This report originally appeared in the June 2009 issue of DOTmed Business News

Like every industry, health care is facing tough times due to a shaky economy. "The tough environment is forcing many hospitals to evaluate the cost of outside service contracts on medical devices and whether bringing them in-house will save money," says Jay Oyakawa, Chief Development & Operations Officer at ReMedPar. In fact, many health care facilities are finding they can save money by performing many services themselves and are making this transition by recruiting, staffing and training personnel to fill roles once performed by outside service vendors. "In tough financial times, more customers are seeking alternatives that provide them comparable quality at significantly lower costs from their traditional vendors," says Oyakawa.

The continuing education sector of the medical field has also been affected by the economy because many of the facilities that had once fully reimbursed for continuing education, travel and per diems, are now tightening those budgets or discontinuing reimbursements entirely. "Even though support is being cut back, continuing education requirements are increasing," says Bill Bresser, Director of Marketing at Medical Technology Management Institute (MTMI), in Waukesha, WI. "Now more so than before, modality-specific continuing education is recommended and I only see that trend increasing." Bresser says that while he thinks it's a good thing to recommend training specific to a modality, it does make it harder for health care professionals to find enough training to meet requirements.

Who's doing the training?

Radiological Service Training Institute (RSTI) provides diagnostic imaging training using 33,000 sq. feet of space filled with state-of-the-art imaging equipment. In the past three years, RSTI has spent more than $500,000 upgrading their lab equipment used to offer a variety of courses including foundations in ultrasound, diagnostic X-ray, computed tomography, PACS and DICOM and mammography/women's health. In these classes, the technologies, principles and physics related to the modalities are covered.




RSTI trains around 500 students each year, including hospital personnel, OEMs and independent service organization employees and self-pays. They also offer closed-door classes for various equipment manufacturers. The most popular training at RSTI provides the basic X-ray or X-ray Certificate Series known to the market as "Phase I through Phase IV," and any of the digital X-ray classes.

Most general courses range from $2,000 to $3,000 per week - while a cutting edge course like digital mammography costs around $5,000. Most of RSTI's students are there at the request of their employers, who pay for the training. There are also a significant number of people looking to change careers and paying for classes on their own. "Repair and maintenance training may appear to be expensive at first blush, but the truth is, hospitals and third parties recoup their costs within the first six months," says Dale Cover, Jr., VP of Training & Logistics at RSTI.

Radiologic Educational Services (RES), located in Austin, TX provides continuing education programs to radiologic, mammography and ultrasound technologists. The programs are American Society of Radiologic Technologists (ASRT) approved and meet the American Registry of Radiologic Technologists (ARRT) and/or American Registry of Diagnostic Medical Sonographers (ARDMS) license renewal requirements and all state licensing renewal requirements. They range from 5 to 28.5 credits and are approved by the ASRT Department of Continuing Education. The programs offered at Radiologic Educational Services are correspondence courses and come with textbook and post-tests mailed to the participants to complete in their home or office. Sixteen programs are offered including mammography, general radiography and sonography. A score of 75% or greater must be achieved on the post-test answer sheet in order to pass. "If anything, more technologists are looking for inexpensive ways to meet their continuing education requirements, and we fit that bill," says President of RES, Caron Colvett, RT.

Similar training goes on at Advanced Education Center (AHEC) located in Houston, TX - offering training and continuing education for technical providers of services in imaging. AHEC is accredited to sponsor physician CME and approved for continuing education for radiologic technologists. AHEC provides the training/CME required to meet accreditation and, combined with the experience gained in the sponsoring health care facility, meets the qualification to perform certain duties or to take an advanced standing exam. AHEC has 40 Internet-based educational activities that satisfy the requirements to gain renewal of license, and a post-test is given with each activity. Some of AHEC's sponsors and partners include Sonosite, Philips Ultrasound, GE Healthcare, Beekley Markers, Siemens Ultrasound and Cardiovascular Healthcare Evaluation Systems, Inc. "We train customers, present special courses for them, train their salespeople, and they help us with equipment for training that matches the customer's purchase. It's really a win-win for everyone," says AHEC President, Marilyn Sackett. AHEC training comes in two forms: teaching new imaging skills like ultrasound, MRI, CT, mammography and bone density for career advancement; and continuing education for performance improvement.




