This document provides an administrator's guide for implementing digital radiography. It discusses evaluating needs, gathering information, budgeting, evaluating options, awarding contracts, and implementing digital radiography systems. The guide aims to help administrators make better decisions and maximize return on investment when transitioning to digital radiography.
The goal is to optimize processes around the use of our assets, to drive new opportunities wrapped around a model of predictive and preventive maintenance. You will learn how to:
• Prepare for this year of cost containment and savings with expert advice on how to self
fund your remote service project
• Use existing product offerings to create new revenue streams and address declining profits
• Mine real-time and historical data to improve customer understanding, touch and experience
• Decrease service costs through more efficient deployment and centralized management
• Use device connectivity to maintain and enhance your own differentiators rather than being a carbon copy of your competitor
• Increase customer awareness of remote service benefits and increase customer satisfactionthrough improved promotion, measurements, and value reinforcement techniques
“Clinical Grade" Requirements to Enable a Mobile Health and Advanced Workflow Environment by Laurence Beaulieu; Chief Architect, Healthcare Solutions
Nortel Business Solutions
Telephone improvement project a skills assessment of refractive surgery provi...SM2 Strategic
This document summarizes a study that assessed the telephone skills of refractive surgery providers. Over 500 phone calls were made to 77 refractive practices to evaluate how they handled incoming calls from potential LASIK patients. The calls were scored based on 13 criteria like greeting, discussing pricing, and anticipating caller needs. Most practices struggled, with average scores around 50/100. After feedback, scores improved slightly to 52/100 in a second round. While basic skills improved, practices had more difficulty controlling conversations and anticipating needs. The study shows room for practices to enhance telephone training to improve conversion of interested callers to patients.
The document summarizes NASA Langley Research Center's initiative to foster creativity and innovation among its employees. It discusses how creativity is important in today's conceptual age. The Center established a Creativity and Innovation team to develop training like the "Enhancing Your Creative Genius" course. Over 200 employees have participated in the training, which aims to develop a creative mindset. The initiative has also formed partnerships to support creativity across various organizations.
Organizations often struggle with costly and delayed ERP implementations when they focus solely on technology, ignore requirements definition, and rush from requirements to development without proper planning. Implementing a project management office (PMO) can help organizations avoid common pitfalls by providing structure, oversight, and governance over project scope, scheduling, resources, communication and reporting. Leveraging a PMO's roles in solution architecture, process improvement, mentoring, knowledge sharing, and facilitation can help ensure ERP implementations are successfully delivered on time and on budget.
This document discusses health IT and clinical decision support (CDS) in Egypt. It describes a feedback loop model for CDS, using best practice guidelines, tailored health information for patients and populations, and real-time dashboards to monitor providers, populations, and individual patients. The document also outlines Penn Medicine's approach to implementing the "Five Rights" of CDS to improve outcomes: providing the right information to the right stakeholders in the right format through the right channels at the right point in the clinical workflow.
This document provides guidance on selecting a disaster recovery (DR) solution. It discusses conducting a requirements gathering process and evaluating different DR solutions, including in-house or co-location sites, managed services, and cloud-based options. The key phases outlined are: 1) Conduct requirements gathering; 2) Evaluate potential DR solutions; and 3) Design a best-fit DR strategy. Different deployment models and levels of control with various solutions are also reviewed to help determine an appropriate solution.
Sanjeevi has over 4 years of experience as a Test Engineer and Scrum Master in the healthcare IT industry. He has extensive experience implementing HL7 interfaces and testing Electronic Health Record systems like Centricity EMR, Allscripts Pro PM&EHR, and hospital transition care programs. Some of his key skills include Agile methodologies, SQL, testing tools like ALM, and healthcare standards like HIPAA, LOINC, and ICD-9/10.
The goal is to optimize processes around the use of our assets, to drive new opportunities wrapped around a model of predictive and preventive maintenance. You will learn how to:
• Prepare for this year of cost containment and savings with expert advice on how to self
fund your remote service project
• Use existing product offerings to create new revenue streams and address declining profits
• Mine real-time and historical data to improve customer understanding, touch and experience
• Decrease service costs through more efficient deployment and centralized management
• Use device connectivity to maintain and enhance your own differentiators rather than being a carbon copy of your competitor
• Increase customer awareness of remote service benefits and increase customer satisfactionthrough improved promotion, measurements, and value reinforcement techniques
“Clinical Grade" Requirements to Enable a Mobile Health and Advanced Workflow Environment by Laurence Beaulieu; Chief Architect, Healthcare Solutions
Nortel Business Solutions
Telephone improvement project a skills assessment of refractive surgery provi...SM2 Strategic
This document summarizes a study that assessed the telephone skills of refractive surgery providers. Over 500 phone calls were made to 77 refractive practices to evaluate how they handled incoming calls from potential LASIK patients. The calls were scored based on 13 criteria like greeting, discussing pricing, and anticipating caller needs. Most practices struggled, with average scores around 50/100. After feedback, scores improved slightly to 52/100 in a second round. While basic skills improved, practices had more difficulty controlling conversations and anticipating needs. The study shows room for practices to enhance telephone training to improve conversion of interested callers to patients.
The document summarizes NASA Langley Research Center's initiative to foster creativity and innovation among its employees. It discusses how creativity is important in today's conceptual age. The Center established a Creativity and Innovation team to develop training like the "Enhancing Your Creative Genius" course. Over 200 employees have participated in the training, which aims to develop a creative mindset. The initiative has also formed partnerships to support creativity across various organizations.
Organizations often struggle with costly and delayed ERP implementations when they focus solely on technology, ignore requirements definition, and rush from requirements to development without proper planning. Implementing a project management office (PMO) can help organizations avoid common pitfalls by providing structure, oversight, and governance over project scope, scheduling, resources, communication and reporting. Leveraging a PMO's roles in solution architecture, process improvement, mentoring, knowledge sharing, and facilitation can help ensure ERP implementations are successfully delivered on time and on budget.
This document discusses health IT and clinical decision support (CDS) in Egypt. It describes a feedback loop model for CDS, using best practice guidelines, tailored health information for patients and populations, and real-time dashboards to monitor providers, populations, and individual patients. The document also outlines Penn Medicine's approach to implementing the "Five Rights" of CDS to improve outcomes: providing the right information to the right stakeholders in the right format through the right channels at the right point in the clinical workflow.
This document provides guidance on selecting a disaster recovery (DR) solution. It discusses conducting a requirements gathering process and evaluating different DR solutions, including in-house or co-location sites, managed services, and cloud-based options. The key phases outlined are: 1) Conduct requirements gathering; 2) Evaluate potential DR solutions; and 3) Design a best-fit DR strategy. Different deployment models and levels of control with various solutions are also reviewed to help determine an appropriate solution.
Sanjeevi has over 4 years of experience as a Test Engineer and Scrum Master in the healthcare IT industry. He has extensive experience implementing HL7 interfaces and testing Electronic Health Record systems like Centricity EMR, Allscripts Pro PM&EHR, and hospital transition care programs. Some of his key skills include Agile methodologies, SQL, testing tools like ALM, and healthcare standards like HIPAA, LOINC, and ICD-9/10.
This document discusses implementing lean processes at a hospital to improve performance. It outlines objectives like achieving JCI re-accreditation, increasing throughput, and improving the patient and staff experience. The document describes collecting initial data, identifying bottlenecks, and co-creating solutions. It also outlines establishing leadership support, core and department teams, and implementing best practices to build capacity and sustain initiatives through review and monitoring. The overall aim is to enhance the hospital's operations and service delivery through lean methodology.
Presentation on DR testing featuring quotes by Robert Nardella in an intervie...Robert Nardella
This document provides an overview and guidance for developing an effective disaster recovery (DR) test plan. It discusses the benefits of DR testing such as reducing downtime and improving organizational preparedness. Regular DR testing ensures an organization's DR plan stays up-to-date as IT infrastructure changes and validates the effectiveness of recovery procedures. The document outlines a 4-phase process for creating a DR test plan and provides tools and templates to help with planning, execution, and incorporating lessons learned from tests. It also offers options for guided or onsite assistance to help organizations develop and implement their DR test plan.
The document discusses the benefits of using an open innovation platform called Challenge-Driven Innovation (CDI) to solve problems for NASA. It summarizes the results of a pilot program between NASA and InnoCentive. Key findings include:
1) Over 2,900 solvers from 80 countries participated in the program and helped solve several NASA challenges, with a 35-40% solve rate.
2) The program validated that NASA could source valuable solutions from outside experts. One challenge on predicting solar events was fully solved.
3) NASA reported qualitative benefits like identifying future collaborators, improving their research process, and fostering a more open culture.
This document provides an overview of the United Launch Alliance (ULA) transition and the challenges faced by the Launch Services Program in overseeing the transition. It discusses the ULA transition management approach, key projects in the transition like business operations and production, and risk mitigation efforts. Some of the challenges highlighted include managing requirements from multiple sources, the complexity of the transition due to legal, procurement and technical factors, and ensuring skills retention. It concludes with the top 10 risk management lessons learned, emphasizing communication, collaboration, understanding changes, and maintaining focus on NASA's interests and mission success.
Three Confluence Deployments That Will Blow You AwayAtlassian
There are lots of great Confluence deployment stories. And then there are a few that are just mind-blowing. This session highlights three incredible Confluence deployments that will make your head turn.
Customer Speakers: Nate Nash of BearingPoint, Tim Colson of Cisco, Connie Taylor of Premier Inc
Key Takeaways:
* Incredible Confluence examples
* Innovative uses of a wiki and enterprise collaboration
This document provides information about the 2009 Juvenile Reentry Conference, which will take place June 24-26, 2009 in Washington, DC. The conference will focus on reducing recidivism and reintegrating juvenile offenders back into society. It will feature workshops on grant writing, aftercare coordination, and substance abuse treatment programs. The conference aims to help attendees develop comprehensive reentry plans, implement programs to address behavioral issues, and establish performance measures to evaluate reentry programs.
"Show me the money": evidence from and for accountability (Christina Laybourn...ALNAP
This document discusses the intersection of accountability and evidence generation in humanitarian work. It begins by analyzing self-regulatory initiatives like the Humanitarian Accountability Partnership certification process and the Disasters Emergency Committee accountability framework which involve collecting, analyzing and using evidence to assure accountability to external stakeholders. It then discusses how accountability mechanisms themselves can generate evidence through participatory evaluations, feedback mechanisms and consultations. Finally, it outlines some limitations like internal organizational barriers preventing cross-fertilization between evidence and accountability, and the backwards-looking nature of most evidence which doesn't support adaptive capacity or anticipate future crises. It proposes dialogues for disaster anticipation and resilience to address these issues.
