Operating
the system

Mr. Hochholdinger, you are in charge of medical tech­nol­ogy at Upper Austrian Health Holding. How did this come about?

(BH) In 2003, I started working for the former General Hospital (Allge­meines Kranken­haus AKh) of the city of Linz as a project man­ager for medical tech­nol­ogy. 13 years later the AKh, the Regional Women’s and Children’s Hospital and the Wagner-Jauregg-Hospital merged to form the Kepler Univer­sity Hospital (KUK). In 2017, I took over the man­age­ment of the Medi­cal Tech­nol­ogy and Medi­cal Infor­matics Division. Since the inte­gra­tion of KUK into the Upper Austrian Health Holding in July 2019, my team and I have been respon­si­ble for the medi­cal tech­nol­ogy of the entire holding.

What role does Upper Austrian Health Holding play in Austria?

(BH) With around 14,500 employees, the holding com­pany is Upper Austria’s largest hospi­tal oper­ator and, in addi­tion to the Kepler Univer­sity Hospital, oper­ates five other regional clinics at eight locations.

How is Kepler Univer­sity Hospital differ­ent from other health­care providers?

(BH) With around 6,500 employees and approx­i­mately 1,800 beds, the KUK is Austria’s second largest hos­pi­tal, and the cen­tral health­care pro­vider for the city of Linz and the entire region. It covers the clini­cal spec­trum including all depart­ments and chairs. The close con­nec­tion to the medical faculty at Johannes Kepler Univer­sity enables new ways of teach­ing and offers many opportu­nities in the field of research and develop­ment. The campus character of the hospital creates an opti­mum set­ting for effi­cient work and flex­i­bility. With the excep­tion of the Neuro­med cam­pus, which is located at a differ­ent loca­tion in Linz, the build­ings on the Med campus are con­nected by under­ground sup­ply routes as well as above-ground corri­dors. The narrow glass pas­sages between the build­ings, which we inter­nally call ‘the lion’s walk,’ are a symbol of networking.

Mr. Lechner, you are an impor­tant con­tact person for medical tech­nol­ogy at KUK. How did you grow into this role?

(NL) After eight years in the field of X-ray tech­nol­ogy, I started my career in 1998 in the former AKh Linz as a ‘one-man-show.’ I started as the first X-ray tech­ni­cian in the com­pany. Over a period of five or six years, I was able to build up a small medi­cal tech­nol­ogy divi­sion with two employees that is respon­si­ble for all imaging pro­ce­dures. At the moment, we sup­port the Med campus with about 150 sys­tems, from CT and MRI sys­tems, angi­og­ra­phy and X-ray work­stations, to ultra­sound equip­ment and C-arms. Besides the practi­cal work with the equip­ment, teaching is very impor­tant to me. Lec­tures and courses have long been an integral part of my work.

What are the main respon­si­bilities and daily tasks in the Medical Tech­nol­ogy Department?

(BH) Ensuring the func­tional and oper­a­tional safety of all medical devices is one of our central tasks. We are respon­si­ble for budget con­trol, coordi­na­tion, implemen­ta­tion, and moni­tor­ing of main­te­nance, repairs, and safety inspections. Due to our tech­ni­cal exper­tise, we are not only the con­tact for medical per­son­nel, but also for the pur­chasing depart­ment of the clinic. We are closely involved in the pro­cure­ment pro­cess. In addi­tion, col­lab­o­ration with research and teaching is becom­ing more and more impor­tant. The intro­duction of new tech­nol­ogies and col­lab­o­ration and joint develop­ment with com­panies is essen­tial for the KUK.

What is your role in the procure­ment, oper­a­tion, and main­te­nance of mobile C-arms?

(NL) Our core com­pe­tence lies first and fore­most in main­tain­ing oper­a­tions, like repair­ing, test­ing, and main­tain­ing the C-arms. So we are in regular con­tact with the respective man­u­fac­turers. What distinguishes our medical tech­nol­ogy, however, is the exper­tise that enables us to carry out work inde­pen­dently on site. This sets us apart from other hospitals. In addi­tion, we con­stantly observe and analyze the market in order to be able to pro­vide qualified advice to doctors and pro­curers when making new acquisitions. We keep ourselves informed about the latest developments by following con­gresses such as the RSNA or ECR.

