By K. Richard Douglas
How many imaging teams can claim centuries of experience? If you are the imaging team at Banner Health, you have the green light to do just that. The team has more than 450 years combined experience. The 37-member team is dedicated to medical imaging and radiation/oncology service.
“The imaging team is led by Director of Diagnostic Imaging Support Services Sherman Abernathy in Arizona who is flanked by three senior managers; Jon Morgan, Guillermo ‘Memo’ Valles and Jack Plummer,” says Perry Kirwan, MSE, CCE, vice president of technology management for Banner Health.
“In Colorado, the team is led by Todd Lowe, senior director of technology management/ENTECH. He oversees all of the non-imaging and our ENTECH operations for all states outside of Arizona,” Kirwan says.
Banner Health is one of the largest nonprofit hospital systems in the country.
The system consists of a 5,500-bed integrated health delivery network headquartered in Phoenix, Arizona and operating in six states. The integrated delivery network (IDN) consists of 28 acute care hospitals ranging in size, scope and complexity from small, rural facilities to quaternary academic medical centers and every size and flavor of community medicine facility in between.
The team has a large inventory of equipment to manage. They provide service to 132 fixed X-ray rooms, 123 portable X-ray units, 77 R&F rooms, 189 C-arms, 59 cardiac cath labs, 26 interventional radiology labs, 94 CT scanners, 10 PET enabled technologies, 43 nuclear medicine cameras, 44 MRIs, 109 mammography systems, 643 ultrasound units and 19 radiation oncology systems (linear accelerators, tomosynthesis, image-guided surgery).
The team’s training comes by way of OEM, third party and through cross training.
“Our pre-purchasing processes are highly structured to provide OEM training as much as possible,” Kirwan says.
“Most purchases come with a minimum of two-year warranty so that there is time between initial commissioning and warranty expiration to train our engineers. This is critically important for brand new models that enter the marketplace as there typically are no third-party resources that we can turn to for training, service and parts,” he says.
He says that the occasions where such an approach is not possible, they utilize many reputable third-party sources to help supplement training.
“Third-party training has been invaluable in training engineers into imaging or upgrading their current skills. It has also been valuable to help us take over service on imaging modalities that are added to the inventory via acquisitions. Cross training is a key feature in skill development as well in that we expect engineers that are formally trained to teach other engineers via a see/learn one, do one, teach one approach,” Kirwan adds.
“Our operations budget for training ranges from $200-$250,000, however the value of training that we receive in any given year is almost double that (taking into account negotiated service schools, etcetera),” he says.
Big Projects
Big hospital systems provide big projects and the Banner imaging team has met that challenge head on.
“In the last 24 month, the imaging team has been involved with several high-profile projects including the building of two large academic medical center tower projects that are about $900 million and include about $40 million in new imaging equipment,” Kirwan says.
“Both projects are happening simultaneously which creates some challenges on bandwidth when mixed with the routine service volumes. These projects feature a mixture of new implementation and relocation of existing systems,” Kirwan adds.
Radiation dosage has become an important focus in health care and the implementation of procedures to monitor it are critical. The imaging team has executed procedures to monitor it enterprise wide.
“This system has the ability to receive dose specific information from imaging modalities injected with PACS information to help provide information relative to the radiation dose that a patient receives. This is an area that a fair number of facilities cannot quantify because they cannot measure it and that is the beauty of the software in that it shows an organization its baseline level of performance and most people, including us, are shocked by what we see and what we didn’t actually know,” Kirwan says.
“Data analyzed from the system have played a large role in helping medical physics and radiologists standardize imaging protocols across the IDN in modalities like CT. The ability to measure dose performance enables knowing whether the organization is really performing in the spirit of ALARA or Image Gently/Wisely. Notifications can be configured as well to alert clinical and business leaders when certain thresholds are exceeded. This work was recently recognized at one of our academic medical centers by TJC as being a best practice,” Kirwan says.
He also says that the team is involved in implementation of a business analytics solution that holds the promise of helping better optimize the clinical and business operations of all of the medical imaging departments.
“This system has unique and vendor agnostic connectivity to the imaging modalities, radiation dose monitoring, PACS, RIS and other BI related systems in the IDN to provide access to departmental performance through an easy to use dashboard,” Kirwan says.
He says that the dashboard contains information about custom set key performance indicators (KPIs) relating to the utilization, usage and performance of the connected systems as a whole while also enabling a specific modality to be examined in greater detail.
“The data set further includes access to technologist level information to help identify insights into how the systems are used, what features are/aren’t utilized, and outlying issues that might require further training,” Kirwan adds.
The team also helps manage and commission between $10 and $15 million of refresh replacement imaging capital per year just for good measure.
The imaging team has also recently developed a workflow to help the internal development and construction department, as well as contracted design team consultants (architects and engineers), make decisions on how to supply incoming power to medical imaging modalities.
“These decisions aren’t to deviate from manufacturing specifications but to provide additional clarity on what can be on normal versus emergency power, when other power bridging and/or conditioning provisions are required, and how this information needs to be incorporated within the physical plant of a given facility, etc. This is information that the manufacturer specifications do not define because they are locally based decisions,” Kirwan says.
Big hospital systems demand big service teams and the imaging team at Banner Health fills those big shoes with centuries of expertise to keep diagnostic imaging online.
