 pulses per second.

Other features include a 24-inch monitor and surgical LED lights under the tubehead.

Instead of adjusting the room lighting, clinicians can use the LED lights, reducing the

shadow effect of the tubehead, Prikryl says.

The model has the company’s Generation 5 CMOS detector, which Prikryl says is 25 to 30 percent larger than anything available in a mini C-arm, used for extremity surgery.

The company touts the FD Pulse’s pulse generator, which Prikryl says allows it to emit the lowest radiation of a mini C-arm.

“That’s a big driver for a lot of radiology departments and ORs,” Prikryl says. “They’re looking to lower the radiation on the pa-

tients and staff on a daily basis.”

OrthoScan’s FD-OR mini C-arm, also with a flat-panel detector, was released in 2012.

“The key differences in the two models are a smaller detector and continuous fluoroscopy for the FD-OR versus pulsed fluoroscopy, and pricing for the FD Pulse, which is marketed to larger facilities. The company no longer manufactures new image intensifiers.

“Eighty to 90 percent of sales are driven to the higher-end product,” Prikryl says.

Philips BV Vectra

Philips Healthcare While Philips Healthcare has not released a new mobile C-arm in the last year, it offers three products in the space.

The company’s Veradius Unity C-arm provides the ability to store previous posi-

tions and comes with a tablet-like user interface that allows users to draw on the touchscreen with a finger or stylus.

Philips’ BV Pulsera mobile C-arm is an interventional radiology tool that can be used for a range of procedures, including cardiac interventions.

The BV Vectra is aimed at orthopedic surgical procedures, including trauma and pain management. The company says the C-arm, with its depth and angulation reach, is easy to maneuver and to use with both small and large patients.

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C-arms

Siemens Cios Fusion 1

Siemens Healthineers In March 2016, Siemens Healthineers received FDA clearance for its Cios Fusion, Cios Connect and Cios Select mobile Carm systems. They are lower-priced alternatives to the company’s ultra-premium Cios Alpha mobile C-arm, Siemens’ first flat-panel detector C-arm, which was cleared by the FDA in 2014.

The Fusion, like the Alpha, has flatpanel detectors, as well as a touchscreen system.

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“With a tableside remote, the surgeon has complete control of the C-arm in a sterile field,” says Lisa Reid, product manager for mobile C-arms at Siemens Healthineers.

The Cios Connect and Select are image intensifier systems, with a redesigned user interface that has some high-end functions, Reid says. The Connect includes extra features, such as vascular options and wireless transfer of images, making it an ideal fit for general surgery, orthopedics and some vascular procedures, while the

Select works for smaller environments, such as pain management clinics.

“A lot of customers are looking for flat-panel detectors specifically because of image quality and they’re looking for the latest technology,” Reid says, noting that C-arms with flat-panel detectors provide better image resolution and a full field of view, and deliver less radiation than an image intensifier. “But we still have part of the market that’s looking for a lower-cost system.”

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Whale Imaging B6

Whale Imaging In January, Whale Imaging received FDA clearance for its G-Arm B6 Duo. The improvements over the previous model, the GXi-2, which was introduced in 2015, include compatibility with the Jackson spine table and 45-degree axial tilt, or head-totoe movement, says Philip Posa, vice president of sales for Whale Imaging.

The major differences between the company’s G-arm and a conventional C-arm is that a C-arm moves in one direction. The company’s technology allows for both the AP and lateral images to be captured at once. This has the potential to reduce dose and procedure time and minimize the risk of infection, Posa says.

“In order to get an AP and lateral view, you have to move the C-arm,” Posa says. “You’re not moving a G-arm from AP to lateral and back and forth and disrupting [the] sterile field.”

The system offers panoramic view and stitching of the spine, allowing surgeons to count vertebrae, Posa says.

“A surgeon wants to make sure they’re working on the right spot,” Posa says. “They’re always counting. This allows for easy counting to make sure you’re in the right area. In a very scoliotic spine, it allows for better understanding of the procedure.”

The company debuted the G-Arm B6 Duo at the American Society of Spine Radiology (ASSR) meeting in February.

Ziehm Imaging At last year’s RSNA, Ziehm Imaging presented its Ziehm Solo FD and the Ziehm Vision RFD, both mobile C-arms with CMOS flatpanel detectors, what the company says are the first full-size Carms equipped with the CMOS technology.

The Ziehm Solo FD provides optimal soft tissue and bone contrast especially in orthopedic, A CI stent implantation at the knee, acquired trauma and pain management with Ziehm Vision FD. procedures, according to the company. The Ziehm Vision RFD, which comes with a 25-kilowatt generator for vascular procedures, has been commercially available with CMOS technology since last month.

To broaden the CMOS product portfolio, Ziehm introduced a new version of its Ziehm Vision FD, which now features the new detector technology.

The company also debuted its Ziehm NaviPort 3D interface for image-guided navigation, which the company says improves reliability and precision during surgical procedures, and the Ziehm Vision RFD Hybrid Edition, which the company says is the first fully motorized mobile C-arm, which can be used as an alternative to fixed systems for cardiovascular procedures.

“I am convinced that our latest flat-panel detector generation further strengthens Ziehm Imaging’s technological leadership by combining outstanding image quality and efficient workflow,” says Klaus Hörndler, chief executive officer of Ziehm Imaging. “Overall, our CMOS flat-panel detector is an excellent package, offering more possibilities and benefits for the clinician while keeping dose levels minimized.”

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C-arm

PRODUCT SHOWCASE

C-arm manufacturers are constantly working to improve the offerings available in the marketplace.

The products appearing on the following pages represent some of the best innovations available.

Look for the companies in this space to continue rolling out enhancements that will improve patient experience and outcomes.

Share this story: dotmed.com/news/36041

GE Healthcare / OEC Elite MiniView Ergonomically designed for fluid maneuverability, the OEC Elite MiniView allows surgeons to visualize finer details during extremity surgical imaging.

The features of the mini C-arm focus on minimizing positioning struggles with SmartLock and enabling greater clinical imaging confidence with the largest displayed image size. This product is a perfect companion for ambulatory surgical centers, sports facilities, physician offices and hospital emergency rooms and operating rooms.

GE Healthcare / OEC 9900 Elite The OEC 9900 Elite is designed to deliver superb clinical images during both simple and challenging imaging cases with fast and easy positioning. Loaded with features including highly articulating monitors and an intuitive touchscreen, this C-arm helps maximize patient throughput and staff productivity. The OEC 9900 Elite is a choice fit for the ER, OR, ICU or any surgical imaging or interventional setting.

GE Healthcare / OEC Brivo Plus

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GEMSS / KMC 650 The latest GEMSS C-arm is versatile, compact and economical with advanced functionality featuring expanded 31.5” free space, 27.2” arc depth, 39.3” SID and a greater orbital range (-90°/+45°). 2kW/40kHz high frequency monoblock generator and next generation software provide excellent high-resolution imaging, dose management and increased functionality to promote safety and improved workflows. Coupled with a two-year parts warranty that includes glassware, it’s the clear winner for small budgets.

NEW PRODUCT SHOWCASE

The affordability and mobility of the OEC Brivo Plus C-arm have the ability to transform health care in private practices and rural hospitals simply by increasing access to quality mobile imaging.

The familiar interface makes working, maneuvering and connecting simple and productive. It easily brings images into sharp focus using intelligent point-and-shoot technology.

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NEW PRODUCT SHOWCASE

GEMSS / SPINEL 3G

This new, high-performance mobile surgical C-arm features an expanded 135° orbital rotation, larger 800mm free space, premium cart with twin elevating 19” LCD monitors and smart CXView software with DSA cine peripheral angiography functions and virtual collimation. The 300kHU rotating anode tube supports a wide exposure range with Boost Mode (up to 20mA) and Pulse Mode (up to 30FPS). The system provides added stability, Back-Up Fluoro and RAID 1 storage and a two-year warranty.

GEMSS / SPINEL 12HD The flagship C-arm is equipped with a 15.3” dynamic flat-panel detector and boasts wider free space (880mm), expanded orbital range (-120°/+45°), wider SID (1,110mm) and low ISO Center (910mm). The GEMSS Smart Angio Package includes DSA, Roadmap, Re-Mask, Pixel-Shift, Max Peak and Minimum Opacification, and Bone Landmarking plus Metal Detection, IODC, ABC and Virtual Collimation. Additional features include Back-up Fluoro, RAID 1, Premium Cart, third monitor, two-way laser and a two-year warranty.

Experience the Bluestone Difference: . Solutions to meet your needs & budget . Highest quality systems . Backed by unparalleled service

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PRODUCT SHOWCASE Hologic / Fluoroscan InSight FD Designed to meet the challenges of extremity imaging, the InSight FD Mini C-Arm allows you to: see more detail from a distance when viewing larger and brighter images on the new 24” HD color widescreen display; change positioning to best suit anatomy and optimize patient dose with a rotating flat detector; image at up to 38 percent less dose than the competition — without the need for pulsed fluoroscopy.

OrthoScan Mobile DI Portable digital diagnostic imaging and fluoroscopy.

Portable, Light Weight: 35 lbs. unit easily moved between patient rooms and clinics Flat Detector Technology: Capable of still images and fluoro for extremity imaging Optimal Positioning: Capable of imaging fingertip to elbow, weight-bearing knee/foot views Improved Workflow: Secondary imaging source reduces patient wait times Connectivity: DICOM, EMR, USB, wireless Increased Reimbursement: Allows for additional procedures, established CPT codes

OrthoScan FD Pulse The first and only mini C-arm with pulsed fluoroscopy.

24” High Resolution Diagnostic Widescreen Monitor: 20 percent larger viewing area Reduced Dose: Selectable pulses per second depending upon imaging needs Largest Flat Detector: Square-shape CMOS detector provides greatest field of view; users see more anatomy Surgical LED Lights: Reduces shadows, illuminating anatomical detail 150° Orbital Rotation: enables preferred views without stressing anatomy Flat-Form Detector: thinnest flat detector housing on the market

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Philips / Veradius Unity

Veradius Unity has re-defined workflow during surgical imaging. With ClearGuide and a color-coded C-arm, the system establishes exceptional communication between the physician, operator and the C-arm, resulting in easy positioning.

The ability to store previous positions increases first-time-right positioning from 49 percent to 94 percent. The user interface with tablet-like simplicity changes the user experience.

Outlining is made simple with a tool that allows you to draw on the touchscreen of the mobile view station using a stylus pen or finger. The system design leaves ample room for patient access and provides a full range of dose management features and exam-type selections. Veradius Unity is a multipurpose system with exceptional image quality, thanks to the high dynamic range of the Trixell detector.

Philips / BV Vectra Reliance on fast, good, quality imaging for orthopedic procedures is a given in your daily routine. Ease of use, ease of positioning and the power to penetrate complex anatomies are key requirements. The Philips BV Vectra mobile C-arm system is intuitive to operate. BodySmart, Digital Exposure and MetalSmart allow you to simply point and shoot. Its consistent, crisp, high-quality images support you in providing excellent care. This compact system is dedicated to orthopedic surgical procedures, including trauma and pain management (non-DSA).

Highlights: • Better user experience to promote greater consistency and efficiency • Easy to maneuver and access small and large patients with excellent C-arm depth and angulation reach • Intelligent, ergonomic design with workflow-friendly features • Low X-ray dose for you and your patients with the high power of its class whenever needed • Intelligent design of the Mobile View station provides optimal viewing and connectivity options

Philips / BV Pulsera Intelligent and intuitive integration of multi-modality imaging, patient information and procedure-based applications deliver critical information to optimize real-time guidance through complex vasculature and dense anatomy. The Philips BV Pulsera mobile C-arm solution gives you the power and superb visualizations to support a variety of challenging interventions.

Power: 15 kW; II-Format: 31 / 23 / 17 cm; Highlights: • An interventional powerhouse covering the widest range of applications, including cardiac interventions • SmartVision — a fully digital imaging chain including powerful image processing functions • High quality images at a low dose, time after time pulsed acquisition 30 pulses/sec • Rotating anode power

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PRODUCT SHOWCASE Siemens Healthineers / Cios Fusion The company’s premium flat-panel detector system in the mid-level price segment has two detector sizes: 30 cm x 30 cm and 20 cm x 20 cm. Provides the same easy-to-use touchscreen interface and software options as the company’s ultrapremium Cios Alpha mobile C-arm, simplifying cross-training.

Touchscreen remote can be positioned at the operating table to control the C-arm from within the sterile work area.

Siemens Healthineers / Cios Select The company’s entry-level image intensifier-based system possesses easy-to-use push button interface for fast workflow. Uses IDEAL (Intelligent Dose Efficiency Algorithm) imaging processing algorithm to provide continuous contrast and brightness adjustments as well as the automatic dose performance adjustment that is available across the company’s entire Cios family.

Whale Imaging / G-Arm®B6 Duo

Siemens Healthineers / Cios Connect The company’s mid-level image intensifier-based system weighs only 545 lbs., maneuvers easily and provides many high-end features of a multifunctional Carm at a lower cost. Addresses all main surgical disciplines, including vascular with subtraction and pulsed fluoroscopy. With the free space of a larger C-arm, the system can accommodate larger patients even for spine procedures, without power concerns. Removable anti-scatter grid enables low-dose pediatric treatment.

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The G-Arm is a unique surgical X-ray system that provides two planes of images at the same time. By providing still images and fluoroscopy of AP and lateral views, the GArm is designed to improve user confidence and patient outcomes. The system is used in areas such as orthopedics, spinal surgery, neurosurgery, trauma and pain management. Providing unprecedented capability and control, G-Arm aims to improve your surgical experience.

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NEW PRODUCT SHOWCASE

Ziehm / Solo FD The size of hospital and surgery center ORs decreases and equipment quantity rises. The demand for imaging systems with smaller footprints is growing. With its all-in-one design, the Ziehm Solo FD is one of the most compact C-arms for even the smallest treatment scenarios on the market.

Ziehm Solo FD is equipped with the latest flat-panel technology called CMOS, to perform a broad portfolio of applications like orthopedics, trauma and pain management.

Ziehm / Vision RFD Hybrid Edition This is the first mobile C-arm offering motorization of all four axes. The movements can be accurately steered with the Position Control Center, saving valuable time during surgery. The 25 kW generator is one of the most powerful on the mobile market and delivers crystal-clear images.

With flat-panel detectors measuring 20 cm x 20 cm and 30 cm x 30 cm, this C-arm is ideal for complex interventions in cardiology, cardiac and vascular surgery. *The Hybrid Edition represents optional hardware and software that creates an option package for the Ziehm Vision RFD.

Ziehm / Vision RFD Ziehm Vision RFD, with its 30 cm x 30 cm flat-panel detector, provides a field of view that is up to 2.5 times larger than that of conventional 9� image intensifiers. Ziehm Vision RFD also delivers a higher resolution thanks to its 1.5k x 1.5k image matrix. The powerful monoblock generator with its unique liquid cooling system is specially designed for extended use in operating theaters. It is also a perfect fit for vascular procedures, interventional radiology and hybrid room applications.

Ziehm / Vision RFD 3D The Ziehm Vision RFD 3D is the only 3-D C-arm worldwide with flat-panel technology that provides a 16 cm edge length per scan volume. It combines 2-D and 3-D functionality to offer maximum ease of use. Available with a 30 cm x 30 cm flat panel, the C-arm offers game-changing 3-D imaging and is ideally suited for orthopedics, traumatology and spinal surgery, but also for demanding cardiovascular hybrid applications.

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PRODUCT SHOWCASE

C-arm Tables

Biodex / Surgical C-Arm Table 840 The Biodex new Surgical C-Arm Table 840 is designed for imageguided fluoroscopic procedures where stability, access and precise, quiet, vibration-free positioning are essential. Choose from rectangular or contoured tabletop design. This table is ideal for cardiovascular procedures. New features include an extra-large radiolucent area (71”), extensive head-to-toe tabletop motion (35”) and isocentric lateral roll that maintains image center during tabletop movement, minimizing image distortion. Ergonomic mushroom-shaped control optimizes command of the Smooth Glide™ free-float tabletop.

Biodex / Urology C-Arm Table 800 The Biodex Urology C-Arm Table 800 is an ideal choice for image-guided procedures. The narrow Fiberesin™ tabletop is cantilevered to accommodate portable or ceiling-suspended C-arms. Radiolucent areas are free of cross members, allowing full fluoroscopic visualization and unobstructed C-arm positioning. Optional cassette tray and X-ray grid allow for use of overhead or portable X-ray. Functional design provides complete access while minimizing radiation exposure to clinicians. The radiolucent extension offers capability for general C-arm applications.

Biodex / 3D Imaging C-Arm Table 820 The Biodex 3D Imaging C-Arm Table 820 is designed and equipped for use with 3-D C-arms for seed implantation, urology, thoracic/vascular and other general C-arm applications. Functional design provides complete access with minimal radiation exposure to clinicians. The 820 is equipped with a lightweight, non-imaging patient transfer extension, a radiolucent extension and a standard OR accessory rail located at the foot end. Select optional accessories to customize for your facility. Configure to your exact specifications.

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GLOBAL STAR MEDICAL / 2000 ECONOMY This cost-effective c-leg style table is manufactured in a long tradition of high quality and durability. Bariatric rated at 650 lbs. patient capacity. 35” fixed height table. Standard 2” thick premium foam pad. 5” swivel locking casters with top lock.

GLOBAL STAR MEDICAL / 8000 HLTES UROLOGY The urology package is available in many combinations of height, lateral, Trendelenburg, extend and side-to-side movements. Low profile frontal base design to prevent C-arm damage. Large selection of accessories available and compatible with most other accessories. Best specifications, 650 lbs. capacity and longest warranty in the industry. Shown with optional fluoroscopy extension providing 56” of imaging.

GLOBAL STAR MEDICAL / HLT PLATINUM The Durabuilt PMT 8000 HLT Platinum series table contains three of the most used movements, a 50-month warranty, 18” of height range (24”-43”), a 650 lbs. patient weight capacity and standard 2” pads. Available with four standard carbon fiber tabletop configurations and one cost-efficient composite, as well as custom configurations.

