Ultrasound systems continue to be a valuable medical technology. We asked industry experts about the latest advances in this medical imaging modality and how HTM departments can best manage and service them. The panel of experts is made up of Jim Carr, Director of Service and International Operations, Advanced Ultrasound Electronics (AUE); Bob Coyle, Director, Northeast Division, MW Imaging Inc.; Don Fletcher, Owner, InterMed Ultrasound Services Inc.; Nick Haralam, Senior Territory Manager, Trisonics; Tobin Taylor-Bhatia, Senior Director, Customer Services, Ultrasound, Philips Healthcare; Matt Tomory, Vice President of Sales, Conquest Imaging; and Christine Wright, Director Business Development, Axess Ultrasound.
Q: How can purchasers ensure they are making a wise investment in an ultrasound system?
CARR: Purchasing a used or refurbished system from a reputable company is the best way to maximize your investment. Ensure the systems you are considering meet your clinical needs, including any features such as DICOM or 3D that you may want to use in the near future. Carefully investigate the service options for the system and probes, and purchase a system that has alternate providers for parts and probes.
COYLE: Buy from a reputable dealer, don’t buy on price alone. Check references and talk to others who have purchased from the dealers that you are considering. Ensure that you will be supported after the system is delivered.
FLETCHER: Understand in detail what the user’s needs are, find out which make/models will meet those needs, determine if a used system will meet those needs or if the unit has to be new. Consult with multiple sellers of both new and used equipment, this will help you determine if additional questions need to be answered prior to making the purchase.
HARALAM: Purchasers should get the department requesting the unit involved, make sure the unit is the correct model type, has the options they need for their specific applications, and be sure the system is at a current software level. The buyer should also research the company they are buying from and ask what type of warranty they will receive and for how long. Ask the vendor for references from customers who have purchased equipment from them and request a brochure on the product you are considering for purchase.
TAYLOR-BHATIA: When purchasers look at making an investment in ultrasound, it is important that they consider the total cost of ownership. In addition to the upfront cost of the system, there are additional components purchasers should consider when comparing the value of an ultrasound system including reliability, services, warranty, education, and financing. Finding an ultrasound manufacturer partner will help ensure that they find the right solution to help ensure that they’re able to maximize return on investment.
TOMORY: Ensure the system meets all the current and potential future needs of the department(s) using it as upgrades can be very costly post-installation. Also, does the system have a proven track record for performance and reliability? Ask for a comprehensive list of customers, not just reference sites.
WRIGHT: Knowing what your clinical demands are is the most important factor in assuring each system will fit the need for purchase. Many look for all the bells and whistles and can overcomplicate the requirements resulting in an increase in workflows and potential decrease of diagnostic confidence. You should always ask two questions, 1. Will a new system improve patient throughput? 2. Do I realize additional revenue?
Q: What are the most important features to look for when it comes to an ultrasound system?
CARR: The system needs to meet the needs of the clinical users, with the modes and transducers required for the diagnostic studies they need to perform. Good reliability and serviceability means the system will be available for clinical use more often. Buying a system for which third-party service, training and parts are available will assure the lowest cost of supporting and maintaining the system over its life.
COYLE: System feature requirements vary greatly from department to department and hospital to hospital. Upgradability and probe availability are major features to consider. Look at the types of scans your department is currently doing and what types you foresee them doing in the future. System reliability and ease of operation should be a strong consideration. Support after the sale, both technically and in system operation, should also be strongly considered.
FLETCHER: Image quality, type of exams the system will be used for, calculations capability, connectivity and image storage, and, of course, serviceability.
HARALAM: It depends on the application the system will be used for. DICOM and Harmonics are a must. It should have the option to export to CD/DVD or USB stick, in case PACS is down. The buyer should be aware of all transducers and applications the unit can support for possible future use.
TAYLOR-BHATIA: It is critical to understand the use environment and needs of a department. Is it a high volume environment? Is there a clinical area of focus? How experienced are the ultrasound users? Having a keen understanding of the use environment will help purchasers choose the right solution for their department. Philips RightFit Service Agreements include a range of comprehensive options, including custom onsite services for biomedical support and multi-vendor services for all medical systems. The aim is to help enhance operational efficiency and control cost, while providing flexible service options.