The Drug Discovery Factory (DDF) transforms leading academic research into successful business propositions by selecting attractive research projects and setting up spin-off companies. DDF has set up over 15 biotech spin-offs over the past decade. DDF provides funding and grants assistance, project monitoring, patent filing, partner finding, project and business management, marketing, and administration services to help get life sciences projects off the ground. DDF has a 90%+ success rate for grant applications and offers expertise in obtaining different types of funding that researchers and entrepreneurs may not be aware of.
The document discusses agile software project management methodologies. It presents the main characteristics of agile approaches like Extreme Programming (XP), Scrum, Crystal, and Microsoft Solution Framework (MSF) for Agile Software Development. These methodologies focus on people over processes, collaboration over contracts, responding to change, and producing working software. The document compares methodology components and outlines the principles and practices of some popular agile methodologies.
This document discusses a SWOT analysis for implementing business analysis work offshore. It lists strengths like lower costs and weaknesses like communication barriers. Opportunities include accessing new markets, and threats include loss of stakeholder engagement. A PESTLE analysis covers political, economic, social, technological, legal and environmental factors. A customer journey map outlines expectations of end users, business stakeholders, and colleagues for offshore analysis work. Touchpoints and moments of truth are also examined.
This document discusses increasing the robustness of flight project concepts. It proposes several improvements and innovations, including establishing new concept maturity levels (CML) to better communicate a concept's readiness. A new P4 document is suggested to provide requirements and guidelines for incorporating and evaluating a concept's robustness. Additional proposed enhancements involve new tools and templates, increased project team support, organizational changes, and training for the pre-phase A community. The overall goal is to address current challenges around assessing risks, communicating maturity, and guidelines for robustness evaluations in NASA's competitive funding environment.
Innovation in Action :Designing a niche healthcare delivery modelDr Vijay Raaghavan
This document discusses a healthcare consulting firm and its approach to innovation. It begins by introducing the firm and its goal of making a difference through healthcare innovations. It then discusses the firm's approach, which involves identifying dissatisfactions in the current system, envisioning potential solutions, and developing initial concrete steps.
The document uses a case study to illustrate its approach. It analyzes the dissatisfactions patients and physicians reported with outpatient consultations. It then develops a vision for improving the patient and physician experience. Its initial concrete steps included gathering patient and physician feedback and developing a one-page electronic medical record system and clinical protocols. This helped improve various metrics like physician involvement, decision consistency, and patient satisfaction.
George Beaudin has over 20 years of experience leading large and complex IT projects in healthcare, banking, and government. He has a proven track record of successfully implementing enterprise systems on time and under budget. Beaudin is skilled in Agile methodologies and has extensive experience managing projects and teams across multiple organizations.
The document discusses how intuitive technologies like tablet PCs, digital pens, and surface computing can improve clinician efficiency and patient safety in healthcare settings. It identifies ways these technologies can impact patient safety positively by improving outcomes and staff response times. It also explores how they can enhance clinician efficiency by streamlining workflows and supporting mobile decision making. The document compares current states of clinician efficiency to potential future states enabled by intuitive technologies and explains how these technologies can coexist in today's hybrid electronic environments.
The Composite Crew Module project brought together engineers from multiple NASA centers to design and build a composite crew capsule. A broad team was assembled with representation from various NASA centers and aerospace industry partners. They worked collaboratively over 18 months to design, build, and test a full-scale composite crew module, gaining hands-on experience. The goal was to advance composite materials technology in anticipation of future exploration systems utilizing composites.
This document discusses innovation at Quest Diagnostics and its subsidiary MedPlus. It provides background on the companies, including that Quest Diagnostics is a global leader in diagnostic testing with over $7 billion in annual revenue. It then outlines MedPlus' vision and solutions to enable connected healthcare networks. The document discusses opportunities in healthcare IT and challenges faced by the business and innovation program. It proposes developing an innovation community and adopting complementary management frameworks. Finally, it recaps steps taken to launch a formal innovation program at MedPlus aimed at fostering new ideas aligned with strategic objectives.
The CDDI approach provides drug development services through a virtual asset development model using an external team of experienced professionals. This allows clients to outsource drug development functions and access dedicated experts in a flexible manner. By using CDDI's virtual teams, clients can reduce costs and infrastructure while expediting development timelines.
This document discusses the implications of changes to CGIAR funding on IITA research and operations. Key points include:
- Future funding will be fully projectized and restricted to specific projects rather than strategic programs.
- IITA programs will need to be better aligned with CRPs to access funding, bringing new challenges around partnership and project management across centers.
- Opportunities exist to access more funding by taking on larger roles in CRPs, strengthening partnerships, and demonstrating greater impacts and outcomes.
- 2011 will be a transition year requiring prudence as IITA adapts to the new fully projectized funding model.
This document summarizes findings from a 2011 professional services study involving 450 participants. It shows that 56% of participants had engaged a professional services/consulting firm for clinical transformation, system implementation, or vendor selection between 2008-2010. The most commonly engaged firms were Deloitte at 18% and CSC at 9%. It also found that 34% of participants had engaged a firm for revenue cycle management projects, with Huron being engaged by 20% and Deloitte by 14%. The document provides breakdowns of firms used for both clinical and revenue cycle projects.
KaplanResearch Quatitative Research CapabilitiesJack Jackson
KaplanResearch is an experienced healthcare market research firm that offers tried and true qualitative and quantitative methodologies. They have innovations like ReCAP and 10+100 designed to meet specific client needs. KaplanResearch understands the healthcare landscape and helps clients decide what to do with research findings through clear, actionable recommendations from their experienced researchers.
Key Indicators: An Early Warning System for Multichannel Campaign ManagementCognizant
Phrmaceuticals companies are adopting multichannel marketing approaches, carefully identifying and measuring both leading and lagging indicators, to reach physicians and other health care providers and guide the process from awareness through purchase.
This document discusses implementing lean processes at a hospital to improve performance. It outlines objectives like achieving JCI re-accreditation, increasing throughput, and improving the patient and staff experience. The document describes collecting initial data, identifying bottlenecks, and co-creating solutions. It also outlines establishing leadership support, core and department teams, and implementing best practices to build capacity and sustain initiatives through review and monitoring. The overall aim is to enhance the hospital's operations and service delivery through lean methodology.
Presentation on DR testing featuring quotes by Robert Nardella in an intervie...Robert Nardella
This document provides an overview and guidance for developing an effective disaster recovery (DR) test plan. It discusses the benefits of DR testing such as reducing downtime and improving organizational preparedness. Regular DR testing ensures an organization's DR plan stays up-to-date as IT infrastructure changes and validates the effectiveness of recovery procedures. The document outlines a 4-phase process for creating a DR test plan and provides tools and templates to help with planning, execution, and incorporating lessons learned from tests. It also offers options for guided or onsite assistance to help organizations develop and implement their DR test plan.
The document discusses the benefits of using an open innovation platform called Challenge-Driven Innovation (CDI) to solve problems for NASA. It summarizes the results of a pilot program between NASA and InnoCentive. Key findings include:
1) Over 2,900 solvers from 80 countries participated in the program and helped solve several NASA challenges, with a 35-40% solve rate.
2) The program validated that NASA could source valuable solutions from outside experts. One challenge on predicting solar events was fully solved.
3) NASA reported qualitative benefits like identifying future collaborators, improving their research process, and fostering a more open culture.
This document provides an overview of the United Launch Alliance (ULA) transition and the challenges faced by the Launch Services Program in overseeing the transition. It discusses the ULA transition management approach, key projects in the transition like business operations and production, and risk mitigation efforts. Some of the challenges highlighted include managing requirements from multiple sources, the complexity of the transition due to legal, procurement and technical factors, and ensuring skills retention. It concludes with the top 10 risk management lessons learned, emphasizing communication, collaboration, understanding changes, and maintaining focus on NASA's interests and mission success.
Three Confluence Deployments That Will Blow You AwayAtlassian
There are lots of great Confluence deployment stories. And then there are a few that are just mind-blowing. This session highlights three incredible Confluence deployments that will make your head turn.
Customer Speakers: Nate Nash of BearingPoint, Tim Colson of Cisco, Connie Taylor of Premier Inc
Key Takeaways:
* Incredible Confluence examples
* Innovative uses of a wiki and enterprise collaboration
This document provides information about the 2009 Juvenile Reentry Conference, which will take place June 24-26, 2009 in Washington, DC. The conference will focus on reducing recidivism and reintegrating juvenile offenders back into society. It will feature workshops on grant writing, aftercare coordination, and substance abuse treatment programs. The conference aims to help attendees develop comprehensive reentry plans, implement programs to address behavioral issues, and establish performance measures to evaluate reentry programs.
"Show me the money": evidence from and for accountability (Christina Laybourn...ALNAP
This document discusses the intersection of accountability and evidence generation in humanitarian work. It begins by analyzing self-regulatory initiatives like the Humanitarian Accountability Partnership certification process and the Disasters Emergency Committee accountability framework which involve collecting, analyzing and using evidence to assure accountability to external stakeholders. It then discusses how accountability mechanisms themselves can generate evidence through participatory evaluations, feedback mechanisms and consultations. Finally, it outlines some limitations like internal organizational barriers preventing cross-fertilization between evidence and accountability, and the backwards-looking nature of most evidence which doesn't support adaptive capacity or anticipate future crises. It proposes dialogues for disaster anticipation and resilience to address these issues.
The Drug Discovery Factory (DDF) transforms leading academic research into successful business propositions by selecting attractive research projects and setting up spin-off companies. DDF has set up over 15 biotech spin-offs over the past decade. DDF provides funding and grants assistance, project monitoring, patent filing, partner finding, project and business management, marketing, and administration services to help get life sciences projects off the ground. DDF has a 90%+ success rate for grant applications and offers expertise in obtaining different types of funding that researchers and entrepreneurs may not be aware of.
The document discusses agile software project management methodologies. It presents the main characteristics of agile approaches like Extreme Programming (XP), Scrum, Crystal, and Microsoft Solution Framework (MSF) for Agile Software Development. These methodologies focus on people over processes, collaboration over contracts, responding to change, and producing working software. The document compares methodology components and outlines the principles and practices of some popular agile methodologies.
This document discusses a SWOT analysis for implementing business analysis work offshore. It lists strengths like lower costs and weaknesses like communication barriers. Opportunities include accessing new markets, and threats include loss of stakeholder engagement. A PESTLE analysis covers political, economic, social, technological, legal and environmental factors. A customer journey map outlines expectations of end users, business stakeholders, and colleagues for offshore analysis work. Touchpoints and moments of truth are also examined.
This document discusses increasing the robustness of flight project concepts. It proposes several improvements and innovations, including establishing new concept maturity levels (CML) to better communicate a concept's readiness. A new P4 document is suggested to provide requirements and guidelines for incorporating and evaluating a concept's robustness. Additional proposed enhancements involve new tools and templates, increased project team support, organizational changes, and training for the pre-phase A community. The overall goal is to address current challenges around assessing risks, communicating maturity, and guidelines for robustness evaluations in NASA's competitive funding environment.
