Every doctor’s office visit starts with a medical professional taking basic and important measurements including height, weight, temperature and blood pressure. This process provides a quick snapshot of the patient’s health.
If a patient is admitted to a hospital or undergoes an outpatient procedure medical professionals often turn to patient monitor devices to take similar measurements and track them for changes. These devices, as the name implies, monitor the patient.
HTM professionals play an important role in every patient’s health by providing patient monitor devices that work as they should via PMs and repairs.
TechNation reached out to a panel of experts to quiz them about patient monitors and what HTM professionals need to know when working with these devices. The panel is made up of Pacific Medical Senior Sales Manager Bobby Brosan, Tenacore Service Manager Oswaldo Chavez, Philips Senior Director of Field Marketing and Sales Support Julie Milner, Southwestern Biomedical Electronics Inc. President Larry R. Neilson, and Integrity Biomedical Services Owner Michele Shahbandeh.
Q: What are the latest advances or significant changes in patient monitoring and in the patient monitoring market in the past year?
Brosan: With the hyper focus on health care costs, a connected OR can serve to cut the incredibly high cost of OR time. Better networking and integration of your OR through upgrades of existing networks, or through the creation of new network platforms, can definitely provide tremendous cost savings. Whether your facility has 50 operating rooms or just a few, networking your OR can save lives and make your facility much more efficient. Pacific Medical is constantly updating its software to ensure that the products we sell are up to date and comparable to the latest OEM equipment.
Chavez: Patient monitoring has become much easier to use in the last decade. User interface is improved, things are now wireless instead of wired, and the data is easier to read. For example, in monitors, the screen is larger with a touch screen to make it easier to use. Another big advancement is that the monitors have a good interface with the central station and hospital network. Vital signs are easier to read and analyze which ultimately leads to patient safety.
Milner: One of the most significant shifts we have seen is a convergence of the biomed and Information Technology (IT) sectors as patient monitoring is moving away from a device based business model to a clinical information system solution. These systems can be individually designed and scaled to meet a health care organization’s changing care models and clinical workflows. An example of this is the monitoring war room or cockpit. As organizations continue to look for creative ways to deliver higher quality care at lower costs, moving back to monitoring cockpit or war room is a care model that health care organizations are exploring.
Neilson: In the immediate past patient monitoring has had little change other than the always occurring software improvements. In the marketplace, SBE Inc. is receiving an above average request for refurbished patient monitoring and additions to existing telemetry systems. More facilities are using their budgeted money more wisely, taking advantage of the cost of re-furbished equipment with extended warranties than in the past.
Shahbandeh: Patient monitoring, such as telemetry, has improved technology. The clinicians want real time data. They now have the information at their fingertips. They have a screen on the front to show ECG, SP02, and NIBP.
Q: How will those changes impact equipment maintenance?
Chavez: Patient monitoring equipment keeps getting more complex, therefore it requires a higher cost to repair. Continued training and education is required as well as learning how the new components work. At Tenacore we are always looking for ways to be the leader in patient monitoring repairs so education and training of new equipment is a top priority.
Milner: The industry is moving away from the device break/fix model to a support model that incorporates commercial operating systems and application software updates and upgrades. As biomed and IT share patient monitoring support responsibilities of the real time clinical information system, remote access and remote support have become a larger piece of the organization’s strategy. As a result, proactive system health monitoring – a solution that monitors the health of the network and end devices – has become more prominent.
Neilson: The software improvements present a challenge to the HTM community. If not a mandatory upgrade, we have seen that these changes may affect the soft key menus, or a combination of some menu driven operation. Regarding the market and purchases of refurbished equipment, a one-year warranty should be expected, and extensions to that are available from most ISOs. Purchases must be procured from a reputable company with references and history, or there may be unpleasant maintenance issues.
Shahbandeh: The cost of replacing those screens and cases, if broken, will be considerably higher. Sometimes the only place to have those repaired is the OEM.
Q: How can a facility with a limited budget meet the patient monitoring needs of today?
Brosan: Utilize a trusted third-party medical device supplier to repair your existing equipment and ensure its optimal performance as well as provide refurbished equipment with the same quality as OEM at huge cost savings. Pacific Medical carries an enormous inventory of recertified monitoring equipment for sale along with OEM compatible accessories and parts from all major manufacturers.
Chavez: Facilities with low budget have many options in the third-party market. First, they need to identify their needs, and figure out a plan of action. Because a limited budget is always a concern, sending equipment to the OEM is sometimes not an option. There are many third-party companies that can do the repair at a fraction of the cost. At Tenacore, we are always providing an affordable alternative to OEM pricing without sacrificing quality.
