Is your hospital paying for expensive new medical devices that vendors convince physicians to try out? Here are two simple ways to curtail these unexpected costs:

* Add a term to your supplier contracts that says something like this: “New technology that has not been added to the existing contract before delivery is not authorized for purchase.” This politely informs suppliers that they risk nonpayment by introducing new technology without agreed-upon deliberations.

* Institute hospital procedures to back up this contract term. Require purchasing staff to seek executive authorization before issuing purchase orders for medical devices that are not matched back to a contract. Also, establish a committee to rationalize purchase of new products.

Is your hospital paying for expensive new medical devices that vendors convince physicians to try out? Here are two simple ways to curtail these unexpected costs:

* Add a term to your supplier contracts that says something like this: “New technology that has not been added to the existing contract before delivery is not authorized for purchase.” This politely informs suppliers that they risk nonpayment by introducing new technology without agreed-upon deliberations.

* Institute hospital procedures to back up this contract term. Require purchasing staff to seek executive authorization before issuing purchase orders for medical devices that are not matched back to a contract. Also, establish a committee to rationalize purchase of new products.

Bar Coding

120 South Sierra Ave.

Solona Beach, CA 92075

858-350-0100

MedPoint uses bar code scanning, expert clinical knowledge bases, wireless networking and integration capabilities. Bar code-enabled point-of-care system designed to help nurses intercept a variety of potential medical errors at the bedside through the use of three software applications to prevent medication administration errors, blood transfusion errors and laboratory specimen collection errors.

Brooks Memorial Director of Medical Records Cheryll Rogers leaped at that one. “Brooks Memorial’s administration is very progressive. Our president has talked for years about speech recognition technology, so when a promotional opportunity made it possible to purchase 10 speech licenses, we thought that would be a great introduction to the technology. At the time, we also thought 10 licenses would be plenty.”

When the time came to select a transcription text product, Brooks Memorial Hospital involved their transcriptionists in a month-long process of examining several vendors’ text products before officially signing on with their selection of Dictaphone’s EX-text. It was a short but intense period of hands-on due diligence. In the end, Transcription Supervisor Sandy Congdon says the hospital chose the Dictaphone product primarily for ease of use, but also for the reassurance of their support system. “Doctors dictate 24/7, so transcriptionists need support 24/7, too,” she says. Those promotional-opportunity benefits to add on the speech recognition product also were an incentive.
Founded in 1898, Brooks Memorial is a community hospital about 30 miles outside Buffalo, situated on the shores of Lake Erie, with 99 beds and a staff of more than 400 employees. The hospital provides a full array of services such as inpatient and outpatient surgery, cardiopulmonary services, cancer and radiation therapy, obstetrics, physical therapy, radiology and imaging, intensive care and sleep-disorder services.

The transcriptionists at Brooks Memorial aren’t novices. As unit supervisor, Congdon has 27 years of experience; one of the transcriptionists in her unit has 24 years, and the other three have about five years each in the field. For many years, Brooks Memorial transcriptionists fit the stereotypical image–the headset-and-foot-pedal equipped transcriptionist keyboarding away and turning physicians’ dictations into typed texts.

When the transition to EXSpeech occurred, “I was the number one skeptic,” says Congdon. “I’d been doing transcription for 27 years, and all of a sudden, I had to learn something new. I was well aware of speech recognition products on the market from seeing them at conferences, but I thought I would be retired before having to learn one.”

She and the hospital’s other transcriptionists retained their skepticism well into their intensive, Dictaphone-provided training in the fall of 2003, when they began to slowly embrace the technology. From the transcriptionist’s perspective, Congdon says, there were two initial hurdles to overcome with the software: elimination of the ubiquitous foot pedal and having to learn certain keystrokes to trigger specific commands. Beyond that, she says, the technology isn’t difficult, and at Brooks Memorial, it has helped to morph typing transcriptionists into medical text editors–and even an entrepreneurial unit of sorts–in a short time.