Innovation in Action :Designing a niche healthcare delivery modelDr Vijay Raaghavan
This document discusses a healthcare consulting firm and its approach to innovation. It begins by introducing the firm and its goal of making a difference through healthcare innovations. It then discusses the firm's approach, which involves identifying dissatisfactions in the current system, envisioning potential solutions, and developing initial concrete steps.
The document uses a case study to illustrate its approach. It analyzes the dissatisfactions patients and physicians reported with outpatient consultations. It then develops a vision for improving the patient and physician experience. Its initial concrete steps included gathering patient and physician feedback and developing a one-page electronic medical record system and clinical protocols. This helped improve various metrics like physician involvement, decision consistency, and patient satisfaction.
George Beaudin has over 20 years of experience leading large and complex IT projects in healthcare, banking, and government. He has a proven track record of successfully implementing enterprise systems on time and under budget. Beaudin is skilled in Agile methodologies and has extensive experience managing projects and teams across multiple organizations.
The document discusses how intuitive technologies like tablet PCs, digital pens, and surface computing can improve clinician efficiency and patient safety in healthcare settings. It identifies ways these technologies can impact patient safety positively by improving outcomes and staff response times. It also explores how they can enhance clinician efficiency by streamlining workflows and supporting mobile decision making. The document compares current states of clinician efficiency to potential future states enabled by intuitive technologies and explains how these technologies can coexist in today's hybrid electronic environments.
The Composite Crew Module project brought together engineers from multiple NASA centers to design and build a composite crew capsule. A broad team was assembled with representation from various NASA centers and aerospace industry partners. They worked collaboratively over 18 months to design, build, and test a full-scale composite crew module, gaining hands-on experience. The goal was to advance composite materials technology in anticipation of future exploration systems utilizing composites.
This document discusses innovation at Quest Diagnostics and its subsidiary MedPlus. It provides background on the companies, including that Quest Diagnostics is a global leader in diagnostic testing with over $7 billion in annual revenue. It then outlines MedPlus' vision and solutions to enable connected healthcare networks. The document discusses opportunities in healthcare IT and challenges faced by the business and innovation program. It proposes developing an innovation community and adopting complementary management frameworks. Finally, it recaps steps taken to launch a formal innovation program at MedPlus aimed at fostering new ideas aligned with strategic objectives.
The CDDI approach provides drug development services through a virtual asset development model using an external team of experienced professionals. This allows clients to outsource drug development functions and access dedicated experts in a flexible manner. By using CDDI's virtual teams, clients can reduce costs and infrastructure while expediting development timelines.
This document discusses the implications of changes to CGIAR funding on IITA research and operations. Key points include:
- Future funding will be fully projectized and restricted to specific projects rather than strategic programs.
- IITA programs will need to be better aligned with CRPs to access funding, bringing new challenges around partnership and project management across centers.
- Opportunities exist to access more funding by taking on larger roles in CRPs, strengthening partnerships, and demonstrating greater impacts and outcomes.
- 2011 will be a transition year requiring prudence as IITA adapts to the new fully projectized funding model.
This document summarizes findings from a 2011 professional services study involving 450 participants. It shows that 56% of participants had engaged a professional services/consulting firm for clinical transformation, system implementation, or vendor selection between 2008-2010. The most commonly engaged firms were Deloitte at 18% and CSC at 9%. It also found that 34% of participants had engaged a firm for revenue cycle management projects, with Huron being engaged by 20% and Deloitte by 14%. The document provides breakdowns of firms used for both clinical and revenue cycle projects.
KaplanResearch Quatitative Research CapabilitiesJack Jackson
KaplanResearch is an experienced healthcare market research firm that offers tried and true qualitative and quantitative methodologies. They have innovations like ReCAP and 10+100 designed to meet specific client needs. KaplanResearch understands the healthcare landscape and helps clients decide what to do with research findings through clear, actionable recommendations from their experienced researchers.
Key Indicators: An Early Warning System for Multichannel Campaign ManagementCognizant
Phrmaceuticals companies are adopting multichannel marketing approaches, carefully identifying and measuring both leading and lagging indicators, to reach physicians and other health care providers and guide the process from awareness through purchase.
KC Cyviz The Future of Collaboration Report - Executive SummaryKjetil Kristensen
The document summarizes the findings of a survey on collaborative work environments in the oil & gas industry. It finds that (1) collaborative environments are seen as mission critical by most participants and their importance is expected to increase, (2) audio/video conferencing and data sharing are the most important functionalities but can be difficult to use, and (3) current and anticipated use of collaborative environments is higher than expected, with over 30% of respondents working in them for over 6 hours per week.
Flockmob is a startup developing an algorithm and platform to optimize commuting through "swarm intelligence". Their system analyzes user mobility data to recommend the most affordable, comfortable, and timely commute options like public transport, ridesharing, or private vehicles. They plan to generate revenue from governments, companies for marketing data, and user fees. Flockmob has a passionate team with expertise in transportation and software.
How CMOs Can Solve the Next Set of Hospital Challenges - Ian Maynard, Real Ti...marcus evans Network
Ian Maynard of Real Time Medical, a solution provider at the marcus evans National Healthcare CMO/CMIO Summit 2013, on setting up efficient patient diagnostic systems.
Interview with: Ian Maynard, Chief Executive Officer, Real Time Medical
The document outlines the vision and goals of the Centre for Workforce Intelligence (CfWI). It discusses establishing CfWI as the primary source of workforce intelligence for health and social care in England. It also mentions bringing together best-in-class organizations to provide complementary specialisms and using innovative methods to improve available intelligence for workforce planning. The success of CfWI will be secured through engagement with stakeholders.
Medical Device Business Plan Sample RedactedJackson Wu
The business plan proposes bringing a foreign national, NNNNNN, to Canada as the new Chief Executive Officer (CEO) of ????. ???? produces the TM, an automated image cytometer that can help detect cancer cells faster and reduce healthcare costs. As CEO, NNNNNN would oversee production, staff, budgets, and expansion into new markets to make the TM more cost-competitive and accessible worldwide. The plan forecasts spending over $$$$$ on new hires, including highly paid jobs for multiple foreign nationals, to grow the business and benefit the Canadian healthcare sector and economy.
This presentation is from a workshop presented at the 2011 National BDPA Technology Conference. The workshop reviews how high levels of user adoption and sustainable business value can be achieved by implementing user centered design techniques for application development and deployment projects.
This is the 30-page handout provided to those who attended the 2011 BDPA Technology Conference Workshop entit
Workshop presenter:
Michael Davis, Director
Macquarium Intelligent Communications
Creating Business Value Through User Experience
BDPA Atlanta Chapter
This document describes KaplanResearch, a market research firm that specializes in qualitative and quantitative services for healthcare clients. It highlights KaplanResearch's experience in the industry, innovative methodologies like telephone focus groups, ReCAP, and 10+100, and full suite of services including focus groups, interviews, surveys, and reporting. KaplanResearch aims to provide flexible, individualized attention to both large companies and startups to help clients understand their markets and make strategic decisions.
Healthcare Information Technology: IBM Health Integration FrameworkIBM HealthCare
Today’s challenges to health plans call for business transformation — the individual member is now the customer. IBM can help make this transition from product model to service model with Health Integration Framework-enabled solutions
The document discusses balancing agility and efficiency in software delivery. It addresses challenges like managing a multi-source supply chain and optimizing business outcomes. Effective software delivery requires balancing speed and innovation with delivery discipline and management discipline through practices like transparency, governance, and continuous improvement. Global delivery models are also evolving to leverage talent across geographies through networked centers and outcome-based work.
Este documento describe un estudio sobre el uso de resonancia magnética no ecoplanar para diagnosticar colesteatoma. El estudio evaluó 8 pacientes con sospecha de colesteatoma mediante resonancia magnética no ecoplanar, cirugía y anatomía patológica. Los resultados mostraron que la resonancia magnética no ecoplanar confirmó correctamente el diagnóstico de colesteatoma en 6 de los casos y descartó el diagnóstico en 1 caso. La resonancia magnética no ecoplanar podría usarse para reducir el
El documento describe la anatomía y patologías del oído. Describe las tres partes principales del oído: externo, medio e interno. El oído externo incluye la aurícula, el meato auditivo externo y la membrana timpánica. El oído medio contiene los tres huesecillos auditivos y la cavidad timpánica. El oído interno alberga la cóclea, el vestíbulo y los canales semicirculares. También describe varias patologías comunes como el colesteatoma ad
This document provides information on several medical imaging topics and technologies:
- It highlights abstracts from the ECR 2014 conference focusing on adaptive diagnostics and how they can solve clinical challenges. Abstracts discuss the latest 3T MRI experience, a new metal artifact reduction algorithm, and lung subtraction versus dual energy CT.
- It also provides information on Toshiba's new products and technologies including the next generation Aquilion ONE CT scanner, planning for hybrid labs, dual energy CT applications, and dose reduction techniques for interventional procedures.
- Additional sections profile customer sites and applications of Toshiba ultrasound, CT, and MRI systems.
Dr. Punwani at University College London Hospital uses the Philips Ingenia 3.0T MRI for multi-parametric prostate and whole-body oncology exams. Multi-parametric MRI provides more information than standard anatomical imaging alone by including techniques like diffusion-weighted imaging, dynamic contrast-enhanced imaging, and spectroscopy. This additional data helps localize and characterize lesions, assisting in initial diagnosis and monitoring treatment effectiveness. The Ingenia's dS coils enable high-quality, whole-body multi-parametric MRI exams within a reasonable scan time.
This document discusses advanced neuroimaging solutions from Philips including high performance susceptibility weighted imaging, arterial spin labeling for non-contrast perfusion imaging, and high-end diffusion weighted imaging technologies. It provides information on visualization and analysis tools for multi-modality viewing as well as dedicated offerings for neuroscientists including high-end DTI, fMRI, and quality assurance tools. The document also highlights specific neuro imaging techniques such as diffusion tensor imaging with up to 128 directions and 32 b-values, fat-free diffusion weighted imaging, and comprehensive tools and quality assurance for fMRI.
The new Siemens SOMATOM Force CT scanner, installed at the University Medical Center Mannheim in Germany, enables more individualized patient diagnostics and contributions to personalized medicine. It is twice as fast as previous Dual Source CT systems and allows for improved image quality. Radiologists believe the SOMATOM Force opens possibilities for value-based medicine by targeting the clinical outcomes of medical procedures and patient recovery. The consistency of quantitative data produced by the high-end CT system cannot be matched by other imaging modalities, making CT an accepted imaging biomarker.
