Posted on August 4, 2018 October 4, 2018 by Greg Kemper

Pediatric Exam Tables For Your Most Precious Patients

PEDIATRIC EXAM TABLES

Pediatric treatment tables help keep young patients calm and comfortable during a medical examination in doctor’s offices, clinics or hospitals. Some pediatric exam tables come in colorful designs to create a fun and kid-friendly environment for children of all ages. If you work in a pediatric care facility, then pediatric exam tables are just what you and your patients need. Pediatric exam tables are smaller than treatment tables, typically sized appropriately for children of various ages. Most importantly, they’re designed with fun art and bright colors that help make children feel more at ease when visiting the doctor—a prospect that can be scary for young ones. Do you need new exam tables for your healthcare facility? From keeping patients and caregivers safe to meeting health codes to sticking to your budget, there’s a lot to consider before choosing the right tables for your hospital or private practice. That’s why we’re breaking down the different types of exam tables along with their benefits so that you can have a comprehensive look at what to expect before you start shopping.

TREATMENT TABLES

Treatment tables are the simplest form of exam table, and they are commonly found in physical therapy facilities and other medical areas where similar treatments are performed. This type of table is padded for comfort and upholstered in healthcare grade vinyl for cleanability. There may be a shelf or storage drawers underneath the seated area, but treatment tables are generally quite simple and meant only to provide basic functions needed in an exam area.

BOX TABLES

Standard box tables are found in most exam rooms. These feature the same padded vinyl seats as treatment tables, but the backrest of the chair is able to be moved up and down either pneumatically or electrically so that the patient can be easily repositioned as needed. Box tables typically include a heavy duty step to assist patients in getting up onto the table, which is raised high off the ground so that the exam can take place. Storage is often included within this type of healthcare table so that hospital gowns and paper rolls can be kept nearby. If possible, choose a box table with dual access drawers when outfitting a small exam room. This will ensure that healthcare providers can get to the contents of the drawers easily no matter where the exam table is set up.

Treatment tables are more than just a piece of clinic furniture. They ensure the best possible interaction between the therapist and special needs patient. Look at all selections of user-friendly wood, steel and pediatric treatment tables and accessories to find the right solution for your medical office. Visiting the doctor’s office as a child has the potential to cause anxiety and uncertainty. Oftentimes pediatricians design their office space to display colors and playful designs that are appealing to pediatric patients. If you’re looking for the appearance of a doctor’s office to help reduce anxiety for young patients, there are many types and styles of pediatric exam tables for you. Pediatric treatment tables are first designed with safety in mind. Although the tables are intended to entertain and maybe distract pediatric patients, safety and durability are essential.

There are a lot of fun pediatric treatment tables with different designs and accommodating features. We will talk about some basic functions, colors, and central themes. For example, there are some themes that you can find at every company that sells pediatric exam tables. We will look at six of the most popular themes and what you need in these exam tables for great ease and function in their use:

FIRE ENGINE: Your patients will be smiling when they see a Fire Engine pediatric exam table and won’t know even remember they are at the doctors office. You will be smiling too as you speed through exams without stopping for unhappy kids. Their ride will be a safe one with graphics that are permanently embedded in high pressure laminate and will not peel off The comfort pad is made from high-density foam and has premium stain resistant woven knit back upholstery . These tables have 3 separate storage units in them and a concealed paper dispenser.
SAFARI: Cruise through the jungle on a safari pediatric exam table. Kids will love “riding” on a safari wagon while getting examined and you can ask them about all the animals they see. This off-road vehicle sports plenty of animal illustrations, authentic wheels, and black tread tires. The 2″ thick replaceable pad will ensure a comfortable ride for your patients. This pediatric exam table is perfect for getting through the jungle safely and quickly.
TROLLEY: Bring a little bit of magic, comfort, and “Mr. Rogers” familiarity with a trolley pediatric exam table. Your patients will love climbing aboard a trolley designed table and it will have plenty of room for supplies in drawers, cabinets and paper dispenser that are hidden in the trolley itself. A trolley designed pediatric exam table is full of fun and functionality.
ZOO BUS: A Zoo Bus is always a popular motif for a pediatric exam table. What kid does not like climbing onto a bus, especially when they can pretend they are on the way to the zoo, with animals already peeking out of the windows? Your patients will love climbing up onto a Zoo Bus pediatric exam table. The pads should be a two inch foam pad with a durable kid-resistant cover. Drawers and cabinets should be easy to access and hidden in the design and art on the table.
OUTBACK RIDE: Capturing the same fun and excitement of a Zoo Bus or a Safari themed pediatric exam table, complete with animal laminate pictures in the windows of the Outback Ride, this table stays with the knowledge that all kids are delighted by animals. This pediatric exam table is perfect for getting through the outback (and the exam) safely and quickly.
ICE CREAM TRUCK: If you are looking for something a little different than animals, an ice cream pediatric exam table features a ice cream treats and imagination that your patients will love. Look for plenty of storage in a pediatric exam table with doors and full extension drawers. Some exam tables even have retractable foot rests providing a way for the kids that “can do it myself” to climb up. Maybe, if they are good, there may even be a treat waiting inside for them.

Pediatric exam tables can take a lot of the worry from little minds about visiting the doctor. Look for quality construction and durability. Also, look for rounded, soft edges and the ability to be cleaned often without chipping or fading any of the detail that makes them so interesting, comfortable, and fun for kids.

Posted on July 30, 2018 July 24, 2018 by Greg Kemper

KEMPER MEDICAL OFFERS TELERADIOLOGY IN THE IMAGEQUBE CLOUD PACS

INTERPRETATION

When patients require procedures that involve medical images, the actual scans are only half of the process. What remains is the reading, or interpretation, of the exam. This is usually handled by a doctor who’s a radiologist. Common types of exam modalities include X-Ray (Radiography), MR or MRI (Magnetic Resonance Imaging), CT or CAT (Computed Tomography) and US (UltraSound), among others.

TELEMEDICINE

Initially, exams like X-Rays were read on film by being developed and placed on a lightbox mounted on the wall. This meant the radiologist had to be on location at the facility where the modality was located to interpret the X-Ray. When emergency situations arose after hours, physicians would often end up driving back into the hospital to be able to review the results of a study. Early advances to address this inconvenience were made possible using a modem and a camera-on-a-stick (which was literally as described). This crude method was a slow transmission, but marked the beginnings of remote viewing in medicine.

With the advent of PACS (an acronym for Picture Archive and Communication System), access to receiving, displaying and storing exams from a multitude of modalities on one workstation was a giant leap forward for medical technology. But it was to go one further; sending exams, Telemedicine or Teleradiology.

REMOTE ACCESS

Teleradiology is the transmission of patient images from one location to another for the purpose of sharing studies with other radiologists and physicians. It offers improved patient care by allowing radiologists to provide their expertise without having to be at the same location as the patient. This is particularly important when a subspecialty is needed (like a pediatric radiologist or neororadiologist). Essentially, Teleradiology makes it possible for trained specialists to be available around-the-clock.

In order to protect private patient data from unauthorized access, the issue of being able to communicate securely is also a requirement. Teleradiology systems must be HIPAA (Health Insurance Portability and Accountability Act) compliant, to ensure that a patient’s privacy is protected. Many times, this requires communication over a VPN (Virtual Private Network), though some advanced PACS systems offer built-in encryption and security (making VPNs unnecessary).