Selecting Dictators

Brooks Memorial management chose to utilize a backend speech server so that deploying the system would pose nothing new for physicians. Physicians dictate just as they always have, and the product of the voice files appears as text on the transcriptionist’s monitor. With her headset, she listens to the dictation as she visually reviews the written text for accuracy, using up to a half-dozen keystrokes to interrupt the voice file and edit directly into the text for 100 percent medical accuracy. The software injects into the text cues and symbols such as cubes or musical notes to indicate a segment of text it’s not certain about and that warrants a transcriptionist’s attention. Transcriptionists edit the digitized text for medical accuracy as well as grammar and punctuation.

Congdon stresses that speech recognition technology won’t provide a knowledge base of medical terminology where there is none, but for the trained transcriptionist with a medical terminology background, the software is an efficiency boon.

In the beginning, Rogers, Congdon and the transcription team selected the physicians they thought would make the best speech dictators for the trial run, and found they had even more physicians than they needed who were interested in using the technology. They also found that the physician’s country of origin wasn’t a significant factor in whether or not he would be a successful dictator, and that both American-born and foreign-born physicians make good speech recognition dictators; it depends entirely on the individual. Rogers says the initial 10 licenses were “gobbled up quickly.” Brooks added an additional 18 licenses in 2004, and Rogers will be requesting an additional 5 licenses for capital purchase in 2006.

Stratasys, Inc. (Minneapolis, MN; www.stratasys.com) is the exclusive North American distributor of the “CAD to Metal” process from Arcam AB (Molndal, Sweden; www. arcam.com). This process uses electron-beam melting (EBM) to transform titanium alloy (Ti6Al4V and Ti6Al4V ELI) or cobalt chromium (ASTM F75) powder into real metal parts. Although medical implants (using cobalt chromium powder) is a big application area, the auto industry uses EBM, as well. Parts up to about 8 x 8 x 8 in. are built by layering metal powder. A 4-kW electron beam operating in a vacuum chamber melts the layer of powder along a contour defined by a solids modeler. Upon completion, the net-shape part is cleaned. (Its “semi-rough” finish can be polished as needed using conventional machining methods.) Larger metal parts can be created by e-beam welding parts together. EBM operates like a picture tube, explains Kirby Quirk, senior sales executive, direct metals manufacturing, for Stratasys. Basically magnets steer and accelerate electrons through a little aperture. “There are no moving parts. No mirrors, servos, nothing to get out of whack or out of adjustment. You don’t have to worry about dust on the mirrors. It makes no noise. It just runs.”
Stratasys now offers the FDM Vantage X, which starts at $99,000. There are two configurations. The “A” configuration uses ABS, ABSi, and PC-ABS materials; the “P” configuration, PC, PC-ISO (a medical modeling material), and PC-ABS. Model resolution is 0.005 in. for ABS, ABSi, and PC-ABS materials.

Stratasys has beefed up its Eden line of PolyJet RP systems, which are manufactured by Israel-based Objet Geometries. These office systems use a printhead that passes from left to right to deposit a layer of photopolymer. The modeling material is fully cured with UV light during the build process. There are now six Eden systems, ranging from the Eden250, which has a 10.1 x 9.8 x 8-in. build envelope, to the Eden500, which has a 19.7 x 15.7 x 7.9-in. build envelope. The trend, explains Fred Fischer, Stratasys product manager for the Eden Distribution Line, is that “the jetting of resins is replacing the old way of making high-resolution parts, which is the vat-and-laser technology.” He cites cleanliness (better) cost (lower) and speed (generally faster) as reasons. What’s more, he says, “It’s simpler.”

By Lawrence S. Gould, Contributing Editor

RELATED ARTICLE: DUCATI SPEEDS DEVELOPMENT

During the development of a new engine for a road bike based on its Desmosedici race bike, Ducati Motor Holding S.p.A. (Bologna, Italy; www.ducati.com) first built the engine out of polycarbonate. Not quite the same as the real thing, but close enough to validate the new engine design. In working to develop the engine, Ducati used Stratasys FDM (Fused deposition modeling) systems. According to Piero Giusti, R & D CAD Manager for Ducati Motor Holding, Ducati has assembled and analyzed an entire engine without machining a single metal piece.