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PRODUCT SHOWCASE

Oakworks / SU-07 Available from Oakworks Solutions, the iNSPIRIT Medical SU-07 Operating Table offers a large carbon fiber radiolucent imaging area of 59.1” (1,500 mm) from the head end of the table. Electric tabletop adjustments including longitudinal, lateral and diagonal shift simulate a “floating top” for precise patient positioning. With two speed setups, fine tuning adjustments are possible. The table can also change position by initiating the movements of lateral tilt, Trendelenburg, Reverse Trendelenburg and height. Removable tabletop pads are made of memory foam and are covered with artificial leather.

Oakworks / SU-05 Available from Oakworks Solutions, the iNSPIRIT Medical SU05 Operating Table is designed for a wide variety of operating procedures, including vascular surgery, cardio surgery, neurosurgery, urology, proctology, gynecology, ophthalmology, oncology and others. Electrically controlled table movements include height, lateral tilt, Trendelenburg and Reverse Trendelenburg, kidney elevation and longitudinal tabletop shift.

The tabletop segments can also be adjusted for leg rest angle, kidney elevator and backrest. This multi-functional surgery table is also compatible with a C-arm for procedures that require continuous patient monitoring.

Surgical Tables, Inc. / URO MAX

Oakworks / SU-04 Available from Oakworks Solutions, the unique iNSPIRIT Medical SU-04 Operating Table makes patient transport easy, safe and quick in the operating room suite. Medical staff can move a patient on the SU-04 tabletop via a transport trolley and attach the tabletop to the table base in the operating room. After a procedure, the tabletop can be dismantled again, moving the patient to a recovery area, saving space and increasing efficiencies in the modern OR suite.

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When it comes to a urology table, lithotripsy table or a nephrology table, you need a table that’s capable of handling a wide variety of patients and procedures. The URO MAX Imaging C-Arm tables allow for simultaneous motion in all five directions for fast and accurate patient placement.

The 24” x 84” carbon fiber tops make for the best image quality. 500 lbs. weight capacity with a four-year warranty. www.dotmed.com/news

NEW PRODUCT SHOWCASE

STILLE imagiQ2

The STILLE imagiQ2 has a patented ultra-transparent, carbon fiber top (.4mm Al) helping to reduce dose while enhancing crystal imaging. The True Free Float™ capabilities and extended tabletop allow for full imaging head to toe. With bestin-class functionality and slim design, the imagiQ2 can also help reduce C-arm adjustments. Visit our website for Ambassador testimonials from leading surgeons worldwide on improving OR efficiency and dose reduction with imagiQ2.

STILLE Medstone imaging tables STILLE offers a broad range of mobile imaging tables ideal for pain management and general purpose imaging. The STILLE Medstone line of tables are manufactured with high-quality, hospital-grade materials built to last. With different options for patient positioning and configurations, you are sure to find the perfect imaging solution at a cost-effective price. Now offered by the same company that brought you the original low-dose imagiQ2 imaging table.

STILLE Medstone urology table STILLE is pleased to present the STILLE Medstone Precision series urology table.

This mobile imaging table features a large radiolucent imaging area of 24x24” and a 500 lbs. patient weight capacity. It comes equipped with a variety of urological accessories and four movements (longitudinal, lateral, elevation and Trendelenburg) that make it ideal for urology imaging procedures. STILLE has been serving surgery with high quality products since 1841!

Surgical Tables, Inc. / Streamline Series Imaging Tables Designed for high patient throughput for surgery centers, pain management and other multidisciplinary medical facilities, the Streamline Series Xray imaging tables are the lowest-priced tables in the imaging table industry. The 24” x 84” carbon fiber tops make for the best image quality. 500 lbs. weight capacity, 2” pad for patient comfort and 56” of metal-free area.

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Hospital Beds Hill-Rom’s Envella Air Fluidized Therapy bed.

Can smart hospital beds replace patient monitors?

By Lauren Dubinsky

Bedsores are the No. 3 disorder after cancer and cardiovascular diseases in terms of cost, according to a 2015 study published in the International Journal of Research in Medical Sciences. Grade 1 and 2 bedsores can cost between $125 and $451, and grades 3 and 4 between $1,400 and $2,300.

The Centers for Medicare & Medicaid Services penalizes hospitals for these hospital-acquired infections. The cost issue, combined with the fact that bedsores affect over 1.3 million adults globally per year, has encouraged hospitals to look for a solution.

“Hospitals are extremely aware of what they will and won’t be reimbursed for, so if they can invest a few more dollars in a [hospital] bed that will save them an average of $40,000 per hospital-acquired pressure ulcer, that’s a good return on investment,” says Julie Andrews, clinical analyst at MD Buyline.

Smart hospital beds are capable of automatically turning patients every few hours.

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North York General Hospital in Toronto has been using these beds since the early 2000s in its intensive care unit to prevent bedsores. “[The beds] rotate patients so [nurses] don’t have to roll and turn them as frequently,” says Dr. Donna McRitchie, vice president of medical and academic affairs at the hospital. “It also does it in a somewhat gentler way with a continuous slow rotation. That helps take pressure off skin and other bodily areas that can be impacted by pressure.”

The patients that present to the ICU are very different than those of 20 years ago.

Many of them are elderly or obese with multiple chronic diseases such as diabetes and infections, and the smart beds are especially useful for them.

The beds can move in all directions, be tilted at different angles and extended for very tall patients. They can also weigh patients and perform vibration and percussion massages.

Historically, a team of nurses would have to manually turn patients every two hours.

With these new beds, the staff isn’t at risk for wrist or back injuries.

“Once it became very apparent that this was a quality of care issue and not just a nice thing to have, we really needed to step up and redefine our priorities and the smart beds became a must have,” says McRitchie.

The smarter, the better Smart beds are also capable of sensing the patient’s position, alerting the clinicians regarding any issues and transmitting the data to the hospital’s electronic medical record (EMR).

Stryker Corporation offers a technology called iBed Awareness on its InTouch Critical Care and S3 Med-Surg beds. It monitors local bed status and alerts clinicians if preset parameters are compromised.

The company’s iBed Connectivity technology connects the beds to third-party systems like EMRs. A major hurdle for hospitals is cost. A standard hospital bed costs about $6,000, www.dotmed.com/news

Stryker’s S3 Med-Surg bed with iBed technology.

says Johnson. “Whether it replaces it or not, it’s a little early [to tell], but I think there is some natural synergy that will probably occur and we are looking at it.”

Hill-Rom is testing different technologies and looking into creating a bed that can run the patient data through sophisticated algorithms to predict if the patient is going to move or get out of bed.

Floating bed Hill-Rom recently introduced its Envella Air Fluidized Therapy (AFT) bed for specialized wound care. It’s geared toward patients with burns or skin grafts from a surgical procedure.

“It’s like floating on air,” says Johnson. “There are silica beads [inside] that heat up and get excited and create a frictionless surface.”

AFT helps to accelerate wound healing and reduce complications, which helps to improve outcomes for patients with flaps/grafts, stage 3 to 4 pressure injuries and deep tissue injuries.

Joerns Healthcare’s Dolphin Fluid Immersion Simulation (FIS) system is a competitor of Envella. This system redistributes pressure by simulating the effects of a body immersed in a fluid.

It automatically measures the characteristics of patients when they are on the support surface and then creates a personalized immersion profile. but the smart beds can range from $10,000 to $40,000, according to MD Buyline.

Although hospitals are cost-conscious, they see the added value in the smart bed data, says Ken Clark, senior technology solutions manager of Stryker’s medical division.

“When you look at the impact the beds can have on programs such as a fall prevention program at a hospital, the return on investment can be significant,” he adds. “In the ICU, the protocol reminders allow caregivers to better track events such as turns and skin checks, again helping caregivers to better improve outcomes and reduce the cost of care.”

In December, Stryker delivered new S3 Med-Surg beds to Three Rivers Hospital in Brewster, Washington, and provided free upgrades to the iBed technology. The hospital can now benefit from anti-fall warning lights and sounds to help protect high-risk patients.

If a patient typically moves two to three times per minute and starts to move 10 times per minute, the smart bed technology can spot that change and alert clinicians.

Hill-Rom, another major player in the hospital bed market, also offers smart beds that can send alerts. Alerts can either be transmitted through the EMR or sent directly to nurses’ mobile devices.

“Some customers want us to integrate with the EMR so we can send relevant patient information like bed weight and head of bed angle,” says Paul Johnson, president of patient support systems at Hill-Rom. “If the patient is going through some therapy in the bed, they want that information transferred to the EMR so they can keep track of it.”

The big question on customers’ minds is if these smart beds can replace patient monitors. Hill-Rom gets many requests for beds that are capable of monitoring respiratory and heart rate.

“If we can do that in a reliable and sustainable way, that might be an interesting way to provide some of the real-time monitoring,”

The U.S. market The U.S. hospital bed market was worth $1.2 billion in 2016 and is expected to grow at an annualized rate of 2.8 percent and reach $1.4 billion by 2021, according to an IBISWorld report published in February. Stryker makes up 15.5 percent of the market and Hill-Rom accounts for 52.2 percent.

The market is increasingly demanding bariatric beds. More than one in three adults in the U.S. are considered to be obese, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Hill-Rom’s most popular bed for obese patients is the Compella Bariatric Bed, which can support up to 1,000 pounds. Johnson has noticed that hospitals are ramping up bariatric services and a popular option is to rent the beds.

“You might not have the need for a lot of these bariatric beds, but when you need them, it’s an urgent [situation], or you may [only] need it for a week or two,” he adds.

Other factors driving the market are the rising elderly population and incentives from health insurance providers to use at-home hospital beds to lower the rate of hospitalization.

Most hospital beds in the U.S. have some form of smart bed technology, according to MD Buyline. It can range from basic alarm capabilities to advanced integration with the EMR and mobile devices.

Since hospitals have made a significant investment in EMRs, many are now looking to incorporate medical device data to enhance their EMRs. “If the trend over the last three years is an indicator of the future, we will continue to see this technology become adopted by more hospitals, similar to the way bed exit and local bed status monitoring options became standards in the past,” says Stryker’s Clark.

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Hospital Beds PRODUCT SHOWCASE

Hospital bed manufacturers are constantly working to improve the offerings available in the marketplace. The products appearing on the following pages represent some of the best innovations available. Look for the companies in this space to continue rolling out enhancements that will improve patient experience and outcomes.

Share this story: dotmed.com/news/36044

Arjohuntleigh / MaxiSlide- Versatile Repositioning Sheets Caregivers spend a large part of their working day transferring or repositioning patients. Using MaxiSlide™ is a fast and convenient solution for many everyday handling situations including common bedside activities such as moving, turning or sitting up the resident/patient. Routines involving lateral transfers and resident/patient repositioning can be performed safely and efficiently while improving the quality of care and creating a safe working environment for caregivers.

Hill-Rom / Envella™ The Envella™ Air Fluidized Therapy bed is Hill-Rom’s latest advancement and provides the highest quality wound care across the care continuum. It delivers superior clinical and financial results all while elevating the standard of care. Air fluidized therapy accelerates wound healing, reduces complications and improves patient outcomes for a range of patient acuities. The Envella™ bed is an ideal solution, especially for complex patients like those with stage 3-4 wounds, flap or graft wound sites or DTIs.

Linet / Multicare Multicare uses innovative technologies to help meet the needs of high acuity patients while providing caregivers the necessary tools to care for their patients safely and efficiently. Unique features such as Mobi-Lift® patient mobilization and frame-based lateral tilt help caregivers safely turn and mobilize patients. The Hercules Patient Repositioner® allows a single caregiver to reposition a 500 lbs. patient up in bed with the touch of a button, maintaining a low pressure state for the patient and reducing back injuries for caregivers. Other standard features include a scale, i-Brake® automatic braking, CLRT, bed exit alarm and battery backup.

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NOA Medical / NOAH Platinum NS Bed The NOAH Platinum NS Bed includes top-of-the-line features at an affordable price, including: • battery backup; • high impact head and • side rails; footboards; • patient exit alarm and nurse call; • CPR quick release; • 600 lbs. safe working load; • nurse panel; • four-year warranty on electron• central locking and steering; ics and lifetime on bed deck and • under bed lighting and backlit frame. handset;

NOA Medical / NOAH Platinum SC Plus Bed The NOAH Platinum SC Plus Bed includes top-of-the-line features at an affordable price, including: • backlit handset; • patent pending integrated • battery backup; in-bed scale and bed exit alarm; • side rails; • electronic braking system; • nurse call; • CPR quick release; • 600 lbs. safe working load; • nurse panel; • four-year warranty on electronics • central locking and steering; and lifetime on bed deck and frame.

• under bed lighting;

Linet / Multicare LE The Multicare® LE hospital bed is designed to meet the needs of a higher acuity patient in a multitude of care settings.

Improve patient comfort and pain management during turning, repositioning and standing, with features like the platform-based lateral tilt and Mobi-Lift®. And enhance patient outcomes with progressive mobility and earlier ambulation.

Multicare® LE is compatible with the Hercules Patient Repositioner®, which allows a single caregiver to reposition a 500 lbs. patient up in bed with the touch of a button.

Linet / Protevo® GTE+ Microclimate Protevo® GTE+ Microclimate provides pressure redistribution through an open, self-adjusting air cylinder system. Ten self-adjusting air cells provide optimal pressure redistribution with dedicated air cells for the heels. This surface is easily converted with an optional control unit to engage microclimate management and alternating pressure therapy. This surface is compatible with the Hercules Patient Repositioner® which allows a single caregiver to reposition a 500 lbs. patient up in bed with the touch of a button.

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Sizewise / Bari Rehab Platform 3™ Bari Rehab Platform 3™ debuts the innovative Power Drive 360™, which easily moves forward, backward and side to side for smooth navigation. This bed is one of the first to comply with the newest IEC safety standards. Our Shared Risk ProgramSM, available at the time of purchase, gets you a free loaner if your covered bed is out of commission for 48+ hours. 1,000 lbs. safe working load safely accommodates most patients.

Sizewise / Sizewise Alliance™ Alliance’s lightweight frame and easy maneuverability easily adapts to multiple acute settings, from the ICU to Med-Surg. An open architecture flat deck allows for multiple mattress options, and its simple design is easy to clean and maintain.

Our Shared Risk ProgramSM, available at the time of purchase, gets you a free loaner bed if Alliance is out of commission for 48+ hours. 551 lbs. safe working load.

Sizewise / Shuttle B Series Advanced™ Shuttle B Series Advanced™ is the ultimate mobility and SPH product. With the touch of a button, it transforms from stretcher to chair and is perfect for use in lateral transfers.

The seat assist function comes with ambulation poles for the safety and confidence of the patient and caregiver. The seat itself has a three-layer foam insert for further comfort and weight distribution. A 1,000 lbs. weight capacity makes Shuttle the choice for any patient.

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Span-America / Geo-Mattress® UltraMax™ stretcher mattress

Premium pressure redistribution, infection control and superior comfort designed to provide continuity of care facilitywide. Patented Shear Transfer Zone™ cover helps eliminate the effects of dangerous shearing forces. Proprietary stretch fabric provides industry-leading resistance to bleach, while allowing outstanding immersion into the multi-tiered surface.

Features a non-slip bottom with universal hook and loop pattern. Multiple sizes fit most common stretcher models.

Span-America / Encore ™ retractable deck expandable bed The new Encore bed provides superior safety and ergonomics for patients and caregivers in long-term or LTAC units. Features GlideAlign™ retractable deck, which helps maintain user’s relative positioning when head of bed is elevated. ReadyWide™ integrated expansion allows tool-less, pin-less expandability to 42 inches.

Smart Stop™ low position auto pause helps eliminate hazards.

Span-America / PressureGuard® recessed deck air therapy surfaces Span-America proudly offers four unique air therapy pressure redistribution surfaces to meet the special requirements of a hospital bed with V-shaped recessed decks. Proprietary design created two-piece modified “Safety Edge” for stability and fall prevention. Available models include non-powered air, convertible non-powered to alternating pressure, convertible non-powered to low air loss and standalone low air loss. All foam also available.

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Endoscopy

Minimizing infections when reprocessing equipment

By Thom Wellington

Endoscopic procedures involve a flexible or rigid tube with a light and camera attached to it which is inserted into an organ cavity. This invasive imaging technique is sometimes combined with specific surgical procedures. Endoscopes fall into categories based on the area of the body that they investigate.

The Food and Drug Administration states that in the U.S., duodenoscopes are used in more than 500,000 endoscopic procedures annually. The advancement in 66 HealthCareBusiness news

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these medical devices for the treatment of gastrointestinal diseases is evident. However, there is a link between infections and inadequately cleaned endoscopes, specifically duodenoscopes due to their complex design, which remains unsettling among many health care organizations.

According to the Centers for Disease Control and Prevention, outbreaks of bacterial infections are associated with endoscopes being improperly reprocessed. Due to duodenoscopes containing many small

working parts over other types of endoscopes, the instrument can be more difficult to clean and disinfect. If not thoroughly cleaned and disinfected after each use, tissue or fluid from one patient can remain in the device when it is used on a subsequent patient, causing an infection to be acquired via patient-to-patient or environment-topatient. Failing to clean endoscopes correctly can also result in the instrument channels becoming blocked, leading to inadequate functioning. www.dotmed.com/news

After an agency-led expert panel meeting in 2015 regarding concerns with endoscope reprocessing, the FDA published a guidance that provides a detailed list of reprocessing measures, in addition to meticulously adhering to the manufacturer instructions for health care facilities to follow. The purpose of this guidance is for health care facilities to take one or more additional steps to further reduce the risk of infection, maximize patient safety and increase the safe handling of these medical devices. The FDA encourages health care facilities to understand the importance of their role in reprocessing the device as well as maintaining proficiency in performing these reprocessing tasks.

