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Health Care Providers Face More Direct Billing, More and Tougher Collections

Health Care Providers Face More Direct Billing, More and Tougher Collections | IT Support and Hardware for Clinics | Scoop.it

Opponents figure that they pretty much killed the Affordable Care Act in December when they ended the individual mandate. They may be right. The mandate – the part of the ACA that required Americans to buy health insurance or face a minor penalty – was a key to trying to broaden and deepen the insurance pool, mitigate payers’ risk and, not least, keep premiums at least remotely tethered to people’s ability to pay.

 

Another part of the ACA is also under threat. The law allowed states to agree to an expansion of Medicaid that was meant to help people who couldn’t afford to meet the mandate on their own.  Still another: it also offered subsidies to help payers meet the expenses of covering all the previously untreated people they’d have to insure and of covering everyone’s pre-existing conditions. 

Premiums in fact did not grow as fast in states that accepted the Medicaid expansion during the past three years and as an estimated 40 million more people gained some form of health insurance.

The end of the individual mandate, the junking of one of the subsidies for health insurers and last year’s drastically truncated open enrollment period for the remaining Exchange plans, however, have again started to reduce the number of Americans with health insurance.

 

These changes affect more than practice volume. They impact operations for practices that retain patients, too.

For without increased attention to “revenue cycle,” all health care providers can expect to be doing more direct billing of patients, doing more collections work and assuming more bad debt from people with higher, tougher-to-pay deductibles in the coming months and years.

 

Here’s why: No one yet knows how many people who bought insurance only because they were required to. There’s reason to believe the end of the individual mandate will start making them drop out of all kinds of plans during the next open enrollment period.

A federally truncated open enrollment period October-December, 2017 has already reduced the number of insured people in the nation.  A number of forces are leading fewer people – and fewer younger, healthy people – to buy plans, and some predictions have premiums rising an extra 10 percent this coming year.

 

More shrinkage is coming. Newly permitted work requirements for Medicaid coverage promise to push still more people into the ranks of the uninsured. Kentucky’s new rules, for example, will drive an estimated 40,000 people out of Medicaid coverage during the next five years. As of this writing, nine other states are considering imposing new restrictions on who can qualify for Medicaid coverage.

 

The increase in the numbers of the uninsured obviously has disturbing implications for the nation’s health as a whole. It will also force payers to raise premiums to make up for the rising costs of being able to spread their risk across smaller, riskier customer pools.

 

The uninsured aren’t the only ones threatening practice finances.

Rising premiums, in turn, are leading employers to offer employees more high-deductible health plans. These HDHPs have lower premiums but higher risk for patients, who in addition to their premiums must pay an average of the first $2,400 of their families’ medical bills out of their own pockets. Some plans have deductibles as high as $10,000.

 

The lower premium costs, however, are attracting more and more people.

 

They are also higher risks for physician practices, which have a harder time collecting from patients with HDHPs. Thirty-seven percent of the people working for employers who offered plans in 2017 chose high-deductible plans. That’s up from 28 percent in 2016. The same year, that accounted for 39.3 percent of all Americans on employer-based health plans. All told, up to 37 percent of insured Americans, regardless of where they bought it, were using HDHPs.

 

But there have been dire unintended consequences. With the costs of care so high, 64 percent of those with high-deductible plans say they’ve put off care because they didn’t want to or couldn’t pay the deductible. And 62 percent said that, despite the lower premiums, they end up spending more on health care than under their previous plan.

 

People with the high-deductible plans thus tend to be bigger financial risks for providers.

Of HDHP customers, 15.5 percent reported having trouble paying medical bills in 2016 (versus 10.3 percent of those with “traditional” plans).

 

In sum, this means everyone in health care – providers, hospitals, practices – are going to chance offending more patients by billing them directly and, at minimum, going to have to devote more resources to revenue cycle and collecting what patients owe them.

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Cloud performance tests reveal the impact of location

Cloud performance tests reveal the impact of location | IT Support and Hardware for Clinics | Scoop.it

If a cloud-based EHR isn’t fast enough to meet the needs of hospitals and other medical facilities, quality of care will suffer, clinicians and support staff will become frustrated, and provider organizations operating on thin margins will have wasted valuable IT dollars on inadequate technology.