How are you involved in the decision and pur­chase pro­cesses for a mobile C-arm?

(BH) The medical tech­nol­ogy depart­ment is an impor­tant pillar for the hospital oper­a­tor and is involved in the clinic’s mid-term budget plan­ning pro­cesses. Our exper­tise on device cycles, spare parts sup­ply, or man­u­fac­turer end-of-life data is both nec­es­sary and desirable.

How does such a decision-making process work?

(NL) With us, new or replace­ment procure­ment always begins with user discus­sions: In the run-up, we get feedback from users such as doctors, oper­ating room nurses, depart­ment and clinic man­agers, and gather infor­ma­tion about possible pref­er­ences. We con­sider and dis­cuss the field of appli­ca­tion, special require­ments and expe­ri­ences, but also the latest studies on sys­tems from differ­ent man­u­fac­turers. With this level of knowl­edge, we can com­pile a selection of suitable imaging sys­tems. On the basis of user discus­sions and empirical values, a con­cept for invest­ment plan­ning is created and imple­mented in coop­er­a­tion with invest­ment man­age­ment and pur­chasing.

What are the advan­tages of this process?

(NL) To a certain extent, inde­pen­dent con­sul­tants for tenders are always market driven. The KUK’s inter­nal con­sulting exper­tise in medical tech­nol­ogy is essential for suc­cess­ful invest­ment plan­ning. Another decisive advan­tage is the pres­ence of our depart­ment on site. We’re on hand as the sys­tems age: The first step is the integration of the devices accom­panied, for exam­ple, by fine tuning, and con­tinues until the tech­nol­ogy is bug-free. Later, main­te­nance and repairs become necessary. We are there­fore in ongoing con­tact with the nurses, doctors, or radiol­ogists who oper­ate the equip­ment. This enables us to evaluate and docu­ment the fulfil­ment of the require­ments or the handling of the equip­ment.
(BH) The con­sulting, sup­port, and con­cept develop­ment for invest­ment plan­ning within KUK is excellent and offers many advan­tages. It is partic­u­larly impor­tant for us to keep and pro­mote the medical tech­nol­ogy exper­tise in our com­pany in order to guarantee the best possible advice for the vari­ous specialist depart­ments. Mr. Lechner’s state­ment applies to the entire holding. In the holding com­pany, the medical tech­nol­ogy depart­ment within the Tech­ni­cal Directorate of the Upper Austrian Health Holding is the point of con­tact for all relevant medical tech­nol­ogy issues. The aim now is to bring the KUK’s expe­ri­ence and func­tion­ing pro­cesses into the holding com­pany. Since we are con­stantly gathering expe­ri­ence in medi­cal tech­nol­ogy from the vari­ous com­panies, we can immediately suggest suitable devices for pro­cure­ment, sup­ported by a loan device pro­cess for testing new types of devices.

What criteria is used to select a C-arm?

(NL) Our advice is always tailored to specific users and their area of appli­ca­tion. Of course, when selecting a new C-arm, we always pay attention to criteria such as adequate image quality, radiation dose, efficiency, or the appro­pri­ate detec­tor size. Stan­dard­iza­tion across all specialist areas is also necessary.
(BH) The latest tech­nol­ogy is impor­tant to us, especially as limited financial or human resources call for modern technologies and innova­tions that sup­port the hospital in the best possible way and over a long service life. Here, too, the merger of the hospitals offers an excellent oppor­tu­nity: Regional clinics benefit from innova­tive equip­ment. The challenge in pur­chasing new sys­tems is always a balancing act between the latest tech­nol­ogy and the maturity of the pro­duct – we want to avoid ‘green bananas.’

You men­tioned the dose as well as the image quality. What role does it play in the decision-making pro­cess?

(NL) Dose is highly relevant for us. The KUK is the European leader in pediatric heart diagnostics and surgery. In this highly sensitive area, we have to keep dose values as low as possible. Although the dose curve has been steadily decreasing over the past 20 years, the new CMOS detector tech­nol­ogy has been a significant and welcome leap forward. In order to ensure that we use C-arms that are as dose-saving as possible, we carry out our own dose measurements on site, check differ­ent C-arms from differ­ent sup­pliers, and com­pare our measure­ments with the infor­ma­tion pro­vided by the man­u­fac­turers. This pro­ce­dure distin­guishes our medical tech­nol­ogy depart­ment from many other institutions. It enables us to expand our know-how and make our own decisions. We can measure realistic values that correspond to our OR oper­a­tion and it’s pre­vailing require­ments. Ulti­mately, the dose factor is a factor in the pur­chasing decision, and was the main argu­ment for a Ziehm Imaging C-arm in a specific neo­na­tology case, for example.