As a supplement to the manufacturer reprocessing instructions and the recent FDA guidance, health care facilities should consider the following six steps when assessing the adequacy of reprocessing common endoscopy devices:

Competency verification should include direct observation in addition to other assessments such as written tests. With innovative, cloud-based technology, there are some new programs available to health care facilities that will reduce the need for meetings and align their vendors and staff around relevant training topics.

ten tests. With innovative, cloud-based technology, there are some new programs available to health care facilities that will reduce the need for meetings and align their vendors and staff around relevant training topics. Health care facilities should require all personnel responsible for reprocessing endoscopes to receive proper certification, specifically in line with the manufacturer of each device.

Manual cleaning It is vital to clean endoscopes manually in a room dedicated to the purpose of removing the organic debris and microorganisms that may be present. Personnel responsible for reprocessing should flush the air/water channel to expel any blood, mucus or other debris. To clean the outer surface of the endoscope thoroughly, all valves should be removed and cleaned separately with a soft brush. It is important to pay particular attention to the control section, angulation controls, distal end and the bridge mechanism of duodenoscopes. After removing the instrument from the electrical equipment, fully immerse and wash the suction channel in warm soapy water with a flexible brush. The used brushes should then be cleaned thoroughly by putting them through an ultrasonic cleaner before they are sterilized and repackaged. Always refer to the manufacturer’s recommendations specific to each component.

Staff training Ensuring personnel performing the endoscope reprocessing procedures have received appropriate training with competency verification will enhance patient safety. Training should be introduced at the initiation of employee duties, and then reevaluated on an annual basis, anytime a breach is identified or a new technique or equipment is introduced. When developing an endoscope reprocessing education and training program, there may be different needs for the various types of personnel who are cleaning and reprocessing endoscopes.

Therefore, materials should be established for the unique role each staff member plays. For example, training for a staff member who performs pre-cleaning and transports the endoscope to a central reprocessing area will be very different than a staff member who works in the reprocessing areas. Competency verification should include direct observation in addition to other assessments such as writHealthCareBusiness news

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Endoscopy

Disinfecting Flexible endoscopes should be disinfected in automatic washing or disinfection units. Most manufacturers recommend immersion in the disinfection solution for routine endoscopy.

There should be adequate ventilation and exhaust systems to remove any fumes.

When the disinfection cycle has been completed, the endoscope should be rinsed thoroughly both internally and externally using fresh, sterile and filtered water. Drain and flush with air and alcohol, which can be done manually or in an automated system, before it is reassembled for use. Repeat for extra precaution. Before storing away, ensure that all the channels of the endoscope and elevator mechanism are thoroughly dried to prevent bacterial growth or the formation of biofilm that is difficult to remove and could result in persistent contamination.

Surveillance culturing Health care facilities may perform microbiologic culturing, which involves sampling endoscope channels to identify any bacterial contamination that may be present on the scope after reprocessing. International guidelines have recommended intervals ranging from every four weeks to annually. Although numerous health care facilities have successfully implemented routine or periodic microbiological culturing, the CDC encourages that additional data and validation testing is needed to demonstrate the robust methodology and reliable culturing results before health care facilities can incorporate it as a best practice.

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training for reprocessing staff in health care facility reprocessing units and incorporating human factors testing when developing reprocessing instructions. Additionally, to prevent the risk of infection, single-use or autoclavable accessories should be used wherever possible. Do not reuse accessories labeled for single use.

Recordkeeping Health care facilities should develop procedures and responsibilities for tracking the useful life of endoscopes and accessory equipment, including equipment and supplies for reprocessing. These procedures should address specification evaluation, scheduled maintenance and removal of equipment from use. Identify all endoscopes, endoscope accessories and endoscope reprocessing equipment used in your facility, including manufacturer, models, serial numbers or hospital-specific equipment tag numbers and unique device identifiers (UDIs). It is important to also include the location within the facility where the equipment is reprocessed and stored, and the status or maintenance schedule of the device.

Infection preventionists play an important role in endoscopy leadership and quality reporting to further reduce the risk of infection and increase the safety of endoscopes. It is critical that health care organizations include endoscope-related infections in surveillance activities in the event that an environment-topatient infection is acquired, also referred to as a health careassociated infection (HAI). Although conducting surveillance for HAIs is part of every infection preventionist’s job, there is not a standard definition set for determining if a patient acquired an infection from an endoscope. Therefore, it is critical to examine all aspects of the endoscope reprocessing programs to ensure that staff are meticulously adhering to the cleaning and reprocess instructions.

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Imagine this scenario: an endoscopy unit at a major hospital is in the midst of a large construction renovation project. The endoscopy equipment and accessories were just cleaned and sterilized by the appropriate hospital staff for use on the next patient. Various construction vendors carrying potentially harmful debris unknowingly on their shoes and clothing are walking in and out of the area where these sterilized devices are being stored. If even the smallest amount of dust or other bacteria-laden debris becomes airborne and falls onto sterilized endoscopy equipment that then enters a patient, specifically an immunocompromised patient, the result could be deadly.

Additionally, some ventilation systems in the endoscopy units were not sealed securely, causing bacteria from the construction site to enter the clean areas in the facility. Due to poor surveillance and recordkeeping, this health care facility’s role in HAI prevention could be in jeopardy. Although this scenario is not a direct result of improper endoscopy reprocessing, it is a very plausible and preventable situation that should be considered.

While the FDA is studying the problem and working with manufacturers to determine whether new cleaning protocols should be mandated or the endoscopes should be redesigned entirely, health care facilities must act now to do what they can to maintain patient safety and prevent exposure to endoscope-related infections.

fectant following some manual cleaning. The FDA estimates that about 1,000 hospitals and clinics nationally rely on the manufacturer’s equipment to prepare reusable endoscopes for the next patient. Most hospitals that do these procedures are not even looking for this problem, or they may not be aware. Even when the devices are cleaned strictly in accordance with manufacturer and FDA-approved guidelines, there is still a great risk of infections being transmitted.

While the FDA is studying the problem and working with manufacturers to determine whether new cleaning protocols should be mandated or the endoscopes should be redesigned entirely, health care facilities must act now to do what they can to maintain patient safety and prevent exposure to endoscope-related infections. Ensuring a safe and reliable endoscope program requires a multidisciplinary approach and is truly a team effort in order for it to be successful.

About the author: Thom Wellington is the CEO and a stockholder in Infection Control University, a company that provides staff training programs and control processes for infectious microorganisms in hospitals, clinics, long-term care facilities and other health care-related institutions.

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When the FDA investigated other cases concerning endoscopy reprocessing issues, the investigators identified the same source of transmission: a specialized endoscope, threaded down the throat of a half-million patients a year to treat gallstones, cancers and other disorders of the digestive system. They found that the duodenoscope devices accumulated bacterium that was not fully removed by conventional cleaning techniques, causing an infection to pass from patient to patient. This bacterium is known as Carbapenem-Resistant Enterobacteriaceae (CRE), an antibiotic-resistant superbug that can kill up to 40 percent of the people it infects.

Endoscope cleaning machines can cost roughly $30,000 to $50,000 and typically take about 30 minutes to wash with disin-

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Endoscopy PRODUCT SHOWCASE

Endoscopy equipment manufacturers are constantly working to improve the offerings available in the marketplace. The products appearing on the following pages represent some of the best innovations available. Look for the companies in this space to continue rolling out enhancements that will improve patient experience and outcomes.

Share this story: dotmed.com/news/36042

Boston Scientific / SpyGlass™ DS Direct Visualization System The SpyGlass DS System enables high resolution imaging and therapy during an ERCP procedure to target biopsies and fragment stones, which may result in more efficient evaluation and help reduce the need for additional testing and repeat procedures compared to traditional ERCP, and enable patients to receive treatment sooner.

Boston Scientific / Resolution 360™ Clip The Resolution 360 Clip builds on the strong clinical and economic track record established by Resolution™ Clip and offers new benefits to providers and patients, including controlled clip placement and shorter procedure times.

Boston Scientific / Acquire™ Endoscopic Ultrasound Fine Needle Biopsy Device The Acquire FNB Device is designed to capture bigger tissue specimens. The three points provide stability at puncture while the high quality, fully formed heels are designed to maximize tissue capture and minimize fragmentation, which may result in improved diagnostic yield and specimen adequacy to support oncology research.

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NEW PRODUCT SHOWCASE

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NEW PRODUCT SHOWCASE

CONMED/DuraClip™ Repositionable Hemostasis Clip For hemostasis in the gastrointestinal tract, ConMed’s new DuraClip™ Hemostasis Clip has 360° rotation and no limits to the number of times it can be repositioned. The DuraClip’s unique clip component has a thin leading clip arm, with a profile that is 40 percent shorter than other devices.

The 10mm remaining clip takes up less space in the field of view to see mucosal defects with unhindered visibility and precise placement.

CONMED / DRSHD™ 1080P IMAGE MANAGEMENT SYSTEM WITH WIRELESS APP The DRS1080p Image Management system from ConMed allows surgeons and health care providers the means to securely archive, access and report on surgical cases. The ease of use provides the OR staff with the ability to quickly prepare the device for surgical procedures. In addition, the iPad application allows for the image review, patient information entry and reporting to be performed well beyond the sterile field.

CONMED / Ultra-High Def Laparoscopes High Definition Laparoscopes for Optimal Imaging The ConMed Ultra High Definition (UHD) Laparoscope is our third-generation laparoscope, providing enhanced image clarity and sharpness for improved viewing within the anatomy. The ConMed laparoscope provides a better image quality, which optimizes the image on the screen. With an improvement of light transmission and vignette, this improved scope allows for better clarity and brightness in the joint space and a brighter image, from the center all the way to the edges.

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Endoscopy PRODUCT SHOWCASE

KARL STORZ / ENDOCAMELEON® Telescope Achieving optimal visualization, even in areas hidden from traditional telescopes, the ENDOCAMELEON Telescope combines the benefits of a flexible scope with the advantages of a rigid scope. For specialties from laparoscopy and GYN, to urology, thoracic and single-port access procedures, our ENDOCAMELEON Telescope enables surgeons to easily and intraoperatively adjust the viewing direction from 0° to 120°.

KARL STORZ / Flexible Video Cystoscope Offering the benefits of distal chip technology, the Flexible Video Cystoscope delivers the highest image quality to give urologists crisp, clear visualization that does not require focusing. Compatible with both analog and digital camera systems, this new cystoscope offers an optimum solution for both office and hospital settings. Its full-screen image provides a more complete and accurate overview of anatomy.

KARL STORZ / Extended Length Instruments Bariatric surgery presents a range of challenges to laparoscopic surgeons. KARL STORZ offers solutions to these challenges with extended length instrumentation and telescopes specifically for these procedures. And because you can’t operate if you can’t see, our HOPKINS® Rod Lens System has become the optics of choice for many laparoscopic surgeons performing bariatric procedures.

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NEW PRODUCT SHOWCASE

NovaProbe / HD CAMERA SYSTEM HDCAM 3000 NovaProbe Video Systems offer a clear, bright image designed to enhance outcomes. Utilized by surgeons around the globe, NovaProbe Video Systems provide the best quality at an affordable price. NovaProbe HD Camera System HDCAM 3000 is a waterproof camera powered by a full HD SONY CMOS chip with 2,400,000 pixels.

The video resolution of the camera system is at 1920 x1080p/60 fps. The user is able to adjust the white balance, red and blue gain for better image clarity, sharpness, brightness and capture images during surgery. The camera system has DVI, HDMI, S-Video and USB 3.0 outputs.

NovaProbe / LED Light Source LEUKOS 175 The NovaProbe LED Leukos 175 is specifically designed to provide the cold light intensity required for modern-day endoscopic procedures. The LED light provides the color temp of 6,500 deg K also known as white light.

The white light offers unmatched quality for the single chip, three chip and HD cameras.

The NovaProbe LED Light source assures that the light passing through the fiber optic cable is a cold light and is far superior to the light sources from other manufacturers.

NovaProbe / 40 L Insufflator 10040 The NovaProbe CO2 Insufflator is specifically designed for modern-day endoscopic procedures. This insufflator is intended to facilitate the use of the laparoscope by filling the peritoneal cavity with gas. The insufflator is solely designed for distention of the abdomen for diagnostic and/or operative laparoscopy. The unit delivers a maximum gas flow of 40 l/min.

The pressure is adjustable in the range of 5-30 mmHg.

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Reprocessing Orthopedic and ENT devices during reprocessing.

Reprocessing: From FDA regulation to best practices

By Dan Vukelich

The Association of Medical Device Reprocessors (AMDR) turns 20 this year.

As the global trade association representing the legal, regulatory and other trade interests of the regulated, commercial “single-use” device (SUD) reprocessing industry, it’s nothing less than extraordinary the changes that have occurred in the reprocessing industry in the last two decades.

Reusing single-use devices. It flat-out seems counterintuitive, and yet, what was once shunned is now an FDA regulated industry providing services to a majority of U.S. hospitals, saving hospitals hundreds of millions of dollars a year and reducing medical waste. Safety, savings and sustainability are the cornerstones of the positive financial and environmental impact of reprocessing.

These participating hospitals, including most on the Honor Roll of facilities as listed

by U.S. News and World Report, utilize medical device reprocessing to bring eco74 HealthCareBusiness news

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nomic and environmental benefits to the nation’s health care system, its practitioners and the patients they serve.

How it works: Single-use device (SUD) reprocessing The growth of SUDs — both in number and in cost — was one factor that led many hospitals to reuse SUDs in the late ‘90s. Greater reliance on SUDs was wasteful, inefficient and expensive. A spent SUD (or one that is opened, but not used) also becomes trash, adding to costs to the environment and a hospital’s waste removal costs. If, technically speaking, the manufacturer or other third party could extend the life of the product to another use, while meeting the same FDA safety standards, why wouldn’t we encourage this? This is where AMDR’s members have stepped up, to provide the FDA with the data demonstrating that they can safely reprocess these products to reduce costs and waste.

Reprocessors turn these former SUDs into new, rebuilt SUDs meeting the same FDA standards for device manufacturing that apply to any other original equipment manufacturer (OEM). The reprocessed devices are, in the FDA’s terms, returned “substantially equivalent” to the predicate OEM device — assuring health care providers and patients that reprocessed SUDs are “as safe and as effective” as a new device.

Reprocessors become the manufacturers of these reprocessed SUDs, assuming all manufacturer obligations. This is distinct from the “reprocessing” done in hospitals for reusable devices, whereby OEMs have provided instructions and hospitals implement those cleaning protocols.

Commercial reprocessing is essentially manufacturing, and complies with internationally accepted standards. Devices are collected, disassembled, cleaned, functiontested, repackaged and sterilized. The devices are 100 percent traceable, enabling www.dotmed.com/news

quality controls and accountability. Reprocessed devices are as safe as the original product they replace, a finding confirmed by the FDA and a 2008 Government Accountability Office (GAO) report.

Reprocessed devices There are three main categories of devices that are reprocessed and that can be found within a hospital’s reprocessing program: cardiovascular devices; OR instruments; and noninvasive devices. But reprocessing companies offer hospitals a variety of ways to reduce cost and waste by finding more SUDs to reprocess.

One of the greatest savings opportunities we’re seeing is in the cardiac catheterization lab. Reprocessors have FDA clearance for many models of diagnostic cardiac catheters. And by using reprocessed catheters, hospitals can cut the device costs portion of these procedures by up to half.

Another area for savings is the OR. More complex laparoscopic instruments have escalated costs for hospitals. Reprocessors can offer alternatives, ranging from trocars to ultrasonic scalpels to graspers and forceps. The third area for savings is noninvasive devices.

Examples include compression sleeves, tourniquet cuffs, bed alarms and pulse oximetry sensors. Nurses and physicians can use the same brands they have always used.

Savings and benefits Reprocessing is one of the most impactful initiatives a hospital can implement to reduce costs and waste. According to the 2016 Practice Greenhealth sustainability benchmark report, a survey of its members showed that hospitals saved $30.5 million in combined savings between purchase and avoided waste disposal fees on medical device reprocessing. The average facility saved $295,238 annually. Additionally, reprocessing eliminates red bag waste, which can cost 10 times as much to dispose of as regular waste.

Over the course of the growth of the reprocessing industry, there has been a bending of the cost curve, and the cost of original manufactured devices has decreased due, in part, to the competition from reprocessed

devices. This further brings savings to the supply chain within hospitals.

Best practices One key to a successful program is placing used devices in the proper bin to maximize reprocessing savings. Devices should be treated as valuable assets, not as waste, so extra care should be taken to ensure they are not damaged when being placed in the bins. Also, hospitals should use reprocessed devices first. Train all staff to use the reprocessed devices first to lessen dependence on new devices and keep the savings within the institution.

The savings can be used to retain staff, buy new equipment and make investments in education.

Other aspects of a successful reprocessing program require more diligence. Some device companies bundle new and reprocessed SUDs as ”comprehensive or circular device programs,” claiming to offer consistent, predictable supply and pricing. However, these bundled programs can negatively impact savings and waste reduction potential. After all, the manufacturer may stand to gain by selling you more “singleuse” devices and less reprocessed to keep their profits high. Remain vigilant and take ownership of your program. Will the promised savings be guaranteed? Are there minimum purchasing requirements hidden in these proposals? What percentage of the devices will be reprocessed and will the vendor be transparent with this information.

Hospitals can partner with multiple vendors (OEM and reprocessor) rather than only one manufacturer, and maintain more clinical autonomy and control over their device mix, and therefore better maximize the savings and sustainability potential of reprocessing To better inform and educate purchasers and hospitals about these threats to a successful reprocessing program, AMDR created a fact sheet to help identify these and other obstacles to reprocessing.

reprocessing plays a role as a viable solution.

Medical waste is the second-largest contributor to landfills after the food service industry.

With reduced savings, there are fewer resources for patients, your staff and facility.

Dr. Marty Makary, a surgeon, medical commentator and advocate for transparency in medicine and common-sense solutions to health care’s problems, was coauthor of a 2011 JAMA Surgery article, “Green Surgical Practices for Health Care,” which identified reprocessing of single-use medical devices as one of five green recommendations for safe and efficient strategies for hospitals and providers to protect the environment while delivering high-quality care. The American Nurses Association, Association of periOperative Registered Nurses, Practice Greenhealth and Health Care Without Harm have all recognized or endorsed reprocessing as a way to reduce waste.