 

Several industry trends make it clear that providers are increasingly confident cloud-based EHRs can deliver data and applications at sufficient speeds because vendors have dramatically reduced latency. Epic Systems, the largest EHR vendor in the U.S., began offering cloud services in 2014 to medical groups and small hospitals. The company said in 2016 that it has seen a big shift among its customers toward cloud-based systems. One of those customers is University of California San Diego Health, which announced in August 2017 that it is migrating its Epic EHR to the cloud.

 

Cerner has also revealed that a number of healthcare systems are moving onto its hosted cloud environment. Inspira Health Network, a nonprofit healthcare organization that serves communities across New Jersey, and Bay State, an integrated health system in western Massachusetts health system, have both moved to Cerner’s cloud hosting model.

 

Another EHR vendor, Athenahealth, offers only cloud-based EHR services to its network of 56 hospitals and 106,000 providers that serves more than 100 million patients. Ellenville Regional Hospital in upstate New York, reports that running its EHR on a single network gives staff in all departments real-time access to patient records.

 

For health systems that will select their own cloud host, after considering the cost of strategic planning and security, the success of a migration ultimately rests on performance. Can EHR data, applications and services be delivered fast enough to support the needs of clinicians? Cloud performance is generally measured by average latency which represents the delay between the time when a client computer requests data and the cloud platform responds.

 

Tests have shown that distance between the cloud provider and the enterprise can have a significant impact on latency with delays of as much as 50 percent when the cloud is at a great distance.

 

Cedexis tested services and found distance was a leading indicator of performance

 

Monitoring company Cedexis performed tests throughout the United States that quantify this. Tests were performed on all of the major cloud platform vendors. The determining factor in latency performance was distance from the test client system to the servers at the cloud data center, with a deterioration of as much as 50 percent seen over longer distances within the same region.

 

For example, tests performed in the northwest region recorded latency was as low as 63 ms. when the cloud was near; a latency of 92 ms. was recorded on a cloud system at a greater distance from the test location. A test on cloud platforms in the northeast found 66 ms. latency on the low end and 78 ms. on the high end.

 

A number of vendors offer cloud performance tests that are free to be used during an evaluation process. One example is

 

CloudHarmony who offers a free service that will test performance for many of the leading vendors at a variety of their geographic locations. The test, at Cloud Harmony Speed Test will provide results for DNS query, downlink and latency.

Integration challenges


Migrating an EHR system to the cloud rarely is an all-or-nothing process. Rather, many healthcare IT managers are moving incrementally, evaluating the success of each application migration, learning from mistakes, and carefully preparing the next move based on need and experience. For example, some may decide to first migrate back-office or HR applications, and eventually, migrate clinical apps and billing data at a later date. Providers certainly can choose a one-shot migration to the cloud, but they run the risk of network and system disruptions, loss of productivity, and bandwidth limitations.

 

After cloud migration goals are set, computing models are chosen, and a migration plan established, healthcare providers can begin choosing a CSP (or more than one). For providers with concerns about potential latency issues, selecting a CSP with a hosted location close to the provider’s facilities makes sense. The provider’s IT staff and the CSP can then begin the cloud migration. This process involves addressing several integration challenges.

 

Perhaps the primary challenge is to prevent disruptions to systems or services during or as a result of the migration that would impact clinical care, staff productivity, or IT processes. Other challenges include protecting and backing up migrated data and connecting to and integrating disparate systems.

 

Integration may involve linking cloud-based apps and data with non-cloud apps in legacy systems. “An illustrative scenario could involve a multi-hospital operation which chooses to retain on-premises EHR for inpatient operations but wants to leverage public cloud services for geographically distributed outpatient clinics,” according to the Cloud Standards Customer Council (CSCC).

 

The CSCC argues that a successful cloud EHR migration depends on security and network connectivity.

 

“Whether you are ensuring insurance coverage for the public, developing the next generation of cancer drugs, or providing critical care/tier I trauma services, the new emphasis is being put on providing network availability, performance and security,” CSCC writes. “Although creating a highly available network might be expensive, those costs can be offset by the capabilities provided to the organization.”

 

The vast majority of healthcare providers today have moved or are moving applications, infrastructure, or development platforms to the cloud because they recognize the performance benefits and cost savings. For a cloud migration to pay off, providers must develop a realistic migration strategy and goals, choose the appropriate cloud computing and services models, find one or more CSPs whose services, support, and pricing match their needs and ensure that their networks have the bandwidth capacity to handle cloud-based workloads.