COMPARISON STUDIES

When a new exam is done, it is useful for a radiologist to have access to prior exams in order to compare results. The convenience of storage in a PACS system makes comparison with previous studies possible. Sometimes, awareness and organization of multiple prior studies presents a potential problem. Radiologists don’t want to miss being able to reference a prior exam, but also don’t want to be overwhelmed by what could be irrelevant studies. Patients could have multiple prior exams, but if one is on a different body part than the most current study, it may not prove useful. Or, if exams were acquired at different locations, organization of them by a facility’s MRN (Medical Record Number) may not properly match them, as MRN naming conventions vary by site. This even presents a more dangerous situation, which is pairing unrelated exams due to unintentional MRN duplication. Add to this the potential for data entry typos common with human error, and the need for a reliable, configurable means of searching for prior studies is obvious.

Sophisticated PACS systems overcome these problems using a Master Patient Index (MPI). This functionality ensures a radiologist can access all prior studies regardless of where they originated. This is because the MPI overcomes demographic variances from disparate centers. Flexibility in matching exam search, using not just MRN, but name, date of birth, gender and RIS system, may deliver more accurate search results. This offers invaluable exam pre-fetch capabilities for consolidated sites.

TELERADIOLOGY

Teleradiologists can provide a Preliminary Read for emergency (or stat) cases, or a Final Read, for the official patient record and for use in billing. Preliminary Reports include pertinent findings. Final Reports include all findings and require access to prior studies and other relevant patient data. Turn-around time is often critical, with a 30-minute window common.

The past 25 years have seen tremendous growth in Teleradiology utilization. From initially using individual radiologists to interpret occasional emergency studies from off-site locations–frequently in the radiologist’s home, using a dial-up modem–it has expanded rapidly as the speed and accessibility of the internet improved and spread. Reading occasional studies per week turned into a handful per night, to working as much as a radiologist desired, with studies available 24 hours a day, seven days a week. Teleradiology saw the advantage of taking time zones into consideration; when it’s the middle of the night in Los Angeles (and few radiologists may be available), it’s early morning on the East Coast. Medical outsourcing grew rapidly, with radiology groups forming Teleradiology on-call services around the country. Some even expanded to taking advantage of international opportunities, using services based in India, Australia and Switzerland, to maximize the time zone difference for hospitals based in the United States. The American College of Radiology (ACR) requires physicians interpreting images in other states to be licensed in both the state where the image was generated, as well as the state where the interpretation takes place, which adds a further complication.

DICTATION

Radiologists have options when it comes to recording their impressions as part of their interpretation. Some capture their thoughts in audio recordings, which are then transcribed by a transcriptionist. Some launch a dedicated voice-recognition system, which transcribes their thoughts in real-time as spoken, and some use common voice-recognition programs interfaced with their PACS system. Many make use of dictation templates, including “normals”, which present an expected result for patients not presenting pathology, and can be easily tailored for selective patients with a few mouse clicks.

CRITICAL FINDINGS

When urgent findings are discovered during the interpretation, the radiologist needs to confidently communicate that result to the referring physician. This is often referred to as Critical Results. In addition to communicating the critical finding to the referring physician, the radiologist often follows up with the referring for an update on what actions were taken as a result.

KEMPER MEDICAL OFFERS TELERADIOLOGY IN THE IMAGEQUBE CLOUD PACS

With the ImageQube Cloud, teleradiology is available with all the functionality needed for utmost efficiency. It offers a configurable, remote application delivering real-time, fully-functional, fault-tolerant access to studies, with the capability to display all modalities, including built-in PET Fusion, Digital Mammography (with Tomosynthesis) and ABUS. All core radiology tools are native, including MPR, Anatomic Triangulation, MIP, Slab Imaging and more. The ImageQube Cloud is secure, without requiring VPNs. This means exams can be uploaded from the facility to the Cloud Data Center securely using its DICOM Upload application, and users can access studies securely logging in from anywhere.

Using a sophisticated Master Patient Index, radiologists can rest assured that any related prior exam is made available to them for comparison. This MPI is configurable, with four different confidence settings in presenting archived exams, including matching:

Medical Record Number and Last Name.
Last Name, First Name and Date of Birth.
Last Name, Date of Birth and Gender.
Last Name, First Name.

