Sponsored by Medical Equipment Dynamics
By John Schafer, MBA, CHTM
After a career in health technology management (HTM) spanning 40 years, I find myself running an HTM program in a “little country hospital” in North Texas for Renovo Solutions. I have excellent corporate support and I can get the resources I need to make our HTM program a success. It is nice that I can take a step back and enjoy life for a while.
Hunt Regional Healthcare, in Greenville Texas, is a public hospital licensed for 182 beds. Hunt Regional is respected within the community for quality. “We are expanding rapidly with two satellite emergency medical centers and five urgent care clinics as well as an increasing footprint of physician clinics,” states Hunt Regional CEO Lee Boles. This organization definitely qualifies as, “The little hospital that could.”
Before you start to think that operations in small facilities lack challenges for the HTM department, you need to take into account that Hunt Regional has the same operational tempo as larger facilities. Maybe even higher since we are the only game in town, and we treat everything from boo-boos to major trauma. To make our days even more interesting, we have almost zero redundancy in our medical equipment inventory. We can’t just grab another one off the shelf if something breaks. There isn’t another one, so we have to figure out how to get this equipment back online right now.
I interact with the C-suite and department directors on an almost daily basis. I work with them on cost avoidance in equipment service, making sure we are getting the best deal from vendors and suppliers, and occasionally I get a request to, “Call some of those friends of yours and get us a deal on one of these.” Whatever we can do to cut costs and promote patient care, nothing is off the table.
U.S. Economy
Economic conditions in the United States right now are unsettled. Health care organizations, with a few exceptions, are operating with far less funding for capital purchases this year than was originally planned.
This is where things can get really challenging for HTM. Medical equipment does not improve with age. Parts cost more, service contracts cost more, you must have a purchase order number before OEMs will help you with tech support to make a machine function again. Technical expertise is leaving the field through retirements. Parts and accessories are becoming scarce for anything more than 8 years old.
I want to share some of my budget stretching methods of making your equipment as good as it can be, especially since you may be owning it longer than you thought.
Imaging Systems
Imaging Technician Rachel Chennault is currently working through our imaging inventory. Some of the major considerations for how much effort and money to put into these units include:
- How many years does this platform have until the end of OEM support? Can we get third-party support?
- Can this platform handle current patient throughput?
- Does it have the image resolution needed for the studies being ordered?
- Are there any software updates that would improve the system’s performance?
Do not be afraid to look into upgrades for your imaging systems. A new detector plate for a rad only X-ray room can do wonders for image resolution. For example, a golden opportunity for this is a detector gets dropped and with a couple of phone calls to local sales reps we got a complete replacement system of the detector plate and everything else needed for the upgrade. All for over $10,000 less than the cost of the direct replacement of the original plate. It was a huge upgrade in technology as well as image quality. We have done this twice in the last six months, saving money on both upgrades. The upgrades also greatly improved workflow and patient throughput for these rooms.
One of the biggest “bangs for the buck” for improving imaging system performance, regardless of modality, can be system applications training. Are the technicians currently using the latest apps for the studies they are performing? Are new staff using the same techniques as everyone else that has been in the department for a while? Operator error can induce image quality problems especially when trying to use techniques originally developed for a different platform. Software updates and corresponding applications training can give you marked improvements in your imaging quality because of the improved imaging processing capabilities and improved procedures working together.
Ultrasound
One of the first things to remember about ultrasounds that you have under contract is that many current OEM specifications for ultrasound do not require PMs!
Ultrasound image resolution naturally degrades over time. There are a few things you can do to make the most of your systems. One is to do a general PM on your units. Vacuum out dust bunnies to reduce problems caused by heat, make sure circuit boards are securely seated, check connections, and check cables and probes for insulation and shielding damage. Large ultrasounds are a lot more portable than when I first came into the HTM field somewhere between the dinosaurs and the bubonic plague. I see ultrasounds going to the patient’s rooms on a daily basis. Being bumped and bounced in elevators, bumping into walls, etc., can induce problems over time.
The next place to look is your ultrasound probes. Has the soft scanning surface of the probe been damaged? Any break in the physical continuity of the probe surface will induce an image artifact. Ultrasound crystals will degrade over time.
