For years, members of corporate IT teams have remotely accessed employees’ workstations to discover problems and unlock frozen computers. They could do so without leaving the IT department and without entering the workspace of the employee. Sometimes they did this from the same building and sometimes from across the country. For the employee, the process was often surreal, with their computer coming to life, looking like some invisible force had taken control.
Remote support is not a new idea, but its application and acceptance have increased and improved over time. Today, support from a remote location is common and practical. Remote access to a medical device also provides the means for diagnostics, providing software updates, applying patches and doing repairs. It allows engineers to monitor the device and foresee maintenance issues or provide a troubleshooting heads-up.
Monitoring equipment remotely often allows for the detection of minute changes that may go unnoticed otherwise. Environmental factors, undetected by those present, may be picked up on by the remote engineer and communicated to those providing patient care.
“Today almost every service action, except physically touching the system, can be performed remotely,” says Mike Swinford, president and CEO, GE Healthcare Global Services. “In addition, the constant monitoring of equipment parameters, makes possible contextual maintenance actions (service actions based on how the system is used).”
“With the use of predictive algorithms, we are able to anticipate and tailor service actions in order to increase efficiency. Beyond maintaining equipment in the best condition of safety and availability, new technologies are also offering many possibilities for workflow and operations optimization,” Swinford says.
The intention of the manufacturers, who have utilized this technology for a long time, is reflected in the experience of users. While some HTM professionals complain that remote service is an expensive addition to a service contract that doesn’t offer much return, others like what they see.
“Since most of the medical equipment these days is not purely mechanical; and even the mechanical pieces are computer controlled, and are constantly providing and logging data, much of the support of the equipment can be done remotely,” says Qusai A Shikari, clinical systems engineer with Kaiser Permanente Clinical Technology. “The constraints start when there is a pure mechanical part failure, and a replacement is necessary. Up until this point, most of the services can be provided remotely; it is only the constraints of the implemented IT infrastructure the system resides on, that prevents remote service for medical equipment.”
“As the service engineering workforce continues to age, and many knowledgeable and highly experienced technicians retire, remote support is an excellent way of consolidating much of that knowledge and experience and making it available in today’s work environment,” says Joseph A. Haduch, MBA, MS. He is the Director of Imaging Services for University of Pittsburgh Medical Center PMC and BioTronics.
Haduch’s facility uses the remote support offering from GE Healthcare.
“Every organization in healthcare or healthcare manufacturing is looking for ways to streamline operations and find more efficient and cost-effective ways of delivering service,” Haduch says. “Remote service technology is one means of providing hospitals with a higher level of service at minimal cost.”
“I believe remote support for equipment is the new platform for many of the manufacturers these days. In my experience, most of the IT-based medical equipment issues can have resolutions via remote service, in a quick and efficient manner,” says Shikari.
“It allows manufacturers to quickly diagnose errors and issues by viewing the logs and providing remedies for resolutions. Remote service is quickly becoming the new standard for the industry and will enhance the ability for the in-house BMETs to support the medical equipment,” he says.
Shikari says that remote service, for both software and hardware issues, should be based on a dual support solution.
“Dual support, so that depending on the type of error, the remedy might involve physical intervention and the in-house BMET can support those situations. These days, many — if not most — manufacturers provide remote service as a base package within their support service contracts (SSC),” Shikari says.
“In dual support situations, the SSC is quite a bit cheaper if a remote service is provided, because it saves the company money to send a field service engineer (FSE) out to the site, which adds travel and sometimes lodging costs,” he adds.
Several OEMs provide real-time remote monitoring programs to handle preventive service in addition to offering predictive features to stave off potential future problems.
Asked about GE Healthcare’s remote monitoring capabilities and their benefits, Art Larson, MBA, general manager of product service for the company’s U.S. business, points to a “significant investment in remote monitoring and diagnostics to manage systems and keep them ‘in spec’ to their ranges.”
Larson points out that the alerts that result from remote monitoring can notify remote engineers and field engineers when a remote check or field visit might be warranted without interrupting customer use.
“Trend data is also gathered to help customers improve their actual utilization of the equipment,” he says. “Big data is a key component of our strategy, and is analyzed for both customer and OEM productivity and value.”
GE Healthcare’s InSite service allows the company to proactively monitor its diagnostic imaging equipment, and frequently, resolve issues on the spot. When an onsite repair is required, this technology can provide the service engineer with detailed knowledge of both the equipment performance and potential problem, often cutting down on the service activity. With a digital broadband connection, GE can provide faster response and shortened repair time, minimizing the overall unplanned downtime for the customer.
By using a virtual private network and encryption technology, the proprietary broadband connection also provides safety and security of the data transfer.
“GE’s ability to provide productivity and effectiveness in covering an expanded install base, which is growing more complex with both product introductions and acquisitions,” are some of the reasons Larson gives as benefits to the biomed department. “Biomed departments are challenged to maximize their in-house resources,” he says.
In addition to these benefits, he points to “quick access to expert support as incentives for our in-house customers to drive productivity and uptime, building customer satisfaction” as incentives. “A growing number like the idea of being connected, as it instills confidence with end users. GE is here with you, even when you don’t see them,” Larson says.