As the search criteria loosens, more potential patient matches are presented as possible prior exams. Radiologists can choose from these for comparison studies.

ImageQube Cloud can not only auto-distribute exams to specified users by specialty, schedule or a multitude of other configurable variables, but also allows for exams to be downloaded from the Cloud to local computers. This comes in handy since the quality of internet connections may fluctuate for some users; download to local may deliver better interaction performance and speed. Once the exam interpretation is complete and internet connection re-established, the new exam status is automatically synchronized with the ImageQube Cloud in the Data Center.

ImageQube Cloud offers great flexibility in dictation. Users can choose to capture recordings using its built-in transcription module, or auto-launch a third-party dedicated voice-recognition system, where the Medical Record Number is sent across and the patient file opened. Or, the user can take advantage of the ImageQube’s integrated dictation module using their own Dragon software for voice-recognition capabilities. The dictation module allows users to sign preliminary reports, sign final reports, add an addendum to a final report, or take advantage of templates, including custom and “normals” templates. Reports generated on ImageQube Cloud can have custom headers and footers, if desired. There’s a built-in “state machine”, which tracks an exam’s progress. If turnaround time is limited by contract, the ImageQube Cloud offers elapsed time reporting, so affected exams are prioritized. The ImageQube Cloud includes the ability to email out the report when completed.

Paperless workflow is enabled on the ImageQube Cloud, with the ability to scan documents directly into patient portfolios, or drag-n-drop any file. Referring physician portals can be accessed securely in real-time, containing images, reports, key images, print pages and annotated images highlighting pathology. Instant messages can even include images, and be sent securely between users. ImageQube Cloud includes its own, built-in Critical Results application, which not only allows a radiologist to confidently communicate an urgent finding to a referring physician with an acknowledgement of receipt, but can prompt the radiologist for follow up, if desired, while creating a log of all communication activity.

ImageQube Cloud’s API is configurable, and can easily integrate with today’s EHR technologies. It even includes the ability to limit access to only states where a radiologist is licensed to practice. With auto-assignment, and an effortless, rules-based workflow distribution, its convenience is state-of-the-art.

ImageQube Cloud makes PACS available without any of the usual barriers to entry. There’s no hardware to install, no minimum volume or commitment, no up-front costs or capital investment and no VPN required. It includes unlimited licenses, online archive, disaster recovery, maintenance and support and software upgrades in a competitive, per-exam price. The ImageQube is platform and browser independent, so it runs on any desktop operating system. With cumulative pricing discounts, and the ability to scale from individual users to large facilities without sacrificing functionality, the ImageQube Cloud can fulfill the PACS needs of any type of user. You don’t need an IT department; installation is almost DIY. Start your one-month free trial today!

Posted on June 4, 2018 June 4, 2018 by Greg Kemper

Medical Imaging Storage

In medical imaging PACS systems, storage is a significant consideration. In fact, the “A” of “PACS” stands for “Archive” (“PACS” is an acronym for “Picture Archive Communication System”). Medical archives are comprised of newly acquired exams, prior studies (for comparison) and some type of disaster recovery. Newly acquired exams and prior studies from the past three to seven years are usually kept in an online archive, which provides retrieval of exams in a matter of seconds . Disaster recovery, in simple terms, ensures that all data has duplicate copies archived, often on a different format and/or in a separate location to eliminate threats from Acts-of-God, viruses, hackers and media failures in impacting the stored studies.

Storage used to largely be on spinning disc servers, stratified in a hierarchical design, which organized and separated studies by age (some PACS providers permit this to be configured per a facility’s preference). Online studies may include current to six months old; nearline exams could be comprised of six months to two years old; farline studies would be made of exams from two years to seven years and beyond. What drove this breakdown was the performance difference dictated by cost of hardware components (online servers were faster and more costly). As hardware costs have become more affordable, while simultaneously improving their performance, these server classifications have tended to disappear into simply, “online” and “long term archive”. Historic media included tape (DAT, AIT, LTO formats), optical discs (DVD), spinning disc (SCSI, SATA, SAS) and, presently, SSD. State-of-the-art systems demand RAID-6 arrays and redundancy of components, with farline studies often still migrating to tape media. Rules of how long particular studies must be maintained in an archive vary by state; the general rule of thumb is seven years, except for mammography and pediatric studies, which are typically longer.