What the future holds FDA oversight and regulation, a proven safety record and a significant reduction in medical device and waste removal costs are the current benefits of a reprocessing program. But there’s much more we can do. Independent research shows that reprocessing has the potential to help lower health care costs by billions of dollars. One estimate states that if reprocessing was fully implemented in the U.S., we could save $2.7 billion over five years. This savings potential does not require any upfront hospital capital investment to get started, offers the same standard of care, allows doctors to use the device brands they already are using, and extends the life and value of the medical devices hospitals already own. What will you do with those savings and resources?

About the author: Dan Vukelich, Esq., CAE, is president of the Association of Medical Device Reprocessors.

Sustainability There are ethical and moral responsibility issues at stake in today’s health care arena, and

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Reprocessing

Unlocking SUD reprocessing savings in your hospital's OR

By Bill Scott

Operating rooms (ORs) are one of the leading contributors to a health system’s medical waste and supply chain spend.

Health systems, large and small, that focus on implementing green initiatives in their OR have made significant strides in achieving financial and environmental sustainability in recent years. Practice Greenhealth examined this topic in its 2016 Sustainability Benchmark Report. One initiative that showed the largest impact in terms of cost savings was single-use device (SUD) reprocessing, helping some health systems achieve an annual savings of more than $12,500 per OR. What’s exciting about this initiative is that there are opportunities to expand those savings even further.

The OR is home to a number of devices that are suitable for reprocessing, including ultrasonic scalpels, laparoscopic instruments, trocars and arthroscopic shavers and wands. Because these items are frequently used, implementing an SUD reprocessing program opens the door for health systems to achieve significant financial savings by buying back reprocessed devices at a fraction of the original device cost.

While SUD reprocessing has been a widely embraced practice in the U.S. for 20 years, many health systems have not unlocked their full cost savings and waste reduction potential. Achieving savings requires hospitals to maximize the number of reprocessed devices purchased and reduce the number of new devices. However, surgeon engagement and vendor pushback are two of the most common obstacles that limit a health system’s ability to purchase reprocessed devices. Here is a closer look at these barriers and how to overcome them.

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Surgeon engagement A successful reprocessing program requires surgeon engagement. Often, surgeons are skeptical about the reprocessing industry based on misperceptions of device quality. To overcome this, the most successful health systems engage their reprocessing partner to help educate their staff about the rigorous reprocessing process every device undergoes under stringent FDA requirements and oversight.

One of the most common tactics we have seen is contract limitations. On the surface, a discounted price or a rebate tied to a volume commitment from the OEM might look appealing. In some instances, the prices of other products in that OEM’s portfolio might be raised to offset the discount. In others, a hospital may find it has to significantly increase purchase volume to qualify for the rebate.

While not an exhaustive list, these examples

Health systems that focus on implementing green initiatives in their OR have made significant strides in achieving financial and environmental sustainability.

Sharing relevant industry research and statistics about the strong efficacy and safety record of reprocessed devices also helps correct misunderstandings, especially when peers deliver that message. Terrence J. Loftus, M.D., MBA, FACS, a former medical director of surgical services and clinical resources at Banner Health, was one skeptical surgeon turned believer. To settle an internal debate about whether reprocessed devices were equivalent to original devices, he pulled data and analyzed the efficacy of the two types of devices at his facility. In his study, published in the Journal of Medical Devices, he found that original equipment manufacturer (OEM) devices were nearly five times more defective than reprocessed SUDs. Sharing these findings with staff can help build confidence in the safety of the devices, and improve surgeon engagement.

Vendor pushback Another common SUD reprocessing hurdle health systems face in the OR is vendor pushback. As the reprocessing market has grown, vendors have deployed a range of strategies to limit a hospital’s access to reprocessed SUDs.

underscore the importance of carefully examining contracts to identify and address tactics that limit reprocessing savings opportunities.

Some vendors have also pushed back by threatening to remove representatives from procedures that use reprocessed devices. To help gain more control over their supply chain, some health systems are beginning to train staff to play the role the representative once did. By reducing dependence on vendor support, health systems have more options to make decisions with their hospitals’ best interests in mind.

ORs are ripe with savings opportunities.

Utilizing SUD reprocessing in the OR can play a big role in helping health systems achieve both financial and environmental sustainability. When ORs can overcome these common reprocessing obstacles, they can unlock their true savings potential.

About the author: Bill Scott is senior marketing director for Stryker’s Sustainability Solutions division, an industry leader in providing third-party medical device reprocessing and remanufacturing services.

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Sterilizers

PRODUCT SHOWCASE

Sterilizer manufacturers are constantly working to improve the offerings available in the marketplace. The products appearing on the following pages represent some of the best innovations available. Look for the companies in this space to continue rolling out enhancements that will improve patient experience and outcomes.

Share this story: dotmed.com/news/36043

Belimed/MST V 446 Small Chamber Steam Sterilizer The MST V 446 steam sterilizer is designed to provide the flexibility and functionality you need in the OR, ASC and sterile processing areas. Compliant to AAMI-ST8:2008 and AAMI ST79:2010, the 446 is capable of processing two 25 lbs. instrument sets in immediate use, pre-vac or gravity cycles. Custom cycles are available based on the instrument manufacturer’s Instructions for Use (IFU). An optional stainless steel electric steam boiler is available when the benefits of contaminant-free steam (clean steam) are desired.

Belimed/MST H 9600 Series Horizontal Steam Sterilizer

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Belimed/MST V 600 Series Vertical Steam Sterilizer The MST V 600 Series steam sterilizer combines high productivity with minimal space requirements. With a capacity of up to 12 standard 25 lbs. instrument sets, the MST V 600 Series can be installed side by side with no side or rear service access required, making extremely space efficient department designs possible. Innovative technologies including a liquid-ring vacuum pump, high efficiency heat exchangers and temperature regulated control valves reduce water consumption to the lowest levels in the industry. Options for integration to the facility’s chilled water systems will reduce potable water consumption down to 2.6 gallons.

NEW PRODUCT SHOWCASE

The MST H 9600 Series Horizontal Steam Sterilizers consist of carriage loading and ground loading steam sterilizers. Designed to maximize throughput, carriage and ground loader steam sterilizers are available in single-door or double-door configurations, offering the flexibility of fitting strict layout requirements of the sterile processing departments. Automation is also available for both sterilizer configurations to maximize processing throughput while minimizing material handling.

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NEW PRODUCT SHOWCASE

MAQUET / STERIZONE® VP4 Sterilizer

Getinge brings a higher intelligence to low temperature sterilization with the STERIZONE® VP4 Sterilizer. As the only low temperature sterilizer to deliver the killing power of dual sterilants and single-cycle simplicity, the STERIZONE® VP4 Sterilizer is uniquely ready to meet the demands of the operating room (OR), support the smooth and efficient operation of central sterile (CS) and ultimately help ensure positive patient outcomes.

Midmark / Ritter M11 UltraClave Automatic Sterilizer Provides an intuitive display and simple prompts that help you easily select the cycle you need … whether it is for unwrapped items, pouches, packs or hand pieces. Once the sterilization process is complete, the door conveniently opens automatically and quietly to dissipate the steam to provide fast and efficient drying of your instruments.

Midmark / Ritter M9 UltraClave Reliable and easy to use. The intuitive display and simple prompts help you to easily select the cycle you need … whether it is for unwrapped items, pouches, packs or hand pieces. Once the sterilization process is complete, the patented automatic-opening door quietly opens to dissipate steam, providing fast and efficient instrument drying.

Simply load it, set it and forget it!

PRIMUS Steam Sterilizer Midmark / Ritter M3 UltraFast Automatic Sterilizer Sterilize unwrapped instruments and hand pieces in just six minutes and pouched instruments in just over 10, with the touch of a button. The M3 is the simple, intelligent and fast choice for your sterilization needs, featuring one-step loading, push-button cycle selection, automatic-opening door and intelligent features that monitor water levels for worry-free operation. 25-minute drying time.

PRIMUS is the leader in U.S.-made health care sterilizers that are designed for multiple applications and are an essential part of the decontamination and sterilization process in special pathogen units, surgery, central sterile supply, clinical laboratories, dental facilities, among others.

With 12 standard sizes and a variety of options to meet nearly any requirement, PRIMUS sterilizers are simple to operate and even easier to perform maintenance on. The PRIMUS PRI-Saver™ Water Conservation System reduces water consumption by 97 percent.

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Sterilizers

PRODUCT SHOWCASE Skytron / Integrity 175/175SG The Integrity 175 Steam Sterilizer gives you standard throughput in a tight footprint. Process up to two 25 lbs. trays in one cycle — all while requiring minimal floor space! Reduce water usage up to 67 percent with the integrated water recirculation system. Simple touchscreen control, combined with a large countdown timer and progress bar, make operating the Integrity 175 easy. Record, store, chart and print data for thousands of cycles — all with simple touchscreen control.

Skytron / Integrity 215/215SG

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Skytron / Integrity 270/270VP The Integrity 270 is the workhorse of the Integrity Line, exceeding all standards for capacity and processing up to 16 25-pound trays per cycle. Reduce water usage up to 33 percent with the integrated water recirculation system. Simple touchscreen control, combined with a large countdown timer and progress bar, make operating the Integrity 270 easy. Record, store, chart and print data for thousands of cycles — all with simple touchscreen control.

NEW PRODUCT SHOWCASE

The Integrity 215 exceeds all standards for capacity — efficient enough for immediate use, productive enough for immediate use, productive enough for high-demand environments and compact enough for most replacement applications. Despite the compact footprint, you can process up to six 25 lbs. trays. That’s over twice the content of competitive-sized models while reducing water usage up to 43 percent with the integrated water recirculation system. Record, store, chart and print data for thousands of cycles — all with simple touchscreen control.

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NEW PRODUCT SHOWCASE

Steris / V-PRO ® 60 Low Temperature Sterilization System The V-PRO 60 Sterilizer offers the same trusted VHP technology as the V-PRO maX, with space saving flexibility offered by a cart mounted or countertop option. This model offers three sterilization cycles to match the device being processed. Wider cycle claims and the ability to have mixed loads allows you to maximize devices per load.

Steris / AMSCO® 400 Series Small Steam Sterilizers AMSCO® 400 Series Small Steam Sterilizers are engineered to be fully compliant with current steam sterilization standards. The 20 x 20 sterilizer is validated to accommodate a maximum of three 25 lbs. sets (up to 75 lbs.) per load, and the 16-inch models can sterilize two 25 lbs. sets (up to 50 lbs. per cycle), per AAMI guidance for processing weights.

Steris / V-PRO® maX Low Temperature Sterilization System The V-PRO maX Sterilizer just got more productive. The 28 minute non lumen cycle can now process loads up to 50 lbs., including cameras, batteries, cables, non-lumened endoscopes and similar devices. Steris continues making sterile processing departments more productive, consistent and dependable to ensure a high standard of patient care.

Tuttnauer / Steam Sterilizers The Tuttnauer 4472/5596, featuring 16” x 16” and 20” x 20” chamber sizes, comes standard in a space-saving design capable of fitting into the smallest of footprints. FDA cleared, these sterilizers are manufactured primarily for use in the operating room and ambulatory surgery centers. Reliable, non-proprietary components add to the “uptime” and low cost of maintenance. Flexible door designs, eco-friendly systems and a wide range of options are available. Tuttnauer also offers larger sterilizers for central sterile supply applications.

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Best Practices

Controlling dangerous inflammation during open heart surgery

By Phillip P. Chan

Heart disease shows no signs of slowing down as the leading cause of death worldwide, driven by the aging baby boomer generation, epidemics in obesity and diabetes, high blood pressure, smoking and unhealthy diets and lifestyles.

Blocked coronary arteries, diseased heart valves, aortic aneurysms and dissections, and heart failure are just some of the reasons that 1.5 million people undergo open heart surgery each year, with a half million annually in the U.S. alone.

But the routineness of cardiac surgery belies its great technical complexity. To operate on the heart, the chest cavity is “cracked� open and the heart is then exposed and stopped. To keep the patient alive during surgery, the blood is diverted through a heart-lung machine that oxygenates and pumps blood to the rest of the body, in a process called cardiopulmonary bypass (CPB).

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Then, over the course of many hours, cardiac surgeons often combine multiple surgical procedures such as valve replacement, coronary artery bypass grafting (CABG), aortic reconstruction and congenital defect repair to safely correct as many critical problems as they can in order to avoid future surgeries.

Unfortunately, high-risk, complex cardiac surgery and long CPB times can generate a host of inflammatory toxins that can directly injure vital organs and contribute to serious postoperative complications such as acute kidney injury, failure to wean off of mechanical ventilation, circulatory collapse, risk of stroke and even death. For example, patients undergoing aortic surgery have a 17 percent incidence of acute respiratory distress syndrome, one of the most severe forms of lung injury, that can be fatal in up to 80 percent of cases following cardiac surgery. And up to 30 percent of cardiac surgery patients develop significant kidney injury, 1 to 2 percent

of whom will require dialysis, increasing the risk of death eightfold.

To avoid these dangerous complications, it is important to first understand how this inflammation occurs in cardiac surgery and what surgeons can do to prevent and treat it.

What happens during open heart surgery?

Cardiac surgery generates significant inflammation that is directly proportional to the length and complexity of the procedure. For example, standard CABG does not involve cutting into the heart, has relatively short CPB times, and consequently, does not cause significant inflammation. However, more invasive procedures such as valve replacement and aortic reconstruction generate significant inflammation, putting patients at higher risk of latent organ failure and serious postoperative complications.

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Of the various inflammatory mediators that are generated during cardiac surgery, plasma free hemoglobin is one of the primary offenders. Hemoglobin, the oxygencarrying component of red blood cells, is generally non-toxic when contained inside the red blood cell. But when these cells get damaged and hemolyze, due to shear forces caused by high blood flow or suctioning of blood from the surgical field under vacuum, hemoglobin is released into the bloodstream where it can cause toxic oxygen radical damage as well as scavenge nitric oxide, the body’s most important vasodilator, from blood. This can lead to the damage and constriction of blood vessels throughout the body, leading to decreased blood flow and increased risk of ischemia to vital organs, increased resistance that the recovering heart must work hard to pump against, and a significantly increased risk of organ injury and organ failure.

Also complicating open heart surgery outcomes is the activation of complement, a family of immune system components that normally helps to fight infection, but when abnormally activated — as through blood contact with the foreign surfaces of the CPB circuit — it can cause widespread tissue and organ injury.

Cytokines round out the top three classes of inflammatory mediators. Secreted by immune cells in response to injury or infection, more than 100 different cytokines orchestrate the body’s immune response. Overproduction can lead to a “cytokine storm” that can cause widespread inflammation, capillary leak syndrome and direct tissue injury, resulting in organ failure in the postoperative period.

Battling inflammation Uncontrolled inflammation and perioperative complications increase the risk of morbidity and mortality following cardiac surgery. Interventions that can control this inflammation that are administered before, during or after surgery may ultimately improve safety and long-term outcomes. The following represents some past, present and future strategies to achieve this goal.

The use of anti-inflammatory or immunosuppressive drugs represents the first therapeutic category. For example, corticosteroids such as methylprednisolone have been evaluated at high doses before and during heart surgery to reduce the risk of the inflammatory response. However, meta-analyses of published studies are mixed.

Some show evidence that corticosteroids reduce the risk of death and reduce hospital stays, while others show no significant advantage of using corticosteroids for heart surgery.

Optimizing surgical conditions represents another viable strategy. For example, cardioprotective anesthetics such as desflurane, isoflurane and sevoflurane have been evaluated in the past as a means to protect the heart during and after surgery by a variety of mechanisms, including helping to reduce cardiac ischemia and reperfusion injury and to control inflammation.

An improved CPB design called minimized extracorporeal circulation (MECC) is another innovation in cardiac surgery. MECC combines shortened blood lines coated with heparin and other techniques designed to minimize blood contact with air and the blood circuit — known triggers for complement activation and cytokine release. MECC has been commercially available for nearly two decades and has been adopted by many centers. Although MECC has not demonstrated improved mortality compared to regular CPB, it has been associated in some studies with a reduction in adverse events such as stroke and the need for vasopressors as well as faster ventilator weaning and shorter ICU stays.

Another current and future strategy is the direct removal of free hemoglobin, cytokines, activated complement and other substances from whole blood during CPB. In the past, this was not technically possible, but led to the intraoperative use of leukoreduction filters that tried to indirectly lower cytokines by reducing circulating leukocytes that produced them.

A more advanced blood purification technology called CytoSorb, approved in

the European Union, has been used to directly and safely reduce these inflammatory mediators in more than 4,000 open heart surgeries. CytoSorb is a hemoperfusion cartridge filled with hemocompatible, porous polymer beads the size of a grain of salt that rapidly reduce substances from blood using size exclusion, pore capture and adsorption. It is used during CPB and installs directly into a bypass circuit (postpump to venous reservoir) at approximately a tenth of the blood flow of the main blood circuit. In small, randomized, controlled trials, CytoSorb has been used safely in mild to high-risk cardiac surgery patients, reducing cytokines, free hemoglobin and activated complement C3a and C5a, while leading to decreased sternal wound infections and reduced ICU times.

A large-scale U.S. randomized, controlled trial called REFRESH (REduction in FREe Hemoglobin) II, intended to support FDA approval of CytoSorb, will start later this year. This study will evaluate intraoperative CytoSorb use during elective, complex cardiac surgery, on clinical outcomes and reductions in adverse events.

Complications from uncontrolled inflammation after surgery can be life-altering and even deadly. For the large number of patients who undergo major cardiac surgery in the U.S. and around the world each year, better therapies are needed to lower the risk of serious postoperative complications.

These various strategies, that use different methods to counter inflammation, are likely to act in synergy. This could pave the way for safer and more predictable clinical outcomes in complex cardiac surgery that is anything but routine.

About the author: Dr. Phillip P. Chan, M.D., Ph.D., is chief executive officer and president of CytoSorbents Corporation.

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Focused Ultrasound

Collaboration is fueling a changing landscape

By Jessica L. Foley

Innovation is the driving force for biomedical research as we strive for health care that is safer, more effective and of greater value.

