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How to leverage mobile imaging when facing a natural disaster

Posted on: 09.06.18

In times of disaster, the demand for immediate emergency healthcare services can quickly surpass an area’s capacity. Most disasters are localized, and residents who are sick or injured depend on the care, services, and expertise provided by the local hospital. It’s critical for the hospital system to have an effective recovery and management plan in place.

Here are some considerations for designing a comprehensive, multi-faceted, and scenario-driven approach to disaster response:

Disasters are unpredictable

In the aftermath of a disaster, patients in need of care will instinctively head to the nearest hospital. Most disaster recovery plans address preparation for the onslaught of emergencies, overcrowding, and insufficient personnel. But, you also need to plan for the possibility that the facility may be unreachable for some. Roads may be impassable due to flooding, landslides, or debris. Transportation services may be limited, or the hospital itself may be damaged or inoperable.

How to prepare for the worst

Under any conditions, hospitals need to be resilient. They need to be able to absorb and respond to the shock of a disaster, continue to provide critical functionality and work quickly to recover to their original state. Sometimes that may require the help of an outside organization who can fill the gaps and bring imaging and emergency clinical services to the community.

A well-designed recovery plan should most certainly consider partnering with a mobile health care provider that, when necessary, can respond quickly and arrive at any location with the critical staff, supplies, and equipment.

In preparation, it’s important to research your vendors. Before the emergency you should use due diligence to identify providers who are reputable and have the appropriate credentials like ISO 9000 accreditation and the Joint Commission (JCAHO) certification. They’ll have the policies and procedures already in place and have the support structure, too. In doing so, you’ll ensure the same high quality of care for your patients, regardless of who administers it.

How will service be delivered?

A mobile healthcare unit is comprised of a fully equipped, furnished, tractor-trailer with onboard equipment powered by a generator. It can be parked at almost any location that has a flat surface. Asphalt is ideal because its surface is firm and level, but tightly packed gravel is an option in certain cases.

Once it’s delivered to the designated site, the staff will set up the equipment and establish the electrical and internet connections. These mobile units can provide CT, MRI and Ultrasound imaging as well as acting as a freestanding medical clinic.

The mobile healthcare company can provide a team of fully functional personnel to operate the unit, but their personnel can also provide on-site ad hoc equipment training to your staff in order to provide a continuum of care.

What information will we need to provide?

During a disaster, the following information can help decrease response time and significantly increase a mobile unit’s preparedness.

1. Network information

Providing network information in advance of arrival allows the unit to establish a connection as quickly as possible and minimize start-up time.

2. Identification of an alternative site, as needed

Potential alternative sites should be identified well in advance of any disaster, if possible. Whether it’s an empty parking lot, a football field, or any other location, permissions should be in place prior to the mobile unit’s arrival. It’s also helpful if on-site power is identified, rather than relying on the onboard generator.

3. Staff

It’s important to have an accurate count of your available staff and be able to communicate your additional personnel needs. Upon the unit’s arrival, there should be a key staff member who can take charge of the unit and give direction to the team.

4. Resolution of specific state regulation conflicts

Any specific state regulations that can complicate delivery of services should be identified in advance. For example, some mobile healthcare companies may not be registered in all states, and special prior approval may be needed.

Planning is not a prerequisite

While partnering with a mobile healthcare company in advance is the best approach to managing any disaster scenario, it’s not a prerequisite. Mobile healthcare companies can often respond on-demand and together you can still create a customized plan as you go.

The most important thing is that people receive the necessary medical attention and can trust their local hospital to continue to provide the highest level of quality care, even in the face of disaster.



How mobile imaging is changing healthcare in rural areas

Posted on: 11.16.17

Years ago, all hospitals were primarily independent, but recently we’ve seen more consolidation in the healthcare industry. The consolidation has largely been driven by new economic realities, which have pressured hospitals and clinics to band together and create their own partnerships or merge with larger hospital systems, in order to survive.

Patients are being drawn out of smaller communities

Smaller, rural facilities are being significantly impacted by the consolidation trend as well. While creating or joining a larger organization generally results in more money to fund needed improvements and garner greater negotiating power, it may also be unintentionally promoting smaller, rural hospitals as urgent care facilities. One consequence is that patients tend to utilize their services for urgent care, but choose to continue any follow-up care at larger hospitals in nearby cities, and that’s creating a new level of competition.