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8 Health IT Trends to Watch

8 Health IT Trends to Watch | IT Support and Hardware for Clinics | Scoop.it

“We’re in the middle of an incredible moment in the healthcare industry, where expectations and standards are shifting.”

 

That statement was part of the opening remarks from Cerner’s Senior Vice President of Population Health John Glaser at the 2017 Cerner Health Conference. His position was a strong one: The industry, he says, is shifting from reactive sick care to proactive health management, from fragmented niche care to a cross-continuum care system and from reward for volume to reward for quality, efficiency, and safety.

 

Today, we’re watching as the physician, long considered to be at the center of the healthcare universe, is moving aside in favor of the consumer.

 

These shifts aren’t happening in a vacuum: They’re touching in every area of the industry, and they are reshaping the way the business of healthcare is done. Here’s a look at some of the top trends that will push the industry forward in 2018.

 

Consumer-centered health care


We talked a lot about the rise of consumerism in health care over the last year, and that train is not going to slow down in 2018. Increasingly, we're seeing people wanting to have a more active role in managing their own health and care (this is particularly clear when we consider the rise of mobile health apps and wearables). They expect the same level of information, detail, and options that they have in other industries when it comes to making purchase decisions, and there is a rising call for data transparency and access.

 

While there have been some great strides toward empowering the individual with healthcare organizations working to improve the patient experience, we're still waiting for the healthcare industry to wholly adapt to the needs of the consumer.

 

At Cerner, we recognize this as a new era, where the consumer will, at last, join their own health care team. That's why, at this year's CHC, Cerner President Zane Burke announced that we’re making a free consumer-directed health record available within our clients’ enterprise portals, providing individuals more control over how their data is used and shared. Each patient will have his or her information compiled on their behalf and can direct the use of that information to create their own experience.

 

The era of the consumer is here – and it’s time for the healthcare industry to embrace that.

 

IoT


From controlling the thermostat on your phone to monitoring your health with technology, the Internet of Things (IoT) is transforming the way we work, live and interact with the world around us. IoT has been a popular phrase in health care for the past few years, but today, the conversation is shifting. The primary issue now is understanding how we can take the plethora of big data available from connected systems and tailor it to provide person-centric care.

 

Moving forward, we need to harness the potential of IoT to drive better efficiencies. From a data collection perspective, the advantages of connected medical devices are vast. When we can provide data bridges from disparate health care systems within a single organization, we’re making critical patient information more accessible to clinicians and care teams and ultimately impacting patient outcomes.

 

Through the use of IoT devices, we have the opportunity to deliver true virtual care for chronic condition management, virtual visits, and other care coordination activities to streamline and benefit the patient. Connected devices enable more real-time insights and health status for a person.

 

“IoT is tied to consumer enablement, which ranges from remote patient monitoring to mobile applications,” Hamilton says, “and it certainly includes the ever-increasing trend of telehealth, which isn’t going to go away.”

 

Artificial Intelligence


“Intelligence isn't a new idea,” Glaser said at CHC. Our cars tell us when the oil is low, and they’ve been doing that for years. But we’re about to take a significant leap in the intelligence of our devices. We’re already seeing this with products from companies like AWS, Azure, and Google.

 

We're in the early stages of seeing how artificial intelligence will play out in the healthcare industry. One example is in precision medicine, an approach for disease treatment and prevention that accounts for individual variability in genes, environment, and lifestyle for each person. This approach relies heavily on big data analytics, where machine learning algorithms and precision molecular tools make it possible to understand the mechanisms of disease and match up individual problems with personalized treatments. The implications for genomics and precision oncology are significant.

 

We’re also beginning to see AI algorithms affect and enhance medical imaging. These algorithms find patterns in images, identifying specific anatomical markers and scoping details that the human eye can’t – while simultaneously combing through a patient’s history, helping clinicians make efficient and quick diagnoses. The future of AI in health care won’t see clinicians being replaced by machines but rather empowered by them.

 

Big Data


“Data is the new oil,” Andreas Weigend, Amazon's former Chief Scientist, said recently. It’s a bold statement, but he has a point: Big data and cloud technology are changing how we interact with data, and previously untapped data sources are now attainable.

