Cardiovascular disease claimed 831,272 lives in the United States in 2006, accounting for one of every 2.9 deaths, according to the American Heart Association. In three different clinical trials, Toshiba America Medical Systems is validating the use of CT and ultrasound technology for noninvasive, earlier detection of the signs of heart disease.

The three trials include: CorE 64, the largest trial ever initiated evaluating the use of 64-detector row CT, which investigated the use of multidetector-row CT as the primary diagnostic tool for detecting cardiovascular diseases and disorders; faCTor64, which evaluates the use of CT angiography (CTA) and echocardiography as diagnostic tools; and CORE 320, which examines whether the combination of CTA and myocardial perfusion can identify coronary stenoses of 50 percent or less (by quantitative coronary analysis) that correspond to SPECT perfusion defects.

In all three cases, validating the technology for noninvasive, early diagnosis of cardiovascular disease or defects could change how cutting-edge technology improves outcomes. Rich Mather, senior manager, Clinical Programs at Toshiba Medical Research Institute USA, says, “We expect CORE 320 findings to affect the way the medical community views the role of dynamic volume CT in the diagnosis and treatment of life-threatening diseases. When these results are available they could eventually have an impact on the way patients are diagnosed and treated.”

The CORE 320 study, which recently commenced at Johns Hopkins University School of Medicine, compares the effectiveness of 320-detector row CT angiography and perfusion with that of the combination of SPECT and coronary catheterization in identifying coronary stenoses with an associated perfusion defect. Johns Hopkins will serve as the core site for CT, while Brigham and Women’s Hospital in Boston will be the core site for SPECT. Mather explains that the multisite approach is designed to provide statistically reliable data. He says, “The trial’s design calls for an international, multicenter approach, bypassing the limitations of study bias and those associated with focusing on one geographic area and/or small patient populations.”

Toshiba’s faCTor64 study looks at the use of both 64-detector row CT and echocardiography in diagnosing coronary heart disease (CHD). Around 300,000 U.S. residents per year experience their first symptoms of CHD as either heart attack or sudden death, but there is no accepted detection test for the presence of the disease. On the CT side, the study, performed in conjunction with Intermountain Healthcare in Salt Lake City, will look at 1,000 patients over the age of 50, using Toshiba’s Aquilion® 64-detector row CT system to capture both obstructive and nonobstructive CHD data to determine the best method of treatment.

The faCTor64 research picks up where Toshiba’s CorE 64 study left off; the CorE 64 results,1 which were published in the November 27, 2008, issue of the New England Journal of Medicine, investigated CT’s ability to detect disease, as compared with that of diagnostic catheterization. The faCTor64 work not only focuses on detection of the disease in asymptomatic patients, but also assesses whether the ability to detect and treat coronary-artery disease has improved patient outcomes. “We believe the results of faCTor64 will improve the diagnosis and treatment of diabetic patients, who are more likely to develop CHD,” Mather explains. “This study will provide optimal information to guide patient management and measure clinical outcomes.”

In a recently announced faCTor64 substudy known as Speckle Tracking by Echo, Intermountain Healthcare will also examine the use of Toshiba’s Wall Motion Tracking (WMT) ultrasound technology to evaluate asymptomatic patients with diabetes for CHD. Using echocardiography to evaluate patients could help physicians detect disease noninvasively at its earliest stages, bypassing more costly procedures like catheterization.

WMT evaluates one region of the heart muscle to show how it is moving in relation to other regions, revealing even subtle abnormalities; 300 patients have already been enrolled in the substudy. J. Brent Muhlestein, MD, director of cardiovascular research at Intermountain Healthcare and the study’s lead investigator, says, “So far, Wall Motion Tracking shows significant promise as an inexpensive, noninvasive tool to detect subtle differences in how regions of the heart muscle are working.”

All three studies are aimed at providing additional information to direct patient management and track clinical outcomes. Donald L. Lappe, MD, chief of cardiology at Intermountain Healthcare, says, “Patients with diabetes have a two-to-four times greater risk of cardiovascular disease than nondiabetic patients. The ability to detect CHD in at-risk, asymptomatic patients will have a significant impact on the ability to improve their cardiac conditions and will help save lives.”