Traveling outside of the community for all types of services has become less of an inconvenience and more of an accepted practice in today’s society. When a patient thinks about where they’ll receive the best care, a 60-90 minute car ride does not negatively impact their decision.

Many rural hospitals are banding together to form their own associations or networks. Others are independently fighting to hold onto their patients. They’re supplementing their services and employing state-of-the-art shared and mobile solutions that are cost-effective, reliable and customized to meet the facility’s needs.

Critical Access Hospital designation

In an effort to continue and improve the availability of essential healthcare services, and to reduce the financial vulnerability of providing those services to some of the rural communities, the Centers for Medicare and Medicaid Services (CHS) designates some rural hospitals as “Critical Access Hospitals.” Through cost-based Medicare reimbursement, hospitals can true-up their costs at year-end to alleviate any deficit.

Every rural hospital cannot be designated as a Critical Access Hospital, however. There are eligibility requirements and restrictions that generally include:

  • 25 or fewer acute care inpatient beds
  • 35 or more miles between hospitals
  • average stay of 96 hours or less for acute patients
  • 24/7 emergency care services

Where do we go now?

It’s more important than ever for rural hospitals to offer core services, or even consider expanding the list of core services that they have offered in the past. They may not own the in-house equipment and employ the full-time staff needed to support the community, but that’s no longer a challenge that can’t be overcome. Providers like DMS Health are committed to providing cost-effective options to hospitals and patients through their mobile healthcare services. By helping to alleviate equipment shortages, outdated technology, and understaffed facilities, they are able to work with medical facilities and physician groups to overcome the challenges in order to deliver excellent patient care.



Key requirements for a mobile CT provider

Posted on: 06.22.17

Most hospitals offer CT imaging services in-house, but there are times when bringing in a mobile imaging service on a provisional basis makes more sense. Whether you’re remodeling your CT imaging space, your equipment requires repairs, or you need help managing a backlog, provisional imaging can be a smart decision.

Vendors become an extension of your hospital

One of the most important things to keep in mind, however, is that any vendor you partner with becomes an extension of your hospital. Your patients should not be able to make any distinction between the level of service delivered by the hospital staff and the mobile imaging staff. The cleanliness of the environment, the detailed protocols, and the quality of the equipment should be the same, ensuring the patient’s positive experience follows through to the mobile service. What qualities help demonstrate and reinforce a commitment to upholding your high standards? Here’s a list of requirements to look for in a quality CT mobile imaging provider:

Equipment

Mobile providers should provide equipment that is currently and widely used in the market. While a 64-slice CT scanner might be preferable, a 16-slice camera is an excellent fit for most studies and provides image quality with high throughput. You’ll also want to ensure that the CT scanners are XR-29 compliant as non-compliance can adversely impact your reimbursement.

An OEM Service Agreement

To safeguard against downtime, a mobile provider should have an OEM Service Agreement. This ensures that factory-trained service engineers are performing preventative maintenance on a regular basis and that they’ll have access to OEM parts.

JCAHO Certification

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an independent group that administers voluntary accreditation programs for hospitals and other healthcare organizations. They develop performance standards that address elements of operation, such as patient care, medication safety, infection control and consumer rights. Your mobile provider should be JCAHO certified, which implies that they have a superior level of quality standards and processes in place.

HIPAA Compliance

The mobile provider staff should be just as committed to protecting patient privacy and abiding by all healthcare regulations set forth by HIPAA as your hospital staff. Be sure they have an active and ongoing HIPAA training program in place.

A Hygiene Program

Many healthcare workers say hygiene is the most important tool in preventing the spread of healthcare-associated infections among patients. Be sure the mobile provider has strict policies and procedures around hygiene and they educate their staff on the critical importance of infection control.

When you’re looking for a mobile provider, high quality and excellence come at a premium. If a hospital truly desires the patient experience to carry through to that mobile asset, they have to look to vendors that are committed to providing that same level of superior quality, patient-centric service.