Continued innovation requires collaboration, particularly in this time of limited resources, global competition and long timelines from bench to bedside. The biomedical community is recognizing the need to break down the silos that impede progress, and foundations — including the Focused Ultra-

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sound Foundation — are realizing a need for quick and widespread dissemination of research results that will forge new partnerships among multiple stakeholders including researchers, clinicians, industry, government and patients.

Promising areas of focused ultrasound, including brain applications and cancer immunotherapy, are benefiting from this culture of collaboration. Recently, there have been many exciting developments in the

field of focused ultrasound that are demonstrating the potential of this early-stage, noninvasive therapeutic technology to treat a wide range of serious medical disorders.

Due to focused ultrasound’s ability to elicit more than 18 distinct bioeffects in the body — including destroying tissue, delivering drugs in high concentrations, enhancing radiation therapy and stimulating an immune response — it is now approved or under investigation to treat more than 70

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conditions ranging from neurological disorders to cancers, and beyond. Recent Food and Drug Administration approvals for the treatment of essential tremor and prostate diseases have propelled the technology into many clinics and academic medical centers around the world, expanding patient access to this exciting new therapy. As these and emerging clinical applications of focused ultrasound advance through clinical trials and gain critical regulatory approvals, and new fields of research take off, it is clear that collaboration has helped to fuel progress and bring successes at a faster pace.

The tools of a new research paradigm Over the last several years, foundations are playing an increasingly critical role in moving research discoveries to the clinic and to commercialization. As many companies have become more risk averse, foundations can help to de-risk innovations. The flat or declining availability of research funding from government and industry players has left a critical need. Organizations like the Focused Ultrasound Foundation have become models for how donor funding can be used to bridge the gap between laboratory research and widespread patient treatment.

Foundations are driven by the needs of patients and tasked with being good stewards of their donors’ generous contributions.

To meet their mission, foundations must ensure that their financial support leads to new patient treatments as quickly as possible.

This sense of urgency is where collaboration becomes essential. If stakeholders are open to sharing their experiences, ideas and important data, the field can streamline research pathways, avoid duplication and enhance the impact of individual contributions to the field.

Open science is emerging as a methodology that facilitates collaboration by making important research products — experimental design, research data, preprints of publications — freely available as soon as possible. It has become too common in medical research to guard individual work closely, for a host of reasons, but that mentality can complicate and delay progress. A more open

and collaborative culture is necessary to get to the finish line as quickly as possible.

Government “big science” initiatives such as the Precision Medicine Initiative and the Cancer Moonshot have put a spotlight on promoting open science, particularly data sharing. Widespread accessibility of important data is necessary to meet their big goals — like achieving a decade’s worth of cancer progress in five years.

In addition to government, many private organizations that are passionate about driving progress — including the Focused Ultrasound Foundation — see open science as central to this mission and are employing open science practices and policies to govern the research projects they fund. Encouraging the use of open-access data repositories, establishing multi-site consortia to answer critical questions and making preprints of important publications widely available, among other practices and policies, will drive progress.

Making the case for collaboration: the essential tremor story This past year brought a key turning point for the field of focused ultrasound when the FDA approved the treatment of essential tremor, marking the first use of the technology for treating the brain to be approved in the U.S. With this procedure, magnetic resonance imaging is used to guide multiple beams of ultrasound energy with extreme precision to a point in the central part of the brain. At the point where the beams converge, the tissue is heated and destroyed in order to alleviate the tremor. The painless

procedure can be performed without anesthesia, and it avoids incisions, burr holes in the skull or placement of electrodes in the brain, thus decreasing the risk of complications like infection or blood clots. The essential tremor approval opens the door in the U.S. to the treatment of other movement disorders, as well as psychiatric disorders, using precise ablation of known targets in the brain.

After FDA approval in July 2016, the Centers for Medicare & Medicaid Services established a payment for the facility component of the procedure that went into effect this year. The next step is to approach both regional Medicare intermediaries and private insurance companies to cover and reimburse the treatment, which will ultimately allow a great number of patients access to this innovative treatment.

The timeline printed on the next page shows the eight-year pathway of focused ultrasound for the treatment of tremor and the Focused Ultrasound Foundation’s role in its progress. Collaboration has been key to accelerating the timeline to bring this new treatment to patients as quickly as possible.

From the early days of this effort, the collective discussion of multiple stakeholders in workshops and meetings convened by the Foundation helped to develop the road map. These early discussions identified essential tremor as a good target for focused ultrasound treatment and designed the first clinical trial. Public-private partnerships between the Foundation, industry and academic institutions enabled the funding of the pilot and pivotal clinical trials. The pivotal trial involved eight prominent academic sites

The Focused Ultrasound Foundation The Focused Ultrasound Foundation was created to improve the lives of millions of people worldwide by accelerating the development of this noninvasive technology. It works to clear the path to global adoption by coordinating and funding research, fostering collaboration and building awareness among patients and professionals. The Foundation is dedicated to ensuring that focused ultrasound finds its place as a mainstream therapy for a range of conditions within years, not decades. Since its establishment in 2006, the Foundation has become the largest nongovernmental source of funding for focused ultrasound research. More information can be found at www.fusfoundation.org.

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Focused Ultrasound FUSF Role in Bringing Patients with Essential Tremor New Therapy

The Focused Ultrasound Foundation convened stakeholders and selected movement disorders as the next target for focused ultrasound brain research.

The University of Virginia and the Focused Ultrasound Foundation funded the world's first clinical trial using focused ultrasound as a therapy for essential tremor.

and brought together neurosurgeons, neurologists and their teams from around the world to assess the safety and efficacy of this therapy. Engagement with patient advocacy organizations helped to raise awareness for the new treatment as the pivotal trial recruited patients and preliminary results were published. Early release and widespread accessibility of data from these important clinical trials has enabled additional trials for other brain indications as well as technical projects to improve the focused ultrasound procedure.

Having learned valuable lessons from the essential tremor pathway, the field is branching out to treat other neurological conditions. Clinical trials are ongoing in the U.S. for Parkinson’s tremor and dyskinesia and epilepsy, and are on the horizon for OCD, depression and dystonia. With continued collaboration within the growing focused ultrasound community of researchers, clinicians, manufacturers, foundations and other stakeholders, rapid progress is expected.

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The pilot clinical trial was successful, and validated focused ultrasound as a treatment technology. The results were published in the New England Journal of Medicine.

This led to an industry-funded pivotal trial conducted at eight centers around the world.

After reviewing results from the pivotal trial, the FDA found focused ultrasound to be safe and effective, approving its use as a treatment for essential tremor in July 2016.

trial using it to noninvasively and temporarily open the blood-brain barrier (BBB) is ongoing, enabling more effective delivery of chemotherapy into patients’ malignant brain tumors. In this trial, a chemotherapy agent and gas-filled microbubbles are infused into the bloodstream of a patient with a brain tumor. Focused ultrasound is applied to areas in the tumor and surrounding brain, causing the microbubbles to vibrate, loosening the tight junctions of the cells that comprise the BBB and allowing delivery of the chemotherapy to the targeted tissues.

With promising early results from this trial suggesting the feasibility and safety of opening the BBB, and building on preclinical results, a pilot clinical trial for treatment of Alzheimer’s is being organized.

The trial design was a collaborative effort led by the Foundation and included members of industry, scientists and clinicians from several academic sites, government and representatives from patient groups.

This safety and feasibility trial should begin this year, and successful results could lead to follow-on trials investigating the efficacy of focused ultrasound with and without drugs to treat or slow the progression of Alzheimer’s.

In November, the Centers for Medicare & Medicaid Services (CMS) agreed to pay for focused ultrasound to treat essential tremor.

With the CMS decision, leading centers will start to provide the treatment and focused ultrasound will become widely available as a new option for patients with tremor.

Pre-clinical evidence is mounting demonstrating that focused ultrasound can enhance the immune response to cancer and/ or enhance the effects of promising cancer immunotherapies such as checkpoint inhibitors. In the near future, the first clinical trial testing focused ultrasound in combination with immunotherapy should begin. If successful, this study could open the door to a promising new combination approach in the treatment of advanced cancer. The Foundation has helped to advance this burgeoning field, in part, through partnering with other organizations including the Cancer Research Institute.

To understand the results of early clinical trials and to inform the design of future trials, the field still needs to answer key questions about the different bioeffects (parameters, mechanism of action) of focused ultrasound. To move the field forward, the Foundation has established multi-site consortia to investigate the impact of different FUS modalities on the immune response in models of glioblastoma (aggressive and malignant brain tumor), breast cancer and melanoma. By convening world-class experts from around the globe, we are able to benefit from a streamlined, collective approach. Consortia can improve research www.dotmed.com/news

Neurological

Essential tremor Neuropathic Pain Parkinson's Disease Brain Tumors Depression OCD Alzheimer's Disease Epilepsy Hydrocephalus Multiple Sclerosis Stroke Traumatic Brain Injury Trigeminal Neuralgia AVMs Cancer Pain

Oncological

Bone Metastases Prostate Cancer* Breast Cancer Kidney Cancer Liver Cancer Pancreatic Cancer Soft Tissue Tumors Brain Tumors Pediatric Neuroblastoma Head & Neck Cancer Lung Cancer Ovarian Cancer Bladder Cancer Colon Cancer Esophageal Cancer

Musculoskeletal

Women's Health

Back Pain Osteoid Osteoma Osteoarthritis Disc Degeneration Muscle Atrophy Sacroiliitis Spinal Cord Injury Spinal Tumors

Uterine Fibroids Breast Fibroadenomas Uterine Adenomyosis Tubal Pregnancy Fetal Surgery Ovarian Cancer Polycystic Ovarian Syndrome

quality while drastically reducing the project timeline, allowing the group to rapidly gain critical information needed to develop robust focused ultrasound immunologic therapies.

We are in an unprecedented position to employ collaboration to drive medical innovation beyond any foreseeable limit.

Digital channels and technological advances have created a world that is constantly connected, where data from one laboratory is globally accessible in a matter of seconds. When we realize that collaboration is itself the tipping point, we can envision better care and outcomes for patients around the world.

About the author: Jessica L. Foley, Ph.D., is the chief scientific officer of the Focused Ultrasound Foundation.

Dr. Foley joined the Foundation in 2012 after completing a one-year AAAS Science and Technology Policy Fellowship at the National Science Foundation.

Prior to that, she was the neuro projects manager and clinical marketing manager at INSIGHTEC, one of the pioneering focused ultrasound medical device manufacturers. Her experience also includes senior scientist at Medtronic. She has numerous publications, patents and presentations at academic conferences in the field of focused ultrasound. She holds a BSE in biomedical engineering from Duke University and a Ph.D. in bioengineering from the University of Washington.

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Cardiovascular

Hypertension Atherosclerosis Atrial Fibrillation Deep Vein Thrombosis Heart Block HLHS Peripheral Artery Disease Septal Perforation

Urological Prostate Cancer* Kidney Cancer Benign Prostatic Hyperplasia* Acute Kidney Injury Acute Tubular Necrosis Ureterocele Bladder Cancer

Endocrine Disorders Thyroid Nodules Diabetes Obesity

Miscellaneous Hypersplenism

A look at focused ultrasound Focused ultrasound (FUS) is an early-stage, noninvasive therapeutic technology that has the potential to transform the management of a variety of serious medical disorders. FUS could one day be a costeffective alternative or complement to surgery, radiation therapy, chemotherapy and immunotherapy.

Much like a magnifying glass focuses multiple beams of light on a single point, focused ultrasound utilizes multiple intersecting beams of ultrasound energy concentrated accurately and precisely on tissue deep in the body. At the point where the beams converge, the ultrasound energy induces a variety of biological effects while avoiding damage to surrounding tissue.

Magnetic resonance (MRI) or ultrasound imaging is used to guide and control the focused ultrasound treatment in real time. The treatment can be performed on an outpatient basis, requires no incisions or general anesthesia (only mild sedation is used) and greatly reduces discomfort and complications, allowing for rapid recovery.

Focused ultrasound is approved in the U.S. to treat essential tremor and uterine fibroids, as well as to ablate prostate tissue and relieve the pain of cancer that has spread to the bone. Outside the U.S., focused ultrasound is approved to treat more than 15 conditions, including breast cancer, pancreatic cancer and Parkinson’s disease.

The technology is being studied on a range of neurological conditions, cancers, cardiovascular and musculoskeletal diseases, and beyond.

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Focused Ultrasound

MR-guided focused ultrasound: A game-changing innovation that is redefining surgery

By Maurice R. Ferré

Modern surgery has become extremely advanced.

Over the last several decades, we have made great strides in combating life-threatening diseases due to significant improvements in both imaging and technology. At the same time, the health care system is bearing a heavy burden with lengthy hospitalization and increased risks of infection.

Ultrasound technology, past and present Since the 1950s, ultrasound waves were used for safe diagnostic imaging of a developing fetus. The first time we saw noninvasive surgery was on “Star Trek” and it seemed unattainable back then. We have caught up with that futuristic “Star Trek” technology with the development of focused ultrasound for treating inside the body without making any cuts.

When ultrasound energy is raised to high temperatures and focused on a target, a noninvasive treatment of tissue within the body can be performed, while minimizing damage to adjacent healthy tissue. MRI is ideal for imaging and is necessary in order to plan the treatment, identify the target area and monitor the procedure in real time.

Procedures can be performed in a single treatment and have been proven to be both safe and effective. The risks of bleeding and infections are reduced or eliminated, hospitalization is minimized or avoided altogether and patients can quickly return to their lives.

Treating essential tremor Essential tremor is a neurological condition that causes shaking of the hands and other parts of the body, affecting up to 10 million Americans. Medication is used as a first line of treatment, but as there are no medications specifically designed to treat essential tremor, 88 HealthCareBusiness news

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they can have serious side effects or provide little to no improvement. Invasive procedures are the next line of treatment, including thalamotomy and deep brain stimulation (DBS), which involves placing electrodes in the brain, as well as fitting a pacemaker-like device into the patient’s chest.

MRgFUS allows neurosurgeons to noninvasively target and ablate the Vim nucleus of the thalamus in a treatment that typically lasts three to four hours. Data from a multi-center clinical study published in the New England Journal of Medicine showed that patients generally experience an immediate and significant reduction in their tremor following the procedure. Neurosurgeons at leading U.S. treatment centers are treating essential tremor patients with this technology.

Treating uterine fibroids Uterine fibroids are noncancerous growths in the uterus that cause extremely serious side effects and greatly impede on daily function. Many patients tend to avoid invasive procedures and opt for watchful waiting, which results in continued growth of the fibroid. Today’s standard of care for treating large fibroids is hysterectomy, an invasive surgery that results in the complete removal of a woman’s uterus, leaving no option for having children in the future.

MRgFUS offers patients a treatment option that spares the uterus and it may be considered in patients who seek fertility-sparing options. Furthermore, there are no scars, no risks associated with surgery and patients have a quick recovery. This treatment is available at leading hospitals around the world.

Treating bone metastases Bone metastases (bone mets) occur when cancer cells from a primary tumor spread to the bone. Prostate, breast and lung are the

cancers that most commonly spread to the bone. When a person has bone metastases, the most common symptom is pain, which may be severe enough to impair daily living.

To relieve the pain from bone mets, the main treatment options are opioids and the standard form of care is radiation therapy. Focused ultrasound provides non-toxic pain palliation of bone metastases, and has been shown to provide pain relief within days providing substantial improvement in patient quality of life.

Transforming patient lives Noninvasive surgery places the patient in the center of care and holds the potential to safely treat millions of patients. MRgFUS has already been adopted and is in use by physicians in more than 80 leading medical facilities around the world. As the treatment becomes more widespread, it presents an opportunity for physicians to access new patients who desire noninvasive treatment options.

Focused ultrasound shows promise in becoming a new era for the way we look at surgical procedures and patient care. All of us, and the health care system at large, would opt for undergoing a surgical procedure that is incisionless, without lengthy hospital stays or succumbing ourselves to the risk of infection. We are quickly beginning to realize the enormous potential of focused ultrasound and we are constantly researching treatments for a variety of clinical indications that many thought were impossible to treat.

About the author: Maurice R. Ferré, M.D., is INSIGHTEC CEO and chairman of the board of directors.

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Purchasing Insights

Adapting to a dynamic market: Operating room buying patterns

By James Laskaris

With the rapid growth in recent years of new operating room and sterile service building projects has come an increase in technology buying.

The focus, of course, is to provide optimum patient care with optimum efficiency — a key to staying competitive.

What is behind this buying pattern? One factor is an increase in volume. Baby boomers have reached the age where they require surgery more often.

Much of this investment in new technology is focused on infection control, minimally invasive surgery and improving outcomes with quicker recovery and a shorter length of stay.

Specialized OR tables Specialized OR tables target anterior hip replacement and high-end spinal procedures.

These are designed to assist the physician in performing less-invasive procedures. Anterior hip replacement is a tissue-sparing approach that allows the surgeon to work around major muscles as opposed to cutting them. This results in sparing healthy tissue and speeding recovery time.

Implants are being designed to last longer, and with the added accuracy of using a computer or a robot to assist with the precision of the procedure, they offer the promise of extending the life of the implant. While robotic surgeries, image-guided computer systems and manual techniques are all treatment options for patients in the orthopedic market, they vary in terms of durability, most notably in relation to implant longevity. The current level of implant technology offers the potential for implants to last more than 15 years, with newer technology extending this to more than 20 years.

However, even with new technology, the life expectancy of implants is limited by the accuracy of their alignment. Studies have found that alignment errors greater than 3 percent in artificial knee procedures are associated with

implant failures. Conventional manual techniques had an almost 32 percent chance of a greater-than-3-percent misalignment, while this number was 9 percent in cases when an image-guided computer system was used. In contrast, surgical orthopedic robots were able to achieve consistent alignment within 1.6 degrees. This translates to a longer-lasting procedure, opening the market to younger patients.

Imaging Just when we thought video surgical imaging had reached its peak, vendors are now offering 4K imaging technology. 4K resolution offers 4,000 pixels or dots per line, which translates to four times the resolution of current HD systems. This assists surgeons to better distinguish between pathologies, allowing for new procedures to be performed safely in a minimally invasive format.