Reference
1. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl Med. 2008;359(22):2324-2336.

Reference
1. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl Med. 2008;359(22):2324-2336.

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For nearly 20 years, Toshiba America Medical Systems has been a vanguard-level sponsor of the RSNA’s Research and Education Foundation, which funds grants for young researchers in the imaging field. Since its inception 26 years ago, the foundation has provided more than $25 million in grants to 630 radiology investigators and educators. “These grants align with Toshiba’s focus on education and research,” Cathy Wolfe, director of marketing services for Toshiba, explains.

Toshiba’s education-focused collaboration with professional associations has expanded in the past few years to include the American College of Healthcare Executives (ACHE) and AHRA: The Association for Medical Imaging Management. The company sponsors the AHRA’s Putting Patients First Program, and has completed its second round of grant giving.  The program seeks to improve the safety and quality of care in imaging both pediatric and adult patients. Putting Patients First provides six grants of up to $7,500 per year to hospitals and imaging centers to help fund programs, training, or seminars focused in this area.

In 2008, one such project involved developing a patient-handoff system to facilitate transferring patients from the hospital to the imaging department. Another looked at creating a bar-code system for identifying patients with allergies to contrast media. All grant recipients agree to share their results with others so that facilities around the country have the ability to implement similar systems, according to Ed Cronin, executive director of AHRA. Cronin notes that one of the 2008 recipients developed a seminar to present to other hospitals in the region; others wrote articles on their results for the AHRA’s journal, Radiology Management.

A similar partnership with ACHE gives a boost to midlevel managers who aspire to be leaders in the radiology field. Beginning this year, Toshiba will sponsor scholarships for 60 executives to attend a series of three leadership seminars throughout 2010, 2011 and 2012. “This is a program we developed several years ago to help middle managers move into roles in the C-suite,” Peggy Gordon, vice president of development at ACHE, explains. “It’s very intensive. The seminars happen three times a year, for three days at a time and are given by a very distinguished roster of faculty teaching management and leadership.”

The first 2010 seminar occurs in June and focuses on establishing leadership; the second takes place in August and looks at innovation and overcoming the financial challenges facing the health care industry; and the third, themed Manage for the Future, is slated for October. “Part of the reason for participating in the ACHE program is helping to strengthen health care leadership through quality education,” Wolfe says. “ACHE is an impressive organization in terms of its mission and vision, and of its focus on integrity, which we thought was a good fit with Toshiba.”

Through a fourth, emerging partnership with the Society for Pediatric Radiology, Toshiba has helped the organization develop a survey to address the concerns of pediatric radiologists. “We try to look at ways to collaborate that are more unique, that provide new benefits to the organization and an opportunity for differentiation,” Wolfe says. “We believe in investing in the industry in which we work, and one of the best ways to do that is to help ensure ongoing education of the membership.”

Finally, Toshiba is continuing its support of the Society of Cardiovascular Computed Tomography’s (SCCT) Young Investigator Awards.  The SCCT is the leading international professional society dedicated to research, education and clinical excellence in cardiovascular computed tomography (CT), and is now accepting submissions for the fourth annual awards program. Sponsored by Toshiba, the unrestricted educational grants will be awarded to two residents or fellows in either radiology or cardiology for their patient care research in the categories of technical and clinical advancement of cardiovascular CT.  The deadline for submissions is April 2, 2010.   Abstracts are being accepted in two categories – Technology of Cardiovascular CT, or Clinical Applications of Cardiovascular CT.  Applicants may enter by submitting an abstract through the SCCT Web site.

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Today’s economic environment makes it increasingly challenging for physicians and technologists to travel to educational events. Robb Young, senior manager in the CT Business Unit for Toshiba, explains that this obstacle inspired the company to begin sponsoring webinars on applications for its imaging technology. “Webinars are easier for people to access,” he says. “We can do them during the day, and we can make the expertise of a particular speaker available to a broader audience. A webinar can also be saved online, so if people missed it, they can easily access the information later.”