The Medical Technology Management Institute, (MTMI) headquartered in Waukesha, WI offers both initial training courses and continuing education courses for medical imaging and radiation therapy professionals. Initial training courses are designed for imaging professionals who want to expand their careers into a new modality. A radiologic technologist could come to an MTMI training course and walk out with enough knowledge to pass the specialty registry and start scanning patients.

Initial training and continuing education courses are offered in radiography, mammography, computed tomography, magnetic resonance, imaging, bone densitometry, breast ultrasound, digital radiography, PACS and medical dosimetry. They all provide continuing education credits.

J. Ed Barnes, Ph.D., Executive Director at MTMI explains that individuals who complete MTMI training courses frequently utilize the certificate of completion they receive to show prospective employers they have taken the initiative to get training to qualify for a new position or promotion. "We can also assist individuals that have completed our training in finding jobs through our sister company Clarus Medical Staffing," says Barnes.

ReMedPar customers are cognizant of the foregone revenue associated with excessive downtime according to Oyakawa. As a result, the company has seen a significant increase in the interest surrounding its Technical Training Program. "An average facility could lose more than $67,000 in revenue per day by having just one inoperable CT System," says Oyakawa. That means it's highly beneficial to have the best training for those operating the equipment.

According to Kim Presley, Sales Operations Communications Leader at ReMedPar based in Goodlettsville, TN, "If you don't see what you need, we will customize a training program for you."

Although the CT program has been the most popular, with C-arm and portables classes a close second, their newly added ultrasound and additional X-ray offerings, like the Innova and the Integris courses, are quickly becoming favorites. Presley says that tuition for classes ranges from $2,000 to $10,000.

Healthwork, Inc., Douglassville, PA, provides technical and clinical personnel, education and specialized knowledge-based resources, including consulting services, to serve the diagnostic and invasive cardiovascular and imaging industries - delivered through a variety of channels. "Teaching at customer facilities provides an option for the greatest participation among the staff at their catheter and EP labs," says Keith Chamberlain, MA, MBA, EVP, Education and Chief Marketing Officer.

Healthwork also offers foundational classes online via the eLearning Center, and produces other self-directed learning modules including printed articles and CDs. Chamberlain explains that the company also has a clinical staffing division that provides area hospitals with registered and credentialed nurses and technologists with invasive cardiology experience including electrophysiology and interventional radiology backgrounds. Some of Healthworks, Inc. clients include the Hospital of the University of Pennsylvania, Kaiser Permanente, Albert Einstein Medical Center and Philips Healthcare and Atrium Medical Center.

"Healthwork has an industry sector business strategy and works collaboratively with manufacturers in this business unit," says Chamberlain. "We license educational content, as well as co-host invasive cardiology programs with companies including Toshiba America Medical Systems, Philips and Bracco Diagnostics (contrast media). "Being vendor neutral, we are able to build custom clinical education programs for the customers that these companies serve as a means of providing additional client value." Recently, Healthworks partnered with Philips Learning Center offering a series of live lecture webinars in Electrophysiology.

ISO and OEM Training Boost Skills

"Responding to industry changes is how medical imaging equipment services are now being delivered," says Paul Baumgartner, Director of Service Development at MagnaServ Enterprises, Inc., "and field service technical training is extended to in-house biomedical organizations."

With fully functioning MRI and CT staging bays installed at MagnaServ's corporate facility in Stuart, FL, a comprehensive training program is in place to ensure field engineers receive periodically updated service training. The company also takes the training program to the customer site. Training programs include both classroom and equipment lab instruction, which enables the field service professional to periodically update technical competencies.

Responding to industry changes in how medical imaging equipment services are being delivered, field service technical training is also extended to in-house biomedical organizations through MagnaServ's "In-House Choice" equipment service offerings. Biomedical staff training courses are custom-tailored to provide specific equipment technical training to qualified clinical engineering staff. "By training qualified hospital biomedical staff to provide "first call" and preventative maintenance services, it is a benefit for the facility," says Baumgartner. "The facility realizes a significant service contract cost savings, with improved on-site service technician response times."