In designing the new engine based on its Desmosedici MotoGP race bike, Ducati used Unigraphics NX2 CAD/CAE software (www.ugs.com/products/nx/). The engine layout–a twin-cylinder, oval-piston configuration–was designed to have the power and torque of a conventional twin-cylinder engine, plus the necessary performance to compete against multicylinder engines. Ducati then produced an engine model assembled with polycarbonate components built within the 16 x 14 x 16 in. build envelope of its in-house Stratasys FDM Titan system. Then the design strategy changed. A new engine was designed with an L-shaped layout and four round pistons using a two-by-two firing order, which reproduced the working cycle of a twin-cylinder engine. Again, the engineers built a new prototype out of polycarbonate.

In the past, Ducati employed RP service bureaus to make such prototypes. In designing and building a previous engine, that approach took 28 months. With FDM in-house, designing and assembling the Desmosedici engine took only 8 months. “Prior to purchasing the FDM RP systems, our service-bureau expenses totaled approximately 1 million euro per year. That was much higher than the cost of purchase, maintenance, and materials For our two FDM machines,” says Giusti.

Each year, MLO sponsors a friendly competition among laboratories in conjunction with National Medical Laboratory Week. A three-judge panel selects a winner, a first runner-up, and a second runner-up from among the nominees. Our April issue presents these three winning laboratories to MLO readers in this very brief summary of some of their community support and team activities aside from their outstanding lab work. To each of these–and to all nominees–congratulations on bringing high quality and high performance to America’s laboratories.Jean Sapere, Inland Hospital’s laboratory director and a 25-year lab veteran, has worked at several hospitals but notes: “I feel privileged and humbled every day that I have been honored to work with the laboratory staff. These staff members thrive on their passion for their career, not for the glory. I feel that they should be duly honored at last for all their efforts.” And this year they are. Inland’s laboratory has been selected as the winner of MLO’s Medical Laboratory of the Year for 2005.
Inland Hospital (Waterville, ME) hires its lab employees based on education and experience but also for personality and a smile–thus, its patient-satisfaction survey scores consistently rank between 92% and 100%. Proper patient care drives Inland’s Customer Service Initiative goals. Phones in the laboratory are manned 24 hours, beepers are in place for phlebotomy personnel, and the laboratory director can be reached 24/7. A daily in-house newsletter features a customer-focused “standard of the week.” Customer service strives for process improvement–not blame. Patient events requiring resolution must be documented by lab personnel on forms submitted to and tracked by administration in order to establish corrective action and avoid recurring events.

Vendor Gives Hospitals Cash Awards

In its first annual Quest Award program, Reston, Va.-based QuadraMed Corp. gave three hospitals $5,000 grants, to acknowledge and reward innovative uses of the company’s healthcare IT. The winners and their categories were:

* Good Samaritan Hospital, Vincennes, Ind., for reducing accounts receivable days and accelerating cash flow through revenue cycle improvement;

* Coshocton County Memorial Hospital, Coshocton, Ohio, for improving patient safety by using online screening criteria and automated patient notification to increase pneumococcal vaccination for at-risk patients; and * Hannibal Regional Hospital, Hannibal, Mo., for deploying an electronic document management system in their emergency department to improve efficiency.

The awards, made for the hospitals’ general funds, were presented in late September at an awards luncheon at QuadraMed’s user group conference in San Antonio.

Each year, MLO sponsors a friendly competition among laboratories in conjunction with National Medical Laboratory Week. A three-judge panel selects a winner, a first runner-up, and a second runner-up from among the nominees. Our April issue presents these three winning laboratories to MLO readers in this very brief summary of some of their community support and team activities aside from their outstanding lab work. To each of these–and to all nominees–congratulations on bringing high quality and high performance to America’s laboratories.

Jean Sapere, Inland Hospital’s laboratory director and a 25-year lab veteran, has worked at several hospitals but notes: “I feel privileged and humbled every day that I have been honored to work with the laboratory staff. These staff members thrive on their passion for their career, not for the glory. I feel that they should be duly honored at last for all their efforts.” And this year they are. Inland’s laboratory has been selected as the winner of MLO’s Medical Laboratory of the Year for 2005.