You can QC your probes with a physical inspection and check your image with an ultrasound phantom. Check for image continuity. Look for drop out in your image field, especially while you are moving your probe over the phantom. Watch for what moves and what does not in the image field.
Getting ultrasound probes repaired is relatively inexpensive compared to the improvements you will get. There are numerous independent companies servicing imaging, and specifically ultrasound probes.
Last, but not least, make sure you have current backups on your ultrasound operating system! Nothing will ruin your day as quickly as having to rebuild your ultrasound’s operating system.
Non-Imaging Equipment
There can be many opportunities for extending the life of your non-imaging equipment. Talk to the department heads and equipment users. I have HTM Techs Bradley Wong and Thomas Aguirre constantly looking for opportunities to improve our medical equipment fleet. An example I can provide from a previous facility of mine is a department physio monitoring system was not replaced as scheduled. I talked with the staff about the capabilities of the current system and the new one being purchased. The current system worked fine and did everything they needed, but the replacement system had large video screens for better visibility of the patient data. No problem! We can add those to your current system! This upgrade extended the useful life of our current system until that model reached end of OEM support in four years.
You also have the option of replacing one or two pieces of a system from the used/third-party companies in our industry. Hospitals that would not consider utilizing used or refurbished equipment in the past may soften on their stance in the current economic reality.
Refurbish your own machines. In past years, I was at a facility that was under contract with a major OEM. The contract covered labor, and they purchased their own parts. Their fleet of 10 operating tables were in very poor condition. There was no funding for replacement. I contacted my leadership with my idea of having these tables refurbished by the local dealer one at a time, and we would be provided with a loaner table at no cost since I was sending him 10 units for service. They agreed. I brought the idea to the surgery department, and they were in full support of the idea, since these tables were still the current model being offered to the health care market. They made complete lists to replace the tabletops, many accessories, etc. When they received the cost estimates for this (about $15,000 per table) their plans were revised to replace what needed to be replaced. Over the next three months all tables were serviced and returned one at a time for an average cost of approximately $2,800 each. And, they were off the capital equipment list for another 8 years. Refurb in place is a viable option for a lot of your physically heavier items, such as OR tables, sterilizers and washers, OR lights, hospital beds and stretchers, and possibly anything that is “constantly breaking down bane to our shop’s existence” piece of equipment that you are unable to get rid of.
A task that almost every shop can utilize is refurbing your own IV pumps. If you have a few hundred IV pumps there will be some that break constantly. Compare the cost of refurbing the worst of your own existing IV pumps vs. the cost of purchasing used pumps or new from the OEM. Don’t forget that your tech’s labor is not free, and constantly patching troublesome IV pumps together over and over is costing you a lot more than the cost of parts.
Keeping the museum pieces running.
You will have to service equipment that is past end of support from the OEM, no question about it. This is the area of servicing equipment where three strikes is not out, and age and treachery will overcome youth and exuberance every time. All of us here know that you can still support these units for years by working with third-party parts suppliers. However, not everyone may be aware that many of these units are not actually manufactured by the OEM that sold them to you. I have had numerous examples over my HTM career where we could go to the original manufacturer, usually outside of the United States, and buy parts so we can keep the equipment going for another year. You can find original manufacturers with a little time on Google, using the model number or other designators. Also, try to Google the part numbers out of the service manual. If you find numerous parts for that unit all manufactured by the same company that is not the OEM you bought the unit from, you are on the right trail. You can also look inside the unit with the covers off for manufacturer’s trademarks, or in the service manual, which will sometimes be the original service manual, with the new OEM logo printed on it.
Conclusion
Get out and talk to your stakeholders. Find out what their needs are, and their future desires. Budgets are tight, but you can make your conditions as good as they can be. Offer to work with the capital request committee and the COO for what units are coming up on their end of support dates, which units can be supported past the end of support date, and which models have a hard stop in their service life and will need replacement. This sort of information is gold for the decision makers that we support.
Do not make illegal modifications. Stay within standard practices and procedures. There will be opportunities to pull a rabbit out of the hat one more time to magically help your facility or organization maximize equipment usage and manage expenses.