TOMORY: Aside from performance, research the serviceability of the product post-warranty. There are a lot of good systems in the market today, but what happens after the warranty? Are manuals, passwords and software available or are you in essence forced to stay with the OEM for the life of the product?
WRIGHT: Features must meet the needs of expected performance. Ultrasound is a user dependent modality and giving up any confidence or ease of use by that clinical provider poses risk for the consistent quality of images from patient to patient. The best starting point is to ask, what OEM models are my technicians used to?
Q: How can HTM departments be sure to obtain the best ultrasound system for their facility?
CARR: Start by educating the clinical users regarding the cost of ownership and the factors that affect it. Ensure the users have identified and prioritized their clinical needs using the common or engineering terms for modes and features, and don’t allow any OEM-specific terminology that their salespeople try to use as “lock-out terms” to ensure they have the only system that meets it. Ask for, and check with referrals and other users through groups or user forums, and visit clinical sites using systems under consideration to get a good idea of the clinical usability, serviceability, and reliability to be expected.
COYLE: Each department varies when it comes to its ultrasound system requirements. Look at both your current needs and what you foresee your department needs will be 3-5 years down the line. Don’t overspend for options and probes that you don’t foresee being utilized by your department during the equipment’s lifespan. It is equally important that you don’t purchase equipment based on your current needs without considering your departmental growth over that same time period.
FLETCHER: Ultrasound purchases are very user dependent. Get informed on what operational capabilities are needed i.e. cardiac studies, small parts, vascular – for the department that the unit is being purchased for such as radiology versus cardiology. The configuration and functional capabilities of the system will be different for each department.
HARALAM: The buyer should research the product and look for comparable units the department may be interested in. If possible, speak to other facilities using the same system for similar applications. Ask the vendor if a demo is possible so that the department can get a “hands-on” view of the units they are considering.
TOMORY: Work in conjunction with the clinical departments when shopping for replacement or additional equipment to assess needs, capabilities and projected reliability. This relationship is critical as HTM is an invaluable resource when it comes to making well-informed purchasing decisions.
WRIGHT: Talk to the clinical associates and physicians using the device. What are they trying to improve from their current unit? What is missing from their current unit that puts their diagnostic confidence at risk? Do they want exactly what they have, just new or newer? Basically, ask questions to help them through the process and weed down to the essentials necessary to achieve confidence and stay within a budget.
Q: How can a facility with a limited budget meet its ultrasound system needs?
CARR: It is critical to have the HTM department(s) as a major decision maker, because the cost of ownership of the system over seven years can easily be twice as much as the original purchase price. Avoid buying a system that has been in production for less than two or three years because the price of the system will be very high and there will be little or no experiential data on it, plus you will be part of the “Beta test group” dealing with all the new-system design bugs. Purchase a refurbished system using information on reliability, alternate service providers and the expected service costs as key criteria, and develop a service support strategy that utilizes the in-house HTM departments as much as possible.
COYLE: Consider buying gently used refurbished equipment from a reputable dealer. Remember “refurbished” does not always mean refurbished. Sometimes it means “used.” Make sure that the company that you are buying from has the technical expertise and trained staff to supply you with reliable, up-to-date ultrasound equipment. Also, make certain that you will be supported after delivery by both the company’s in-house and field teams.
FLETCHER: Purchase a system a few years old that has the operational capabilities of the end user. Ultrasound comes in a number of configurations and price points. Find a system that is less than five years old and is easily serviced.
HARALAM: The buyer should consider the most important reasons for the need of a system and where it will be used. For example, if the department needs a unit to occasionally go portable with, that does not mean they necessarily need a laptop based unit that can run on battery. In most cases, you will pay a premium for a laptop based unit than a comparable stationary unit that can easily go portable. Be sure not to purchase transducers you may not use.
TAYLOR-BHATIA: Beware of features and benefits that do not add value to facility users. Facilities should ensure that they aren’t lured by a cool new feature that its users cannot or will not use. An ultrasound solution is a significant investment. It’s crucial to partner with manufacturers that work with customers and prospective customers to assess risk over time and evaluate the total value of the system to ensure that every customer gets the right solution for their department
TOMORY: Clinical departments may want to buy the latest and greatest with all the options, but is this needed for current and future patient needs? Also, a reconditioned system is an excellent way to save scarce dollars and still obtain a contemporary system. Like purchasing a pre-owned car, the previous owner has already taken the depreciation.