[ILLUSTRATION OMITTED]

Inland Hospital (Waterville, ME) hires its lab employees based on education and experience but also for personality and a smile–thus, its patient-satisfaction survey scores consistently rank between 92% and 100%. Proper patient care drives Inland’s Customer Service Initiative goals. Phones in the laboratory are manned 24 hours, beepers are in place for phlebotomy personnel, and the laboratory director can be reached 24/7. A daily in-house newsletter features a customer-focused “standard of the week.” Customer service strives for process improvement–not blame. Patient events requiring resolution must be documented by lab personnel on forms submitted to and tracked by administration in order to establish corrective action and avoid recurring events.

Inland’s empowered laboratory staff fosters ideas to decrease patient wait time, improve the testing turnaround time (TAT), and assist other departments. In the past year alone, lab techs were involved in switching a microcapillary device to prevent clotting and decrease patient re-sticks, as well as changing to another sedimentation rate analyzer to decrease wait time from 60 to 15 minutes. Before the flu season, a new flu A and B test was added. A new seven-day blood bank preop extension was put into place for patients not transfused or pregnant within the last three months. A new Gram-stain reagent was researched and implemented, along with a new microscope. A second chemistry analyzer was installed for a reliable backup and to add more in-house testing for Inland’s emergency room patients. Recently, several nonintegrated computers were installed on one PC to increase workflow. Bar-code scanners and new label printers were also added. A lab employee who developed a special red envelope for expediting results from the patient’s physician to the operating room in a more timely fashion received a “Bright Idea Award.”

When a team member needs to attend a meeting or has a project, others cover his bench, and many employees often work extra hours to contribute to a productive and positive working environment. Inland’s laboratory “star” award gives employees the opportunity to publicly recognize co-workers’ efforts with special “star” notes presented as a thank-you for a favor, for recognition of a positive change, or after assistance in a difficult situation. Five “star” notes earn an employee a special “star” diploma and gift certificate from the hospital and a special gold “star” pin from the laboratory.

The lab’s community efforts supported a Salvation Army family and the Waterville Home for Orphaned Children. Through its employee-benefit fund, lab staff members who may be in temporary need receive gift certificates.

There is no idle time in the Inland lab. The full-time equivalent index is distributed on six-, eight-, 10-, and 12-hour shifts for maximum productivity; scores, rated by administrators, have not deviated from 2% of the projections. Quality control (QC) is performed on all chemistry instruments at night so that morning patient work is not affected. Batching is done in the late evening on routine but time-consuming tests. Techs and phlebotomists draw blood for morning testing before physicians arrive for rounds. With proper protocols in place–and expectations for high quality and fast TATs for specimen processing from the staff, several of whom are former military personnel–the department runs quickly and quietly during peak workloads. A special daily audit of lab tests prevents billing and testing discrepancies. A new QC manager saves time and more efficiently monitors all QC results; these are now sent to the service provider via computer, rather than being manually delivered. A newly developed instrument manager for chemistry instrumentation monitors through one computer and specialized “rule” applications, and effectively files specimens that are now easy to find.

Stratasys, Inc. (Minneapolis, MN; www.stratasys.com) is the exclusive North American distributor of the “CAD to Metal” process from Arcam AB (Molndal, Sweden; www. arcam.com). This process uses electron-beam melting (EBM) to transform titanium alloy (Ti6Al4V and Ti6Al4V ELI) or cobalt chromium (ASTM F75) powder into real metal parts. Although medical implants (using cobalt chromium powder) is a big application area, the auto industry uses EBM, as well. Parts up to about 8 x 8 x 8 in. are built by layering metal powder. A 4-kW electron beam operating in a vacuum chamber melts the layer of powder along a contour defined by a solids modeler. Upon completion, the net-shape part is cleaned. (Its “semi-rough” finish can be polished as needed using conventional machining methods.) Larger metal parts can be created by e-beam welding parts together. EBM operates like a picture tube, explains Kirby Quirk, senior sales executive, direct metals manufacturing, for Stratasys. Basically magnets steer and accelerate electrons through a little aperture. “There are no moving parts. No mirrors, servos, nothing to get out of whack or out of adjustment. You don’t have to worry about dust on the mirrors. It makes no noise. It just runs.”

