By ECRI
Procuring and implementing networked medical devices often comes with a host of IT-related costs—some obvious, some less so. Identifying and considering IT costs during the procurement process will allow you to avoid surprise expenses that can stretch budgets, strain relationships, and delay project timelines.
“The last thing a health care facility needs when implementing a clinical system is to have department leaders butting heads and pointing fingers. But we’ve seen it happen,” notes Chad Waters, senior cybersecurity engineer in ECRI’s device evaluation group. To avoid interdepartmental battles and budget-busting surprises, ECRI stresses the value of anticipating IT costs up-front, collaborating with the various stakeholders impacted by the project, and investigating (and budgeting for) the specific costs associated with the device or system under consideration.
Anticipate
Implementing networked medical devices may require expenditures related to the purchase and installation of network equipment, the implementation of security controls, yearly or monthly software licensing fees, and added personnel, to name a few. These costs can represent a significant portion of the total cost, and they come at all stages of the procurement cycle. While some expenses are obvious from the outset, others may be less so. Unexpected costs can overstretch budgets and delay project timelines.
To reduce the number of surprise costs, an organization must identify as many of the IT requirements as soon as possible in the procurement and planning process. “And don’t forget about dependencies,” advises Waters. “Costs associated with other systems on which the new device will rely can easily be overlooked.”
It’s important to account for all the capital expenses, operational expenses and administrative/support expenses associated with installing, connecting and supporting the device. Specific examples are outlined below. Anticipating all such costs will allow you to more accurately gauge (and budget for) the total costs of the system.
Collaborate
Getting the most accurate estimate of IT costs will require the involvement of the project management team, the purchasing team, the application owner (e.g., IT clinical systems analyst), the clinical leaders requesting the system, health technology management (HTM) staff, the IT networking team and IT security personnel. Effective communication among these groups is needed to clearly outline the system requirements, necessary infrastructure modifications, clinical needs and workflows that require support, and any dependencies with other applications (e.g., integrating a physiologic monitoring system with the clinical communications system).
The purchasing department should consult with IT to see what resources will be needed before making a purchase. Additionally, the HTM and IT/security departments must be on the same page as early in the process as possible. Furthermore, all stakeholder groups should discuss and come to agreement on the budgeting process for IT costs – specifically, whose budget IT costs will come out of? This can vary from one facility to the next and can lead to interdepartmental conflict if expectations aren’t established up-front.
Finally, communication with the medical equipment vendor is critical. Asking the right questions can help identify certain costs the vendor might not otherwise bring up.
Investigate
Review the four areas outlined below during the procurement process to help capture applicable IT-related costs.
1. Infrastructure. Infrastructure encompasses the computing and networking hardware and software necessary to support the prospective device or system and to facilitate its integration with other applications. Considerations include:
- Bandwidth – High-bandwidth systems like imaging modalities or video systems may require adding more bandwidth within the network. Having sufficient bandwidth is important for critical clinical systems.
- Wireless – If the system is dependent on Wi-Fi, the wireless signals in the required band (2.4 GHz versus 5 GHz) must be adequate in the areas where the system is used; this may require Wi-Fi coverage to be improved in certain areas. A wireless network survey measuring signal strength in the building may need to be conducted to identify dead spots and possible signal interference. Recognize that expanding the coverage could require adding wireless access points that, in turn, require cabling and sufficient network switchport capacity, as outlined below. Additionally, some projects may require wireless system settings reconfiguration or software upgrades, which could affect the entire organization.
- Cabling – For example, a device may need a network jack and cabling to the nearest network closet.
- Electrical power – If the room does not already contain enough electrical outlets, or if available outlets do not provide the appropriate voltage and amperage, new outlets and wiring may need to be installed.
- Network switchport capacity – Each network jack in use requires an available port to plug into on the network switch. If the switches in the closet are at capacity, more will have to be installed to accommodate the project. Similarly, if devices run on PoE (Power over Ethernet), the switches must be able to handle the wattage for the project. And if the entire network closet is at physical capacity, a new closet will have to be built.
- Data storage – Systems that produce a large amount of data could require the installation of more storage in the data center, both for the systems in service (i.e., production systems) and for their backups.
2. Staffing and Support. Adequate staffing, either in-house or contracted, is necessary for:
- Installation – IT staff will be required to install any infrastructure hardware identified above, as well as any servers or workstations that support the project. This could include IP address allocation and user account or certificate creation.
- Application support – IT staff must work with the supplier to implement the solution and ensure that it communicates reliably with other systems. For example, staff will need to verify proper integration of the system with relevant information systems, verify proper system configuration, support troubleshooting and manage downtime.
- Administration/maintenance – Any IT system that is installed will need to be maintained. This includes updating the software, scheduling backups, transitioning from legacy operating system platforms over time, and modifying settings and user accounts as needed.
3. Security Controls. Any system will need to be monitored for and protected from IT security threats, and these security controls need to be properly resourced. A risk assessment by the IT security team will determine the appropriate risk mitigation measures, such as firewalls and network segmentation, virtual private networks (VPNs), multifactor authentication, and antimalware/antivirus software.
4. Licensing. The system or dependencies may include recurring licensing fees. Various licensing models exist, including a flat annual fee, charges based on revenue, and fees per study, per user, per patient, or per bed. As such, licensing can represent a significant portion of the total cost of ownership for the system over time.
To Learn More
This article is adapted from the ECRI Guidance Article “During Medical Device Procurement, Be Aware of These ‘Hidden’ IT-Related Costs“ (Device Evaluation 2023 Nov 22). Members of ECRI’s Capital Guide, Device Evaluation, and associated programs can access the complete article, along with guidance on similar topics.
To learn more about membership, visit https://www.ecri.org/solutions/device-evaluations, or contact ECRI by telephone at (610) 825-6000, ext. 5891, or by e-mail at clientservices@ecri.org.