In addition to 4K, the use of fluorescence imaging technology has all o we d fo r di rec t i magi ng of bl ood flow. Fluorescence imaging is based on using an imaging dye, such as indocyanine green, that fluoresces or glows when exposed to ultraviolet light. This assists surgeons in avoiding blood vessels while identifying tumor margins in critical areas of the body. These technologies offer the promise of sparing healthy tissue and improving outcomes.

Soft tissue or tumor ablation One of the fastest growing procedural areas is the soft tissue or tumor ablation market.

No longer are surgeons using a scalpel or even a basic RF generator to remove tissue.

Despite the fact that capital costs can reach $100,000 or more, and consumable costs can be in the thousands, evolving technologies such as light (laser), radiofrequency, ultrasound (HIFU), microwave and cryo-thermal offer tradeoffs such as shorter recovery

Much of this investment in new technology is focused on infection control, minimally invasive surgery and improving outcomes with quicker recovery and a shorter length of stay. time, shorter surgical times, lower risk of infection, minimal damage to the healthy tissue, less blood loss, less pain and shorter hospital stays. This has allowed these technologies to be more financially attractive.

Health care has become more competitive. To stay competitive, operating rooms have to change with the markets. Although this requires an investment in capital, consumables and training, it offers patients many more options.

About the author: James Laskaris is a senior emerging technology analyst at MD Buyline and serves as the primary analyst of high-end operating room technology. He also covers issues related to the legislative and reimbursement effect on health care and authors a bimonthly “Issues that Matter� publication.

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Year in Review/Operating Room

Top Operating Room Stories On the following pages are the stories and news events regarding the operating room space from the last 12 months that the HealthCare Business News editorial team deemed the most significant. All of the stories first appeared in HCB Daily News online.

Study: Doctors optimistic about robotic surgery Posted online July 06, 2016 by Gail Kalinoski Are doctors biased about the pros and cons of robotic surgery? A report on Forbes.com found that it depended on the physicians’ access to robotic surgery.

Author Peter Ubel referred to a study done at four Veterans Affairs medical centers of men making decisions on how best to treat their prostate cancer. As part of their report, the researchers recorded clinical interactions between patients and surgeons discussing the pros and cons of robotic surgery for treatment of their prostate cancer.

The study found that some surgeons had access to robotic surgery while others did not. Those who used robotic surgery were more positive about the outcomes using the robotic surgery. The study determined that those surgeons who didn’t have a robot available “downplayed its advantages.”

Ubel, who wrote about the study with colleagues Angela Fagerlin, Karen Scherr, John T. Wei and Lillie D. Williamson, said he did not believe the surgeons were willfully misleading the patients. While he does think most physicians do believe the robotic surgery is better, they want to reassure patients that they will still receive state-ofthe-art care without the use of a robot.

He also noted that in the case of the Veterans Affairs doctors they were not promoting the use of the robotic surgery for financial gain because there is no financial

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incentive for surgeons at the VA medical centers to choose one procedure over another.

In an abstract describing the VA medical centers study, the researchers noted they performed a content analysis of the physicians’ descriptions of robotic surgery for prostate cancer during 252 appointments at four facilities. They found the doctors were more likely to describe the robotic surgery as superior if it was available at their center.

The researchers also provided evidence that the physicians were shaping how they described the treatments “in an effort to manage patients’ emotions and demands for the robotic technology.”

They conclude that treatment availability does influence how the doctor describes the pros and cons of alternatives, “which has important practical implications for patient empowerment and patient satisfaction.”

A study like this is important because prostate cancer is the most common solid organ cancer in men in the U.S. A recent HCB News story noted that one in six men will develop prostate cancer and many will choose between radical prostatectomy, the removal of the prostate gland and some surrounding tissue, and robotic surgery, which is less invasive and generally has shortened hospital stays.

A recent Loyola Medicine story found

that the robotic-assisted surgery reduced the risk of blood loss and prolonged hospital stays in obese prostate cancer patients.

While that study specifically tracked obese men, researchers concluded the results found both surgical options are “feasible and safe” and the “surgeon’s comfort level should dictate which surgical approach is used,” according to the HCB article.

An earlier study published two years ago as part of the RAND report, "Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value, noted that health care systems had been purchasing robotic systems at an increasing rate primarily because of patient demand.

The study, described in an article on the Robert Wood Johnson Foundation website, found hospitals not using a robot for prostate surgery since 2005 had seen a decrease in cases — down 41.2 percent as of 2014. The doctors writing the report questioned whether promotional and advertising campaigns used by the medical facilities to tout their robots as the gold standard in treatment were pushing patients to demand robotic surgery rather than open surgery.

HCB News reported on findings from Mount Sinai Beth Israel indicating that the majority of patients getting access to robotic surgery are wealthy white males.

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Operating Room

Johnson & Johnson to acquire Abbott’s eye surgery unit for $4.33 billion Posted online September 19, 2016 by Thomas Dworetzky Johnson & Johnson is snapping up Abbott Medical Optics (AMO) for $4.325 billion in cash.

The wholly-owned subsidiary of Abbott Laboratories had 2015 sales of $1.1 billion.

The deal also gives Johnson & Johnson AMO’s products in cataract surgery, laser refractive surgery and consumer eye health.

Eye health is a large, fast-growing health care segment. “With the acquisition of Abbott Medical Optics’ strong and differentiated surgical ophthalmic portfolio, coupled with our world-leading ACUVUE contact lens business, we will become a more broadbased leader in vision care,” Ashley McEvoy, company group chairman, responsible for Johnson & Johnson’s Vision Care Companies, said in a statement, noting that “with this acquisition we will enter cataract surgery — one of the most commonly performed

surgeries and the No. 1 cause of preventable blindness.”

AMO is a leader in the intraocular lens market for cataract surgery, which the World Health Organization estimates will grow as people live longer. It is estimated that agerelated cataracts have caused blindness in 20 million worldwide — with another 100 million affected by the treatable condition.

“Our vision care business will be well-positioned for continued success and advancement with Johnson & Johnson,” Miles D. White, chairman and chief executive officer of Abbott, said in a statement, adding that in addition to vision-related care, “we’ve been actively and strategically shaping our portfolio, which has recently focused on developing leadership positions in cardiovascular devices and expanding diagnostics.”

The transaction is slated to complete in

the first quarter of next year and the net impact of the deal should not cause a change in Abbott’s 2017 per-share earnings.

The deal won’t disrupt the rest of Abbott, as it was “a self-contained business and had very little synergy with anything else in their device portfolio,” Morningstar analyst Debbie Wang told Bloomberg News.

She advised that it looked to be part and parcel with a move by CEO White to redirect the firm through a number of moves — the 2013 spinoff of AbbVie, and the agreements to acquire medical testing firm Alere and device maker St. Jude.

The Abbott move, she suggested, is part of this larger strategy that aims to take Abbott “down the path of these more sophisticated products.”

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For better MR breast cancer surgery planning, try flipping the patient over for improved imaging Posted online June 22, 2016 by Christina Hwang Have we been conducting MR upsidedown? Lying supine, or face up, during a pre-surgery MR scan for breast tumors may provide more accurate imaging than the current method of a patient lying face down, a new study from Brigham and Women’s Hospital has shown.

MR can be used as a way to examine breast cancer tumors, but according to the announcement, there is no evidence that pre-surgery MR currently translates into improved outcomes following surgery.

“Among women undergoing breast conserving surgery, 15 to 40 percent need to have a second operation to remove remnant tumor,” said senior author Dr. Mehra Golshan, distinguished chair in surgical oncology at Brigham and Women’s Hospital, in a statement.

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In a phase one clinical trial, researchers had taken MR images of 12 women prior to their undergoing lumpectomy for breast cancer. Half of the women underwent MR in the traditional prone position while the other half were in supine position. After surgery, all the women had a supine MR scan.

“Supine imaging allows the surgeon to visualize the position of the tumor in the position we operate, [which is] the patient on her back,” Golshan told HCB News. “MRI is done with the patient on her stomach, and we can’t operate on her breast in that position. The breast is not a fixed organ and moves with positioning.”

The researchers had measured the size, position and shape of the tumor between the prone and supine images and found that

certain characteristics of the tumor had substantial differences depending on how the patient was positioned during her MR exam.

Golshan said that if a surgeon can look at the picture of the tumor in the actual position the surgeon is operating in, it may accurately facilitate the removal of the tumor and lead to lower re-excision rates.

“If validated in future large studies, intraoperative, and, more importantly, pre-operative supine MRI could … reduce the need for re-operation, which negatively impacts the patient emotionally, delays postoperative therapy, and increases infection rates and cost,” said Dr. Eva C. Gombos, radiologist at the hospital and lead author of the study, in a statement.

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Researchers use imaging to investigate the link between ACL surgery and osteoarthritis Posted online October 19, 2016 by Lauren Dubinsky Young adults who undergo anterior cruciate ligament (ACL) surgery, typically athletes, may be at a higher risk of developing early-stage osteoarthritis (OA) in their 20s and 30s. New research involving X-ray evidence aims to understand the link, and limit the number of affected individuals.

Thomas Buchanan, professor of mechanical engineering at the University of Delaware (UD), partnered with Lynn SnyderMackler, professor of physical therapy at UD, to investigate the connection between ACL surgery and OA so therapeutic interventions can be developed to prevent it.

“We want to determine why some people get OA after ACL repair, and determine if those people can be readily identified very early,” Buchanan told HCB News. “If so, we ultimately would like to create a physical therapy protocol aimed at preventing the development of OA in that population.”

They recently received a $357,234 grant from the National Institutes of Health to evaluate the biochemical and biomechanical bases for the development of OA after ACL surgery. The two have been working together for over 15 years, and have already uncovered that some patients displayed unusual gait mechanics six months after ACL surgery.

More specifically, they found that immediately after the injury the knee starts unloading, in which the joint contact force is less in the involved knee than the uninvolved knee when walking. After six months, the knee is still unloading.

For the new study, they are going to evaluate patients three months, six months and two years after ACL surgery. Initially they are going to use gait analysis and electromyography to assess the biomechanical basis of the unloading. Then they’ll use quantitative MR imaging to observe any biochemical changes in the cartilage. Lastly, they will use

a finite element model to examine the effect that differences in knee loading has on knee cartilage stress distribution.

The team believes that research will help them understand the mechanisms behind knee unloading after ACL surgery. Having that understanding will help them make recommendations for clinical treatment paths

to prevent OA in that population.

“At present, we do not understand what causes osteoarthritis (OA) in people after ACL surgery. Some get OA, others do not,” said Buchanan. “Until we can identify who will get OA and why, she won’t be able to formulate a treatment path.”

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Operating Room

Philips introduces first augmented reality surgical navigation technology for spine surgery Posted online January 13, 2017 by Lauren Dubinsky Royal Philips announced that it has developed the first augmented reality surgical navigation technology for imageguided open and minimally-invasive spine surgery.

The technology combines 3-D X-ray and optical imaging to generate a 3-D augmented reality view of the patient’s anatomy. Highresolution optical cameras are mounted on the flat panel X-ray detector to image the surface of the patient and the X-ray system captures the internal 3-D view of the patient.

“There is a trend from open to minimallyinvasive surgery and the currently available technology in this area has a lot of disadvantages,” Ronald Tabaksblat, business leader, image-guided therapy systems at Philips, told HCB News. “The new technology is an easy-to-use technology with superior image quality, compared to currently available minimally-invasive solutions for spine surgery.”

The technology is designed to be used in the hybrid operating room. In addition to spine surgery, the technology can also be used for cranial and trauma procedures.

“Minimally-invasive spine surgery has a high need for accuracy, to avoid collateral damage,” said Tabaksblat. “With this technology we aim to improve procedure planning, surgical tool navigation and implant accuracy, as well as reducing procedure times.”

Philips, Karolinska University Hospital Medical Center and Children’s Hospital Medical Center partnered to conduct a pre-clinical study to test the technology. They found that it was significantly better in terms of overall accuracy compared to traditional pedicle screw placement.

The results of the study, “Surgical Navigation Technology Based on Augmented Reality and Integrated 3-D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study,” were published in the jour-

nal SPINE in November.

As part of a clinical research program, Philips will install hybrid ORs with this technology in a network of 10 clinical collaborators.

“This new technology allows us to intraoperatively make a high-resolution 3-D image of the patient’s spine, plan the optimal device path, and subsequently place pedicle screws using the system’s fully-automatic augmented-reality navigation,” Dr. Skúlason of the Landspitali University Hospital in Iceland said in a statement.

It also allows him to check the overall result of the procedure in 3-D without having to move the patient to a CT scanner. All of it can be done without any radiation exposure to the surgeon and minimal dose to the patient.

The technology was recently presented at the North American Spine Society annual meeting in Boston.

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Hospitals save almost $2 million each after implementing catheter safety programs Posted online January 10, 2017 by Lauren Dubinsky Hospitals around the country have implemented new safety procedures and are reaping the benefits. A study led by Cedars-Sinai Medical Center in California found that it led to a reduction in catheterrelated bloodstream infections and a substantial amount of cost savings.

These types of infections result in thousands of deaths each year and cost the U.S. health care system billions of dollars, according to the CDC. CMS now penalizes hospitals through its Hospital-Acquired Condition Reduction Program for catheter-related bloodstream infections.

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catheters, also known as central lines, which are often used in ICUs. In recent years, hospitals have introduced new safety procedures including checklists for attending staff, sterile gloves, covering catheters with antimicrobial dressings and checking catheters daily for signs of movement or infection. Some hospitals also offer training, equipment and supplies for safety purposes.

The data revealed that the safety interventions reduced the infection rate on average by 57 percent and generated net savings of $1.85 million for each site over the course of three years. The savings were a result of having to treat fewer patients with infections.

The federal Agency for Healthcare Research and Quality found that these safeguards led to a 49 percent reduction

nationally in the rate of catheter-related bloodstream infections from 2010 to 2013.

The median cost of implementing the catheter safety programs in the hospitals studied was around $270,000 per site. For every $100,000 that was spent, the hospitals experienced an average of $315,000 in savings.

The savings were lower in hospitals that already had low infection rates, but the catheter safety programs still benefitted them.

“Due to the high cost of caring for patients when central-line infections develop, even sizable upfront investments in infection prevention can be associated with large net savings,” Dr. Teryl Nuckols, director of the division of general internal medicine at Cedars-Sinai, said in a statement.

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Kidney transplant patient survival rates improve with big data as study considers organ rejection Posted online January 12, 2017 by John W. Mitchell Predicting the likelihood of organ failure in transplant patients is a big part of preventing organ rejection. As counterintuitive as it may seem, a just published study found that physicians caring for transplant patients don’t always have all the information they should consider.

“Transplantation is really rich in data sources and they are unfortunately largely used for regulatory purpose,” Dr. Titte R. Srinivas, FAST, told HCB News. “Using techniques to harness all the data, both structured and unstructured, could help better predict those who are at risk for accelerated failure or death and thus improve care.”

According to Srinivas, lack of easy access to data means physicians can be “mis-

guided” by hunches rather than relying on proven data.

He explained that when all available data over time is part of the decision-making process, the physician gets a longitudinal viewpoint. This, he said, improves the accuracy for predicting when a transplant might fail.

Such predictions are important in the individual care a patient receives.

The study found that previous predictive modeling to determine the longevity of a kidney transplant was about 60 percent accurate.

But using easily searchable data such as lab values, kidney function, vital signs, virus exposure and pathology reports can improve predictive accuracy of models up to 85 percent.

The study, which was published online by the American Journal of Transplantation, used four predictive models. These models were layered over a cohort group of patients at the Medical University of South Carolina, which had kidney transplants between January 2007 and June 2015.

“Transplant is unique, as we know the date that the medical condition started and the date of transplant. We know when the disease stops, the date of death or the date the kidney transplant fails,” said Srinivas.

He said that the barrier to achieving such a big data application is that manual abstraction is difficult.

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Infection control in the hybrid OR

By Robert Dewey

On any given day, roughly one in 25 hospital patients in the U.S. acquires at least one health c a re - a s s o c i a t e d infection (HAI), according to the Centers for Disease Control and Prevention.

The CDC estimates that a staggering 1.7 million HAIs occur each year in the U.S., contributing to as many as 99,000 deaths annually. And with HAIs costing the U.S. health care system an estimated $20 billion each year, every effort within health care to reduce HAIs is also an effort toward reducing health care’s overall costs.

Concerns regarding HAIs are heightened in the operating room (OR) environment, with surgical site infections (SSIs) making up 31 percent of all HAIs among hospitalized patients. And anxiety over HAIs extends to the hybrid OR, where minimally invasive procedures are performed routinely in a growing number of hospitals. With the global market for minimally invasive procedures expected to double between 2012 and 2019, likely giving rise to a commensurate increase in those procedures, interest in HAIs in the hybrid OR won’t abate anytime soon. How can facilities combat infection in this surgical environment?

The most significant way in which hospitals can help curb infection within the hybrid OR is to consider the physical orientation of the room’s angiography system. A system that is fixed to the floor of the hybrid OR, as opposed to mounted on the ceiling or moving across the floor, is the best design choice to help reduce HAIs. Because infection in hybrid ORs is frequently attributed to an obstruction of air flow from the ceiling, a ceiling-mounted angiography system is not desirable.

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problematic, as they can spread infectious material across the floor.

Floor-mounted systems were the standard when hybrid ORs debuted in the late 1990s. Those early image intensifier-based systems not only provided surgeons with the flexibility to place lights above the patient table, but they also enabled sterile airflow above the table. Then came the highly desirable form of imaging known as rotational angiography, which, on a floormounted system, could be performed only from the head side, limiting the field of view from head to diaphragm and preventing the imaging of abdominal aortic aneurysms (AAAs), particularly in taller patients.

Because they coveted rotational angiography, vascular surgeons began selecting ceiling-mounted angiography systems over floor-mounted units for the hybrid OR, despite ceiling mounts obstructing airflow, and positioning concerns regarding lights and booms with respect to the C-arm’s range of motion.

