By K. Richard Douglas
The Ozarks is a region of the country that includes the Ozark Mountains and spans 93 counties in four states: Missouri, Arkansas, Oklahoma and Kansas. The region offers many attractions for tourists.
Lake of the Ozarks, in the heart of Missouri, offers boating, golfing, fishing and shopping. Resorts, cottages, parks, caves and waterparks are just some of the area’s attractions.
Serving the health care needs of veterans in this beautiful area of the country is the Veterans Health Care System of the Ozarks.
Serving the medical equipment management needs of the system is the biomedical engineering department. The team serves facilities in three states.
“The Veterans Health Care System of the Ozarks (VHSO) consists of one Veterans Health Administration (VHA) facility located in Fayetteville, Arkansas, and seven community-based outpatient clinics (CBOCs) in Fort Smith, Harrison, and Ozark, Arkansas; Branson, Springfield, and Joplin, Missouri; and Jay, Oklahoma. All clinics are VA staff, except for Harrison, Arkansas, which is contract staff,” says Jane Lacson, MS, CCE, CHTM, chief of biomedical engineering for the system.
Lacson says that the seven CBOCs serve veterans in north and west Arkansas, southwest Missouri and east Oklahoma.
“There are two Vet Centers in VHSO’s catchment area, one located in Fayetteville, Arkansas and the second in Springfield, Missouri. There are also two State Veterans Homes in the VHSO catchment area: one in Mt. Vernon, Missouri; and one in Fayetteville, Arkansas,” Lacson says.
VHSO is a 78-bed acute care facility classified as a Level 1C on the VA Complexity Model.
“Comprehensive health care is provided through primary and secondary care in areas of medicine, surgery, mental health, physical therapy, neurology, audiology and speech pathology, dentistry, ophthalmology, oncology and women’s health. Referrals are made to tertiary care facilities. VHSO is part of the South-Central VA Health Care Network (VISN 16), which includes facilities in Arkansas, Alabama, Louisiana, Mississippi, Texas and Florida,” Lacson explains.
Besides Lacson, the team is composed of Biomedical Equipment Support Specialist (Information Technology) Ralph Newman and biomedical equipment support specialists Michael Alf; Robert Casey, CBET; Tom Chapman, CBET; Sergio Cruz-Camacho; Russ Powell and Gerald Williams.
The department manages service contracts with the help of the contracting office.
“The period of performance for these contracts are managed so as to not have a lapse in coverage. Each of the staff members in the biomed department have their contracting officer’s representative (COR) certificate and they manage their individual contracts,” Lacson says.
She says that the major responsibilities and duties of the COR are to manage the activities of the work conducted by the contractor, overall contract performance, to financially accept/reject invoices made against the contract and to create procurement packages for the contract.
Data collection is accomplished using Maximo, which is their CMMS. They have utilized this system for the past three years.
“All this data is pulled into a central database where the VHA Analytics team creates tools and reports, available on a local, VISN and national level that are used to monitor key performance indicators and benchmark performance data against like sites. A site has the ability to look at the KPI Dashboard which includes categories of safety and risk management, process and quality, employee learning and growth, and customer satisfaction,” Lacson says.
Making Facilities COVID-Ready and Saving Money
The team has tackled several special projects in addition to its daily accomplishments. One of those was the department’s CIS/ARK project.
“Ralph implemented both PICIS’s Critical Care Manager and Draeger’s ARK (Anesthesia Record Keeper) solution. It involved working with clinical staff, contractors, IT over multiple months from imaging workstations to servers to creating the cabling/hookups to the computer workstations from bedside monitors and other ICU equipment,” Lacson says.
She says the team also worked on an RTLS project. It involved working with logistics to implement RTLS for all non-expendable equipment at VHSO.
“Over a year was spent in implementing the infrastructure necessary to provide real-time tracking of equipment, as multiple wires and access points had to be run throughout the hospital. An entire network backbone had to be created, working with IT. Working with clinical staff to access and tag all the equipment of over 6,000 assets,” Lacson says.
They have also worked on a virtualization/storage infrastructure project.
“A growing amount of networked medical equipment requires a client/server set-up. Each physical server purchased became more and more costly, requiring many hours to procure, receive, install and set-up. The virtualization of servers and storage was a large project that proved to be very beneficial,” Lacson says.
She says that working in collaboration with IT, the biomed virtual servers were installed and spun-up.
“There are currently 15 virtual servers and more will be added into the future; system upgrades are a breeze as servers can be placed on a different ESXi host without any service interruption,” Lacson says.
Like so many of their counterparts nationwide, the team had to dive into COVID-19 readiness. Lacson explains that the preparation had many facets.
“Performing ahead of time all preventive maintenance on ventilators so that they would not need to be pulled should they become in-use. Helping other VA sites within the region to complete their PMs. Bedside monitoring expansion for different areas of the hospital for COVID/clean ICU. Having to run new cable for APs for telemetry expansion. Working on additional ventilator equipment procurements. Using 3D printing to print PPE and comfort mask tension bands. Making sure all PMs/CMs were done and corrected as soon as possible for equipment in critical areas,” she says.
The expertise on the biomed team has allowed the group to save money and to prevent patients from having to reschedule appointments.
“A vendor quoted a cost for an additional monitor at $23,000 and we were able to find all the parts necessary for $1,000,” Lacson says, pointing to one example of cost savings.
She recalls another time the team came through because of quick thinking.
“Ventilators needed to be plugged into different med gas outlets in the new clean ICU but not all of the outlets were standardized. (The department) was able to create a quick disconnect adapter that allowed for vents to be moved anywhere in new surge units,” Lacson says.
She says that another time, a camera in a microscope used in an operating room was damaged and would have resulted in canceled cases if not for the work of the department.
“Through diligence and problem solving, we were able to order the camera in overnight and get it installed without cancelling patients,” Lacson says.
The VHSO Biomedical Engineering Department has made life a little more enjoyable for the many veterans living in the area by maintaining the equipment needed to deliver quality health care when it is needed.
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