Milner: Many health care organizations are now looking at long-term solution total cost of ownership models, and long-term planning to examine patient monitoring utilization, requirements, needs and budgets. The successful patient monitoring vendor/partner has to design, engineer, and implement a platform that delivers on today’s needs and be capable of evolving with the health care organization’s changing needs over time. As the business of health care quickly evolves, adopting this mindset will become even more crucial. This is in stark contrast to the legacy approach where organizations and vendors were box-based and device-centric and had limited lifecycles.
Neilson: We are repairing patient monitors from some facilities that are 15 years old, some older. I understand the budgeting problems facilities have and hope that our national health care system will soon get on better footing for all citizens. Repairing some models of older equipment is more expensive than a refurbished monitor with warranty, however much time may pass before approval of such improvements can be achieved. Facilities need their monitors fixed and returned fast.
Shahbandeh: They can purchase from a reputable second source company. These companies can save them from 40 to 50 percent off the OEM list price. They can also meet or beat the warranty from the OEM. Also, delivery of the equipment can be within 10 business days from the receipt of PO.
Q: What technologies are worthy of the initial investment?
Chavez: I think a worthy technology to invest in could be a more advanced monitoring system such as multimodality monitoring used in neurocritical care settings. It allows clinics and hospitals to track multiple parameters of brain physiology and function (such as brain tissue oxygen tension) to determine the brain’s relative health or distress. New advancements in modern medicine is the key to patient safety and the health of our communities. With new technology, we can quickly and efficiently identify the root cause of an illness to prevent any misdiagnosis of a patient.
Milner: A large number of health care organizations are now evaluating clinical systems that provide the potential of improving patient care in areas of the hospital that previously did not monitor patients. An example of this is the Philips IntelliVue Guardian solution that is used to monitor patients in general care areas. IntelliVue Guardian with Early Warning Scoring aids in identifying subtle signs of deterioration in a patient, hours before a potential adverse event. It automatically acquires vital signs, utilizes algorithms and data (acquired by patient monitors and wearable sensors) to notify the clinician of changes in health status. By identifying which patients may need more focused attention, health care providers can make a significant difference in patient care.
Larry R. Neilson
Neilson: In my opinion, asset management, or RF tracking systems is at the top. A facility must know how many pumps, portables, etc. they have and where they are, so they can be utilized to the fullest extent. I believe the investment in the in-house HTM department is as important as any technology. Management must learn the importance of their own departments, what and how they do what they do, saving department dollars.
Q: How will remote patient monitors and wearable’s alter the work of HTM professionals?
Chavez: The new wearable technology is a huge opportunity in today’s market. This will alter the work of HTM professionals because the patient can be monitored wherever they are. It can help keep track of their vital signs, and shows promising benefits to automating hospital processes i.e. “smart hospitals.”
Milner: As monitoring becomes more pervasive and technology is changing, HTM professionals may consider learning new and complementary skills that will enable the professional to help the organization realize the full benefit of these changing care models. In the future, the HTM professional will likely be taking a more active role in their organization by consulting, designing, delivering and remotely supporting the technology requirements for these changing clinical workflows.
Neilson: It will be even more difficult to inspect and do performance tests that are so important on these devices. If a patient is wearing arrhythmia monitoring, or NIBP monitoring for diagnoses and treatment, these devices must perform as designed, and should always be inspected/tested before next use.
Shahbandeh: They must all learn to work together, clinicians, IT, and the biomed department. Communication is key to this new technology.
Q: What else do you think TechNation readers need to know about purchasing and servicing patient monitoring devices?
Brosan: Use an established third-party vendor with ISO certification and certified engineers working with the latest equipment to ensure each piece of equipment is ready for patient use. Patients and hospitals depend on equipment that is trusted and up to date. Hospital budgets want the best equipment at the best price. Pacific Medical understands and delivers innovative solutions for the greater good of our customers. This is why Pacific Medical has been able to grow its business year after year and become the leader in repair, service, exchange, parts and accessories.
Chavez: TechNation readers have to consider price and availabilty of the parts as well as time frame. Turnaround time is very important because depending on the availability of parts and service, the unit will not be in service for that amount of time. Ultimately patient safety is the main concern and being able to quickly reduce downtime is necessary. Always do your research and plan ahead before jumping into any purchase.
Milner: The HTM professional should consider thinking outside the traditional device support role, and think in terms of a systems or solutions-based approach. “Systems thinking” is a rapidly expanding approach to creating and maintaining complex systems, thus looking holistically at the entire solution or technology ecosystem. This concept can be applied to systems of all sizes from a single entity deployment or to a large complex multi-site enterprise system.
Neilson: Always contact a reliable source with references and history. Know that there are alternatives to parts and service, price should not be the only factor. Ask your service provider if there are options to the repair of an aging monitor or system.
Shahbandeh: We believe using a ISO-certified company tells the hospital you are using an accountable quality company. We adhere to strict processes and the ISO standard, currently ISO 9001-2008.
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