 

One of the greatest examples of big data’s implications for the healthcare industry is in predictive analytics, where data is used to identify behavior patterns in a patient or population and forecast outcomes. For example, when EHR data is organized into meaningful groups, such as social determinant factors, it can help predict hospital readmissions and can shed some insight on strategies to improve readmission rates.

 

This power to affect additional value and efficiencies within a hospital setting is no small thing. Perhaps most critically, these newfound big data insights are pushed to those that can make a difference: clinicians and care team members. Acute and ambulatory decision support, for example, can be enhanced by creating an empowered care team with a clear picture of the patient, thanks to increased access to patient data that's built directly into the existing daily workflows. And big data has exciting implications for precision medicine.

 

Whatever route organizations hoping to take with big data, it's clear that it will be a catalyst for change for the better good and health of society.

 

Data governance


As organizations begin to share data across departments and with other health systems, there can be a few questions: Who owns this data? Have the appropriate parties consented to its release? What are the rules, conditions, and terms of data sharing?

 

“Data governance is a huge thing that organizations are struggling with right now, even as they try to solve for it,” says Hamilton. In a recent survey, only 44 percent of hospital leaders said they had data governance capability across their entire organization, while 56 percent said they had inefficient governance standards.

 

What organizations really need is a governance strategy that everyone understands and can abide by, Hamilton says. In the future, we’ll see more and more healthcare organizations looking for help from external experts to create and refine their data governance protocol and practices.

 

Open platform development and API usage expansion


Open data access and increased interoperability are continuing to clear the road for development in health IT (HIT) – particularly when it comes to academic medical centers and rural health care systems. This trend will only continue to grow as open standards, like SMART Health IT and the HL7 FHIR standard, encourage a new level of collaboration and innovation.

 

As the FHIR standard matures, we’re going to see an explosion of new apps that can integrate with EHRs to help improve workflow efficiencies and achieve better outcomes. Application programming interfaces (APIs) offer direct programming access to the underlying health IT system and enable 'app' developers to create tools that can ingest EHR data and provide new services to consumers.

 

In a previous blog post, Cerner's Dr. David McCallie discussed how, through projects like SMART® on FHIR®, providers are becoming familiar with APIs that support customization of the EHR experience. However, API access is not limited to providers. A new class of APIs will give consumers the ability to access their health information on demand via apps of their choice. These APIs are emerging thanks to consumer demand, and they are also driven by major regulations coming into effect – particularly Meaningful Use Stage 3.

 

Consumer-directed access will place control of personal health information in the consumers' hands. APIs that allow the transfer of discrete data will help drive the advancement of interoperability by delivering more specific data where it makes sense within the workflow, in a way that positively impacts outcomes.

 

UX and health IT


On the coattails of the rise of consumerism in health care is a growing emphasis on integrating user-centered design into healthcare products and solutions. To optimize any solution, user experience (UX) must be engineered in at every step of the solution design process. This way, the experience for the HIT user – be they a clinician or a patient – should meet or exceed their expectations.

 

Cerner's Vice President of User Experience, Paul Weaver, discusses the integration of UX design thinking and health IT through the example of mobile health apps. "When you think about consumer apps today, there is a huge amount of competition to get people's attention," Weaver says. "If you search for a notes app on the Apple store, for example, there's probably a few hundred for you to choose from. So, if I'm an app developer, how do I design the app of choice?"

 

The answer, Weaver says, is by providing a quality user experience.

 

"In the health space, historically, this has been a little bit of a walled garden," he adds. "You go to a health provider, and they give you a link to the app they want you to use, and there's no choice in the matter." It's the responsibility of the UX team to think about that application in the context of all their other solutions available so that whatever they're designing sits alongside its contemporaries in an equal level of quality.

 

UX is about more than just creating user-friendly applications. It’s a state of mind – a perspective that favors taking a human-centered approach to creating solutions. "That's what we're starting to achieve here," Weaver says, "and we're on the cusp of it becoming real for our end users, which is fantastic. How there be anything more exciting than an application that actually helps your health?"