Three approaches to offering imaging services at a satellite office

Posted on: 06.08.17

Opening a satellite office is an excellent way for cardiologists to expand their reach within a community and grow their patient base. But what level of services should you be offering at the satellite offices? Imaging is often one of these question marks. Sure, it would be great to provide full ultrasound and nuclear imaging services, but equipment and staffing for diagnostic imaging require a sizable capital investment. Knowing the options will help you minimize the pitfalls and position yourself for the best chance of success. We’ve identified three options that practices take when considering how to offer imaging at satellite locations. These approaches include the Hub & Spoke, Mobile First, and All-in. Let’s take a look at each one in detail.

Hub & Spoke Approach

The concept of the Hub & Spoke approach is to limit your capital risk by simply not offering imaging at the satellite office. That may sound simplistic, but many times cardiologists take a “wait and see” approach to satellite offices and are unwilling to invest in any equipment or imaging staff until the location proves itself as viable.

Using this method, these offices are designed to create imaging referrals and not straight diagnostic imaging revenue for the satellite. No nuclear imaging equipment is located in the office and patients who need additional testing are directed to the central office. The glaring drawback is that this works against the two key features that satellite offices offer. First, you are only offering patient convenience for office visits. If a patient chooses the office because of where it’s located, you may see attrition if they have to drive 15+ minutes for their imaging needs. With a patient travel time of 30+ minutes for diagnostic testing, the failure rate is high in terms of capture rate. Second, you are presenting to the referring physician community that you are not fully committed to provide your full list of services to them and their patients. Referring physicians may stick with existing referral patterns if they feel their patients will be inconvenienced. This also limits the opportunity for the physicians assigned to the satellite office to fully connect and engage with the local referral base. Although the financial outlay of the Hub & Spoke approach is minimal, the capture rate for diagnostics is significantly compromised. This fact will limit the overall success of the satellite office concept.

Mobile-First Approach

The reason many physicians hedge when considering imaging at a satellite is that it does involve risk and a higher amount of capital. Because of this, some practices choose to use a “Mobile First” approach to offering imaging at a satellite office.

With a Mobile First methodology, clinics opt for providing imaging on a limited basis (one or two days a week) scalable to the clinical needs. Simply schedule all patients who need the services on the same day. Some practices choose to move staff and equipment from the main office to the satellite office for the imaging days. Another alternative is to utilize a mobile imaging company to handle all the imaging.

The intent with this approach is to use the resources you already have available until you can gauge patient volume, referral patterns and general success of the office. Either of these options would give you the time and realistic, concrete feedback about the likelihood of financial success and eventually the grounds to solidify your long-term plans for your satellite office.

All-in Approach

The All-in approach involves investing in everything needed to run what is essentially a smaller-scale main office. The office is staffed & equipped for in-office imaging, and patients are imaged five days a week. While this approach sounds like a recipe for success, it brings with it more risk than the other approaches. It requires a significant financial investment, and the actual volume might not match expectations.

However, many physicians who currently offer nuclear imaging choose this route with varying levels of success. Having been through the process before, and having a base of knowledge to build from, allows them to have a better grasp of what it takes to get the department running, how to scale and what is required for financial success.

What is right for your practice?

There is no “right” way to offer imaging services at a satellite office, and the approach you choose should be the best fit for your practice and your patients. Your experience, the location of the satellite, and your local market all factor into the decision, but finding the right balance of risk vs. reward will help your satellite succeed.



Two primary types of Mobile Diagnostic Imaging for Hospitals

Posted on: 06.01.17

Hospitals choose mobile diagnostic imaging for a variety of different reasons, from lack of space to increased volume or remodeling of their radiology facility. There are many different types and styles of mobile imaging so it’s critical to know your options and the different paths you can take if you’re thinking about traveling down this road. Let’s start with the two categories of mobile imaging, provisional and mobile.

Provisional

Provisional mobile imaging is typically utilized by hospitals that are experiencing a temporary disruption or short-term need for CT, PET, PET/CT, Nuclear and various other modalities. Often, facilities that choose this option are already providing these services but are using provisional imaging as a way to maintain their current volume while they either remodel, replace or repair their current equipment.

With provisional mobile imaging, the equipment is delivered to the hospital via a tractor trailer. The trailer is set-up and stays in place for the entire duration of the project, typically 3 to 6 months. It can, however, extend to over a year, depending on the circumstances. Under this arrangement, the hospital will often provide their own staff, but the mobile provider can often offer staffing as well.