This document summarizes experiences using dual energy CT (DECT) from experts in Germany, the Netherlands, and Japan. DECT provides additional clinical information compared to conventional CT. Experts in Munich are researching using single source DECT to quantify iodine uptake in lesions. Experts in Rotterdam are using dual source DECT in pediatric patients to assess heart and lung abnormalities without sedation. Experts in Japan find DECT useful for distinguishing thyroid cartilage from head and neck tumors to avoid overtreatment. DECT is becoming more widely used in clinical practice and research due to improved diagnostic capabilities.
1) The syngo.via system and CT Oncology Engine allow radiologist Catherine Radier to spend more time with patients by automating and streamlining tasks like lesion detection, data retrieval, and comparing scans over time.
2) For acute stroke patients, neuroradiologist Peter Schramm uses the CT Neuro Engine and syngo.via to quickly identify the ischemic core, tissue at risk of infarction (penumbra), and location of blood clots within 10 minutes to determine appropriate treatment like thrombolysis or clot retrieval.
3) Dynamic CT angiography applications in syngo.via help estimate clot size over time which is difficult to assess from single timepoint scans, aiding decisions
The Sainte-Marie Clinic in Osny, France was one of the first places to install the new SOMATOM Perspective CT scanner in early 2012. They have already examined around 800 patients for almost all types of pathologies. The medical team is satisfied with the scanner's diagnostic performance, speed of exams, and ability to reduce radiation doses by around 50% compared to their previous scanner. The easy workflow and quick exams are beneficial when imaging children and patients needing repetitive exams.
The article discusses advances in computed tomography (CT) for neuroimaging that enable both exceptional image quality and low radiation dose. It profiles Duke University Medical Center's use of Siemens CT equipment for neuroimaging. New techniques like CT perfusion, Neuro Best Contrast, and dual energy applications have changed the diagnostic approach. CT is now routinely used as the primary modality for evaluating acute neurological diseases before treatment to detect hemorrhages or other causes of symptoms like stroke. The low dose capabilities and high image quality of Siemens CT scanners are helping radiologists maximize diagnostic confidence.
This article discusses Siemens' efforts over the past two decades to reduce radiation dose in CT scans through technological innovations. It provides a timeline of important milestones in dose reduction, including the introduction of CARE Dose4D in 1994, ECG-pulsing in 1999, the Definition Flash scanner in 2008, and Iterative Reconstruction in Image Space (IRIS) in 2009. The article highlights feedback from physicians on the clinical benefits of CARE Dose4D, the Adaptive Dose Shield, the Definition Flash, and IRIS, which together have reduced radiation exposure to a fraction of original levels while maintaining image quality. Siemens' goal is to continuously improve dose reduction and expand the clinical applications of CT
This article discusses the clinical experience and performance of the SOMATOM Definition Flash Dual Source CT scanner. Initial results from early testing at the University of Erlangen-Nuremberg show that the scanner is exceeding expectations. It can perform a thorax scan in under 1 second and a cardiac scan in 270 ms with a radiation dose of under 1 mSv. The extremely fast scan speed provides motion-free images and expands clinical applications to include patients who cannot hold their breath. Early results also indicate potential for cardiac CT screening due to the very low radiation dose.
The article discusses the need for fast, high-quality and low-dose CT imaging in acute care and cardiology settings when diagnosing critical injuries. Two experts, Dr. Savvas Nicolaou from Vancouver General Hospital and Dr. Jörg Hausleiter from German Heart Center in Munich, emphasize the importance of CT for making timely diagnoses and treatment decisions. They expect the new Stellar Detector technology to provide improved image quality while further reducing radiation dose. The detector aims to balance diagnostic image quality with lower patient radiation, especially important for younger patients. Its ability to produce high-resolution images at high speed could help physicians make critical decisions within the "golden hour" window for treating conditions like stroke.
The article discusses the need for fast, high-quality and low-dose CT imaging in acute care and cardiology settings when diagnosing critical injuries. Two experts, Dr. Savvas Nicolaou from Vancouver General Hospital and Dr. Jörg Hausleiter from German Heart Center Munich, emphasize the importance of CT for timely diagnosis and treatment decisions. They expect the new Stellar Detector technology to provide improved image quality while further reducing radiation dose. The detector aims to balance diagnostic image quality with low patient exposure, especially important for young patients and repeated scans. Its high spatial and temporal resolution could benefit applications like trauma, stroke and coronary imaging where seconds matter.
This document is an issue of the SOMATOM Sessions magazine from Siemens Healthcare. The main stories discussed are:
1. Iterative reconstruction is becoming mainstream for computed tomography as new techniques like SAFIRE have accelerated the reconstruction process.
2. A new protocol called FAST CARE has significantly reduced scan times for cardiac CT exams.
3. The software syngo.via allows physicians to view CT, MRI, and PET images simultaneously for a complete picture of the patient's condition.
The new FAST CARE software from Siemens aims to standardize and simplify CT scans through several innovations. It guides users intuitively through the entire scan process from planning to reconstruction. This reduces workload and potential for errors. FAST CARE also facilitates dose reduction through tools like iterative reconstruction and automatic selection of optimal scan parameters. Dr. Michael Lell expects FAST CARE to save time and improve efficiency, allowing clinics to examine more patients with fewer resources. He is also hopeful the automatic coupling of contrast injection and scanning can reduce staffing needs. Overall, FAST CARE makes CT scans safer, more reproducible and effective for both patients and clinicians.
The new FAST CARE software from Siemens aims to standardize and simplify CT scans through several innovations. It guides users intuitively through the entire scan process from planning to reconstruction. This reduces workload and potential for errors. FAST CARE also facilitates dose reduction through tools like iterative reconstruction and automatic selection of optimal scan parameters. Dr. Michael Lell expects FAST CARE to save time and improve efficiency, allowing clinics to examine more patients with fewer resources. He is particularly interested in the potential for automatic contrast injection to reduce staffing needs. Overall, FAST CARE enhances productivity while maintaining diagnostic quality and safety.
The document discusses techniques for magnetic resonance neurography (MRN). It describes various 2D and 3D pulse sequences that can be used for MRN, including T1-weighted, T2-weighted, STIR and SPAIR sequences. 3D sequences like SPACE are commonly used and provide isotropic images. The document highlights the benefits of different sequences for visualizing peripheral nerves and discusses interpretation considerations. It emphasizes the importance of fat suppression and resolution for accurate depiction of the smallest nerve structures.
The document discusses developing optimal protocols for simultaneous MR-PET examinations. Initial experience with the first MR-PET system for clinical use showed promise for anatomically focused and whole-body exams. For focused exams, MR provided high-resolution anatomical maps to localize metabolic information from PET. Whole-body MR-PET allowed metabolic bone imaging with improved localization compared to PET-CT. Continued experience will help optimize protocols to maximize benefits from the multi-parametric data provided by the combined MR-PET system.
This document summarizes techniques for pediatric MRI. It notes that children require specialized skills and equipment due to differences from adults in disease types, sensitivity to radiation, and physiology/behavior. Longer scan times are often needed for neonates due to tissue properties. Techniques to improve image quality include using restore pulses and optimized protocols. Safety is a primary concern, especially for heating risks in neonates/infants. Patient cooperation challenges can be addressed through explanation, mock scans, distraction techniques, and anesthesia if needed. Overall the goal is high quality diagnostic images while minimizing distress.
1. An Administrator’s Guide
Philips X-ray Digital Radiography
Digital radiography: How to make it Many administrators may not be familiar
work for you with the process of managing a large,
The productivity and cost benefits of digital multi-faceted project like introducing
radiography are many and well-documented. digital technology into their departments.
That includes creating the necessary
Many radiology departments report 30–40 understanding and buy-in from other
percent improvement in technologist key stakeholders.
productivity and more efficient room
utilization. By sharing digital images through This Guide is intended to help, by providing
information systems, they also note higher a detailed process – from evaluation through
satisfaction levels with referring physicians implementation – for making better decisions
and patients, which can impact a provider’s when evaluating and purchasing digital
competitive standing. radiography technology. Whom should you
involve on the team? How can you best evaluate
Because film is eliminated, going digital saves your needs? What should you know about
the cost of film itself, processing, related gathering information, evaluating options and
equipment, and storage. Working with digital awarding the contract? How should you plan
images eliminates the problem of lost film for implementation? How can you maximize
and repeat examinations, resulting in better your return on investment?
reimbursement and reduced medico-legal
risk. Staff positions to handle and file film While the Guide is geared toward
can also be eliminated. administrators who are new to managing
complex purchasing projects, it also can serve
But how do you create these advantages for as a checklist for experienced administrators.
your specific site? How do you make digital
radiography work for you?
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2. Table of contents
4 The basics of digital radiography 17 Evaluating your options and
4 Film-based imaging: Why change? awarding the contract
4 Digital radiography: What is it? 17 Creating an evaluation team
5 PACS: The driving force 17 Working with vendors
5 What is direct radiography? 18 What to look for in product offerings
6 What is computed radiography? 20 Case study: Going digital – words of
7 Case study: The benefits of migrating advice from a radiologist
to a filmless environment 22 Narrowing your vendor choice:
8 Image quality and dose Request for proposal (RFP)
8 Impact on physicians and patients 23 Making site visits
9 Case study: The workflow benefits 23 Analyzing RFP responses
of going digital 24 Assessing vendor ranking
24 Negotiating the contract
10 Assessing your imaging needs 25 Awarding the contract
10 The importance of strategic planning
10 Needs assessment for routine 26 Implementation: Final phases
radiography 26 Phasing the installation
11 From system experience to total 26 Ensuring a smooth delivery
experience 27 Training the staff
12 Determining your goals 28 Case study: CR/DR implementation
12 Choosing the right configurations at a specialty hospital
13 Case study: CR or DR? 29 Implementing your plan
29 Case study: Tested implementation tips
14 Gathering information and 30 Celebrating success
budgeting
14 Requesting information (RFI)
15 Securing cost estimates
15 Obtaining management approvals
16 Pro forma model
16 Simplifying the budgeting process
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3. Special thanks Additional contributors include:
Philips would like to acknowledge the significant
contribution of several luminary healthcare professionals Kathleen Kennedy, M.S., R.T. (R) (QM)
in the development of this Guide. Without them, this Assistant Director of Radiology
document would not have been possible. These individuals Hospital for Special Surgery
have generously – and independently – provided their New York City, New York
counsel, knowledge, and time to help others benefit
from their experiences in successfully introducing digital Ralph Koenker, M.D.
radiography into their own organizations. Radiology Director
Novato Community Hospital/Marin General Hospital
Philips is greatly indebted to these individuals for their Novato, California
valued assistance, particularly the primary author:
Gary L. Woodruff, ARRT, BAHSA
Monte Clinton, C.R.A. PACS Administrator/Technical Manager
Administrative Director of Radiology Novato Community Hospital/Marin General Hospital
Dartmouth-Hitchcock Medical Center Novato, California
Lebanon, New Hampshire
The Mall at Dartmouth-Hitchcock Medical Center.