 

Payer-provider convergence


One of the most significant trends in today’s market is the blurring of roles between providers and payers. As the industry shifts toward value-based care, it should become increasingly easy for payers and providers to collaborate at the point of care. A person’s relevant medical history, including medications and treatment plan, should be available to both the healthcare provider and payer – that way the patient’s insurance benefits are included in the provider network and are in sync. Shared access to this data means that clinicians are empowered to provide the right care at the right time to the right patient.

 

That’s payer-provider convergence in theory – but the reality is that there are two dynamics happening in tandem.

 

“You've got providers trying to take on characteristics of a payer because they’re doing at-risk relationships, and you’re seeing the payers making a direct play into the provider market,” says Ryan Hamilton, Cerner’s Senior Vice President of Population Health. Recent moves, such as UnitedHealth’s Optum purchasing DaVita Medical Group and Amazon’s push into pharmaceutical distribution, suggest that the trend of payers and providers merging together will continue to rise.

 

Along the same lines, there’s a lot of interest right now around provider network management – and that focus is only expected to grow. “How you actually recruit, manage and maintain a high-quality network of providers is and will continue to be a huge focus for our client base,” Hamilton says.

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4 Industries That Find Blockchain Technology Useful

4 Industries That Find Blockchain Technology Useful | IT Support and Hardware for Clinics | Scoop.it

 

By 2024, the global blockchain market is expected to be worth $20 billion, and according to a recent study by IBM, one-third of C-level executives are considering adopting these technologies. Does that surprise you? Is your organization exploring blockchain or distributed ledger solutions?

 

Recent reports indicate that blockchain has the potential to reduce certain industries’ infrastructure costs by 30 percent. Additionally, there’s a $8-12 billion annual savings for certain industries that use blockchain technology. Let that sink in.

 

Companies of all industry types are using blockchain technology to help them improve transparency, traceability and trust; but here are four industry-specific benefits.

 

  1. Healthcare: Hospitals are now able to seamlessly access patient data shared between member hospitals and participating hospitals.
  2. Banking: Financial institutions are able to simplify and speed up the transfer of funds, while ensuring the identity of the user.
  3. Supply chain: Manufacturers can ensure the authenticity of goods and products with better transparency and accountability.
  4. Insurance: Companies can eliminate common sources of fraud, and use smart contracts to improve efficiency and improve customer experience.

 

With all of these sample use cases, blockchain helps companies increase efficiency and reduce friction. Sirius offers various services to help organizations define and develop their blockchain solution.

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What is telemedicine involved and how much does it cost? 

What is telemedicine involved and how much does it cost?  | IT Support and Hardware for Clinics | Scoop.it

Now that the use of telemedicine is surging to an all-time high, organizations can easily get lost in implementing the technology just to stay on top of the latest and greatest, but it is easy to get lost in the vast amount of telemedicine technology and equipment options available.

 

If you are researching your telemedicine options, applying for a grant or just need to put your budget plans together, here are six key elements and associated costs for you to consider.

1. Medical Devices for Specialties

The specific medical devices you need may vary depending on the specialties you plan to serve with telemedicine. The good news is you don't need to have all the answers right away because many equipment providers have scalable and modular telemedicine systems. This means you can purchase just what you need to get started and then add additional devices later on as your program expands into additional specialties. 

 

The cost of medical devices for basic primary care services can range from $5,000-$10,000, and this would include devices such as an examination camera, ENT scope, and digital stethoscope.

2. Communication Platform and Video Conferencing Needs

How you plan to manage the patient-to-remote encounter is also a key component to consider for clinical telemedicine applications. Since you are communicating a patient's critical diagnostic data, the optimal choice is to do it securely and in real time. After all, the beauty of telemedicine is the functionality to have a live interaction between a patient and a remote specialist.

 

AMD Telemedicine recommends using a Web-based encounter management portal to communicate and aggregate medical device data and share it live with the remote physician. This is truly the best way to offer telemedicine services that are as close to an in-person visit as possible. For video conferencing, it is best to first evaluate any video conferencing investments your organization might have already made to see if these can be leveraged for your current application. Many times they integrate seamlessly with encounter management platforms.

 

Depending on your video conferencing needs, you can complement a Web-based telemedicine portal with either software- or hardware-based video conferencing. To go the software-based route can cost as little as $1,500 per patient site with no cost for the remote provider. The cost for hardware-based video conferencing can start around $10,000 per patient site and increases with the number of remote provider sites you need.

