Maintenance engineer repairing and checking CT scanner machine every 3 month in the hospital. Services concept.
TechNation magazine recently recruited feedback from healthcare technology management (HTM) leaders regarding equipment acquisition and disposition. The COVID-19 pandemic revealed supply chain issues across several industries, including health care. HTM professionals continue to play an important role when it comes to purchasing new devices, installing new equipment, maintaining these devices and retiring them when the time comes.
The individuals who agreed to share their insights with TechNation readers on equipment acquisition and disposition are Medical Equipment Doctor Vice President of Sales and Procurement Sean Armstrong; ReNew Biomedical Assistant Biomedical Manager Jamie Cagle; Eagle Medical Inc. Global Service and Maintenance Manager Fred Culver; Capital i, Chief Executive Officer Tony Danko, CHTM; and SAKOMED LLC Biomed Matin Kondori.
How can an HTM professional help decide when it is time to retire a medical device?
Armstrong: Typically, you would determine if the unit is at the end of life and if there are any parts or support from third-party organizations that would facilitate a longer parameter of sustainability. Now, with the use of integration, it is important to also look at the security of the device from a cyber perspective. Does this unit store or transmit patient information and is the operating system still protected? If it is not, capital planning should be initiated.
Cagle: Many factors go into deciding when to retire a medical device. In my experience, there are three reasons an HTM professional would retire a medical device. These reasons are scarcity of parts, lack of OEM support, and cost of repair exceeding the unit’s value. Medical device value depreciates as it ages. Since the cost of repairs and service is a significant factor in equipment retirement, consider alternative ways to keep costs down. Whether this means increasing internal efficiency or sending equipment out for repairs, explore your options to save on costs while keeping your units operating correctly.
Culver: This decision is frequently based on a simple cost analysis: is the device more expensive to repair and maintain than the acquisition cost of a new device? Even if the maintenance costs are 75% of the acquisition cost, there is a case to be made for replacement.
Danko: When deciding to retire a medical device, there are three major factors to consider, clinical need, patient safety, and financial stewardship. An HTM professional captures and maintains a historical record of medical devices. These data generate objective information for patient safety and financial stewardship. A good HTM professional continues to monitor technology advancements and clinical requirements to provide subject matter expertise to the clinical need factor.
Kondori: Many factors are involved in retiring a medical device. The most important one will be when manufacturers are not supporting device repair and parts/accessories are not available. Also, in many cases, usage and age of the equipment are factors to consider especially in regards to lifesaving equipment such as respiratory ventilators.
What is the most important thing to keep in mind when removing medical equipment from service?
Armstrong: This might be a bad analogy, but when someone is born, they have a birth certificate; when someone dies, they have a death certificate. The same applies to medical devices. When a device arrives at a facility, an incoming inspection is performed and documented. When a device is removed from service, a work order should be documenting the removal from service. It’s crucial to remove and document PHI/hard drives, asset/biomed labels, etc. Furthermore, if it is a capital item, the facility is required to pay taxes on the device. Removing it from the asset inventory reduces the tax liability and saves money for the health care organization.
Cagle: I believe communication is the most important thing to remember. It is necessary to inform and warn the medical staff that the unit will be removed from service so they can consider replacement options.
Culver: The device still has value and it doesn’t belong in a landfill so don’t throw it away! The device can be disassembled for parts, traded in, sold to a refurbisher, or best of all it can be donated to a program like Project C.U.R.E. which sends medical equipment and supplies to developing countries.
Danko: By removing medical equipment from service, you are reducing patient care capacity and access to care. You must consider the clinical requirement and balance those requirements with the potential safety implications and long tail cost of maintenance. Your organization should be better off when it removes medical equipment from service.
Kondori: When removing equipment from service, you need to make sure devices are fully sanitized and all the hospital tags and data are removed. Removing patient data is the most important step.
What are key steps HTM professionals must take when it is time to remove a medical device from service?
Armstrong: HTM professionals should always be a part of capital planning and prepared to replace an item if it is time to remove it from service. This includes establishing a service delivery plan for the new capital which can include technical training, service agreements or taking on risk. The next step is determining the value of the device being removed from service. Is there trade-in value or value from selling it on the third-party market?
Cagle: A few key steps would be to inform the facility that the unit will be retired so they can remove it from their financial books and their inventory. If the device retains any information related to patient care, then the information must be wiped. The device should be properly tagged “not safe for patient use” and disposed of according to OEM standards.
Culver: Decontamination, removal of patient data, documentation within inventory management system, and following proper waste management procedures are all important steps. But the one often-ignored key step that could have profound adverse implications if skipped: calibration. The EOL calibration confirms that the device was in good working order when decommissioned, thereby removing any potential liability to the hospital.