Photo courtesy of Dartmouth-Hitchcock Medical Center
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4. The basics of digital radiography
Film-based imaging: Why change? Digital radiography: What is it?
Capturing radiology images has changed little since Digital radiography is basically a different way of
Roentgen’s discovery of the X-ray in 1895. While there capturing an image. Rather than film, images are
have been advances in how images are recorded – such recorded electronically on a digital receptor. The
as the move from glass to film – the fact that film-based digital image can then be viewed on a display screen,
imaging provides only a single set of images has always printed on film, or transferred to a Picture Archive
been a drawback. and Communications System, or PACS.
This shortcoming results in a range of inefficiencies: Once the image is on the PACS, it can easily be shared
Radiologists receive analog images manually and referring on information networks. Digital images can be recorded
clinicians must come to the radiology department to either through cassette-based computed radiography
view them. Lost files translate into repeat examinations, (CR) technology or direct radiography (DR) systems.
decreased revenue, dissatisfied patients, and increased
medico-legal risk. Numerous personnel are required to Digital radiography offers many valuable benefits, including
sort, hang, and file the film. And to comply with record quicker, easier, and more reliable management of images.
retention laws, years of film files have to be stored and A major advantage of digital technology is the ability
maintained in large warehouses. to transmit images over information networks and
electronically archive them.
Issues driving digital radiography
Greater demand for high-performance diagnostic In most cases, digital technology eliminates film,
imaging systems with lower radiation dose processing costs, and the purchase, maintenance,
Better staff productivity and staffing expenses associated with film processing
Higher number of PACS implementations equipment. Permanently archived images are never lost
Continued pressure to reduce healthcare costs and and rarely need to be repeated. And by using PACS,
increase efficiencies images can be viewed by multiple people in various
Cost moving within reach of hospital budgets locations at the same time.
Source: Frost & Sullivan, 2004, #A630-50; 3-4
Benefits of digital radiography
Better image quality
Lower dose
Greater productivity
Faster throughput
No film and related staffing, storage, and equipment
costs
Lower medico-legal risk
Efficient image sharing over digital networks within and
outside an organization when combined with PACS
Cost moving within reach of hospital budgets
Source: Frost & Sullivan, 2004, #A630-50; 3-4, 3-5
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5. PACS: The driving force What is direct radiography?
For most organizations, the move to digital imaging Direct radiography (DR) involves the direct capture
is driven by the desire to leverage a PACS. A PACS of a digital image through a detector and digital display
requires that the original images (whether taken by system. A major advantage of DR is that productivity
X-ray, CT, or another modality) are in digital form. can be increased for both the technologist and the
CT, MR, and ultrasound are already in a digital format, imaging room as a whole. Boosting productivity is
and can easily be incorporated into a PACS. In the especially valuable to organizations where real estate
same way, routine radiography images also need to be is at a premium.
digitized before they can be incorporated into a PACS.
By using DR, the technologist conducts an examination,
General radiography studies account for up to 65 percent reviews the image quality, and approves the study without
of all procedures conducted in the radiology department. leaving the imaging room. Technologists save time by not
Radiography studies also put the highest demands on having to handle cassettes.
the department’s infrastructure, require the most staff,
and take up the largest amount of floor space. A typical Improving the productivity of technologists already on
radiology department stands to gain greater productivity staff makes sense, of course, especially during times of
by converting to digital radiography and PACS. technologist shortages. Through DR, hospitals report
30-40 percent gains in technologist productivity. These
Direct radiography (DR) and computed radiography productivity benefits provide an excellent way to justify
(CR) are the two alternatives for capturing digital images the higher cost of DR imaging rooms. In general, DR is
for routine radiography. a cost-effective alternative for higher-volume facilities.
Imaging procedure breakdown by segment
Nuclear medicine 4.28 % MR 4.99 % PET 0.23 %
CT 12.02 %
X-ray 51.72 %
Ultrasound 14.26 %
Other X-ray 12.50 %
Source: Frost & Sullivan, 2004, #A630-50, 1-7
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6. What is computed radiography?
Computed radiography (CR) captures the digital
image on a receptor housed in a cassette. Although
less expensive then DR, CR does not offer the
same productivity gains achieved with DR, since
the technologist must still handle cassettes.
CR is a good system for lower-volume facilities, where
productivity gains may not be as critical or where
existing radiography equipment will not be changed.
CR also can supplement DR, which has limitations in
certain specialized views. For example, CR enables non-
Bucky imaging in the trauma room, OR, or ICU settings.
Some manufacturers are also producing DR units with
more versatile detectors that can be positioned for
table imaging (abdomen), upright (chest), and specialized
views (cross-table lateral views), and therefore provide
a similar application range as CR.
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7. Case study: The benefits of migrating
to a filmless environment
By moving to a filmless environment, the radiology Implementation involved the larger hospital and
department of Marin General Hospital and Novato physician communities. Setting up a PACS committee
Community Hospital increased productivity and reduced with representation from all of the user departments
costs. The hospitals, which are part of Sutter Health, proved useful. Making sure radiology was represented in
a leading non-profit provider of health care in northern influential decision-making groups, such as the medical
California, introduced two DR systems and a CR system. executive committee and surgery committee, was also
They were integrated with PACS and the department’s helpful for facilitating communication.
other digital imaging modalities, including ultrasound and
multislice CT. Re-designing the radiology workflow was critical for
success. To overcome habits formed with previous
After making the transition in 2002, the hospitals noted technologies, the radiology department learned the value
the following benefits: of allotting enough time for the training of radiologists,
• Higher throughput referring physicians, technologists, and clerical staff.
• Fewer repeated scans Radiologists and referring physicians took advantage
• Better room utilization of dedicated times for applications training, using a few
• Faster reporting and report turnaround readers. Technologists were trained by department key
• No lost film operators, supported by training materials.
• Initial capital costs offset by film savings over
five years
Comparisons between analog and digital radiography at Marin General
and Novato Community Hospitals
2000 2003
Total number of exams performed 24,000 36,000
Number of repeat exams 5.9 percent 1 percent
Emergency room reports turnaround time 24 hours 6 hours
Film costs $150,000 $19,500
Staffing
- Technologist positions 11.1 10.0
- Clerical positions 4.5 4.0
Return on investment: Initial capital costs offset by film cost-savings
Capital costs over two years, including Film savings over five years, in addition
a secondary archive expense to savings in staffing and supplies
$544,000 $652,500
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8. Image quality and dose Impact on physicians and patients
The image quality of digital radiography is considered by Digital images, when incorporated into a PACS, have
many to be superior to analog X-ray systems, with the been shown to improve the satisfaction and productivity
added benefit of lower radiation dose. Digital radiography of both radiologists and referring clinicians.
also makes it possible to manipulate the image to obtain
different information. With a PACS, radiologists no longer manually sort films
and handle images of varying size and quality. A PACS
For example, an image can be manipulated to show also enables radiologists to share images with colleagues
both soft tissue and bony detail with one exposure, in different geographic locations through information
thus eliminating radiation exposure from the second networks.
image. Hospitals report dose reductions of nearly
50 percent, depending on patient and examination Referring clinicians no longer need to search for films
type, as compared to film-based imaging. or view images in the radiology department. They view
the images in their own office, minutes after the study
However, dose must be closely monitored since digital is completed, regardless of their location. PACS also
imaging offers no inherent automatic control mechanism, enables referring clinicians to access any digital image
as compared to conventional film. With film, an over- in a patient’s file from their own offices.
exposed study is visible on blackened film. With digital
imaging, a study may be overexposed but still appear as Patients also benefit, through faster scans and less
an acceptable image, as the overexposure is waiting time, as well as greater portability of their
electronically adjusted. images on CDs. More Internet-savvy patients expect
instant access to their images.
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9. Case study: The workflow benefits of going digital
At the 200-bed Mount Auburn Hospital in Cambridge, optimized so that 90 percent of the procedures merely
Massachusetts, the benefits of going digital are require the push of a button after they position the
experienced in the day-to-day radiology workflow. patient. Time spent by patients waiting for room access
Technologists and physicians experience greater has disappeared for the most part.
efficiency as a result of the highly automated, reliable,
rapid diagnostic image capture with DR. As a result, Mount Auburn has been able to perform
a steadily increasing volume of CR, DR, and fluoro
Workflow improved dramatically with the high exams with no increase in staff. When the systems
performance DR system. When PACS was installed, the were first installed in the ER, the radiology department
department got the full functionality for which the system was understaffed by the equivalent of three FTE
was ultimately designed. With the digital radiography technologists. Annual procedure volumes totaled 55,478
system and PACS, workflow efficiency took another in 2000; they grew to 70,312 in 2003.
leap forward for technologists and radiologists alike.
In addition, dose has been reduced. Most exams today
Now Mount Auburn technologists do not have to are performed at film equivalent speeds of 1200 to 800,
process film or run CR cassettes to a processor when compared to 300 or 400. Radiation exposure is reduced
using the digital radiography suites. Settings are by a factor of two to four.
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10. Assessing your imaging needs
The importance of strategic planning • Assess staffing productivity (number of exams per FTE)
Virtually every healthcare organization has a strategic • Evaluate imaging room utilization (number of exams
plan that provides a guide to the organization’s future per imaging room)
directions: outlining projections for new buildings, • Calculate volume variations, by time and day of the week
marketing strategies, new services, added satellites, • Plot your department’s current workflow (Microsoft’s®
and estimates for the number and kind of patients that Visio ® program is helpful in documenting key work
the organization will serve in the future. processes in flow chart form)
• Assess anticipated growth by clinical area (for example,
The strategic plan is critically important in evaluating the a new pediatric satellite) or patient population (based
transition to digital radiography, since almost everything on current trends like the growing aging population and
the healthcare facility does in the future will affect radiology. the institution’s strategic plan)
• Formulate volume projections by exam for the next
While the organization’s strategic plan serves as a guide three to four years (based on current trends and the
for the future plans of the radiology department, it institution’s strategic plan)
also forms the basis for the needs assessment for the • Calculate the turn-around time for readings and reports
move to digital imaging. To conduct a thorough needs • Evaluate the current utilization patterns of referring
assessment, you will need to assess your current imaging physicians by modality (providing the benefits of
program as well as what you plan to do in the future. digital radiography may create additional demand from
referring physicians who already are coming to you for
Needs assessment for routine radiography CT, MR, and ultrasound)
A good starting point is to assess your current and
anticipated film-based routine radiography program, Competitive challenges
including: • Evaluate your major competitors (services they offer,
available technologies, how they are perceived by
Current and anticipated volume and workflow referring physicians and general public, for example)
• Analyze image volume trends, by exam, over the • Analyze how your organization compares to
previous three to four years competitors (referring physician satisfaction, exam
• Evaluate current site-specific technologies to wait times, latest technology, quality/accuracy/speed
determine future workflow needs (for example, of results, patient satisfaction, convenient hours and
identifying the number of processors currently in each location, for example)
location and their usage by film-size will help determine
the appropriate number, type, and location of CR
readers for the future)
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11. From system experience to total experience Consider improving the overall experience for your
The importance of patient satisfaction in creating patients by:
competitive advantages continues to grow. Moving • Evaluating the main waiting area. Provide a comfortable
patients from a system experience to new levels of space and relevant information and distraction; this is
overall satisfaction and comfort can have a significant where patients spend most of their time.
impact on your site’s ability to attract and maintain • Looking at the paths patients travel. Provide clear
referrals. signage and simplified guidance to and from changing
and examination rooms.
