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4 Ways to Get What You Need from High-Def
Advice if you're considering upgrading to high-definition imaging.
Nathan Hall
Publish Date: February 9, 2008   |  Tags:   Surgical Video and Imaging

HD is all about picture clarity, so how do you justify the price and quantify the benefits in terms of clinical outcomes? Here's advice for doing that.

How to justify the higher price
Expect to pay around 30 to 50 percent more for a high-def imaging system than a standard-definition system. That's no small thing. Are the clinical benefits worth the extra you'll pay for a better picture?

HD imaging's increased image depth gives you an almost 3-D feeling. For image-driven procedures like minimally invasive surgery, increased image sensitivity, accuracy and stability is vitally important.

"The pictures we see on the monitors with our new HD system are much more vibrant," says Laura Murphy, RN, MHA, director of operations at Evansville Surgery Center in Evansville, Ind. "Yes, it was more expensive, but the image quality we're getting from ours is remarkable, and the physicians are happy, so it's money well spent."

From the camera to the monitor, the main feature that makes HD systems better than standard-definition systems is their ability to capture and display more imaging data, letting your surgeons theoretically perform better surgery (better depth perception) and work at a faster pace (because they can see sutures better, they can tie better knots).

"One surgeon said that the only way he could get a better view would be by sticking his head into the patient's belly," says Ms. Murphy.

Increased efficiency, too
It's not only surgeons who can work more efficiently with HD. At Glens Falls Hospital in Glens Falls, N.Y., Kristy Vincent, RN, CNOR, patient care coordinator for perioperative services, purchased more cameras when she bought a HD system so her staff wouldn't need to process them as often. That let her facility fit in one or two more cases each day.

"The only problem we had is that we didn't purchase new printers, so trying to adapt the new equipment with our old printers turned out to be an issue," she says. "Otherwise, our system is easy to use, the pictures are very good and, now that we're not doing as much camera processing, our cases are moving faster."

Getting the best price
Justifying the costs of an HD system is one thing, but finding the funds to pay for it is something else entirely. Once you've compiled quotes from several vendors, it's time to figure out if you're going to purchase it outright or lease it. "If you don't figure that out now, you'll be scrambling when the doctors say they want to get an HD system," says Stuart Katz, CASC, executive director of Tucson Orthopaedic Surgery Center in Arizona. "There's some homework you need to do with your administrative board and the local financial institutions before you delve into something like this."

Ask your vendors for creative financing such as discounts for paying for the system upfront or for purchasing ancillary equipment such as shavers, says Mike Pankey, RN, MBA, administrator at the Ambulatory Surgery Center of Spartanburg in South Carolina.

Make the most of the trials
Now that you know how you're going to pay for your system, it's time to call the vendors and set up trials. "It's all well and good to go to a show and have the sales rep tell you what a system is supposed to be like, but without being able to use it intraoperatively, that doesn't make a lot of sense to us," says Mr. Katz, who is currently scheduling trials at his facility. "HD may be better than what you have now, but you have to ask if it is significantly better and are you getting that much more diagnostic quality out of it."

This is where the physicians actually get to see the HD images. It's not uncommon to hear complaints that come from unfamiliarity. "The image seemed elongated on one of the systems we recently had in a trial, so the surgeons said they didn't feel like it was as accurate an image as what they'd like to see," says Debbie Hay, RN, BSN, president of the Texas Institute for Surgery at Presbyterian Hospital of Dallas. "That system isn't completely discounted, but it's certainly a disadvantage for them."

When Ms. Vincent scheduled her potential vendors for trials, she arranged them so there was a one-week overlap between each vendor. That allowed her surgeons to directly compare the systems simply by walking into different ORs as opposed to trying to remember what the pictures looked like a month later. This, she said, made it easy for them to pick their favorite system.

In addition to the surgeons' opinions, Ms. Vincent also collected input from staffers about how easy the systems were to set up, move and otherwise use. In particular, she gleaned more information about how these systems could reduce turnover time. "We talked to central service throughout the trials to see how well they could process the new system's devices, which companies' instruments were the easiest to process and if they were autoclavable or needed to be sterilized," she says.

The trial is also a good opportunity to reassess your equipment needs, like Ms. Murphy did when she told her vendors not to bring in any cameras. "Since we didn't want to change our scopes, we wanted them to put their heads on them," she says. "Then they attached these to the monitors so we could test their compatibility with what we already had."

Before starting the first procedure in a trial room, Ms. Murphy says her staffers autoclaved the vendors' components 10 times to be sure they were durable enough to survive the process. "We tried to put it through all the things we knew were difficult on equipment," she says. "In any surgical setting, the turnover has to be very quick, so for me that means the product has to be durable."

The Clinical Utility of HD Endoscopy

Although HD endoscopy is only in its first generation, these systems offer considerable advantages over standard-definition scopes. The images enhance your view of the polyps so you can examine their edges and their degree of delineation to significantly improve your diagnostic capabilities.

Thanks to the clear images, physicians can tell an adenoma from a hyperplastic polyp with almost 100 percent accuracy.

Scopes equipped with narrow-band imaging can enhance the effectiveness. This technology lets you change the imaging modality to illuminate mucosal and vascular patterns. This makes it much easier to find and define lesions by distinguishing them against the rest of the lining in the patient's lower intestinal tract.

The slim size of some new HD endoscopes means that they could be more comfortable for your patients. These days I almost exclusively use a pediatric HD scope because it's flexible enough to move through the patient's colon without stretching the patient's mesentery yet is rigid enough to keep moving through the colon.

— Jerome D. Waye, MD, FACG

What can vendors do?
The trial is also a good opportunity to assess how much service you can expect from your vendors and clear up any lingering concerns about the cost of the projects. If you know what to ask the sales reps, you can get them to do a lot of work for you.

During the trials at Ms. Murphy's facility, the sales reps worked closely with the physicians. She told them, "You're selling the system, not us," and had them on-site to answer any questions and troubleshoot any problems the OR staff had with the system. But Ms. Murphy says she also told the sales reps that the HD systems were all they were selling. "We made it clear that they were here to sell their product and their product alone," she says. "They couldn't say to our surgeons, ????-??While I have your ear, let me tell you about some other equipment our company makes.' If you let that happen, the next thing you know the surgeons will ask for new clippers or cameras or other products from that company."

When the trials were done at Ms. Vincent's facility and she had picked the vendor, she says the sales rep made a final speech before the purchase so everyone knew what to expect. "He told us what we were getting with the cameras and lenses and how we'd handle processing them before bringing in the systems," she says.

Your vendors may also help you get the word out to the local community, says Mr. Pankey. His facility was the first in his area to get an HD system, and the vendors helped him publicize this with marketing materials such as advertisement templates and press releases. Now that he's looking at upgrading to a newer system, he's asking about how the advertising can give his facility an edge in his market.

"A lot of vendors have departments to help with this," he says. "You will have to pay for the advertisement, but you'll get the information out there with something like a press release to the local newspaper."

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