Danko: Once that decision is made to remove equipment from service, you should have a clear procedure to execute the transactional portion of removal or decommissioning. The procedural steps should include the handling of electronic personal health information (ePHI), hazardous medical waste, hazardous environmental material, physical removal from the clinical care area, and updating the CMMS record.
Kondori: Make sure to plan for the new replacement and schedule all the necessary operation and technical training from the manufacturer.
Why should the HTM department be included in a health care facility’s medical device acquisition process?
Armstrong: It is extremely important for HTM professionals to be a part of the device acquisition process especially with integration. Can this device integrate with our current network and be cybersecurity safe? Can we negotiate technical training upon acquisition? What is the reliability factor in regard to recalls, alerts and adverse events? All of those technical factors will impact how the HTM department will service the devices for years to come.
Cagle: The biggest reason why HTMs should be involved in the device acquisition process is that they inquire about training and maintenance requirements. It would be a shame if a facility purchased a device on which no one can repair or perform annual maintenance.
Culver: Device acquisition outcomes improve when all angles are strategically contemplated and all stakeholders collaborate on the decision. For instance:
Bottom line: there is much to consider other than cost and functionality.
Danko: The HTM department must be included in the acquisition process to build a sustainment plan and provide input to the total cost of ownership. A mature HTM department will be able to conduct a business case analysis for supportability, which includes warranty/service contract strategy, BMET training requirements, consumable material support requirements, test equipment and specialty tool requirements, and start-up planning.
Kondori: The HTM department is one of the most important departments in the acquisition process. HTM will make sure functional requirements are met and it’s the right device for that department.
What role should biomeds take when it comes to the acquisition of medical devices/equipment?
Armstrong: A lot of manufactures lower their acquisition cost but later make up for it on the future service of the device. A biomed’s role is to develop a service delivery plan that is efficient and effective; the easiest way to do this successfully is to be part of the purchase. There is a lot of information from organizations like ECRI that will give an idea of the medical device’s reliability as well as whether or not there are any negative service trends with equipment. Biomeds should be educators from a technical perspective when it comes to addressing a capital acquisition committee.
Cagle: The role biomeds should take when acquiring medical devices is to be a source of information. They should be available to answer questions about the devices, such as what kind of maintenance it requires. Biomeds should also be available to the OEM to help bring the devices into the facility by guiding the OEM around the departments and providing adequate space to work in. Biomeds should also be a point-of-contact for finding out if the OEM offers HTM training, repairs, or ability to purchase parts.
Culver: Most biomeds can provide valuable information that leads to a better decision-making process. Biomeds can provide an assessment of the quality of internal components and can compare/contrast the projected average life span of competing devices.
Danko: Biomeds should support the acquisition process by providing reports and insights on manufacturer and model consideration. The biomed should research training requirements to support new medical equipment coming into the facility. The biomed will also execute the transactional on-boarding when the devices come to the organization.
Kondori: Biomeds’ role in the acquisition process is really important. They need to make sure the new equipment is meeting the requirements for that department, that the technology of the new equipment is matching with the rest of the current equipment, and that they are compatible. Same for the accessories and disposables.
What are some important tips for biomeds to consider during the medical device acquisition process?
Armstrong: The most important tip is to do your homework on medical devices. Examine the technology and focus on risk. The more knowledge you have, the better direction you can give to your health care organization. Look at new risks like cybersecurity and establish service delivery plans before the device arrives at your facility. The majority of the time, technical training can be negotiated before purchase.
Cagle: An important tip for biomeds to remember is that the choice to purchase a device ultimately belongs to the facility. Always ask the OEM questions about training, software updates, a list of what types of repairs will void the warranty, and unit storage guidelines.
Danko: It is important for the biomeds to manage clinical expectation during the acquisition process. Biomeds should talk to clinical staff about their requirements and come to an agreement on the best characteristics for new or replacement devices. Biomeds should create an objective process to develop total cost of ownership and a maintenance strategy to support acquisition decisions. This should be provided during acquisition planning throughout your organization.
What else do you think TechNation readers need to know about equipment acquisition and disposition?
Armstrong: HTM professionals are the technical experts when it comes to medical devices. Their knowledge and direction when it comes to acquisitions can provide reliability and cost reduction. When it comes to disposition, regulatory compliance and tax liability should be considered by the HTM team. These two topics have a direct impact on how the HTM department performs and in turn have consequences for the whole health care organization that the HTM department supports.
Cagle: As a healthcare technology manager, we may not always be involved in procurement choices however, we work hard to satisfy all OEM, FDA and employer guidelines to ensure that patients are always receiving the best care possible from the equipment chosen.
Danko: Acquisition and disposition activities are the bookends of medical equipment data management. HTM organizations must have clear and standardized processes for capturing new equipment data and decommissioning/removing equipment from service. These processes will ensure they have an accurate inventory and are able to perform advanced data analytics for decision support, predictive modeling, audit readiness, and regulatory compliance.
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