DISASTER RECOVERY

Disaster recovery can consist of simple replication of the images associated with a study, to a much more thorough duplication of all aspects of a system, including images, database, annotation, print pages, key images, user preferences and work environments. In a system with thorough, complete disaster recovery, entire PACS systems can be recreated from the disaster recovery layer should the main system suffer any corruption. Though spinning disc servers provide fast retrieval, they may be vulnerable to attacks on data stored, including viruses, hackers and ransomware. By opting to create a disaster recovery layer on a separate format, like tape, many of these risks are eliminated.

Though most PACS providers strive to deliver .99999 uptime of their imaging system, some emergent care facilities seek to insulate themselves from any potential interruption to workflow. Further protection can be had via high-availability servers, where failover is instantaneous to a parallel server, or clustered servers, where multiple systems also offer load-balancing, increased processing power and scalability, or outright parallel systems, where both PACS applications and medical archives are mirrored in their entirety.

PERFORMANCE & FUNCTIONALITY

There are various ways of taking advantage of available archive capacity. Some PACS vendors store studies in an uncompressed state, which delivers the fastest performance in retrieval (there’s no time required for decompression before a study can be displayed). However, compression of an exam allows much more data to be stored on a server with fixed capacity, so the trade-off between speed and capacity needs to be considered by a facility in designing its archive. Some vendors have a means of keeping the database quick and agile, no matter how large the archive grows. When exams are online, the images and the database information (patient, exam, series and image information stored in tables for every image) are kept together. When an exam is moved from an online state, vendors with sophisticated archives can archive (remove) the database information, leaving a pointer to where the exam is located on the storage disc, while simultaneously compressing the image data. This allows the database to remain lightweight and agile, rather than slowing down, as hundreds of thousands or millions of exams are added to the system.

The industry standard in medical storage adheres to DICOM (Digital Imaging and Communications in Medicine), which ensures that technology from various vendors will be interoperable if they are DICOM compliant. In the past, PACS providers stored all of their data within their own system. With the advent of VNAs (Vendor Neutral Archives), additional options are available for medical data storage. However, some PACS providers have archives that are VNAs, but also offer sophisticated functionality in addition. In this instance, they deliver integrated servers, where archive software is installed on server hardware. In this way, when the PACS viewer is used in conjunction with the archive software, faster performance and additional functionality are the result. Examples of these types of benefits over mere DICOM storage include:

fast, 2-3 second retrieval
updating to patient demographics
automatic pre-fetch of prior exams when a new exam is scheduled
maintaining workflow flags into the archive
preserving annotation made on images
storing reports with exams
storing key image summaries
storing print pages
maintaining work environments
maintaining user preferences
system auto-diagnostics.

In addition, some PACS providers permit documents and other data of virtually any format to be stored with exams. This means not only PACS information and reports, but insurance information, prescriptions, audio recordings and many other types of related information is made available to the users of the PACS, via the archive, without having to launch other applications.

CLOUD DATA CENTERS

PACS systems and their archives used to be limited to having hardware installed on-site at the facility at which they were located. In the recent past, some flexibility has been introduced by allowing storage in the cloud, at data centers. Cloud storage offers advantages, including taking the burden off the facility of maintaining a proper, climate-controlled environment for their storage servers and disaster recovery system. However, it does introduce the need for secure communication of the exams from the facility to the data center. For many vendors, this requires the installation and expense of a VPN (Virtual Private Network) between the facility and the cloud site. Some sophisticated PACS vendors have built-in, encrypted, secure upload capabilities, eliminating the need for the VPN.