Another advantage of this system is that the e-beam source does not waver from the time it’s installed till the time it burns out. This is unlike the lasers used in conventional RP and direct manufacturing systems. “Lasers are like people,” explains Quirk. “Once they are born, they get weaker and slower as they get older.” Moreover, replacing the e-beam element costs a fraction of what it costs to replace the laser in conventional systems. Plus, like a light bulb, replacing the e-beam source is a cinch. (The life expectancy of the e-beam source is not yet known.) Because metal parts are produced directly, the lead and prep times for casting and traditional machining are greatly reduced, in some cases eliminated. The functional prototypes, being that they’re made out of metal, can withstand actual operating conditions, including mechanical loads and temperatures.

[ILLUSTRATION OMITTED]

Stratasys now offers the FDM Vantage X, which starts at $99,000. There are two configurations. The “A” configuration uses ABS, ABSi, and PC-ABS materials; the “P” configuration, PC, PC-ISO (a medical modeling material), and PC-ABS. Model resolution is 0.005 in. for ABS, ABSi, and PC-ABS materials.

Stratasys has beefed up its Eden line of PolyJet RP systems, which are manufactured by Israel-based Objet Geometries. These office systems use a printhead that passes from left to right to deposit a layer of photopolymer. The modeling material is fully cured with UV light during the build process. There are now six Eden systems, ranging from the Eden250, which has a 10.1 x 9.8 x 8-in. build envelope, to the Eden500, which has a 19.7 x 15.7 x 7.9-in. build envelope. The trend, explains Fred Fischer, Stratasys product manager for the Eden Distribution Line, is that “the jetting of resins is replacing the old way of making high-resolution parts, which is the vat-and-laser technology.” He cites cleanliness (better) cost (lower) and speed (generally faster) as reasons. What’s more, he says, “It’s simpler.”

DUCATI SPEEDS DEVELOPMENT

During the development of a new engine for a road bike based on its Desmosedici race bike, Ducati Motor Holding S.p.A. (Bologna, Italy; www.ducati.com) first built the engine out of polycarbonate. Not quite the same as the real thing, but close enough to validate the new engine design. In working to develop the engine, Ducati used Stratasys FDM (Fused deposition modeling) systems. According to Piero Giusti, R & D CAD Manager for Ducati Motor Holding, Ducati has assembled and analyzed an entire engine without machining a single metal piece.

In designing the new engine based on its Desmosedici MotoGP race bike, Ducati used Unigraphics NX2 CAD/CAE software (www.ugs.com/products/nx/). The engine layout–a twin-cylinder, oval-piston configuration–was designed to have the power and torque of a conventional twin-cylinder engine, plus the necessary performance to compete against multicylinder engines. Ducati then produced an engine model assembled with polycarbonate components built within the 16 x 14 x 16 in. build envelope of its in-house Stratasys FDM Titan system. Then the design strategy changed. A new engine was designed with an L-shaped layout and four round pistons using a two-by-two firing order, which reproduced the working cycle of a twin-cylinder engine. Again, the engineers built a new prototype out of polycarbonate.

In the past, Ducati employed RP service bureaus to make such prototypes. In designing and building a previous engine, that approach took 28 months. With FDM in-house, designing and assembling the Desmosedici engine took only 8 months. “Prior to purchasing the FDM RP systems, our service-bureau expenses totaled approximately 1 million euro per year. That was much higher than the cost of purchase, maintenance, and materials For our two FDM machines,” says Giusti.

Who says small community hospitals don’t use cutting edge IT, or that age is a negative factor in healthcare professionals willingness o adopt it? Who says increased efficiency through IT leads to lay-offs, or that speech recognition technology is best suited to American-born doctors?