Mobile

Mobile imaging services include a scheduled visit from a provider, who also transports the equipment back and forth to your location. This arrangement is ideal if the hospital does not offer a particular imaging modality or if volumes are especially low. Low volumes make owning the system a financial challenge, and mobile imaging is an ideal way to meet your patients’ needs without making a significant investment.

Typically the mobile provider will visit your facility on a consistent pre-determined day of the week and any patient appointments for applicable diagnostic imaging are made for that same day. Usually the mobile imaging provider supplies everything necessary to perform clinical studies including the equipment, patient consumables, and clinical staff. They operate as an extension of the hospital, which allows the facility to remove the overhead, space requirement, and staffing costs. A critical key to your facility’s success in this type of program is to work with an imaging service provider that is accredited, and has formal HIPAA processes as well as a formal compliance and regulatory program.

Hospital requirements

If you are planning to offer mobile imaging at your facility, there are some initial requirements that need to be in place. The area where the mobile unit will be located will require a concrete pad, which must be poured and set-up before offering the service. Power and data must be brought to the area, so it’s important to plan for the connections prior to the mobile unit’s arrival. Lastly, many of the mobile providers require a patient lift so patients in wheelchairs or those with mobility issues can be accommodated.



How mobile Women’s health facilities are changing the hospital landscape

Posted on: 05.11.17

Patients are expecting better service from physicians and hospitals. Compounded by the new quality measures that are heavily weighted on patient experience, hospitals are recognizing the need to make changes. If patients don’t report a positive, comfortable or reassuring experience, then providers’ quality scores decline, and it negatively affects reimbursement payments.

What’s changing?

The patient experience is a combination of both environment and equipment. A 2015 study of veteran women reported that environmental elements were critical to having a positive experience. At the same time, quality and current technology should be a standard expectation.

Environments

In women’s health facilities, substantial modernizations are being made. Many are looking at how their women’s healthcare environments can improve both quality and environmental criteria so that they meet the public and private sectors’ expectations.

Larger hospitals are renovating their space, but it’s an expensive undertaking. You’re also seeing it in the design of new mobile units, too. There is much more emphasis and attention on creating a more feminine environment, particularly through color palettes, tone, texture, and lighting. The goal is to have the female population feel more comfortable and relaxed. Ultimately, the traditional clinic setting is not as appealing to women during a mammography or gynecological exam.

Equipment

Today, in terms of equipment, the biggest debate is 2-D versus 3-D and whether the additional expense is worth it. The trend is creating a lot of interesting discussion. Equipment, in general, is a factor that contributes to the overall patient experience.

It’s difficult, though, for hospitals to continue to chase the newest trend or the next modality, especially when a new and improved version of your cutting edge technology is likely already in the works. Smaller hospitals are getting out of the business for just that reason. They’re choosing to use a mobile service in order to avoid the risk of not being able to provide the most positive experience for their patients.

In addition, many don’t have enough volume to dictate spending money on the newest technology. It simply doesn’t make sense to have a mammography unit at the hospital. It does make sense, however, for a mobile unit to be at their location once a week that can provide both components to create a positive experience.

Could a mobile service help your hospital?

While renovation might be the right choice for some, using a modernized mobile service unit could be the smart choice for others, especially when it comes to women’s health. From helping large hospitals with high capacity issues, to serving the smaller hospital communities with access to state-of-the-art equipment, the added value they provide could help raise your patients’ positive experience level and ultimately your provider quality scores.



Three reasons hospitals use provisional CT, MRI, or PET Imaging

Posted on: 04.20.17

Most hospitals offer CT, MRI, and PET imaging services in-house, but there are times when bringing in a mobile imaging service on a provisional basis makes more sense.

What is provisional imaging?

In traditional mobile imaging, a technologist visits the hospital or clinic on a weekly basis and transports the equipment back and forth with each visit. With provisional imaging, the equipment is left at the facility for a longer period of time, typically three to six months or more. Hospitals may choose this service option for a number of reasons:

1. Remodeling the CT imaging space or purchasing a new camera

One of the most common reasons a facility may choose provisional mobile imaging is in the case of new equipment or a space remodeling project. The remodeling process requires careful planning so as not to interrupt your current service. In the best-case scenario, your service may be inoperative for a few weeks due to construction, and any unforeseen delays could potentially add to that timeline.