Toshiba’s first webinar in 2010 featured S. Bruce Greenberg, MD, professor of radiology and pediatrics at Arkansas Children’s Hospital, presenting on how radiology professionals and clinicians can leverage 320-detector row CT to reduce sedation needs and radiation exposure for patients while providing them with high-quality diagnostic images.  This webinar was so well received, that Dr. Greenberg conducted a second session in late February.  “We’re focusing on the needs in the market that drove the development of this technology,” Young says. “In pediatrics, obviously, that’s being able to image patients quickly at a low dose.”  This CME-accredited webinar will be available online in April.  At that time, please visit the following site to view the webinar and receive educational credits http://www.ceconcepts.net/CT/ .

Webinars planned for later in the year include sessions on using 320-detector row CT for cardiac care and stroke triage and diagnosis, as well as on applications and technology for non-contrast MRI. The webinars are each an hour long, are free to all attendees, and are accredited by the Accreditation Council for Continuing Medical Education. Each is worth one CME credit.

“We find these events are particularly beneficial for those who are looking at new applications of a technology, or who want to understand a technology better—especially because they get to hear about it from a user,” Young says. “The webinar format allows us to get the information out to those who need it more quickly and easily.”

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At this year’s annual scientific meeting of the American College of Cardiology (ACC), which takes place on March 14–16 in Atlanta, Toshiba (booth #1944) will showcase a range of advances in and enhancements to its cardiac-imaging technology.  Following is an overview of what Toshiba will showcase:

Infinix-i Hybrid Lab

When performing patient procedures in a hybrid setting, it is critical that the imaging system provides the flexibility to quickly and easily access both the patient and ancillary equipment. Toshiba will showcase its Infinix™ VF-i vascular X-ray system with 12” x 12” flat panel detectors and CAT-880B hybrid catheterization table, designed to create a best-in-class hybrid suite.  The new mid-sized 12” x 12″ flat panel detector expands the versatility of the Infinix-i line that features a five-axis C-arm positioner and enables unprecedented patient access and coverage. Along with the new mid-sized detector, the Infinix-i five-axis systems are now available with the new CAT 880B tilt/cradle hybrid catheterization table. This table is designed to allow greater positioning flexibility and patient access during imaging and surgery. The table functionality, with side-to-side cradle and head-to-toe tilt, permits clinicians to angle the table in the optimal position to quickly and comfortably complete procedures. The system on display will also include ancillary equipment typically used in a hybrid suite.

Cardiac Ultrasound Capabilities

The cardiac capabilities of Toshiba’s ultrasound technology will also be featured. The Aplio Artida™ system is a dedicated cardiac system which provides unique 3D Wall Motion Tracking, allowing physicians to rapidly identify wall-motion defects and the timing of cardiac events, as well as real-time, multiplanar reformatting for assessing global and regional left ventricular function. Also on display is the new Aplio™ MX system, which is midsized and cart-based for better portability. Aplio MX is a multi-modality system which includes Differential Tissue Harmonic Imaging, for better results with bariatric patients; ApliPure, which enhances image clarity and detail definition; Advanced Dynamic Flow, which shows flow with directional information for even the smallest vessels.

Cardiac CT Software Enhancements

CT will highlight cardiac-software enhancements for the Aquilion^® ONE and Aquilion Premium, including new ONE Beat Prospective Reconstruction, which shortens the interval window and reduces radiation exposure time, reducing dose by 21 percent; Real Time Beat Control, which calculates the running real-time average of the heart rate to predict the next beat more precisely (and thus, to time the scan more accurately); and optimizing timing for ^SUREStart, which accurately determines contrast uptake time for a better image. Wide Volume Cardiac Protocol on the Aquilion ONE, a work-in-progress enhancement, will enable clinicians to image the entire heart, lungs, and aorta in two rotations.

Cardiac MR

The wide range of cardiac MR capabilities on the Vantage Titan™ and Vantage Atlas^® systems will be highlighted. The Vantage MRI product line offers a range of advanced cardiac capabilities, including a cardiac coil for the Vantage Titan and noncontrast imaging for patients with renal insufficiency.

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At this year’s RSNA, the AHRA: The Association for Medical Imaging Management and Toshiba announced the six recipients of the second annual Putting Patients First grant program.

This year’s Putting Patients First grant program was expanded to include imaging centers and three additional grants specifically for pediatric programs. The six recipients were selected by the AHRA selection committee to receive up to $7,500 grants to fund programs, trainings or seminars aimed at improving patient care and safety in diagnostic imaging.

