By K. Richard Douglas
Based in Clearwater, Florida, BayCare Health System has been serving the Tampa Bay and central Florida region’s health needs since 1997. The system includes 14 hospitals, four outpatient surgery centers, 14 urgent care centers and 27 outpatient imaging centers, with 3,511 hospital beds in total.
Servicing and maintaining the imaging equipment in those imaging centers, and all the other facilities, falls to BayCare’s 11-member imaging services team, which handles all imaging modalities along with ultrasound and radiation therapy. The team’s field imaging service specialists are a component of the larger 97-member clinical engineering department.
The imaging team is responsible for 28 MRIs, 45 CT scanners, 33 digital mammography systems and eight linear accelerators. They support 314 different fixed imaging modalities. They also support 157 mobile X-ray systems across all BayCare facilities, including 86 C-arms and mobile extremity units, 56 mobile X-ray units, 12 specimen units and five dental systems.
“All modalities within imaging are either serviced directly or have shared service responsibility. Other services are managed directly by our imaging staff with the original equipment manufacturer (OEM) or third-party vendor,” says Walter Barrionuevo, director of clinical engineering/medical device integration and security and end-user and infrastructure services (EIS) for BayCare Health System.
The imaging service team attempts to keep as much of the work in-house as possible. Barrionuevo says that all imaging devices are serviced directly or triaged by his team.
“Only a few of our systems have full-service contracts coverage. Full-service coverage is applied to assets that are considered mission critical,” he says.
“If they are down, the hospital would have to divert services and/or the cost liability related to the replacement parts and assemblies within the image chain is too great.”
Part of keeping devices operating smoothly is to make certain that clinical colleagues are fully trained on proper usage.
“BayCare’s quality model emphasizes education and training as well as continuous improvement. Our end-user training is provided in several ways, [including] manufacturer provided end-user training, negotiated at [the] time of purchase [and] one-on-one interactions with our staff,” Barrionuevo says.
He adds that his staff is highly skilled and trained to provide their customers with quality “on-time” service as well as any end-user training necessary to improve the competency of the user and allow for safe use of the equipment.
Training is also provided through clinical engineering-sponsored equipment in-services, education during clinical staff meetings and medical device training using six sigma methodology.
In addition to keeping as much service in-house, the imaging service team, and the larger CE department, is very involved in the capital purchase process.
“BayCare Clinical Engineering Services serves as an approving body on all new capital equipment purchases, replacement of capital equipment and capital equipment acquired through construction. Additionally, BayCare Clinical Engineering provides our customers with asset management and consultative services to assist our customers with capital equipment purchases and budget forecasting,” Barrionuevo says.
The team’s imaging service engineers keep current on clinical and technical advances in several ways.
“Based on strategic decisions to either increase competency and/or reduce cost, our staff is provided with a combination of factory certification and third-party training,” Barrionuevo explains.
“We believe having the manufacturer’s certification, coupled with the analytical and engineering skills provided by select third-party training partners, provides our staff with a well-rounded knowledge base to perform required service on our imaging modalities.”
The team’s projects have included everything from cybersecurity measures to helping patients protect themselves from receiving too much radiation.
Barrionuevo says that some of those projects include an enterprise-wide GE Dose Watch implementation which allows all CT scanners to report to the GE Dose Watch server, which collects patient dose information that can be used to identify outliers or standardize protocols across the system to achieve the lowest dose possible without compromising image quality.
He says that another project has included universal viewer/PACS upgrades with the implementation of a GE PACS upgrade and universal viewer which required adding or changing the modality’s network information.
The importance of cybersecurity remediation and hardening has found the team installing anti-virus, operating system patches, Access Control Lists (ACL) as well as monitoring their network via Network Access Control (NAC) and Zingbox which provides visibility into the nature and actions of all connected devices.
Barrionuevo also says that the team has been involved in an enterprise-wide Xcelera implementation. Xcelera is BayCare’s enterprise solution for cardiology. Xcelera provides image storage and reporting, which required adding destinations to all catheterization labs, and cardiology specific ultrasound systems.
Mother Nature Creates a Challenge
The area where BayCare’s facilities exist happens to also be one of the areas that were thought to be in jeopardy because of Hurricane Irma. The Tampa Bay area was buffeted with strong winds, experienced power outages, had problems caused by a storm surge and received lots of rain.
The imaging services team was all in with their efforts to help the health system prepare for any eventuality.
“Hurricane Irma swept through Florida leaving heavy damage and many residents without power — some for several weeks. Our hospitals and ancillary facilities were not immune to these issues,” Barrionuevo says.
“Prior to, during, and for several weeks after, our field service imaging specialists worked tirelessly to ensure patient care could continue,” he adds. “Our imaging specialists assisted in evacuating one of our hospitals and moving equipment to higher ground in areas susceptible to flooding. They prepared our imaging departments for the storm by shutting down power on all modalities, except MRI, at the breaker.”
Barrionuevo says that the imaging team members stayed onsite at the hospitals for 24 to 36 hours during the storm to support emergency equipment issues, and they provided remediation services, day and night, over several weeks, servicing equipment affected by power loss or severe anomalies.
“Several MRIs experienced cold head compressor and chiller support issues once power was restored. Emergency cryogen/helium fills were also necessary in some cases,” Barrionuevo adds.
The team also supports the HTM community while away from the workplace.
“Our clinical engineering services department is a corporate sponsor for our local biomedical society; Bay Area Association for the Advancement of Medical Instrumentation (BAAMI),” Barrionuevo says.
“Most clinical engineering team members, including our imaging specialists, are members of the local society (BAAMI), a chapter of the Florida Biomedical Society,” he says.
BayCare’s imaging service professionals keep the system’s diagnostic imaging capabilities up and running for the benefit of every patient, even in the worst of conditions.