Current “experience research” is exploring ways to • Thinking about privacy. Create a positive experience
address patient issues such as long waiting times for in the changing area.
short procedures, a lack of information while waiting, • Improving confidence levels. Hide clutter in the exam
and cold and impersonal spaces in patient areas. room, including cables and other technical elements,
This research indicates that patients value comfort, if possible.
personalization, reassurance, and personal contact.
Source: Philips Design – ambient experience research programs
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12. Determining your goals Choosing the right configurations
The outcome of your needs assessment will help to The most difficult decision when considering a move
more clearly define what you need to achieve in the from analog to digital imaging is what equipment to buy.
transition from analog to digital. For example, your Your site’s strategic plan and needs assessment play a
goals may include: major role in determining which digital radiology systems
• Providing a platform for PACS will work best for your organization.
• Boosting staff productivity
• Improving examination throughput How do you know which systems are right for your
• Reducing patient waiting time organization – DR, CR, or a combination of both?
• Increasing your capacity to do more examinations Unfortunately, there is no magic formula for determining
• Improving room utilization the number of digital units required to replace a specific
• Enhancing radiologist productivity and satisfaction number of analog film units.
• Increasing referring clinician and patient satisfaction
• Improving your marketing position The goal is to identify digital radiography capabilities that
will meet your needs in the short, medium, and long run.
Once you have a good assessment of your current Administrators will need to do a cost-benefit analysis,
program, you may find that there are operational starting with an evaluation of each digital modality.
changes that can be made immediately to level out
workflow, better utilize under-performing imaging
rooms, and coach staff members on how to improve
their productivity.
Comparing the benefits of DR and CR
DR Advantages CR Advantages
Enhances staff productivity Lower cost
Reduces number of rooms required Works with existing analog equipment and
workflow to minimize department disruption
Reduces physical labor for staff Good for non-Bucky imaging
Enables staff to stay with patient Good for portable trauma, ICU, and OR work
Eliminates film and cassette handling
Workload comparison – film-based radiography, CR, and DR*
Film-based radiography CR DR
60 80 More than 150
* Source: Philips Medical Systems. Estimated number of radiography
exams (images) that can be performed in an eight-hour day (two-
detector room, with two exams per patient and six minutes total
handling time). Minimum exam time is two minutes. Actual number
depends on exam mix and patient condition.
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13. Case study: CR or DR?
After months of analysis, Dartmouth-Hitchcock Medical combination that put digital capability in each of the six
Center in Lebanon, New Hampshire, decided to replace rooms. The six rooms are configured as follows:
eight analog radiographic rooms that were operating • Two single-detector upright units, which also can be
at capacity with six DR rooms. The six DR rooms now repositioned to do supine extremity examinations
easily handle the current workload and provide an • Two single-detector table units
additional 36 percent capacity. • One dual-detector (upright and table) unit
• One single-detector/multi-functional unit
Initially, Dartmouth-Hitchcock Medical Center planned
to move from film to CR. However, the assessment team By putting digital capability in each of the six rooms,
realized that it would not achieve its major objectives the organization has the flexibility to add the upright
with CR. These objectives included: or table detector to the single-detector rooms.
• Improving examination throughput
• Reducing patient waiting time In terms of teaching technologists how to use the new
• Increasing capacity to do more examinations technology, Dartmouth-Hitchcock has discovered that
• Boosting staff productivity training several key operators by the vendor’s application
• Improving referring clinician satisfaction specialist works best. These key operators then teach
the remainder of the staff. They also help to train new
With this realization, the team made a mid-course change staff members or students as they come to the facility.
by moving from analog directly to DR, supplemented by
CR for cross-table, portable, and OR work. Based on experience at Dartmouth-Hitchcock’s busy
radiology department, the time required to adequately
Because of the higher cost of DR, not all the rooms were train a technologist is approximately four hours for a
replaced with the more versatile dual-detector imaging DR system, and about eight hours for a CR system.
rooms. Instead, Dartmouth-Hitchcock purchased a
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14. Gathering information and budgeting
Requesting information (RFI) Items to remember
Now that you have identified your goals and • Develop a standard RFI outlining your equipment needs
requirements, you can explore the various systems • Include specific details about your department,
offered by different vendors through a formal request including:
for information (RFI). - Number of annual examinations listed by modality
- Inpatient and outpatient volumes
The RFI is generally done in a specific format so that - Why new equipment is needed:
each vendor gets the same information request. It also - Desire the latest technology
provides vendors with basic information about your - Moving to PACS and need digital format
imaging department and your goals. In the RFI, you will - Replacing old equipment
request information about the products you specify, - Increasing volume
i.e., DR and CR equipment. - Must improve staff productivity
- Number of units you are considering
In addition to finding out more about each vendor’s • Select at least four vendors
equipment, the RFI will enable you to narrow the list of • Contact each vendor’s sales representative
companies capable of fulfilling your needs. Later in the to identify who should receive the RFI
process, these companies will receive the formal request • Set a specific deadline when RFI is to be returned
for proposal (RFP). • Your review of the RFI will help you select
the best vendors to receive the RFP
Depending on the size of your department, you may
also consider securing the services of an outside
consultant whose expertise may add value, particularly
when an outside perspective helps to break through
internal politics.
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15. Securing cost estimates Items to remember
As you can imagine, the cost of equipment can vary • Get an estimate of the unit cost of the desired
considerably depending on the features, model, and equipment
vendor. When contemplating a major equipment • Invite the vendor to view the equipment location
purchase, you have an opportunity to optimize your • Make sure the vendor is aware of any building or site
buying power. You may also consider working with limitations (adequate electrical power, etc.)
your facility’s group purchasing organizations (GPOs), • The initial cost estimate can be a verbal estimate from
or a service that provides additional information on the vendor’s representative
comparing products. • The estimate should include a separate price for all
components and options
Through the RFI, your goal is to get a cost estimate • Networking and interface costs should be listed
of your total purchase. You will need this in order separately
to budget for capital equipment and to get approval • Ask for an estimate of the service cost after warranty
from your organization’s management to proceed. • The cost estimate should be for a fully functional unit
Your final price will be in the RFP response, which
will be covered later.
Obtaining management approvals • Quantify the savings in transitioning from film to
The decision to change from film-based imaging to digital digital imaging
imaging will have a major impact on your department’s - Film and processing cost-savings
future. This will also be a major investment for your - Reduction of film library staff and related savings
institution that will require careful analysis and planning. - Elimination of film-related equipment services
- Elimination of space required to handle and store film
Your job is to assess your options for digital imaging, - Productivity savings, illustrating how more studies can
projecting future examination volumes, staffing be done in fewer imaging rooms
requirements, and digital equipment options. You also • Explain the positive impact on staff productivity
need to project the financial ramifications, marketing - Technologist
impact, and the ability of your department to handle - Radiologist
the current and future workload. - Other departmental support or administrative staff
• Demonstrate the positive impact on patients and
At this point you will need to present a proposal referring clinicians
to your senior management demonstrating why your - Saves time when coupled with PACS
recommendation is the right one for your institution. - Eliminates lost film and the need to repeat studies
- Reduces radiation dose (critical with pediatric patients)
Your proposal needs to include the following: - Decreases patient waiting time
• Indicate how reimbursements will improve
• Project the costs associated with the new equipment - Lost film equals lost revenue or costly repeats
- Equipment costs, including options and networking • Make the case for reducing medico-legal risk resulting
- Construction or renovation costs for the new from lost film
imaging room(s)
- Service costs after warranty
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16. Pro forma model
Efficiency improvement resulting from transition from traditional radiography to DR (min.): 30%
Revenue Traditional RAD Room DR System
# of procedures per year 15,000 15,000
Procedure volume growth rate 5% 5%
Avg. reimbursement per procedure $ 50.00 $ 50.00
Reimbursement inflation rate 2% 2%
Bad debt expense % 5% 5%
Other revenues 0% 0%
Expenses Traditional RAD Room DR System
Technologist FTE cost per study $ 9.09 $ 6.36
FTE inflation rate 5% 5%
Dark room FTE cost per study $ 0.21 $–
File room FTE cost per study $ 2.60 $–
Annual rent / facility charge $ 100,000 $ 100,000
Annual utilities cost $ 10,000 $ 10,000
Equipment cost $ 85,000 $ 390,000
Site prep / installation $ 5,000 $ 5,000
Annual service cost $ 8,000 $ 37,000
# of years required to maintain records 6–7 6–7
Annual storage cost per record $ 0.05 $ 0.05
General inflation rate 3% 3%
Processor cost per study $ 0.69 $–
Film/supplies cost per study $ 4.08 $–
Annual courier costs per study $ 0.15 $–
Other expenses $ 100.00 $–
Source: Philips Medical Systems
Simplifying the budgeting process Items to remember
Every healthcare facility has different requirements for • In general, budget for the vendor’s cost estimate;
the capital budgeting process. Budgeting for the change factor in all options and networking costs
from film to digital imaging can be a complex task because • Incorporate construction costs, which generally
of the variety of considerations involved in the purchase are included under a separate category within the
of digital equipment. capital budget
• Any warranty should cover the first year of use.
Generally, once the budget is approved you cannot go Obtain a firm quote of the service costs for the
back and ask for more funding. Your budget projections year(s) after the warranty
must be reasonably accurate but with sufficient flexibility
to allow changes when the final price is obtained.
The RFP response from the vendor, which comes later
in the process, will provide the final price.