In its second year, this program has expanded its scope to include improving the imaging of children.  Children have special imaging needs – exposure to radiation and contrast are concerns within the industry, as is ensuring that children are well prepared for the imaging experience.  Putting Patients First will help facilities address these very specific needs.

“Grant programs like Putting Patients First are critical given today’s health care environment and the pressures hospitals face due to limited resources and other financial challenges,” said Debra A. Lopez, AHRA president, CRA, FAHRA. “This year’s winning programs demonstrated quality and innovation in patient care. They will make significant improvements to patient care and better the imaging experience for physicians and patients, alike.”

The programs funded by the AHRA/Toshiba Patient First grants include:

Children’s Healthcare of Atlanta at Egleston – Use of Bismuth Shields in All CT Exams

• Several recent publications report radiation dose reduction benefits when using bismuth shielding for pediatric patients undergoing multidectector CT. Therefore, Children’s Healthcare of Atlanta at Egleston will implement the use of bismuth shields in all patients undergoing CT examinations. Implementation of this shielding program will entail staff training, purchase of bismuth breast and thyroid shields, ongoing review of images, development of resident and parental educational programs, and a cost analysis.

Community Health Network – Pediatric CT Imaging Simulation Program

• By enabling pediatric patients to better understand the CT imaging process, radiation dose will effectively be reduced, patient comfort will be improved and the overall imaging experience will be safer. Therefore, Community Health Network will create an Internet-based simulation program to educate pediatric patients and their caregivers about the diagnostic imaging process (focused on CT).  By incorporating audio, avatars and animation through a user-friendly computer program, patients will know what to expect of the imaging process and be more comfortable and compliant during the procedure.

Memorial Hermann Outpatient Imaging Division – Improved Process Program

• Memorial Hermann’s goal is to emphasize the importance of keeping radiation dose during CT procedures as low as reasonably achievable for pediatric patients, while still maintaining good image quality. It also recognizes the need for more education for the technologists and pediatricians on pediatric radiation safety. Therefore, Memorial Hermann will implement the Improvement Process Program to: 1) document the dose electronically PACs; 2) scan once – multiphase scanning is usually not necessary in children; 3) reduce or “child-size” the amount of radiation used; 4) audit and evaluate image quality monthly; and 5) provide physician and technologist continued education.

Highline Medical Center – Improvement Project for Scheduling Inpatients for Imaging Exams

• One of Highline Medical Center’s goals is to provide a patient-centered environment that personalizes, humanizes and demystifies patient care. Therefore, Highland Medical Center is undertaking an improvement project to develop, implement and spread a process for scheduling inpatients for imaging exams to accomplish safer patient care through: 1) better communication among the staff caring for the patient; 2) increasing involvement of the patient in his/her own care; 3) better coordination between services for tests and treatments leading to streamlined clinical pathway; 4) eliminating delayed/missed or incorrect imaging exams; 5) improving patient flow to potentially decrease overall length of stay; and 6) having imaging techs rounding on patients prior to high risk, invasive or advanced imaging procedures.

Shields Health Care – Understanding and Reducing Patient Anxiety

• Shields Health Care wants to engage the patient in a common language that educates and reduces patient anxiety. Therefore, Shields Health Care will develop multi-lingual web-based tools as well as professional staff training. Phase one of the program will be to research causes and develop solutions; phase two will be to implement and cross train professionals and technical staff; and phase three will be dedicated to reflection on lessons learned and measuring program effectiveness and outcomes.

St. Patrick Hospital – Interactive Utility to Improve the Imaging Process

• Inaccurate or inappropriate exam orders contribute to increased costs to patients, staff and facilities in terms of dose, money and time. Therefore, St. Patrick Hospital will create on its intranet Web site an interactive utility that is readily accessible to all staff to provide guidance regarding appropriate imaging studies and help facilitate clear exam orders to maximize the value of imaging studies. Once the program is developed for intranet users, St. Patrick Hospital will provide a condensed version of the utility on its hospital Web site with more links to helpful information in order to improve patient understanding of the process. This version also will be a tool used by clinicians and staff when discussing exam specifics with patients.

