As a former product sales manager for a world-renowned medical-equipment company, Karen Leppert knew the drill by heart. Show up, pitch the product to the healthcare facility, make the sale?and move on to the next client. For the next 6 months, a dizzying string of company reps would drop in on the facility, deliver a crash course in technical support, and fade into the background just as quickly. Then, maybe, Leppert would make a courtesy call. So much for total project commitment. It was all rather disconcerting to radiologic technologists often left to their own devices. Leppert vowed that things would be different if she were ever on the opposite side of the purchasing equation.

“As medicine evolves and becomes more and more electronic,” she explains, “it’s not just about how the equipment can meet the customers’ needs, improve and eliminate waste, and obtain the electronic image. It’s also about how these vendors can provide a total solution to your integration of other systems. There’s so much more to project management than just selling.”

Now director of imaging at the Everett Clinic (Everett, Wash), Leppert recently supervised the facility’s major purchase of three DR units from Core Medical Imaging Inc (Kenmore, Wash), authorized dealer for Canon Medical Systems (Irvine, Calif). From the outset of the process, Leppert insisted that history not repeat itself. In other words, whatever vendor the clinic chose as its supplier would be in it for the long haul.

The decision to spend nearly $1 million on the systems did not come lightly. The entire process?from developing a project team, with a senior radiologic technologist as a project lead, to the installation or modification of equipment and the training of staff?took 6 months. In Leppert’s view, however, the clinic had no other choice; it was a matter of dollars and sense.

Decision-Making Process

Shown here at the Everett Clinic is the CXDI-50G DR system retrofitted to a bucky table as well as a CXDI-40G in an upright system.
Shown here at the Everett Clinic is the CXDI-50G DR system retrofitted to a bucky table as well as a CXDI-40G in an upright system.

For all equipment and software upgrades, the Everett Clinic develops a project team, which compiles a situation target proposal with specific criteria to meet its enterprise and radiology goals. Reevaluated annually, these goals take into consideration patient care and improvements to the enterprise?such as the entire Everett Clinic experience, which deals with patient/customer experience improvement across the board.

“First and foremost, we wanted to improve the customer experience, which includes our patients and our physicians,” notes Leppert, who’s been with the clinic for 7 years. “Second, we wanted to meet our core values. We’re always looking for ways to improve our quality as well as eliminate costs or inefficient system processes to improve operations. For example, film costs are extremely high, and with that comes the use of chemicals.”

DR is a direct imaging system that captures an image when an X-ray is taken; the system sends the image directly to a computer within 3?5 seconds. The technologist reviews the image and can either accept or reject it without leaving the patient. In comparison, if a radiologist is unable to read an image when using film-based technology, he or she must repeat the process. That means reradiating the patient. Clearly, DR offers a safe, quick, and inexpensive alternative.

“Since we want to continue to improve patient turnaround times,” Leppert says, “we have to be more efficient. What we want to do is assign more equipment to meet the increased volume without necessarily having to add more staff. In some circumstances, we have been able to decrease staff.”

Managing costs while increasing patient care go hand in hand at the clinic, which has been in business since 1924. The facility comprises two centrally located main campuses and seven outlying satellites in Northwest Washington. The clinic draws from a population of 100,000 in Everett proper and more than 600,000 from a 2,000-sq-mile area of Snohomish County. The 200-plus physician-owned multispecialty clinic had 130,000 visits to its radiology department in 2004. That number translates to more than 11,000 patients per month handled by a staff of 78, of which 60 are radiologic technologists. By sheer volume alone, the clinic was ready for a radiology upgrade.

The Right Stuff

Once the project team decided on a timeline, the tasks to be completed, and the equipment needed, two or three vendors were selected based on their reputation, market share, information gathered from trade shows, and market intelligence reports from such sources as MD Buyline (which provides competitive price and equipment analysis). Leppert says Canon Medical was selected based on the company’s “total commitment, total project management, and total integration support.” She adds that the company was able to provide “a total integrated solution to meet our customers’ needs and our future vision.”

This general radiology room at the Everett Clinic noted efficiency improvements after installing Canon Medical's CXDI-40G in an upright system.
This general radiology room at the Everett Clinic noted efficiency improvements after installing Canon Medical’s CXDI-40G in an upright system.

Canon Medical had talked the talk. But could it walk the walk with the specialized needs of the Everett Clinic? Three DR systems were ordered for three separate radiology rooms on two main campuses, but the needs varied for each space. In some circumstances, not all the DR hardware was necessary. For example, the existing X-ray table or generators were merely retrofitted to accommodate Canon Medical’s DR. Flexible, portable plates were purchased for all three units. Each room cost varied, depending on the number of plates and design, and ranged from $290,000 to $400,000. The clinic ordered two DR two-plate rooms with CXDI-50G and CXDI 40G; and one two-plate room with a CXDI-50G and CXDI 40G retrofit.

“One size does not fit all,” Leppert insists. “We put in three different units in three different areas. Two existing X-ray rooms required a total removal of all equipment; one room was retrofitted.” After the rooms were prepped, installation from start to finish took just 3?5 days. In an unusual twist, the technologists were able to hit the ground running. According to Leppert, training was modified from the standard textbook “sales protocol”?in other words, instruction and a few follow-ups after the equipment was installed. Instead, included in the clinic’s target proposal and eventual vendor selection was a requirement that, before the first switch was flipped, Core Medical Imaging representatives would provide six courses on the history, physics, and inner workings of the DR systems to 25 staff members.

Measuring Success

Although the DR units have been running only since November, December, and February, respectively, the Everett Clinic already has noticed a marked savings in time management, patient turnaround, and product quality?not to mention a healthier bottom line.

“We have definitely saved time and money,” Leppert says. “We’re still in the early stages of examining the impact [of switching to DR], but it looks like we’re meeting our criteria. Number one, there’s been approximately a 30- to 40-percent improvement in productivity from the technologist. Number two, we have a 20-percent improvement in patient turnaround time. And number three, we’re noting a 60-percent decrease in film costs.”

Industry experts predict that a DR unit should pay for itself in 2?2.5 years. “I think we’ll meet that goal,” Leppert says, confidently.

The speed at which a digital image reaches the technologist, and ultimately the patient, first came to light during the clinic’s initial workflow analysis. “The workflow analysis showed that our patients’ turnaround time would be faster, and our interpretation of the reading should be faster,” she says. “The image is available in three to five seconds now, versus 45 minutes.”

Then there’s the quality of the digital image itself, which has dramatically improved. “We measure quality by the remarks of our customers, which are the physicians who review [the images]. The customers and patients benefit significantly, since the image is now digital. If they have prior examinations at one of our partner hospitals, we can look at the prior images, because they’re on our PACS,” Leppert says. “So again, the customer experience is really improved because our radiologists are more accurate in their diagnosis, because they have prior images and data available electronically.”

For Leppert and the radiology department at the Everett Clinic, adding DR units has increased the quality and accuracy of the digital image. And the by-product is better patient care. “When you improve your accuracy and patient care,” she says, “that’s a significant step toward the overall quality of your operation.”

Dave Cater is a contributing writer for Medical Imaging.