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17. Evaluating your options and awarding the contract
Creating an evaluation team Working with vendors
For every major equipment purchase, your organization The vendor’s representative is the best source of
needs a team to evaluate the systems, options, functionality, information about their company’s products. In some
and service requirements. cases, the company may also provide a product specialist
who is knowledgeable about specific equipment, such as
The team should consist of the radiology administrator, who CR and DR. The vendor’s representative and the product
is responsible for making the purchase recommendation specialist should work together to make certain you have
to senior management; the clinical operations manager, all the information you need.
who manages staff members using the equipment; the
asset manager, who oversees service and maintenance; Federal anti-kickback laws require that purchases be made
and a technologist, who actually will use the equipment. in a fair and objective manner so all participants are given
an equal opportunity. Each vendor should be treated the
Each person brings his or her unique perspective to same. These laws also restrict vendor gifts to customers.
the process that together will help the institution Your facility also may have rules concerning gifts.
make the best possible decision. Led by the radiology
administrator, the team needs to have credibility with Items to remember
the radiology chairperson, radiology staff, and your • The evaluation team should participate in all
facility’s senior management. Here is the team’s mandate: vendor discussions
• Your purchasing department may also participate
• Assist with the needs assessment, RFI, and RFP in vendor discussions – invite them to attend
• Attend all site visits at other institutions • The evaluation team should attend all vendor
• Meet with each vendor invited to bid site visits
• With purchasing’s help evaluate the quotation • Avoid any perception of giving one vendor
responses to the RFP referential treatment
• Make the final recommendation to senior management
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18. What to look for in product offerings Image quality
Not all offerings are the same. Here are some guidelines Most will agree that the quality of digital images is
to begin your discussions with vendors, comparing superior to conventional X-rays. In particular, DR
products and services. produces higher quality images at lower speed with
greater sensitivity. Also, detectors with a high matrix
Ease of use size produce images with higher spatial resolution.
All digital radiography systems will provide some You will get more from vendors who provide:
improvement in efficiency. To get maximum benefit, • Solid experience in how the imaging chain works.
consider: That experience translates into better image capture
• Software that integrates the generator and patient and processing techniques.
management systems, making them less dependent • Examples of sequencing images for easier viewing,
on operator involvement. Once a patient is selected manipulation to get desired views, and magnification
from the DICOM modality work list, system settings of fine anatomic detail.
are chosen automatically. After the image is taken,
processing is automatic. Eliminating extra steps for Detector size
the technologist means faster throughput and less Detector size does matter, especially as the population’s
opportunity for error. girth increases. Large detectors, such as 17-by-17,
• Productivity and ergonomic enhancements: easy- will help you avoid having to image larger patients in
to-move patient tables with adjustable height, X-ray sections, resulting in unnecessary exposure to radiation
tube carrier with ceiling suspension, tiltable and and slower throughput. You may be used to working
moveable vertical stands, portable detectors, and easy with standard 14-by-17 size film or cassette. With
collimation. Up to 83 percent of technologists suffer a 17-by-17 digital detector, you will always have full
from back pain, according to the Journal of Industrial coverage to image any type of patient without turning
Ergonomics (January 2004, vol. 33:1, pp. 29-40). the detector.
• Systems designed the way users want to work.
Are the workstations and user interfaces intuitive Upgradeability
and easy to use? Regardless of what system you purchase, it should be
designed to be upgraded. If you are buying a conventional
radiography room now, be sure there is an upgrade path.
You need to be ready to upgrade if your application
mix changes or when your budget allows. Be sure that
the system can be customized, with modules that are
interchangeable.
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19. Utilization Bridging imaging and IT
Your vendor should have a large installed base with The worlds of imaging and information technologies
experience in a variety of settings and circumstances. are increasingly interrelated. Vendors with the widest
Vendors that have been in the industry the longest have portfolio will do a better job of integrating imaging and
the benefit of knowing where medical imaging has been IT information, creating improvements in workflow and
and where it is going. Evaluate your vendor’s experience patient care.
in the following areas:
• Reliability and dependability built into product Organizations that have made the transition to digital
development. Ask how each system is designed radiography report greater success when radiology and
to last. IT are working collaboratively. Choose a vendor that
• A variety of service offerings to fit your needs. has depth of understanding in medical imaging as well
Good service makes the difference between success as medical IT.
and failure. What is the availability of parts and how
fast can they be delivered? For example, organizations that use CR and DR will
• Proactively prevent downtime through clinical want the same diagnostic quality when looking at both
education and support, remote and online resources, images on PACS. Look for multi-resolution image
service contracts, and system updates. processing that enhances details of CR and DR images
If your system does go down, your vendor needs with the same quality and appearance. The images should
to provide fast response and service delivery. look virtually indistinguishable through enhanced
• Some vendors offer additional management reports contrast, which is especially useful in applications
that indicate where you can improve asset performance where high-definition detail is essential.
and operations on an ongoing basis.
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20. Case study: Going digital – words of advice
from a radiologist
When considering digital radiography, there are benefits
in learning from those who have already made the
transition. Ralph Koenker, M.D., Radiology Director at
Novato Community Hospital and Marin General Hospital
in Novato, California, shared major lessons learned when
his organization switched to digital radiography.
Ensure image quality control
Although image quality from digital techniques should
theoretically outperform the older analog film-screen
techniques, it still remains possible to see inconsistency
in the quality of your radiograph. It is critically important
that the initial processing algorithms be correctly set up
for the preferences of your institution. This means that
careful collaboration between the radiologist and the first to minimize scatter within the body, but also to
vendor’s application specialist takes place early in the optimize a definable “exposure field” on the cassette.
implementation. The images need to look acceptable The computer generates histograms after first
to the physicians viewing your studies. identifying an exposed area on the detector sheet
or plate. Without proper collimation, the exposed
Digital radiographs can be manipulated, in ways similar field may not be properly identified and optimized.
to digital photography. However, providing a wide
variety of possible algorithm manipulations makes Don’t expect digital to fix poor workflow
for inconsistency and confusion amongst the X-ray Going digital doesn’t automatically improve your radiology
technologists. Therefore, it is advisable to settle on workflow processes. In fact, if your workflow rules don’t
preferred algorithm settings early in the implementation, work in the analog realm, digitizing them will produce
keeping those settings permanent. even greater disorder. There is an old saying among
project engineers for digital implementations: “If your
Digital radiography systems with the best image quality workflow was a mess before going digital, and you do
have specific settings for every single body part and nothing to change that, then after going fully digital,
X-ray view. Linking the CR system with the radiology all you end up with is an automated mess.”
information system (RIS) charge master can be helpful
in identifying an anatomy database that contains the For example, patient order entry must be performed
pre-loaded optimized algorithm settings. correctly the first time, especially when working with
PACS. A patient entered as “John J. Smith” in one visit,
Take time to train technologists and then as “John Jay Smith” the next, will lead to
Invest enough time to train technologists – about four confusion and difficulties, since the images will be housed
hours for a DR system and eight hours for CR. Although in separate patient digital master folders. Although it is
the basics of X-ray production and X-ray interaction theoretically impossible to “lose” a digital radiograph,
with biologic tissues are not changed, there are some in practice the most common source of “lost” studies
key differences in the way digital detectors respond. involves naming inconsistencies of the digital X-ray file.
The solution is to carefully integrate your RIS system
Centering the anatomy in the middle of the cassette with the digital radiography system through a feature
is more important than it was with film-screen. called modality work list. With consistent use of this
Also, collimation has a double importance now: feature, technologists pick the patient name from a
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21. presented list. Since the data entry is not manually Be mindful of workflow ergonomics
typed, name inconsistencies are not a problem when When trying to decide where to place workstations,
modality work list is used regularly. especially in busy emergency departments, you may
be inclined to put them in the busiest areas for the
Be aware of operating room challenges convenience of referring physicians and ER physicians.
The high-intensity environment of the OR represents This will lead to greater acceptance of your new system.
one of the most challenging areas for digital radiography. However, having a workstation in a high-traffic area
Some of the issues you may confront are CR reader might present issues of medical record privacy and “lines
adjustments in exposure field detection since collimation of sight” between public areas and computer monitors.
and image centering are sub-optimal in operating room Sites that allow ER doctors to determine the location of
situations. Accordingly, you may wish to convert your their workstations generally get through the transition
operating room to digital only after fully implementing with greater ease.
and stabilizing the digital conversion within your X-ray
department. For surgery cases, make the transition when Take charge of safety and legal issues
your technologists are completely trained and comfortable Digital radiography may decrease a hospital’s exposure
with the new technology. For many sites, this might be to legal liabilities, since lost film is no longer an issue.
appropriate after roughly six months’ experience. However, radiology departments may still face legal
exposure. It is important to document and maintain
In orthopedics, the need to provide images for orthopedic records that the CR reader and selenium plate detector
device templates is crucial to allow correct sizing of hip have undergone and passed proper calibration tests.
and knee replacements. In the film/screen realm, this
sizing involved transparent templates physically laid over Moreover, if you have made the move to soft-copy
X-ray films. At a minimum, you will need the capability reading of your digital X-rays, it also is useful to maintain
to provide life-size anatomic printed copy of your digital records of the calibration of the display monitors,
images so that the transparency template techniques can noting the luminance and resolution tests. Quality
continue to be employed. checks, performed at intervals deemed appropriate by
each institution, provide a documented service record
There are soft-copy software options to provide sizing that ensures optimal image quality and protects your
and selection of ortho implantable devices, but this patients’ safety.
software should be implemented with the assistance
of your orthopedic surgeons so that they become
stakeholders in the overall project. Some orthopedic
surgeons find that software methods for templating take
too much time, so you will need to coordinate with your
surgeons to find the right solution for your organization.
Be sure to also manage referring physician expectations
appropriately in terms of turnaround. Some will expect
image turnaround time similar to digital photography.
In DR, images can be produced in 20-30 seconds.
However, a CR image can take five minutes between
exposure and presentation of the image in the OR
because the cassette needs to be developed in the
CR reader and sent through the network.
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22. Narrowing your vendor choice: Request for Vendors should be advised that their responses
proposal (RFP) must follow the format of the RFP, or they will be
Through the RFI process, you created a shortlist of rejected. This format will facilitate product and feature
vendors that can help you reach your digital imaging comparison between vendors.
goals. Now you need to invite these selected vendors
to submit more detailed information in a formal request Because RFPs require a considerable amount of work for
for proposal (RFP). vendors, they should be given adequate time to complete
the bid process. A standard time is generally between
Each vendor is given an identical RFP so each company four and six weeks. The RFP will specify a deadline,
can be evaluated fairly against the others. RFPs should detailing when and where the bids must be returned
only be given to vendors with whom you are willing (generally, to the purchasing department).
to work.
The bids are opened at the same time in accordance
Since the RFP has specific legal verbiage that will protect with your institution’s policy. This will avoid any possible
your facility from error or unexpected problems in the litigation if impropriety is perceived by any of the vendors.
purchase contract, it is very important to have your
purchasing department involved in the RFP development.
Frequently, purchasing will have an institutionally Items to remember
approved format that must be followed. The RFP • The RFP is a legal document subject to audit by
should always require line-item pricing, so that the federal authorities
cost of each equipment feature can be assessed as to • Vendors should be given adequate time to respond –
its benefit versus cost. four to six weeks
• RFP responses are confidential and must not be
Some institutions have a “bidders meeting” shortly shared among vendors
after the RFPs are distributed to vendors. This meeting • The bid response is generally subject to final
consists of representatives from each vendor, purchasing negotiation
representatives, and the evaluation team members. This • Vendors are not permitted to resubmit or alter
enables you to review the project and vendors to ask their bid for any reason
for RFP clarification. By having a group meeting, all of • Be specific. Do not assume that an application,
the vendors hear the same answers, at the same time, hand grip or special table feature is included
avoiding any perception of vendor bias.