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What do an organic vegetable garden, a Great Lakes water-quality analysis, and the DNA mapping of fruit have in common? They’re all science projects funded by the Toshiba America Foundation (TAF), which offers science and math teachers across the United States grants to underwrite hands-on education. Founded in 1990 through an endowment created by Toshiba, TAF provides around 150 educational grants every year, in amounts ranging from $1,000 to $25,000.

“The method we use is unique in that TAF gives grants directly to individual classroom teachers to help them with their wish lists for instructional equipment and to support projects to make the classroom more exciting for students,” Laura Cronin, director of TAF, explains. “Once the students start doing real science and get a sense of how it’s connected to their everyday lives, it becomes fun and exciting.”

Cronin explains that the foundation’s goals are aligned with Toshiba’s desire to contribute in a meaningful way to the community. “Education is always at the top of the list in terms of U.S. charitable concerns,” she notes. “Science and technology are disciplines in which Toshiba has expertise, and so through these grants we can help prepare the next generation.”

A partnership between TAF and Toshiba also led to a second educational endeavor called ExploraVision, which is a nationwide science contest co-sponsored by the National Science Teachers Association (NSTA). “ExploraVision invites students from throughout the United States and Canada to explore solutions for contemporary problems by imagining future technologies,” Cronin explains. “The students think about something that’s happening today that’s important to them, and then they imagine the technology 20 years into the future and invent a solution.”

ExploraVision entries are judged by the NSTA, and finalists are judged by experts from NASA, the National Institutes of Health and other prestigious institutions. “The ideas are extraordinary,” Cronin says. “The children are amazingly imaginative, and their wonderful teachers coach participating students to help bring their ideas to life.”

Cronin emphasizes the importance of working directly with teachers to create innovative new educational opportunities for students. “The teachers are the experts,” she says. “Toshiba America Foundation has a direct impact based on their expertise, and on their passions and interests, and that’s why the foundation supports projects designed by teachers in individual classrooms all over the country.”

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Whatever form the health care legislation under debate in the House and Senate takes, one priority is shared by lawmakers from both sides of the aisle: improving quality and safety. President Obama’s proposed 2010 budget includes a recommendation to implement a hospital quality-incentive payment program; the budget projects that such an initiative could result in savings of $11 billion over the next decade. In addition, the Medicare Payment Advisory Commission has recommended that Medicare revise its payment-system incentives to adjust provider payment based on quality of care, and has suggested that Congress create a wide-reaching quality-incentive payment policy for hospitals and physicians.

With quality and safety in the spotlight on a national level, hospitals across the country are renewing their commitment to ensuring that their services meet or exceed the core measures for quality set by the government. For many facilities, this is a massive, daunting undertaking, requiring a comprehensive reexamination of even the simplest daily processes to ensure that all members of hospital staff are enforcing the common goal: improving patient care.

Memorial Hermann Healthcare System (MHHS), Houston, Texas, embarked on a new quality initiative in 2003. The hospital began by developing a brand promise that Michael Shabot, M.D., chief medical officer, describes as striking at the health care system’s core mission: “That the system provide the highest possible quality and safe health care combined with an outstanding patient experience.”

Shabot, who came onboard in January 2007 as chief quality officer, was hired, in part, to reinforce this renewed commitment to patients. “Everyone talks about differentiating themselves on the basis of quality care and safety,” he says. “Our commitment was actually to do it and demonstrate it. It required real dedication.”

Shabot was instrumental in implementing the second wave of the system’s new initiative, which became known as the Breakthrough in Patient Safety campaign. One idea that set the Breakthrough campaign apart was that it took cues from what Shabot calls high-reliability industries, such as nuclear power and naval aviation, which conduct specialized training for every single employee. “We brought in consultants from other industries to retrain all of our employees, including the kitchen staff, the maintenance staff—everyone who works for MHHS,” Shabot says. “We even train our volunteers to speak up when they think something’s not right. It’s everybody’s job to make every patient safe.”

All MHHS facilities honor a safety hero of the month (an individual who has intervened to ensure patient safety); the system has also designated 600 employees as safety coaches, who perform safety-monitoring services on work areas other than their own. In addition to meeting or exceeding safety and quality standards set by the government, MHHS ensures total transparency by publishing its own core measure data on its Web site.