Some ISO training programs are very specific to one modality. Maull Biomedical Training, Aurora, OH is one that fits this description. The company teaches biomedical service technicians how to operate, PM and calibrate contrast injectors and train on MedRad and Liebel-Flarsheim systems. "Our training provides a huge cost savings to our customers, even short term," says President Steve Maull. "The average service contract for a contrast injector is around $3,000, and a typical hospital group may have five to ten or more of these injectors on contract. So, that is $15,000 to $30,000 a year paid-out for a service contract on a pump." Maull goes on to say for that same $3,000 Maull Biomedical trains students to take all (or nearly all) of these injectors off contract, providing significant, immediate and long-term cost-savings.

Maull says that injectors are really much simpler than the manufacturer would have you believe, "they are just plain piston pumps." Training takes about a day per injector and service technicians are taught proper operation of each model of injector they wish to receive training on, as well as general troubleshooting issues they need to be aware of for each model. They also receive free technical support after training has finished in the event they come across something that wasn't presented in class (troubleshooting issues typically).

Sonora Medical Systems, Inc. is an OEM that trains biomedical and clinical engineers to service ultrasound and MRI equipment and offers basic courses in each modality as well as a number of advanced courses that are system-specific. The most popular course offered at Sonora is for ultrasound, such as advanced training for Philips IU22 and IE33; for Acuson Sequoia; and GE Logic 9.

"Right now, a number of other companies offer the same resources as we do," says Eddie Henry, Marketing Manager for Sonora. "The main point that sets us apart is the fact that our training is college accredited, and we are in partnership with Front Range Community College (FRCC) to ensure the education we provide is undergraduate level in quality." Sonora instructors are certified through FRCC and the program is accredited through the Colorado Community college system (CCCS).

Philips Healthcare provides training for its medical equipment customers to achieve maximum utilization of their equipment capabilities. In addition to providing product training for customers, Philips Healthcare also provides continuing education to healthcare professionals. Global Director of Learning Services at Philips Healthcare, Douglas Dell, says his department focuses on the continuing education programs serving over 200,000 radiologic technologists, sonographers and nurses through online courses available on the Philips Learning Center. "We offer over 450 accredited courses for Continuing Education, ranging from Anatomy and Physiology to advanced courses geared to those working with modalities like CT, MR and Ultrasound." The Philips Learning Center sources content from internal experts and over 25 external authors and organizations that share their knowledge with a cross-section of users to advance understanding in support of better patient care. As an example, the Philips Learning Center recently announced a program with HealthWorks, Inc. offering a series of live lecture webinars called Electrophysiology: The Essentials.

Philips Healthcare also offers specialized technical education for hospitals at its Cleveland Training Facility. Programs are offered to everyone from biomedical engineers to dealers and military personnel. Individuals are trained in-house at the Cleveland facility as well as locally through the Philips Trainer Program. JoAnne Bolas, program director for the Cleveland Training Facility says "Philips Healthcare actually has training campuses located in Cleveland, The Netherlands and Singapore. Our learning programs involve a blend of face-to-face training and online learning courses and we also send trainers out in the field to teach hospital personnel how to run and/or repair Philips equipment."

PMAs

Finally, Professional Medical Associations (PMAs) have always been a source for advancing health care standards through conferences, continuing medical education courses, practice guidelines and more. Many of the continuing medical education (CME) courses they offer are designed to inform association members of new and more effective patient care. These courses are usually offered at the association's annual conference or other educational meetings and members receive credits for attending.

The Executive Director of the American Healthcare Radiology Administrators, Edward J. Cronin, Jr. says, "The number one goal of AHRA is to deliver state-of-the-art, multi-level educational programs for imaging managers at all stages in their careers." AHRA offers a complete slate of professional development programs, including a selection of education conferences and seminars through its Leadership Institute, diverse networking opportunities, publications and the Certified Radiology Administrator credential. AHRA also partners with leaders in the industry like Bayer and Siemens to advance the quality and value of leadership management in imaging departments.

There is a wealth of opportunity for those just starting out or choosing to expand their knowledge in the medical device field. For more information and opportunities go to DOTmed's Career Corner at www.dotmed.com.