Planning ahead and having a provisional mobile imaging service in place is a simple way to avoid inconvenient and costly disruptions. Be sure to start the process early in order to increase the likelihood that you’ll be able to secure the ideal system and configuration for your needs.

2. Long term CT machine repairs

Another popular reason to utilize provisional service is lengthy equipment repairs. When a CT, MRI, or PET imaging system is in need of extensive repairs, a hospital cannot simply stop imaging. Sometimes repairs may only take a day or two, but there are other instances when repairs are significant and can require significantly more time to fix. Waiting on ordered parts or an available service engineer can leave you down for weeks. In this case, utilizing a provisional service is a way to fill the gap while your equipment is brought back online.

3. Bring down a backlog

Lastly, there are times when hospitals simply face a backlog of imaging needs. Regardless of the reason, if volume increases and your current equipment and number of technologists cannot effectively manage the workload, you’re faced with determining the best method of working through the challenge. Bringing in a CT, MRI, or PET imaging system on a provisional basis is not only a way to get out from under the backlog, but it’s also a smart way to determine if this is a trend that needs to be addressed with a more permanent solution.



How to know if mobile CT is right for your hospital

Posted on: 03.09.17

High-volume medical practices and hospitals typically allocate space for procedures including PET and CT imaging systems. The decision to assign valuable space is warranted by the high number of procedures they schedule each day. For smaller practices and lower-volume rural hospitals, however, the decision is not as straightforward. Here are three factors that shape the decision to either purchase and staff in-house equipment or use a mobile service:

1. Capital Constraints

Like most equipment, PET and CT imaging systems are expensive, so you need to determine the best, most cost-effective approach to providing this service to your patients. When evaluating options to purchase an imaging system, ask yourself whether your facility is able to afford the capital costs of this equipment. And if so, will you be able to recoup the capital outlay in a reasonable time period?

Beyond the obvious costs of the cameras, you’ll also need to factor in the additional expenditures required to house the equipment. These include the cost of the staff to operate and manage the equipment. Consider the cost of the service contracts that will help keep the equipment operating accurately, and the cost of the necessary sundry pharmaceuticals.

A second option is utilizing a mobile imaging service. You can compare the rates for renting the equipment and hiring the service, which includes staffing, management, equipment servicing, and all require supplies.

2. Space Limitations

Space is another factor that requires consideration. Does your facility have the space needed for in-house equipment? If you choose to purchase an imaging system, what’s the cost of the real estate you’re allocating to house the equipment? Be sure to evaluate whether it’s the highest and best use for the space. If your facility is “landlocked,” a mobile service that can occupy parking lot space might be more practical.

3. Volume

The decision to purchase or rent a CT or PET camera depends heavily on testing volume; if there are too few patients it will cost the hospital a tremendous amount of money. If there is any question concerning volume, using a mobile imaging service is a way to better match the supply with the demand. It will allow your practice to offer an important service to your patients while eliminating the long-term commitment and responsibility of making a large investment. Mobile imaging can be provided on a long-term or short-term basis with limited or extended operating hours to accommodate the needs of your patients.

Each hospital is different

Committing to the purchase of in-house CT or PET equipment can be a big decision for a smaller hospital or medical practice. While it may be a cost-effective choice for some, a mobile imaging service is an excellent option that can help meet your need without incurring the long-term cost burden.



Digirad Sonographer published in Journal of Vascular Ultrasound

Posted on: 01.26.17

Digirad is proud to announce that sonographer Adam E. Jackson, RDCS, RVT’s recent reports on splenic artery aneurysms and spontaneous hepatic artery dissection were published in the December 2016 issue of the Journal of Vascular Ultrasound. The rarity of both cases, coupled with the use of ultrasound versus the typical CT, MRA or endoscopic modality, made his findings even more notable.

Case I – Splenic Artery Aneurysm

Case I was a young, healthy female, age 38, who was diagnosed with multiple splenic artery aneurysms. A splenic artery aneurysm is a dilation in the splenic artery, the blood vessel responsible for supplying the spleen with oxygenated blood.