In May 2009, the National Quality Forum presented MHHS with its 2009 National Healthcare Quality Award. By that time, the health system had been recognized by the New York Timesfor having the best heart-attack care in the city of Houston, averaging less than 90 minutes from the door to percutaneous coronary intervention. The system has revolutionized triage for both stroke and pneumonia, leveraging top-of-the-line imaging and PACS equipment to create what Shabot calls “a true culture change for everyone involved.”

“Our imaging capabilities are crucial to ensuring rapid, quality care,” Shabot says. “Modalities like CT angiography, CT, and MRI are crucial for rapid diagnosis of trauma. If a patient comes into the emergency department with chest pain, he or she gets an immediate ECG, and if there’s any evidence of an ST-elevation myocardial infarction, the catheterization laboratory is immediately activated.” In some cases, ECGs are actually read wirelessly from ambulances, meaning that the catheterization laboratory is ready by the time the patient arrives at the hospital. “It’s like a ballet,” Shabot says. “We have to make sure all of our staff is committed to this, on call, and available.”

Shabot and the team have also implemented a comprehensive program for appropriate dose in pediatric imaging. “In retrospect, we were often using more radiation than was necessary, like the rest of the country,” he recalls. “At appropriate lower doses, you can get the same quality images, and in the past few years, the need to attenuate these doses for children has become a priority.”

Though the Breakthrough campaign has already cost MHHS around $18 million, Shabot expects the investment to pay big dividends down the line. “We’ve made these improvements because it’s the right thing to do, but reimbursement is very important,” he says. “If we’re able to take a patient who was going to have a heart attack and literally reverse it—so that instead of spending days in critical care, clinging to life, he or she can go home in 48 hours or less—we’ve done the right thing for the health care economy. In our day-to-day operations, quality saves money and it saves lives. It’s a win–win situation.”

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“When you get new technology, it’s important to educate physicians on what makes it different,” Stricker says. “Technologies like this are a big investment, and they are huge assets to the community. Physicians and their patients will benefit from the new features, but they need to know what they are.”

Stricker developed print materials for Glendale’s referring community that highlighted the clinical benefits of the new technologies. “It was a matter of finding out what made our technology better and conveying that in a simple way,” she says. “With the CT, we talked about how you could get high-resolution images for any part of the body in seconds. For the MRI, we emphasized the superior image quality and the availability of non-contrast MR angiography, which is particularly important to patients with renal complications because of the Nephrogenic Systemic Fibrosis risk.”

The materials also focused on aspects of the new technologies that made them more patient friendly, including the MRI system’s proprietary Pianissimo™ noise reduction feature (which reduces noise by 90 percent during scanning) and the CT unit’s rapid speed of scanning, which results in shorter waiting times. “Referring physicians want to make sure their patients have the best experience possible,” Stricker notes.

Jim Burch, director of communications for TAMS, says, “As an imaging-services provider, your currency is information. You’re taking images, but what you’re really doing is providing information about the patient to the referring physician, so the best way to market to that physician is through diagnostic clinical information. You’re speaking the same language.”

Stricker used the TAMS Image Maker kit as a resource for both clinical images and information. “We have our own campaign branding and images we use for most of our materials,” she notes, “but the sample ads and pieces provided with Image Maker were helpful in giving us ideas and showing what the key messages in our promotions should be.”

While Stricker chose to focus primarily on referring-physician marketing, Burch notes the same principle can be applied to patient outreach. “Consumers can get their information from a wide variety of locations, not all of which are trusted. I think the savvy hospitals and imaging centers are working to provide valuable, in-depth information and resources for patients. A print ad doesn’t help them take control; it only provides them with enough information to be curious. The additional educational materials are what consumers are looking for,” he says.

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In this challenging economic climate, extending the life of imaging equipment through proper service and maintenance is more important than ever. Over a period of years, however, the aggregate cost of a service agreement could rival the original price tag of the equipment, making it crucial for purchasers to balance cost against their facilities’ needs.