The leaps and bounds in technology in recent years have made remote support a practical tool, according to Gerald Finis, MSEE, director of computed tomography (CT) service support for Siemens’ Service organization. Siemens Guardian Program uses remote monitoring to help predict and prevent service issues in real time. The program helps to improve workflows and increases patient safety by helping to avoid downtime during invasive procedures, according to the company.
Guardian is used for several imaging modalities such as molecular imaging, ultrasound, MR, CT, angiography, X-ray and women’s health. The program started with angiography and migrated to CT.
“From service experience over the years, there are certain indications on a machine that will throw an error or malfunctions sooner or later,” Finis says. “The purpose of Guardian is to find something that is a small issue indicated, and then either keep track of it, log it or take action to prevent a larger one.”
“When a hard drive starts having read/write errors, there’s nothing wrong. Every so often, it happens,” Finis adds. “Nevertheless, you can only have so many before your drive begins to fail. It’s not fast enough anymore. If it happens in the middle of a patient, it’s a bad situation. Internally, they are all monitored. If you look at your computer, you can see what your hard drive speed is, it’s temperature, the read/write errors, the bad blocks.”
The logic built into the machine can tell if the hard drive is producing errors and can send a message to the monitor that the machine has hard drive errors. With this information, Finis says there are determinations that have to be made; which hard drive is it, how severe is the issue and what can be done about it.
“After that, we go to temperature. Some machines are water-cooled, so we are looking at the flow rates of the water,” he says. “We’re looking at the incoming supply from the facility. Often times, we can tell a facility that something is wrong with your chilled water supply.”
Finis says that the facility can then be notified that something is wrong with the water supply. Even if those in proximity to the equipment monitored don’t notice anything right away, the remote engineer can ask if they noticed the temperature or humidity creeping up. He says that the CT or the angio or MR picks these things up.
“Components get overheated,” Finis says. “Therefore, we’ll have damage on the component when it may just be that the filter is clogged up.”
“It’s easier to go in between patients and check for a filter or have engineering checking if the chilled supply is switching to another cooling solution and in an hour, it’s OK,” he says.
“There are two major developments; one is called Internet and the other one is called computer technology improvement,” Finis says. “Twenty years ago, I had remote connectivity to my CT systems. I could dial in and see some things, but it was rather slow and didn’t lend itself to alert somebody. The amount of data back then would have been overwhelming on the little phone lines that we had. But the fact that everything is going to fiber optic backbones on the Internet now, enables us to transmit large amounts of data in a small amount of time.”
Finis says that the other improvement is in technology itself. He points out that about every 18 months new computer technology, including faster processors, becomes available.
“In the medical environment, we cannot slow down the purpose of the machine. My home computer, if I’m rendering graphics, whether I’m doing this in five minutes or six minutes, it really doesn’t make a big difference to me,” he says. “To a customer, who is in an imaging environment in a hospital, it makes a difference whether they sit there for five minutes or for seven minutes waiting for results to come up. There are some medical needs, the faster you can get the patient to the medical treatment, the better it is.”
“Therefore, the backbone monitoring programs that are being written have very little footprint on the CPU usage itself,” Finis adds. “The faster CPUs are, and the more ROM we have, the less it will impact on the percentage. If 10 years ago, I needed 10 percent of that capability, today, I only need point two percent of the capability. Therefore, it makes it feasible to utilize the technology.”
Finis says that the nuclear power industry has used the technology for several decades.
“We’ve been using remote support for our imaging equipment for many years. All of our high-end pieces — MRI, CT, PET/CT – have OEM remote support,” Haduch says. “We are now incorporating remote support on some of our lower-end equipment as well, ultrasound and portable X-ray units. Remote support is an excellent place to start when our staff experiences equipment issues. Often our in-house engineers will work with our technologist to directly reach out to an online engineer.”
“With some issues, such as corrupted files or oversized queues, the online support engineer can repair the problem in a very short period of time,” he adds. “In these situations not only do we minimize our downtime and maintain a higher level of patient satisfaction, but we are able to do so while minimizing, our in-house engineers’ time.”
“Remote support can provide a more efficient and cost-effective means of repair,” Haduch says. “Even when remote support is unable to repair the problem more often than not they can provide the on-site engineers with some level of direction with respect to troubleshooting the equipment. Again, this minimizes the amount of time the engineer has to spend troubleshooting and repairing the equipment. It can also help the engineer determine what parts may be needed for that particular call. In other instances, remote support can easily diagnose X-ray tube problems and start the process of ordering a new tube and arranging for installation.”
Finis says that not everything can be predicted, but many preventative events can be caught.
He talks about the tubes in CTs as an example. Tubes are prone to vacuum leaks or filaments that burn out. Having one go out can interrupt clinical workflows and often require repair people to be working when it is inconvenient with patient loads. With his company’s remote service, they can predict when a tube will fail based on “novel operating parameters.” A tube can then be replaced at a more convenient time for the facility.
The days of a phantom invader taking over a computer have been replaced with a more seamless monitoring capability. The unseen engineers will become a more common addition to healthcare facilities.
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