WRIGHT: There are alternative avenues for ultrasound. A refurbished piece of equipment offers you the opportunity to purchase a more expensive unit that is slightly older for a much better price tag. Knowing what your true needs are verses your wants help scale down units to exactly what can fit within a budget. Also, consider redeploying existing equipment.
Q: How can HTM departments make sure they will receive proper training and literature when purchasing an ultrasound system?
CARR: The best way is to negotiate at the time of purchase that training, documents and tools needed to maintain the system are included. Do some research to find out what is critical, and get the supplier’s commitments in writing. Some of the critical items typically needed, which the FDA refers to as instructions and procedures, include passwords, copies of installation software, service manuals and procedures. The service training provided by OEMs to users is often not the most effective training available, so try to get a commitment that the training class will be the same as provided to their field service techs.
COYLE: Check the company’s website and talk to their personnel. Ask to see technical information and talk to their engineers to gauge technical knowledge. Ask for references and speak to others who have purchased from them before and dealt with their service group.
FLETCHER: In the purchase agreement, stipulate that training on the model being purchased will be provided to the department as part of the purchase of the equipment.
HARALAM: This should be negotiated and put in writing on the quote. Request a minimum of one-day applications, along with an operators manual (CD, digital or hard copy) and a service manual, if possible. Ask the vendor about who will be doing the applications training and their qualifications.
TAYLOR-BHATIA: If training and education is important to their users, facilities should ensure that this is part of their purchase agreement. Manufacturers should provide in-house teams with the right mix of technical training, education and support. Such classes should focus on real-world maintenance using live systems conducted by highly experienced instructors. These benefits can be an important component of the total cost of ownership adding to the value of an ultrasound solution.
TOMORY: Always include items such as clinical and technical training, service manuals and software in the negotiating process and as line items on the purchase order to ensure you have all the tools to support the use and service of the product.
WRIGHT: Application training is offered even for refurbished equipment from the clinical perspective. One should also make sure service training is included in the purchase price from the biomed perspective.
Q: What else would you like to add or do you think is important for biomeds to know about ultrasound systems?
CARR: Maintaining and servicing ultrasound systems is often a way to save money for the facility while actually improving the level of service, safety and quality. It does require a resource with the proper training, tools and support. One of the quickest and largest impacts you can have at most hospitals is to assure the users are doing the maintenance and inspections recommended by the manufacturers. This is especially true for transesophageal probes (TE, TEE, TOE) that are very expensive to repair or replace and are supposed to be inspected and tested for electrical safety before every patient exam.
COYLE: Ultrasound equipment, as with most capital purchases, is a major investment and a poor decision can haunt your department for years to come. Make certain that your facility is purchasing reliable equipment from a reliable source. Also, ensure that everyone that is being affected by the decision is involved in the decision.
FLETCHER: Some makes/models are more difficult to service due to manufacturer design. Find out how difficult it is to access repair parts for each system that you are looking to purchase prior to making your final decision. Even though this is not the first priority in purchasing, it should be considered carefully to keep cost controlled in the future.
HARALAM: If the department is requesting a particular unit, the buyer should be sure which version or cart level and what options they are getting. Do not assume all unit options or packages are the same. Ask the vendor, whom you are considering purchasing from, about their service representatives and how quick they can respond in case of service issues.
TAYLOR-BHATIA: Biomeds need to understand the serviceability, reliability and remote services of a solution to ensure they can quickly get assistance if they need to escalate issues to the manufacturer. The best services contracts are those that are flexible enough to supplement in-house system education, training and servicing. Ultrasound use is growing and there are a variety of sectors making ultrasound equipment. Understanding a system’s unique needs, what features are most critical to address those needs, and the total cost of ownership of the system will help ensure that biomeds select the right system for their department.
TOMORY: As previously mentioned, partner with the clinical departments before, during and after a purchase to ensure you are not only getting a system that meets your clinical needs but one that also can be supported internally for the life of the product.
WRIGHT: If the biomed is supporting the unit, being properly trained either through the OEM or third-party ISO is critical to understanding how to troubleshoot the failures. Ultrasound is so dependent on the user or clinical provider that learning how to communicate with that associate will help accelerate the troubleshooting process.