3. Packaging Design and Mobility

Telemedicine carts, cases, wall mounts, and other equipment are all just various ways to package the telemedicine hardware and software. Although there is a difference in how aesthetically pleasing they are (or are not), the main thing to keep in mind is whether this packaging will fulfill your intended use, not just now but also in the near future.

 

Ideally, you want a telemedicine cart or case that is modular and can be easily configured for additional medical specialties so it can evolve with your program. For some applications, such as school-based health centers or long-term care facilities, it is helpful to select a telemedicine system that is an all-in-one package. This helps streamline the purchasing, maintenance, and support for those that don't have a dedicated IT team for their telemedicine programs. All-in-one telemedicine systems that include the telemedicine software, primary care medical devices and the mobile cart/case can range from $20,000 to upward of $28,000.

4. Bandwidth and Internet Connection Recommendations

You may be pleased to know that you don't need to invest in a significant infrastructure overhaul to make telemedicine a reality for your clinic. Of course, your specific needs will vary depending on factors such as location and size or your organization, but the most important consideration is not how much bandwidth you need, but rather how reliable and consistent your bandwidth is.

 

The most common Internet connections are shared with others, which can cause the upload and download speeds to lag and be interrupted at busy times. So finding a reputable Internet service provider with a commitment to reliable service is the first step. If possible, purchase a business-grade service so you experience a more consistent bandwidth capability to ensure your real-time data is not interrupted or compromised in any way.

5. Training

You already staff your organization or practice with top-notch doctors and nurses, so the next step is to provide these health care professionals with the skills and knowledge they need to best make use of your new telemedicine technology in daily operations.

 

Fortunately, clinical telemedicine equipment training isn't a complicated need to meet, especially if your staff has any familiarity with basic medical devices and modern communication technology.

 

There are two types of training programs to ensure the long-term success of clinical telemedicine programs: user training for clinicians and nurses, and technical training and installation for the IT staff. Training programs like these can range from $200 to $2,000 per site depending on the complexity of equipment, the number of users and other factors. Additionally, the American Telemedicine Association is a fantastic resource for training and education.

6. Support

Finally, the increased reliance on network connectivity and Internet technology at your office means that you'll need to ensure that you have adequate IT staff support. This is likely more of a concern for smaller practices that may not have an in-house IT department. It's a good idea to talk to your telemedicine vendor to determine if it provides installation services, as well as what technical support options are available if you don't have an IT staff of your own.

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Professional Development Advice from Technology Leaders

Professional Development Advice from Technology Leaders | IT Support and Hardware for Clinics | Scoop.it

This edition of AppointmentPlus Radio brings together two industry leaders within the tech sector. Raymond Wiley, a general manager with Sun-Tec America, shares the story of how he landed his current position, as well as the philosophy that shapes his professional interactions. Dhruv Bhate, a senior technologist who works in 3D printing, offers insight into how reflection on your true values can lead to a meaningful work life. The two also discuss:

 

  • The importance of finding your professional “sweet spot”
  • How to understand, and communicate your professional value
  • Why defining what you do also mean defining what you don’t do
  • Plus: 5 must-have personal technology recommendations and 2 must-read books to overhaul your professional mindset

 

 

About Raymond and Dhruv: 

Raymond Wiley is the general manager at Sun-Tec America, LLC where he is responsible for the go-to-market strategies for Sun-Tec’s high precision lamination, labeling, and taping equipment portfolio for the Americas and European markets. He is the primary interface between the customer and the Sun-Tec design engineers located in Japan and is charged with overseeing the entire sales process through every phase of the project. Previously, Raymond spent 21 years at Motorola in the Semiconductor Products Sector serving in a variety of increasingly responsible positions including operations manager for the Small Signal and MEMS Sensor Businesses in Japan.

 

Dhruv Bhate is a Senior Technologist at Phoenix Analysis & Design Technologies, Inc. (PADT) where he leads R&D efforts in Additive Manufacturing, with a focus on high-performance polymers and metals. Prior to joining PADT, Dhruv spent 7 years at Intel Corporation developing laser-based manufacturing processes. Dhruv has a Ph.D. in Mechanical Engineering from Purdue University and a Master’s from the University of Colorado at Boulder, where he developed fracture models for ductile metal alloys and to simulate adhesion in MEMS.

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