These days, however, hospitals with hybrid ORs can select floor-mounted angiography systems that combine the benefits of a free ceiling (unrestricted airflow and improved light/boom positioning) with the kind of whole-body imaging coverage that once made ceiling systems preferable to floormounted systems.

Another way to help ensure infection control in the hybrid OR is to cover the fixed angiography system with customized sterile drapery. While various types of sterile covers are available for an angiography system, not all of them are customized to conform to a system’s unique shape, which is essential to help prevent exposed system surfaces from breaching the sterile field of the hybrid OR. A third way to foster infection control in the hybrid OR is to obtain detailed information from the manufacturer regarding

protocols to optimally clean and disinfect the angiography system. What types of cleaning materials are best suited to disinfect it, and are those same materials also appropriate for disinfecting the surrounding floor space? Are the steps required for intermediate disinfection of the system identical to procedures necessary for terminal disinfection? What is the manufacturer-recommended frequency for cleaning the angiography system — and with which tools and processes can a hospital verify the efficacy of the cleaning process?

Hospitals that raise these questions soon come to the sobering realization that the medical device manufacturing community as a whole has been late to the game in addressing these issues. Most vendors do not provide comprehensive documentation of system-specific cleaning and disinfection protocols. Expect that oversight to be rectified in an emerging era of health care where heightened sensitivity to HAIs is a hallmark of patient care.

Hospitals can help control the spread of HAIs in the hybrid OR by selecting angiography systems with hermetically sealed surfaces. The most vigorous cleaning and disinfection efforts can be undermined if bacteria find sanctuary in the crevices and nooks of hybrid OR equipment.

By considering these points pertaining to infection control, hospitals can mitigate the rise of HAIs in the hybrid OR, better ensuring patient well-being as well as contributing to cost containment. In this rapidly changing and increasingly unpredictable health care landscape, achieving those twin goals is more important than ever.

About the author: Robert Dewey is vice president of Advanced Therapies, Surgery and Cross-Modality Solutions, at Siemens Healthineers North America.

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Intraoperative imaging brings the MR to the OR

By Lisa Chamoff

Intraoperative imaging equipment has become an important way for neurosurgeons to oversee thermal ablations and ensure more complete tumor resection, though ways of integrating the equipment into the OR can vary.

Dr. Walter Hall

A Siemens biplane angiography suite and Philips 3T MRI in the operating space at SUNY's Upstate Cancer Center.

Dr. Walter Hall, a neurosurgeon at SUNY Upstate Medical University, says that at the facility’s cancer center, a 3-Tesla MRI scanner is stationed in a separate room next to the OR, where it is used several times a week during procedures, to track the temperature of thermal ablations and check the extent of tumor resection, as well as for routine imaging. Hall also utilizes functional MRI prior to a procedure to determine how close motor and speech functions in the brain are to a tumor.

In a room adjacent to the MR scanner is a Siemens biplane angiography suite, where surgeons clip aneurysms and perform postclipping angiography.

This setup is different from systems offered

by IMRIS Deerfield Imaging, which enable ceiling-mounted intraoperative MRI systems.

Hall says having the imaging equipment in an adjacent room is preferable in order to get the best return on investment while ensuring a sterile environment in the OR.

The IMRIS Deerfield Imaging system is “very, very popular, but it’s primarily for surgical use,” Hall says. “It does require additional time because you have to bring the magnet in and take the magnet out.”

The Philips 3-T magnet that SUNY Upstate has is unique, in that they can slide a patient in from either end.

With the MR scanner in a separate space, “patients have access to the MRI scanner without going through the operating room,” Hall says.

The three-room intraoperative suite is next to the facility’s Gamma Knife center, and before all such radiosurgery treatments, the patients undergo an MR scan with a head frame.

Appropriate measures must be taken when incorporating high-tech radiology equipment into an OR environment.

“In general, when you end up taking an OR, which has very strict requirements for being an OR, with air circulation in a certain direction, that environment is unique,” Hall says. “In that suite, the equipment doesn’t move. You have to be able to orient the table so you can do your surgeries and rotate the table to the point where you can do your angiogram successfully.

The nurses, suction equipment [and] cautery equipment [are] going to have to be placed according to [the] angiogram table and MRI couch. The setup requires a little more thought and preparation.”

“We either use the standard couch that comes with the magnet, or go in through the opposite side,” Hall says. “It’s a straighton placement of the patient. You don’t have to go around [the] magnet and place the person in head first.”

While some neurosurgeons prefer the magnet being brought to them, as with the IMRIS Deerfield Imaging VISIUS iMRI system, Hall considers his facility’s current setup more manageable.

“Would you rather move a 200-pound patient that’s asleep on a gurney to the MRI couch, or would you rather bring a 2,000-pound magnet across a room?” Hall says.

While Hall says some other surgical specialties, such as urology, have been slower to adopt intraoperative imaging, it has been crucial to improving patient outcomes.

“If you get a more complete resection and the patient doesn’t experience post-op swelling, they spend less time in [the] ICU and go home sooner,” Hall says.

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OR Suite PRODUCT SHOWCASE

OR suite equipment manufacturers are constantly working to improve the offerings available in the marketplace. The products appearing on the following pages represent some of the best innovations available. Look for the companies in this space to continue rolling out enhancements that will improve patient experience and outcomes.

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Robotic Surgical Equipment Corindus Robotic Equipment / CorPath GRX CorPath GRX is the second generation robotic-assisted PCI system cleared by the FDA, adding procedural control and workflow enhancements to the platform. The system allows interventional cardiologists simultaneous and independent control of guide catheters, guidewires and balloon/stent catheters via a control console in a radiation-protected workstation. In addition to protecting cath lab teams, CorPath GRX offers robotic precision in the movement and positioning of devices to potentially improve patient outcomes.

Intuitive Surgical / da Vinci Xi® Surgical System Powered by state-of-the-art technology, da Vinci Surgical Systems scale, filter and seamlessly translate surgeon hand motions into more precise movements. By providing surgeons with superior visualization, dexterity, precision and ergonomic comfort, da Vinci Surgical Systems make it possible for skilled surgeons to perform robotic-assisted, minimally invasive procedures. The fourth generation system, the da Vinci Xi Surgical System, is a boom-mounted system, offering four-quadrant access optimized for multi-quadrant surgery. Magnified 3-D HD visualization, along with wristed and advanced instrumentation, enables precise dissection and reconstruction. Surgical specialty clearances for the System include urology, gynecology, cardiothoracic and general surgery.

Mazor Robotics / Mazor X System The Mazor X System is the core of the Surgical Assurance Platform by Mazor Robotics: An innovative set of planning and guidance tools indicated for implant and instrument positioning in spine surgery. Mazor X consists of three integrated processes: preoperative analytics; intraoperative guidance; and intraoperative verification. Mazor Robotics core technology has been used in over 23,000 procedures, assisting in the placement of over 160,000 implants.

OMNIlife science / OMNIBotics®System With over 13,000 procedures performed, OMNIBotics® is the global leader in robotic-assisted total knee replacement technology. OMNIBotics enables optimized implant placement which may lead to a more rapid recovery and a more natural-feeling knee. Surgeons can efficiently plan a patient-specific procedure using OMNI’s patented intraoperative 3-D modeling technique, eliminating the need for preoperative CT scans or MRI. Unlike its competitors, the OMNIBotics System is modular, portable, has a compact physical footprint and a unique perprocedure user fee model requiring no capital investment.

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Titan Medical / Patient Cart The patient cart includes a detachable camera insertion tube (CIT) that includes a laser light source and a high-definition 3-D camera. The CIT is configured to provide access for the multi-articulating instruments to perform minimally invasive surgery (MIS) procedures.

Titan Medical / MultiArticulating Instruments Two multi-articulating, snake-like instruments with multiple degrees of freedom of movement are designed for reusable use upon sterilization. The instruments are also designed with removable, sterile single-use robotic tools to provide first-use quality for each patient case.

Titan Medical / Surgeon Workstation The surgeon workstation provides an ergonomically user-friendly interface to the patient cart.

The workstation has an interface to control a high-definition 3-D vision system and two interactive multi-articulating instruments located at the patient cart.

Zimmer Biomet Robotics / ROSA ROSA robot is the latest generation in robotic assistance working alongside neurosurgeons to provide precise targeting, dexterous handling by means of a minimally invasive approach to reduce clinical complications and increase patient safety. ROSA includes state-of-the-art surgical robotics technology as well as comprehensive and innovative proprietary software designed for advanced surgical planning.

General Maquet / Hybrid OR Solution From concept to care, Getinge Group — with its Maquet brand of products — delivers a superior integrated hybrid OR development solution.

Through holistic concepts, innovative technologies and engineering expertise, Getinge Group helps hospitals enhance workflows and improve patient experiences. We’ll consult with you and your colleagues to analyze practitioner preferences and patient flow strategies, as well as the volume and types of surgery your hospital performs. Because hybrid OR design should accommodate your people — not the other way around.

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OR Suite PRODUCT SHOWCASE

Tables

Maquet / MEERA Table Now it’s possible to perform 90 percent or more of your surgical procedures on a single accessory-enriched mobile platform that reduces the need to invest in capital intensive and underutilized specialty tables. Across the full spectrum of surgical disciplines, MEERA multidisciplinary mobile operating tables deliver superior and uncompromised patient comfort, access and safety. Comfort for you, comfort for them.

MEERA’s compact and concave table base allows members of your surgical team to stand as close as possible to the patient to help reduce muscle fatigue during lengthy procedures.

Mindray / HyBase 3000 Operating Table Insightful to the surgeon and nurse’s needs, Mindray is answering demands for a total solution of operating table with better mattress for the comfort of patients, safe and efficient patient positioning and know-how for maximizing the versatility. Additional features include 185 kg weight capacity, 300mm longitudinal shift, 720-1,070mm table height. (Not available in North America.)

Mindray / HyBase 6100 Operating Table Engineered for increasingly complex surgical scenes, HyBase 6100 needs the least effort and time to position the patient in a safe, comfortable and efficient way. With 600 mm low table position, it is a benefit for neurosurgery and minimally invasive surgery. Additional features include 250 kg weight capacity, 320mm longitudinal shift, 600-950mm table height. (Not available in North America.)

Mindray HyBase 8500/8300 Operating Table Engineered for increasingly complex surgical scenes, HyBase 8500/8300 comes with extreme weight capacity up to 460 kg, guaranteeing the highest safety and stability in any position. With longitudinal slide up to 480 mm, it is ideally suitable for cardiovascular surgery with C-arm. The modularized tabletop can be tailored to various surgical disciplines. (Not available in North America.)

Mizuho OSI / Trios® The Trios® Surgical Table System brings enhanced functionality to the original spinal platform used worldwide. In addition to its spine and imaging tops, Trios is equipped with the option of an orthopedic trauma top designed to hold and position patients undergoing orthopedic surgical procedures. Featuring powered floor locks, a unique tabletop mounting interface, and a streamlined 180º rotation mechanism, Trios brings efficiency and ease of use to the operating room.

Mizuho OSI / ProAxis® The ProAxis® Spinal Surgery Table is the first of its kind, featuring software-controlled advanced hinged technology. The table allows for flexion and extension of the spine, providing direct visualization of intraoperative changes in spinal alignment. This capability facilitates controlled closure for lumbar osteotomies and spinal canal decompressions. Offering the latest technology in spinal surgery tables, ProAxis is designed to support the biomechanical aspects of spinal and imaging procedures while expanding on the key benefits of our original Spinal Table System.

Mizuho OSI / Hana® The Hana® Orthopedic Surgery Table is the first surgical table designed exclusively for hip and knee arthroplasty. It is a state-of-the-art orthopedic table that enables surgeons to perform a variety of fracture and orthopedic procedures, including the anterior approach for total hip replacements. The Hana table is an excellent resource for many orthopedic surgical procedures, including femur fractures (supine or lateral positions), tibia fractures, hip pinning, hip scopes and total knee arthroplasties.

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NEW PRODUCT SHOWCASE

Oakworks Solutions / SU-04 Available from Oakworks Solutions, the unique iNSPIRIT Medical SU-04 Operating Table makes patient transport easy, safe and quick in the operating room suite. Medical staff can move a patient on the SU-04 tabletop via a transport trolley and attach the tabletop to the table base in the operating room. After a procedure, the tabletop can be dismantled again, moving the patient to a recovery area, saving space and increasing efficiencies in the modern OR suite.

Oakworks Solutions / SU-05 Available from Oakworks Solutions, the iNSPIRIT Medical SU-05 Operating Table is designed for a wide variety of operating procedures, including vascular surgery, cardio surgery, neurosurgery, urology, proctology, gynecology, ophthalmology, oncology and others. Electrically controlled table movements include height, lateral tilt, Trendelenburg and reverse Trendelenburg, kidney elevation and longitudinal tabletop shift. The tabletop segments can also be adjusted for leg rest angle, kidney elevator and backrest. This multi-functional surgery table is also compatible with a C-arm for procedures that require continuous patient monitoring.

Oakworks Solutions / SU-07 Available from Oakworks Solutions, the iNSPIRIT Medical SU-07 Operating Table offers a large carbon fiber radiolucent imaging area of 59.1” (1,500 mm) from the head end of the table. Electric tabletop adjustments including longitudinal, lateral and diagonal shift simulate a “floating top” for precise patient positioning. With two speed setups, fine tuning adjustments are possible. The table can also change position by initiating the movements of lateral tilt, Trendelenburg, reverse Trendelenburg and height. Removable tabletop pads are made of memory foam and are covered with artificial leather.

STERIS / The STERIS® 4085 General Surgical Table This is a versatile, highly productive general surgical platform specifically designed to help improve patient outcomes. Designed using human factor analysis, this table offers excellent imaging and patient posturing, all in one table. Powered slide improves C-arm access; generous weight limits support virtually any patient; and the table accommodates a broad array of previously purchased accessories.

STERIS / The STERIS® 5085 SRT Surgical Table The STERIS 5085’s fifth wheel allows one caregiver to safely and easily move and rotate patients 360 degrees. The same 5085 SRT table can be used from induction to recovery, to reduce the need to transfer sedated patients. This table offers outstanding C-arm access, for clear, high-quality images during advanced procedures.

STERIS / The STERIS® OT 1000 Orthopedic Surgical Table This table offers superior control to the operative site. Designed with SWAN Technology, our proprietary mechanism for simple, weightless articulation, it enables one person to have control of the slide, traction and rotation of the boot with one hand and fluid movement of the leg spar with the other. This provides focus on the patient, and a full range of motion without interference from the equipment.

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OR Suite PRODUCT SHOWCASE

Lights Amico / iCE LED Surgical Lighting System The iCE LED Surgical Lighting System brings the newest LED technology to the operating room. The iCE LED surgical lights are designed for superior shadow control, increased depth of field and light intensity. They have a CRI of 95 and an R9 greater than 90, allowing surgeons to easily differentiate between tissues. The 4500K color temperature provides a crisp white light, without the color-shifting properties of multicolor LEDs, providing a clearly illuminated surgical field.

Maquet / Power LED Surgical Lights by MAQUET provide a deep column of light with even distribution and true color clarity. Engineered with specialized lenses, high lux is not routinely needed, but can be accessed with MAQUET’s BOOST™ technology.

Additional patented technologies include: AIM™, which reduces the light to obstructed LEDs while increasing illumination to surrounding LEDs; FSP™ that compensates for light fluctuation, ensuring consistent light throughout surgery; and LMD™ to adjust illumination levels for better light consistency and reduced eye fatigue. MAQUET Surgical Lights are the cost-effective choice with the longest LED life in the industry (60,000 hours) and “smart” electronics that ensure a minimum 50 percent illumination in the event of an extreme failure. Easily maneuverable, the suspension arms are integration-friendly and HD cameraready. The SATELITE mounting system allows for simplified system upgrades.

Mindray / HyLED 9 Series Surgical Light

Mindray / HyLED 7 Series Surgical Light The touch control panel allows for clear and intuitive operation.

Three lighting modes, full illuminance, general and ambient, provide more options for the surgeon. Its compact outlook minimizes interference to the laminar flow system. The rotatable HD camera system provides a clear solution for communication and documentation. (Not available in North America.)

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The intelligent shadow management system devotes to the better and more flexible illumination. Three lighting modes, full illuminance, general and ambient, provide more options for the surgeon. Its cross-shaped outlook minimizes interference to the laminar flow system. The rotatable HD camera system provides a clear solution for communication and documentation. (Not available in North America.) www.dotmed.com/news

NEW PRODUCT SHOWCASE

STERIS / HarmonyAIR™ M-Series Surgical Lighting System The HarmonyAIR M-Series Surgical Lighting System provides exceptional surgical site illumination, while its HD capable suspension is modular and upgradable, adapting to your needs as they change.

The M-Series delivers up to 160,000 lux of pure, white light over a broad, adjustable spot, making the spot visibly brighter. M-Series HD-capable suspension’s design gives you the freedom to choose video devices and technologies to meet your changing needs, now, and in the future.

STERIS / HarmonyAIR™ G-Series Surgical Lighting System

Booms

We challenged our engineers to make LED lighting more efficient, while still delivering uncompromising light performance and cool, white light. The result is the HarmonyAIR G-Series Surgical Lighting System: high performance optics coupled to a streamlined suspension. The G-Series uses a single-color, phosphor-coated LED chip for crisp, white light without the colorfringing or color-shifting effects of multi-color LEDs. This provides natural color rendition, allowing surgeons to accurately and consistently assess and interpret tissue and vessel appearance.

Amico / OR Pendant Systems Amico’s OR Pendant Systems feature electric brakes and ergonomic handles that make them easy to maneuver. Select from a variety of console sizes with built-in lighting and accessory rails. A patient lift can be integrated into our pendant arm (PLP), freeing up limited ceiling space, giving you proper placement for your pendants and medical lighting. Amico’s GoLift ceiling lift provides a beautiful and compact design that delivers up to a 700 lbs. lift capacity.

Amico / GoLift The GoLift is a compact ceiling lift system that is designed to safely lift, transfer and reposition a patient up to 700 lbs. Probably most impressive is that it uses all metal gears and weighs only 10 lbs.! The GoLift can adapt into any existing track, giving you the opportunity to upgrade your old lifts with the latest GoLift technology! A combination of two GoLift 700 systems will deliver a lifting capacity of 1,000 lbs.