If a facility is multi-site, and high-volume, some PACS providers can make exam retrieval even more efficient if they have the capability of using a distributed architecture. This capability allows storage modules to be located on-site, while interacting with the cloud, delivering not only faster retrieval of exams and more efficient network communication, but also relieves the burden on scanners inflicted by potential internet disruption.

ORGANIZING & LOCATING

When an archive contains many years worth of exams, perhaps collected from disparate medical facilities, matching existing studies with newly acquired exams is wrought with the potential to miss a prior study that could be a useful reference. This is caused by exams from different facilities being identified with varying facility naming conventions (first name/last name versus first initial/last name, for example), or being tagged with unique medical record numbers per facility, or, through simple human error. These differences present a challenge in matching exams, which usually looks at medical record number. Some PACS vendors have the capability to overcome these demographic variances from disparate centers using a Master Patient Index (MPI), which permits searching by a variety of fields, including medical record number, last name, first name, date-of-birth, sex and RIS key.

ARCHIVE GROWTH

Archive needs are impacted by two major factors. The first is increase in volume. The second is growth of exam size. Over the years, an average exam size across all modalities hovered about 50MB in size. Some modalities have seen significant growth over a short period of time. For example, for the mammography modality, moving from film (approximately 162MB) to digital marked the first step in size growth for this exam. But, that was dwarfed by the addition of breast tomosynthesis, impacting the size to exams that are regularly 1GB each! The storage needs for mammography are compounded by the fact that studies of this modality must be kept significantly longer that other modalities. This raises the consideration of cost. PACS and archive used to be a purchase of a system, which was a capital expense. As forecasted storage capacity was filled, additional storage would be added, equating to additional budget considerations. Many PACS vendors diversified into business models that were based on volume, known as “Per-Exam”. In these models, rather than budgeting for a significant capital expense, systems were leased at a per-exam (or, in some instances, a per-click) rate. A dollar figure per study was established, and multiplied by the number of studies done on an annual basis. Many PACS providers vary the price of the exam according to the modality size; as the modality size increases, the associated cost goes up. Some PACS vendors are able to keep the cost-per-study consistent, eliminating concerns for the facility, and simplifying the auditing of the business relationship. The per-study business model has been applied to VNAs and cloud storage (even without PACS viewer access).

KEMPER MEDICAL OFFERS IMAGEQUBE CLOUD PACS STORAGE

In the ImageQube Cloud data center, access to PACS storage and disaster recovery are available. The archive is configurable per a facility’s preference, permitting modalities to be kept online for defined periods of time in RAID-6 arrays, while delivering an industry-leading level of disaster recovery, duplicating not only images, but the database, annotation, print pages and much more. By replicating this data on tape via fully-robotic libraries, it is protected against viruses, hackers, ransomware and other threats. Though this storage offers many benefits when used with the ImageQube PACS viewer, it is also a DICOM compliant, Vendor Neutral Archive (VNA), guaranteeing interoperability with any DICOM device. The ImageQube Cloud PACS storage offers ease-of-use, where documents and attachments of virtually any format can be stored with the exams using a simple drag ‘n drop (with the security to make these attachments available only to internal users, or extended to clinical users in addition). Taking advantage of the ImageQube Cloud’s secure DICOM upload functionality, a Virtual Private Network (VPN) isn’t required to upload exams to the archive. This feature offers encryption and security from an application installed on a simple desktop PC at the client facility. The ImageQube Cloud PACS archive has a configurable means of matching prior exams with new studies using its Master Patient Index, permitting comparison of a variety of fields in the patient record, including first name, last name, date of birth, sex and RIS key, overcoming the challenges inherent in exams stemming from different facilities, human error and other variances.

Feel the freedom offered by the ImageQube Cloud’s PACS storage, where there’s no minimum volume, no commitment and no up-front cost. You get a vendor-neutral archive with a disaster recovery layer, providing its own secure, encrypted communication where no VPN is required. All with a consistent, competitive per-exam price regardless of modality.