Imaging equipment is generally guaranteed (under warranty) for a year; after that year, a service agreement usually covers the next four years, meaning that hospitals look at the five-year life-cycle cost when making purchasing decisions. Weighing the additional cost of a service agreement can be a tricky proposition, requiring facilities to accurately predict how the equipment will be used over this five-year life cycle. An improperly structured service agreement could result in unplanned downtime, making preventive maintenance crucial to ensure the equipment runs properly. Patient volume is also an important consideration. High-volume facilities may need more entitlements and coverage than those performing fewer scans.

The first step in negotiating the right service agreement is assessing your needs. Are you in a critical care facility that needs its scanner running 24/7 or in a community hospital with more than one scanner, allowing flexibility if one system is out of commission for a short time? Ask yourself these other questions in assessing your needs: What is the scanner’s average daily volume? Is the scanner regularly used after hours? For what types of studies is the scanner generally used? How many scanners do we have? Do we have our own internal biomedical-engineering team?

Having answered these questions, you will be better prepared to discuss service options for your facility with your Original Equipment Manufacturer (OEM). Ted Nemetz is vice president of Service at Toshiba America Medical Systems, Inc. in Tustin, California. He says, “What we want to accomplish on our end is finding out the customers’ needs and what their expectation levels are. At Toshiba, a standard service agreement covers service from 8 AM to 5 PM, and we guarantee 98 percent uptime.” Your facility, however, may need more than the standard service agreement. “You may need 24/7 coverage. Our objective is to provide the placement of parts and people to support what you’re paying for,” Nemetz says.

When you sit down with your OEM to formulate an ideal service agreement, factors to consider include:

• your service needs for this equipment;
• what type of coverage you will need (for example, full coverage, with the OEM providing all necessary support, or partial coverage, with in-house biomedical-engineering staff providing primary service);
• what hours of service/repair coverage you will require;
• what hours of preventive maintenance coverage you will require;
• what other system options you will require, such as coverage for coils or X-ray tubes;
• your risk tolerance;
• whether or not this service agreement will be your long-term solution.

Because your service needs can change over time, shifting with the acquisition of a new piece of equipment or merely exceeding your original estimates, Nemetz also emphasizes the importance of flexibility on the part of your OEM. “We are willing to amend your agreement as time goes on,” he says. “If we see you don’t have enough coverage, or if (conversely) you’re spending money you don’t need to spend, our management team will work with you to adjust your agreement to better meet your needs.”

Remember, as well, to take into account your geographic location, which will affect how quickly service engineers will be able to reach your facility in the event of unplanned downtime. “Most OEMs say they will respond by phone within 15 minutes and be on-site within two hours, but customers in rural areas should be sure the right people are trained and available,” Nemetz says. “Find out how close their parts depots are and how close their personnel are. Personnel and parts are not really on the service agreement, but they are a major part of the service OEMs provide.”

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Joe Graham, vice president of Service for Enterprise and Strategic Business Groups at Toshiba, says, “We have fulfilled some customers’ requests, over the years, to allow a transition between Service agreement programs. The FLEX plan formalizes that model, giving customers the flexibility to craft an agreement according to their own requirements, moving from model to model and customizing their own solutions.”

The FLEX plan encompasses two service agreement models: Toshiba’s InTouch Full Security Agreement (which provides full protection for imaging systems, fixed-price support and customized Service solutions) and the InTouch Partnership Agreement (which allows hospitals to balance fixed and variable service costs while benefiting from discounted rates on parts and labor).

Graham explains the FLEX plan arose out of hospitals’ need to balance the technical expertise of in-house biomedical-engineering staff against vendor support. “The real catalyst for transitioning back and forth generally has more to do with clinical engineering manpower changes than anything else,” he says. “If the hospital didn’t have anyone who worked on CT, and then it hired someone, that would necessitate a change—or if it had someone, but the person resigned or took another position, the hospital would need to move away from a partnership agreement and back to a full-service model.”

The FLEX plan allows customers to secure fixed price points for both the full-service model and the partnership model, giving them the freedom to move back and forth between the two as often as necessary over a five-year equipment life cycle. “We identify the lowest prices, and the hospital is guaranteed that over the course of the agreement,” Graham says. “What’s unique about this plan is the hospital knows, from the outset, what it is going to pay for whatever service model they choose. That’s really the advantage of formalizing a flexible service agreement.”

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