Maquet / MODUTEC Ceiling Supply Units MODUTEC Ceiling Supply Units help you make the most out of every cubic inch by providing the high capacity and adaptability to accommodate the physical requirements of each medical device and the positional preferences of those who need to access them. The large internal diameter allows for multiple services such as electrical, gas and data as well as integration cabling to be integrated within the arm. Multiple arms and utility distributors, combined with single or tandem mounting options, assure adequate reach — where and when you need it.

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Draeger / Apollo® Anesthesia Workstation Equipped to meet the clinical demands of today and tomorrow, the Apollo can grow with your practice to protect your investment. Proven to reduce volatile agent costs, the Apollo’s Low Flow Wizard helps clinicians deliver low flow anesthesia with confidence and ease. Combined with its heated breathing system and precision E-vent® plus piston ventilator, the Apollo offers exceptional opportunity for uniform delivery of low flow anesthesia in your health care facility.

Anesthesia

Draeger / Fabius® GS Premium Anesthesia Workstation The Fabius GS Premium combines time-tested design concepts with the comfort and utility of modern digital technology. It’s an anesthesia workstation built for today and ready for the future. Export gas flows, concentrations and waveforms to our Infinity® patient monitors and Innovian® Anesthesia system to enhance monitoring, charting and networking power. Its intuitive user interface, common to Dräeger workstations, enables fast and precise adjustments.

Draeger / Perseus® A500 Anesthesia Workstation A highly configurable anesthesia workstation, the Perseus A500 can be easily tailored to meet your needs. Its generous, well-lit workspace can be used to keep supplies organized and within reach. Its compact, heated breathing system is designed to reduce condensation build-up and facilitate fast gas exchange rates.

And to support continuity of care between the ICU and OR, the Perseus A500 offers Airway Pressure Release Ventilation (APRV).

MAQUET / FLOW-i® MAQUET’s FLOW-i anesthesia delivery system features a modular, ergonomic design that seamlessly combines high performance ventilation capabilities with precise electronic anesthetic delivery. FLOW-i is engineered with core technology of the unrivaled MAQUET SERVO ventilator platform and delivers ventilation support for all types of patients. The innovative VOLUME REFLECTOR technology replaces traditional bag in bottle and piston designs.

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The comprehensive ventilation modes of the A3 appeal to mid-acuity settings and outpatient surgery centers. The 15-inch touchscreen allows clinicians to easily select ventilation settings. The A3 comes standard with VCV, PCV, PS, SIMV-VC, heated breathing system, mounting rails and adjustable workspace lighting. Built-in HL7 connectivity provides the industry standard interface for AIMS and EMR systems.

NEW PRODUCT SHOWCASE

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Mindray / A3 Anesthesia System

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NEW PRODUCT SHOWCASE

GE Healthcare / Carestation 600 series The Carestation 600 series marries elegant and functional design with digital technologies that anticipate future user demands — instilling confidence in an evolving health care environment. The series which includes the Carestation 620, 650 and 650c (a wall or pendant mount) is a versatile, economical and easy to use anesthesia platform that features a sleek modern size suited for constrained environments, a touchscreen user interface for improved workflows and scalable technology for serving diverse patient acuities.

GE Healthcare / Aisys CS² Modular and upgradable, with Aisys CS² you’re planning for the future while protecting your investment. Electronic agent control allows you to capture set agent concentrations and precisely measures agent usage. The 15” touchscreen ventilator display and ecoFLOW option displays oxygen flow alongside pre-set targets while calculating anesthetic agent cost and usage in real time. Clinicians can use this to adjust oxygen flow to help avoid unnecessarily high fresh gas flow rates.

GE Healthcare / Avance CS²

Mindray / A5 Anesthesia System The A5’s advanced ventilation modes enable effective care across a wide range of patients with optional integrated gas analysis, dual agent auto ID, aged-based MAC values and capnography. The 15-inch touchscreen allows clinicians to easily select ventilation settings. The A5 comes standard with VCV, PCV, PCV-w/Volume Guarantee, PS, SIMV-VC, SIMV-PC, spirometry, temp controlled breathing system, high pressure O2 port, central brake, mounting rails and adjustable workspace lighting. Built-in HL7 connectivity provides the industry standard interface for AIMS and EMR systems.

GE’s Avance CS² features a 15” touchscreen ventilator display. The optional ecoFLOW feature provides a graphical display of oxygen flow and anesthetic agent use that shows your preset target and calculates the cost of agent used in real time. Clinicians can use this to adjust oxygen flow to help avoid unnecessarily high fresh gas flow rates for potential environmental and economical benefits.

Mindray / Anesthesia Consumables Mindray’s new anesthesia consumable line complements your anesthesia system, offering one solution in the OR masks offering high quality breathing circuits, face masks, filters, gas sampling lines and laryngeal airway masks, at a value that is right for you.

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Microscopes

KARL STORZ / VITOM VITOM® represents a new concept in high-resolution visualization during open surgical procedures, including brain, cardiovascular, spine, small joint applications, pediatric, head and neck, plastic surgery and other types of surgery.

More than a simple surgical tool, the VITOM® system enhances visualization with a depth of field up to 2 inches and offers exceptional ergonomics for surgeons. The system simplifies presentation and sharing of clinical images for training, and facilitates documentation.

Leica/ M530 OH6 for Neurosurgery As a surgeon you have to be focused. The Leica M530 OH6 has been designed to support you in staying focused. It offers optimal visualization thanks to the groundbreaking FusionOptics technology, which combines high resolution and increased depth of field. Plus, the truly ergonomic design enables you to operate in a comfortable position. With less physical distraction you can remain focused on the critical tasks at hand.

You want to reach the best possible outcome for your patients. To achieve this you need to see every detail, even in narrow channels. The Leica M530 OHX allows you to see more of the operative field in focus with exclusive FusionOptics, work comfortably thanks to an overhead stand with 36 percent longer reach than competitive microscopes and helps optimize patient safety with innovative illumination controls.

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Leica / Proveo 8 for Ophthalmology Seeing the whole picture at all times is the best start to achieving the best results — because you can’t treat what you can’t see. Proveo 8 goes beyond conventional visualization to deliver stable red reflex even during phacoemulsification, a texture-rich image at all depths with exclusive FusionOptics technology, and enhances collaboration as the assistant sees the same uncompromised image with identical magnification as the surgeon.

NEW PRODUCT SHOWCASE

Leica / M530 OHX for ENT and Spine Surgery

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NEW PRODUCT SHOWCASE

Seiler / Alpha Air Scope The new Alpha Air Scope offers three- or six-step magnification, a 250 mm objective lens, an LED illumination system, 50,000 hours of life and a limited lifetime warranty on optics and mechanics. The Alpha Air Scope provides better visualization, varying levels of magnification, improved ergonomics and many accessories. Some of the accessories we offer include: variofocus objective; beam splitter; DSLR cameras; HD live camera; GoPro Hero 4; extender rotation device; laser barrier filter; and an assistant teaching head.

Seiler / Evolution ZOOM The Seiler Evolution ZOOM is our superior multidisciplinary surgical microscope designed for ENT surgery, spinal, hand, neuro, reconstructive-plastic surgery and ophthalmology (utilizing XY function). It is the perfect choice for any surgery center or small hospital, offering motorized focus and ZOOM functions, all APOchromatic lenses and a wide field of view.

Seiler / Colposcopes With over 75 years of optical experience, Seiler Instrument is a worldwide leader in the field of microscopy. Seiler offers a full line of medical microscope products, including our newly designed colposcopes, featuring technical advances in our illumination system, an innovative fluid design and all apochromatic lenses for superior optics.

Many documentation accessories can be added.

Seiler stands behind their products with a lifetime warranty on the optics and mechanics.

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Intraoperative MR OR GE Healthcare / MR Surgical Suite GE’s MR Surgical Suite, compatible with 70 cm 1.5T or 3.0T GE MRI systems (not shown), provides the iMRI capabilities to address a clinician’s most challenging cases while offering advanced diagnostic and interventional solutions. The Surgical Suite features single-step iMRI table, GEM Suite diagnostic capability, MAQUET surgical tables, Mayfield Skull Clamp, expression MR wireless patient monitoring and integration expertise.

IMRIS, Deerfield Imaging / IMRIS IMRIS delivers high-field diagnostic quality magnetic resonance imaging to the operating room during the procedures — when updated visualization can support key surgical decisions in real time. Using intraoperative MRI (iMRI) inside the IMRIS Surgical Theatre, surgical precision is improved and patient risk mitigated through: • Visualization of surgical progress and results — reduces re-operation rates • No moving or repositioning of anesthetized patient — limits transport risk and image shift issues • Clarity of imaging for detail and guidance into eloquent areas — provides critical decision support in procedure completion

Philips Healthcare / Ingenia MR-OR intraoperative MRI The Ingenia MR-OR intraoperative MRI delivers high-quality images during neurosurgical procedures. It helps you gain up-to-date insight on surgical progress and tumor resection to support confident intraoperative decisions and update neuronavigation. The solution supports smooth, inline patient transfer between the operating room and the Philips Ingenia MR system, with minimal procedure time added. Moreover, it lets you preserve your OR setup for efficient neurosurgical workflows. Thanks to versatile configuration options, Ingenia MR-OR supports high utilization, while driving cost-effectiveness and flexibility.

Siemens Healthineers / MAGNETOM Combi Suite Neurosurgery This Siemens suite brings advanced MRI technologies to neurosurgery. When paired with the Combi Dockable Table, Combi Suite enables single transfer of patients from OR surgery to the MRI system. This solution is compatible with TRUMPF Trusystem 7500 and MAQUET Magnus surgical tables, with both stationary and mobile columns. Together, the compatible Noras Neurosurgery Solution Flexibility (head holder and coils) and Combi Dockable Table support greater flexibility in patient head positioning.

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This Month in Medical History

Ryan White’s legacy Epidemics and outbreaks always receive a great deal of attention.

Unlike the bird flu of a few years back, or the horrifying, but typically distant accounts surrounding the Ebola epidemic, Acquired Immune Deficiency Syndrome, or AIDS, was an epidemic that hit U.S. shores pretty hard.

At its height in the mid-‘90s, more than 40,000 people died from AIDS-related illnesses in a single year.

Initially, HIV and AIDS were perceived to be diseases seen among gay men or intravenous drug users. With that perception came persecution and, unfortunately, some leaders in religious communities fanned those flames, pointing to AIDS as a punishment for sin. There was a lot of misinformation and a lot of fear. With limited knowledge about HIV and AIDS, there wasn’t an effective treatment, so contracting AIDS was seen as a death sentence.

With that understanding — that there was public persecution of AIDS victims, that there were community leaders claiming it was a punishment for sin, that there was no treatment and that the public was misinformed and terrified — imagine for one moment being a child and hearing all these news reports.

Now, imagine that you’re a child with the disease. That’s exactly where the world was when Ryan White contracted AIDS. White was a hemophiliac and in the early ‘80s our country’s blood supplies weren’t shored up against the unfamiliar disease. He wasn’t homosexual. He wasn’t an intravenous drug user. He was a child with an unfortunate condition. Yet he was still banned from attending school. Parents protested to keep him out, with both teachers and parents believing the disease could be spread through casual contact, even though doctors said he posed no risk to other students.

Ryan’s mother, knowing her son wouldn’t have a chance to grow up, wanted to give

him as happy a life as possible. Ryan wanted to be back in school and she wanted to get him there. The two pulled up stakes and moved to Cicero, Indiana, where he was welcomed into the school. Ryan’s struggles put a face to the AIDS epidemic and it was a face of the boy next door. It provided proof that America was facing a horrible disease, not a religious reckoning. Charities were established, research was funded, celebrities championed awareness campaigns and efforts were made to educate the public and separate fact from fiction.

White became a celebrity in his own right, working to educate people across the country. A number of celebrities became his friends, among them, Michael Jackson, Elton John, basketball legend Kareem Abdul-Jabbar, Nancy and Ronald Reagan and then-Surgeon General Dr. C. Everett Koop. He even had a visit from his celeb-

rity crush, Alyssa Milano, who gave him a friendship bracelet and a kiss on the cheek.

White stated on more than one occasion that he would trade the fame in an instant to be cured. Still, he carried on his work as a spokesperson and public face for AIDS. That time drew to a close on March 29,1990, when he went to the hospital with a respiratory infection. He died a little more than a week later on April 8 at the age of 18.

More than 1,500 people attended his funeral and Elton John and Phil Donahue were among his pallbearers. President Reagan wrote a tribute to White, which was published in The Washington Post. White never asked to be a household name, yet the country couldn’t have asked for more when it came to opening a dialogue and increasing understanding of one of the deadliest epidemics of the last 40 years.

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Marketplace & Classifieds

Popular Marketplace Display Ad Sizes 2 3/8” x 3 1/2” $400 12x Rate $4,000 2 3/8” x 4 7/8” $500 12x Rate $5,000

Affiliated with Viking Rigging & Logistics, Inc "NATIONWIDE RIGGING AND LOGISTICS SERVICES COMPANY"

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Popular Marketplace Display Ad Sizes 2 3/8” x 3 1/2” $400 12x Rate $4,000 2 3/8” x 4 7/8” $500 12x Rate $5,000

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ADVANCED ULTRASOUND FIME 41 Pacific Medical 9 www.pacificmedicalsupply.com ELECTRONICS 11 www.fime.org www.auetulsa.com Philips 91 Getinge 4 www.philips.com/mr-or Altima Diagnostic Imaging Solutions 15 www.getinge.com www.altimadis.com Society of Gastroenterology Health Connect Partners 77 Nurses and Associates (SGNA) 35 Amber Diagnostics 21 www.hlthcp.com www.sgna.org www.amberusa.com Image Technology Consulting, LLC 23 Ampronix 43 www.imagetechnology.net Society for Imaging www.ampronix.com Informatics in Medicine (SIIM) 31 MAVIG 95 www.siim.org ANDA Medical 13 www.mavig.com www.andamedical.com Stille Surgical 48 Midmark Back cover www.stille.se Bluestone Diagnostics, Inc. 51 www.midmark.com www.bluestonediagnostics.com Technical Prospects, LLC 25 Nationwide Imaging www.technicalprospects.com COMPLETE MEDICAL SERVICES 19 Services Inc. Inside back cover www.completemedicalservices.com TransAmerican Medical Imaging 46 www.nationwideimaging.com www.transamericanmedical.com Dunlee Inside front cover NovaProbe Inc. 69 www.dunlee.com USOC Medical 17 www.novaprobe.com www.usocmedical.com Ed Sloan & Associates 29 Oakworks 93 www.edsloanassociates.com Varex Imaging 2 www.oakworks.com www.vareximaging.com Endoscopy Development Oxford Instruments Healthcare 1 Company, LLC 67 Ziehm 45 www.oxford-instruments.com www.ziehm.com www.edcparts.com

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The Future of Health Care

The need for risk management

By Chris Odom

Never before in the history of health care have managers and hospital administrators been held more accountable for patient safety and the quality of their care.

The pressure for performance-based results along with budget constraints will continue to increase. From the CEO and throughout the hospital, health care providers are not only held accountable by government regulatory agencies and private accrediting organizations, but also by a well-informed public.

Institutions are facing increasing financial challenges in the ever-changing, competitive landscape of health care reform where patients have greater access to hospital data to make informed decisions about where to seek treatment. Today’s savvy health care consumers seek out hospitals that produce better patient outcomes. These positive outcomes are much easier to achieve by eliminating the consequences of downtime or compromised equipment performance.

Beyond being the right thing to do, the result is that safeguarding patient safety becomes the most important source of revenue. Consequently, the more concentrated areas of revenue in a hospital demand attention to downtime and total cost of

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ownership. For example, many institutions’ patient billings generate more than 65 percent of revenue within the OR. In turn, this significant uninterrupted revenue stream is highly dependent on the reliable and compliant performance of equipment and the people who keep this equipment operating at an optimum level.

What continues to create restless nights among health care professionals is the shared knowledge that in the U.S., health care facilities are challenged to serve an ever-increasing volume of patient admissions. It’s estimated that more than one out of 10 men, women and children will be admitted to a hospital in the next 12 months. Add the increase in patients to achieving better outcomes while maintaining a budget and the future of health care is clear. Health care has become an exercise in risk management that goes well beyond the reduction of downtime or even the elimination of HAIs. Given the continual stream of advancements surrounding surgical workflows, the expectations for positive patient outcomes are far greater than ever before. With this comes the associated clinical, financial and legal risk when something goes awry.

Clinicians, especially surgeons, in ironic fashion have become victims of their own

success. Because they have proven to be able to do more, they are expected to succeed regardless of the circumstances. If they fail, the legal system, media and an increasingly informed public are looking to assign responsibility, if not blame. That puts a lot of pressure on the OR, CS and hospital administrators to get it right each and every time, despite the fact that matters of life and death often are out of their control.

Manufacturers of medical equipment must continue to recognize the role they play in helping all health care members, and those who support their efforts, manage the many risks they face on a daily basis.

As technology advances, medical equipment manufacturers must focus on creating technology platforms that reduce surgeon fatigue, decrease OR turnover time, provide a better view of the surgical cavity, deliver sterile goods and let surgeons quickly access patient data and visual documentation. These are just a few of the imperatives in helping institutions implement a broader strategy of risk containment and ultimately the better outcomes everyone seeks.

About the author: Chris Odom is the president of Surgical Workflows, Getinge.

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No one knows this space better than we do.

While “out of the box” solutions get a lot of attention, we believe it’s what happens on the inside that matters most. That’s why we’ve spent the past 50 years focused squarely on improving the exam room itself with better equipment, smarter workflows and more integrated technology.

More than a million exam rooms later, we’re setting the standard with between-the-walls thinking that leads the way to better care and outcomes—not ideas that are just way out there.

Find out how to bring our thinking into your space at midmark.com/HBNapr.

Manufactured and/or distributed by Midmark Corporation, Versailles, OH