How does main­te­nance and repair work at KUK?

(NL) Due to our profes­sional com­pe­tence, our main­te­nance depart­ment handles most of the main­te­nance work itself. This enables us to react quickly and flexibly, ensuring that users receive the best possible sup­port. We are trained to be able to carry out this work prop­erly, for exam­ple by the Ziehm Academy in Nuremberg. Of course, we are also in regular con­tact with man­u­fac­turers like Ziehm Imaging when it comes to spare parts, for exam­ple. We also have main­te­nance con­tracts with man­u­fac­turers in vari­ous forms. Service, and above all a personal con­tact person, are partic­u­larly impor­tant to us. Ziehm Imaging offers what we need: The service is based on personal con­tact, and response times are short. This enables us to act and solve technical prob­lems quickly and reliably.

What medical tech­nol­ogy trends do you see in the future?

(BH) More and more trends are emerging that serve the cross-depart­mental buzzwords ‘flexibility’ and ‘efficiency.’ Against this background, mobile, space-saving solutions are becom­ing increasingly impor­tant. With them, eco­nom­ically-sound pro­cess flows can be optimally designed for patients and clinical personnel. Significant improve­ments in software will change and sup­port diagnostics and treat­ment in the future. Sys­tem func­tions that we cannot currently manu­ally con­fig­ure and take advan­tage of due to time con­straints are being simplified more and more with the help of automatic pre­set­tings. Robotic-assisted surgery will increase: In the future, inter­action with innova­tive devices will be possible, and necessary, in everyday life. Artificial intelligence is also likely to be a major driver in medical tech­nol­ogy. This rapidly growing field will play a major role in imaging diagnostics.

What does this mean with regard to mobile C-arms?

(BH) Com­pared to mobile C-arms, stationary sys­tems are still in the major­ity, for exam­ple, for heart oper­a­tions. In the past, fixed sys­tems were con­sidered state-of-the-art; today, there is hardly any differ­ence to the mobile sys­tems. Solutions such as those from Ziehm Imaging deliver com­parable image quality and offer addi­tional advan­tages under the high pres­sure for efficiency, such as opti­mum utilization of the oper­ating rooms, the use of hybrid oper­ating rooms, and the pos­si­bi­lity of multi­disci­plinary as well as intra­oper­ative inter­ventions. In the future, people will have to work more flexibly and switch between oper­ating rooms more frequently. For this reason, the trend will clearly be towards mobile devices. Especially in the appli­ca­tion of C-arms, intra­oper­ative navigation with 3D images is becom­ing more and more impor­tant. The possibility to dis­play differ­ent modalities together and the overlay of instru­ment navi­ga­tion are the future.
(NL) An addi­tional, clearly-emerging trend is towards C-arms with­out moni­tor trolleys, like the Ziehm Solo FD. With the help of video distrib­u­tors, it is now pos­sible to wire­lessly trans­mit the image to any moni­tor in the room with­out loss of quality. The impor­tant infor­ma­tion is thus visi­ble to doctors and assis­tants, and we have one less device to worry about in the oper­ating room.

Medical tech­nol­ogy today and in the future: What differ­ence does your profes­sion make?

(NL) I am con­vinced that nowhere else can tech­nol­ogy be used more mean­ing­fully than in the field of medicine. Our work is highly innova­tive, there is hardly any routine. The transfer of knowl­edge is also var­ied and an impor­tant basis for us to train young medical technicians for the future.
(BH) Leaps in tech­nical innova­tion and digital­i­za­tion create a new work­ing envi­ron­ment. In this dynamic envi­ron­ment, I see an oppor­tu­ni­ty to expand the holding com­pany’s potential and exploit the oppor­tu­nities offered by the merger for medical tech­nol­ogy. For me, it is attractive to work at the fore­front of this field, and to be able to actively shape the future.