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23. Making site visits Analyzing RFP responses
Site visits are an important part of the assessment of By requiring vendors to follow a specific RFP format,
any major purchase. Generally the assessment team only the analysis that follows is logical and systematic.
makes site visits with vendors that have been invited to In most cases, the evaluation team is given this
bid. Usually these visits take place soon after the bids responsibility.
have been sent to vendors.
Since the results of the RFP evaluation process are
Selection of the site is the prerogative of the vendor. subject to federal audit (the equipment will be used
Ask the vendor for a list of facilities that have the on Medicare patients), the evaluation needs to be
equipment you are evaluating. Make sure the vendor documented in a systematic way. You will need to
knows that you may call these sites as references, to conduct the evaluation by identifying the factors that
request information about their experiences and their are most important to your organization. There are
satisfaction with the equipment. tools available to help you compare vendors and
their offerings.
The date and time of the site visit is generally determined
at the discretion of the facility being visited to ensure that Some facilities have found it helpful to evaluate the
the equipment is available. A good vendor will permit, bids using a set of criteria and a weighting system that
if not encourage, private time between the evaluation addresses the important aspects of the equipment.
team and their counterparts at other institutions. The criteria may differ for each organization.
Items to remember Criteria Typical Weight
• Conduct site visits only with vendors who have Reliability and service 20 percent
been invited to bid Image quality 25 percent
• All evaluation team members should go on each Price 20 percent
site visit Features 15 percent
• The specific site to be visited is the prerogative of Upgradeability 10 percent
the vendor Company stability 5 percent
• Date and time of the visit is the prerogative of Value-added concessions 5 percent
the host site An evaluation system using criteria and weighting is helpful
• Make sure you know your institution’s policy for evaluating bids in a structured manner
regarding who pays for off-site visits
• The vendor should provide private time for
discussion only between the evaluation team
members and their host counterparts
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24. Assessing vendor ranking Negotiating the contract
To arrive at your final vendor choice, ask team The final contract negotiation should be handled by your
members to assess vendors on each criterion. facility’s purchasing department, which will promote your
organization’s best interests. The vendor’s attorneys
For example, on a scale of 1-10, with 1 being the worst will represent the company’s interests. Both you and
and 10 being the best, each team member evaluates your vendor should gain from the negotiation; view the
vendor X according to each criterion. Next, the team relationship with your vendor as a long-term partnership.
determines the average ranking for that vendor for each
criterion. Then the average ranking score is multiplied Purchasing should be aware of the features and options
by the weight assigned to that criterion; for example, that are important to include in the contract. In addition
vendor X’s average ranking of 8 for reliability and service to price, there are frequently other aspects of the
would be multiplied by 20 percent, giving vendor X a contract that can also be negotiated with the vendor.
final score of 160. The vendor with the highest overall Once the contract is signed, you cannot go back and
score wins. make modifications.
Since the ranking by team members is subjective, the Some facilities have their own engineers or technicians in
final result should be negotiated through consensus of radiology who will take over maintenance responsibilities
the team. This is a fair, objective system that will pass when the warranty expires. If your department plans to
any audit. do its own maintenance, include vendor training of your
staff in the contract.
Items to remember Items to remember
• Invite the purchasing department to monitor • Leave the negotiation to your purchasing
the process professionals
• Use a systematic, objective evaluation process • Make sure purchasing includes the features and
• Select criteria that the team most needs to evaluate options you want
• Weigh the importance of each criterion • Give purchasing a list of acceptable value-added
• Score each vendor on each criterion features to negotiate
• Include the training of your maintenance staff and
service manuals in the contract, if applicable
• Payment terms are generally specified in accordance
with the facility’s standard policies
• This should be a win – win agreement between
the vendor and your facility
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25. Awarding the contract
Awarding the contract will occur at the end of the
negotiation. It is important that purchasing reviews
the final contract with you before it is awarded. If any
changes or modifications are needed, they should be
completed before the contract is signed.
When finalizing the details, you may consider various
financing options offered by your vendor. Ask your
vendor about financing alternatives.
Operating leases, graduated payments, lease with
service, and an upgrade program are just some of the
possibilities that may be right for your organization.
To finalize the contract, purchasing will need to get
administrative (CEO) and finance (CFO) approval,
in most cases.
Items to remember
• Be sure that purchasing reviews the negotiated
contract with you before it is signed
• Compare the contract with the bid – they should
closely match
• Frequently, the contract will contain a clause that
says, “In accordance with bid quotation # XXXXX,
dated January 1, 200*.” This assures the legal
binding of the bid and contract
• Purchasing will award the contract after
management approvals
• Celebrate the agreement with the vendor
and purchasing
• Now the work begins
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26. Implementation: Final phases
Phasing the installation Ensuring a smooth delivery
The planning for delivery and installation should Developing a working time line agreed upon by
start immediately after the signing of the contract. you and the vendor will be helpful in planning
The vendor’s representative will give you detailed construction and delivery.
specifications of the equipment, which will include
power, heating, ventilation, and cooling (HVAC), The date of delivery needs to be coordinated with
and data networks and telephone connections. the vendor’s trucking company and your receiving
department to ensure that a loading dock will be
Most vendors have an engineering staff that will assist available on the day and time of delivery. The delivery
you in planning the modifications required for existing point can be either your loading dock or the finished
space to accommodate the equipment. This needs to be room where the equipment will be installed. You can
closely coordinated with your facility’s engineering staff. specify where you want the system delivered.
An accredited physicist is required to make the shielding
calculations for radiation protection. In some cases, the trucking company will only deliver
to the loading dock, and the vendor’s installation staff
Your state and local authorities have regulations that will move it to the finished room.
need to be followed in order for your organization
to legally operate the equipment. Most states require Be sure to do a “route run-through” so the vendor
the vendor to submit a report to the state’s bureau of and your institution are assured that the equipment
radiation control, indicating that the equipment has will fit through all corridors, elevators, and doorways
been installed. (accounting for the size and weight of shipping crates
in which the equipment is delivered).
Your vendor will be able to give you an accurate estimate
of the installation time. For DR units, installation time is
typically less than a week.
Items to remember
• Obtain detailed equipment and room modification
specifications from the vendor
• Coordinate the construction requirements with
your engineering department
• Shielding requirements must be developed by
a physicist
• Coordinate delivery and internal transport with
the vendor, the trucking company, and your
receiving department
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27. Training the staff
After the installation is complete, the vendor will send
an application specialist to train the technologists who
will operate the equipment. The application specialist
is a technologist experienced in the operation of the
equipment. The amount of time the application specialist
spends at your facility will be specified in the contract
– generally one to three days. Usually this training is
provided for each unit purchased.
The change from analog to digital imaging should not
come as a surprise to your staff. During this entire
process, you should keep your staff informed of what
you are doing and why. This can be done at regular
staff meetings and through newsletters. Working on
new technology usually is an exciting time for the
technologists.
Training time varies by institution, but in general it takes
technologists about four hours to learn how to use a
DR system, and about eight hours for a CR system.
Some organizations first train key operators who serve
as advocates for the new technology, train remaining
staff members, and trouble-shoot when necessary.
Items to remember
• Keep staff informed during the entire process,
emphasizing the benefits
• Vendor’s application specialist will train your
key operators
• Key operators will train the remainder of your staff
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28. Case study: CR/DR implementation
at a specialty hospital
The Hospital for Special Surgery (HSS), a premier The training of key operators by the vendor also played
university-affiliated hospital specializing in orthopaedics a key role. The key operators then trained the remaining
and rheumatology in New York City, New York, planned staff members, ensuring that they possessed appropriate
very carefully before, during, and after the installation skill levels in using the systems. At the same time,
of CR and DR. The hospital aimed to maximize room the organization documented how staff was trained
utilization, workflow, and image quality. to use the digital systems, resulting in proof of their
competency for regulatory agencies that require such
HSS took time to articulate its expectations in detail documentation, such as the Joint Commission for the
with the vendor prior to and during implementation. Accreditation of Healthcare Organizations (JCAHO).
In particular, it was helpful to contact the vendor’s
application specialist prior to arrival to troubleshoot Although good positioning, shielding, and technique are
anticipated problems, e.g., collimation, image quality, etc. vital in ensuring high-quality images, digital systems also
allow technologists to manipulate digital images. Because
Thinking through how to set up the database was time these digital post-processing techniques may actually
consuming. However, this critical investment of time on hide or misrepresent pathology, HSS prohibited this type
the front end paid dividends. The hospital took great of manipulation.
care to create a customized anatomy database tailored
to its specific needs. Particularly essential was developing Overall, the specialty hospital reminded tech-nologists
a customized anatomy database using the radiology that they needed to continue to use all of their “Tech
department’s exam charge master and positioning 101” skills in the transition to going digital. Up-front
protocols as a cross reference. With this information planning initiatives and ongoing supervision has enabled
available up front, the application specialist was better the transition to be positive in terms of department
prepared to enter the key information. As a result, HSS morale and overall improved efficiency.
made better use of training time and developed more
appropriate processing protocols.
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29. Implementing your plan You can help the application specialist by showing him
Now that the equipment evaluation, negotiation, or her acceptable image quality on film studies.
planning and training is complete, it is time to implement
your digital imaging program. Once you have achieved the exact images you want
on one unit, the calibrated factors from that unit will
The vendor’s application specialist will calibrate the unit be used to populate any other CR or DR units you have
to produce the exact image your radiologists prefer. purchased. The goal is to have standardized images for
While each of your radiologists may prefer a slightly every body part regardless of where the study is taken.
different image – some may want more latitude, others
more contrast – they must decide on one acceptable
image. This may change by body part but the equipment
will not permit the same body part to be calibrated in
different ways.
Case study: Tested implementation tips
Dartmouth-Hitchcock Medical Center found that a When Dartmouth-Hitchcock purchased six DR units,
phased implementation works best. This enables the the installation was phased in over a period of several
vendor’s service engineer or application specialist months. As each DR unit came on line, images were
to customize the equipment’s software to the site’s printed on film and handled in the usual manner.
specifications. Each examination done on the unit must After all the units were installed, the next step was to
be separately loaded into the CR or DR control. Each integrate the digital units (DR or CR) into the PACS.
vendor will have default settings but these settings may
have to be adjusted to meet the organization’s needs.
Dartmouth-Hitchcock archived images for 90 days prior
to the switch over to PACS. This allowed the medical
center to build up an archive of old studies, which
eliminated much of the need to compare digital images
with previous images on film.
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