Ultrasound is not a traditional modality in diagnosing multiple splenic artery aneurysms because it has limited spatial resolution and may be difficult in cases of obesity, bowel shadowing and atherosclerosis. The patient was an ideal candidate for the procedure, and Jackson was able to manage some of the other challenges by imaging her on her side instead of transversely through the abdomen. This allowed for a better view of the spleen. With the help of color flow technology, four aneurysms were found in the same vessel, which is extremely rare.

Case II – Hepatic Artery Dissection

Case II was a healthy, 54-year-old, male with hepatic artery dissection, a separation of the layers of the artery wall. It is an uncommon clinical event with very few reported cases in medical literature. This patient fit the demographics of the few reported cases but was unique in and of itself. Every other case study was diagnosed via CT. An initial ultrasound showed evidence of a “string sign” and Jackson was able to reproduce the same results to confirm the diagnosis. Ultimately the case demonstrates a very rare CHA variant that is present in only 1.3% of people and with a dissection in the CHA that has an incidence rate of less than 0.25%.

Click here to read the full report on splenic artery aneurysms and spontaneous hepatic artery dissection



5 mistakes that practices make when choosing a mobile imaging provider

Posted on: 06.23.16

Choosing a mobile imaging provider could be one of the best decisions you’ll make for your practice. As an extension of your staff, your services partner will be a direct reflection of the quality of service you provide, your level of professionalism, and the quality of your medical services. With all that at stake, here are 5 mistakes you want to avoid when choosing a provider.

1. Choosing a provider with old and outdated equipment

One key advantage of mobile imaging is access to the most current technology and protocols without the initial outlay of capital. Outdated equipment will affect your patients and your profitability. An old or outdated camera and/or outdated software can result in poor quality images, reduced clinical confidence, and damage to the quality of the service you provide. Offering nuclear imaging at your location should increase the perceived sophistication of your practice. Why dampen that with inferior equipment?

Additionally, consider the accessibility of replacement parts should the camera be in need of repair. How much time could the provider’s camera be out of commission if parts are not readily available, and how could that impact your scheduled service day? Today’s healthcare environment mandates quality and accuracy; risking false positive studies with outdated equipment or software is not acceptable.

2. Choosing a partner with a small infrastructure

How large is the size of the provider’s fleet? Do they have enough equipment to support their customers’ needs, plus some? Will they have a replacement camera available if another is unexpectedly in need of repair? Do they have enough employees to address the ongoing needs of sick days, vacation days, leaves of absence or employee emergencies? You need to have confidence that your mobile imaging provider will arrive and be ready to see patients on their scheduled service day, regardless of any challenges they experience along the way.

3. Choosing a provider solely based on price

A quality mobile imaging provider should structure your relationship to make your service days profitable. Some practices try to maximize their profit by choosing a provider who offers their services at the lowest cost. While the least expensive service may economically seem like the best choice, be sure to consider the whole picture. If a provider is cutting corners, it will be reflected in the quality of their service, potentially resulting in excessive false positive studies. This negatively impacts your patients and your practice’s reputation with referring physicians. Don’t be afraid to ask a low-cost provider how they are able to offer their services at such price points and still provide high quality studies with the best possible patient outcomes. If a prospective service partner is significantly lower than others, there is likely a reason, and it will end up costing you in the long run.

4. Choosing a partner without supporting services

Partnering with a mobile imaging provider should help take the burden of responsibility away from you and your staff, not add to it. An ideal service should provide all credentialing, accreditation, equipment with the latest technology and software, qualified staff, supplies, study pre-certification, online PACS access, and unlimited billing and coding support. Additionally, the equipment used by the service partner should be under continuous Repair and Maintenance service with a nationally reputable camera support and service provider. When you partner with a mobile imaging services company, the objective is for them to manage all aspects of the additional service so that you can focus on practicing medicine.

5. Unknowingly choosing a provider with illegal or fraudulent practices

Even though your imaging provider is a separate entity, when you hire them, you are responsible for their actions and behavior. It’s important to be well versed in the billing process and the exact terms of your contract. Be continuously aware and thorough in your understanding and agreement. It is also important to understand that the Federal Government holds you and your practice accountable for HIPAA compliance and the HIPAA compliance program of your service partner. Ignorance will not exempt you from the legal consequences of fraudulent and unethical practices.



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