Brooks Memorial Hospital in Dunkirk, N.Y., is smashing misconceptions left and right with its creative and successful use of EXSpeech from Stratford, Conn.-based Dictaphone Corp. The hospital’s journey down the speech recognition road began several years ago, as it was replacing its text product and was offered a promotional opportunity by Dictaphone that would, in part, reduce its initial investment in speech technology.

Brooks Memorial Director of Medical Records Cheryll Rogers leaped at that one. “Brooks Memorial’s administration is very progressive. Our president has talked for years about speech recognition technology, so when a promotional opportunity made it possible to purchase 10 speech licenses, we thought that would be a great introduction to the technology. At the time, we also thought 10 licenses would be plenty.”

When the time came to select a transcription text product, Brooks Memorial Hospital involved their transcriptionists in a month-long process of examining several vendors’ text products before officially signing on with their selection of Dictaphone’s EX-text. It was a short but intense period of hands-on due diligence. In the end, Transcription Supervisor Sandy Congdon says the hospital chose the Dictaphone product primarily for ease of use, but also for the reassurance of their support system. “Doctors dictate 24/7, so transcriptionists need support 24/7, too,” she says. Those promotional-opportunity benefits to add on the speech recognition product also were an incentive.

Experience and Skepticism

Founded in 1898, Brooks Memorial is a community hospital about 30 miles outside Buffalo, situated on the shores of Lake Erie, with 99 beds and a staff of more than 400 employees. The hospital provides a full array of services such as inpatient and outpatient surgery, cardiopulmonary services, cancer and radiation therapy, obstetrics, physical therapy, radiology and imaging, intensive care and sleep-disorder services.

The transcriptionists at Brooks Memorial aren’t novices. As unit supervisor, Congdon has 27 years of experience; one of the transcriptionists in her unit has 24 years, and the other three have about five years each in the field. For many years, Brooks Memorial transcriptionists fit the stereotypical image–the headset-and-foot-pedal equipped transcriptionist keyboarding away and turning physicians’ dictations into typed texts.

When the transition to EXSpeech occurred, “I was the number one skeptic,” says Congdon. “I’d been doing transcription for 27 years, and all of a sudden, I had to learn something new. I was well aware of speech recognition products on the market from seeing them at conferences, but I thought I would be retired before having to learn one.”

She and the hospital’s other transcriptionists retained their skepticism well into their intensive, Dictaphone-provided training in the fall of 2003, when they began to slowly embrace the technology. From the transcriptionist’s perspective, Congdon says, there were two initial hurdles to overcome with the software: elimination of the ubiquitous foot pedal and having to learn certain keystrokes to trigger specific commands. Beyond that, she says, the technology isn’t difficult, and at Brooks Memorial, it has helped to morph typing transcriptionists into medical text editors–and even an entrepreneurial unit of sorts–in a short time.

Selecting Dictators

Brooks Memorial management chose to utilize a backend speech server so that deploying the system would pose nothing new for physicians. Physicians dictate just as they always have, and the product of the voice files appears as text on the transcriptionist’s monitor. With her headset, she listens to the dictation as she visually reviews the written text for accuracy, using up to a half-dozen keystrokes to interrupt the voice file and edit directly into the text for 100 percent medical accuracy. The software injects into the text cues and symbols such as cubes or musical notes to indicate a segment of text it’s not certain about and that warrants a transcriptionist’s attention. Transcriptionists edit the digitized text for medical accuracy as well as grammar and punctuation.

Congdon stresses that speech recognition technology won’t provide a knowledge base of medical terminology where there is none, but for the trained transcriptionist with a medical terminology background, the software is an efficiency boon.

In the beginning, Rogers, Congdon and the transcription team selected the physicians they thought would make the best speech dictators for the trial run, and found they had even more physicians than they needed who were interested in using the technology. They also found that the physician’s country of origin wasn’t a significant factor in whether or not he would be a successful dictator, and that both American-born and foreign-born physicians make good speech recognition dictators; it depends entirely on the individual. Rogers says the initial 10 licenses were “gobbled up quickly.” Brooks added an additional 18 licenses in 2004, and Rogers will be requesting an additional 5 licenses for capital purchase in 2006.