Every healthcare technology management (HTM) professional has at least one story about a nurse, doctors or even another biomed secreting away a favorite device or an extra “emergency” spare. Yet, there comes a time when a device or fleet of devices must be retired. TechNation asked a some HTM professionals to weigh in on the topic and share insights regarding equipment disposition.
Participants in the roundtable question-and-answer article are Stephen L. Grimes, FACCE, FAIMBE, FHIMSS, AAMIF, from Strategic Healthcare Technology Associates LLC; ZRG Medical Director of Business Development Sydney Humes; ProHealth Care Biomedical Equipment Lifecycle Planner Chuck Overeem; and Medical Equipment Doctor Sales Manager Austin Violette.
Grimes: There are a variety of factors that should be considered when deciding whether it is time to retire a medical device. These include the device’s current condition, its current utilization level, the device’s clinical acceptability (i.e., does the device represent the latest and/or most accepted form of technology for diagnosis and/or therapy), the status of manufacturer’s support (i.e., are technical support, parts, updates/patches still available?), its annual maintenance costs relative to new technologies and its reliability (i.e., does age, condition and service history give an indication of whether the device can be depended upon). Of these factors, HTM is in the best position to give input on the device’s condition, state of manufacturer’s support, annual maintenance costs and reliability. Clinicians can speak to utilization level and clinical acceptability. Together their input can help an organization make informed replacement decisions.
Humes: There are a few ways to know when a piece of equipment is ready to be retired. The easiest way to know is if the equipment has been sitting untouched in storage for years collecting dust. But, the best rule to get financial return that many facilities practice, is to retire medical devices when they have replaced the current equipment. This way they are liquidating the equipment when it has the most value and returning capital to the hospital.
Overeem: It’s a matter of reliability and data. Since we fix the equipment and then write the reports to document our service, we can easily look at the history to see that a device not only seems to break down a lot but it actually does break down a lot. With that information, along with knowing the age of the equipment, whether or not it is end of life or past support, we can bring all of that to the attention of the proper parties to make the case for replacement.
Violette: This depends on the goals of the facility as well as the availability of parts and repairs in the marketplace. The HTM professional would need to determine if the manufacturer or a third party can provide support for the device, as well as if there are parts available. They should also ask themselves if the technology is current and if the device provides reliable patient care. The last piece of the puzzle to evaluate is how frequently the device is breaking/malfunctioning.
Grimes: When contemplating the removal or replacement of medical equipment, an organization should fully understand the effect such actions will have on the availability, quality and safety of patient services, and as well as the implications on clinical workflows. Any contemplated removal of medical equipment should be planned in a manner that minimizes the adverse effects and maximizes the positive effects on relevant patient services and clinical workflows. This also includes the effect on other devices and systems that may have been integrated with the device being removed. When removing medical equipment, organizations should also ensure equipment is “sanitized” of any patient (or otherwise sensitive) data.
Humes: The number one thing to remember when removing medical equipment from service is to remove all confidential data. It is also important to have the equipment stored safely even after it is decommissioned, so that you can get the most return on the equipment when it is ready to be removed from the facility.
Overeem: That question is a little more complicated than it first appears because it really depends on what the equipment is and your point of view. From one perspective, the most important thing is making sure that the device does not leave containing patient data. From another perspective (like an imaging department), it could be when will it be removed and how will it affect the workflow and the comfort and safety of our patients. Also, how will we continue to provide services without the device and how soon can it be replaced? From yet another perspective, do we take a trade-in if we are replacing it or do we try to sell it outright and how does that affect the timing of the project?
Violette: I cannot confidently say one thing is more important than another but the most important factors to consider are:
Grimes: Organizations should consider their trade-in options if planning to acquire replacement equipment. If looking to sell old equipment, make sure to deal with reputable third-party buyers. Consider dealing with one of the organizations that are members of the International Association of Medical Equipment Remarketers and Servicers (IAMERS). As a condition of IAMERS membership, organizations must have adopted a quality management system (e.g., ISO 13485, ISO 9001). Have a written agreement detailing schedules, responsibilities and financial terms.
Humes: Hospitals tend to hold on to equipment for years after the equipment is decommissioned. To get the best financial return, it is important to remember that equipment typically depreciates in value year after year. So, the longer a hospital stores the unused equipment, the less value the equipment will have when the hospital is ready to liquidate it.
Overeem: You need to know your options. Get a trade-in value from the vendor(s) you are working with for the replacement. Also obtain values from potential buyers. Give yourself enough time to properly market the system and let buyers know the timeline. There appears to be a sweet spot that maximizes profit. Too much time or not enough time can cause your profits to be less. Buyers need enough time to plan for a removal. Given enough time they can minimize their costs thus maximizing your profit.
Violette: In most cases, a third-party biomed company will pay a higher price for retired equipment that an OEM would for a direct trade-in. Ideally, a facility would retrieve multiple bids for their equipment in order to get the most value and capitalize on their investment.
Grimes: Establish an appropriately detailed plan including activities, schedules and assigned responsibilities for removing medical equipment from service. In developing the plan, be sure to consider the implication of removal steps and timing on the availability, quality and safety of patient services and on clinical workflows.
Humes: The steps to removing a medical device are very simple. First, make sure there is no one else in your system that needs the device being removed (there is no sense buying something the health system already has somewhere else). Second, make sure all confidential information is removed from the device. Third, document the removal of the device in the hospital’s internal system. Last, call your liquidation vendor that specializes in medical equipment to ensure the device is removed safely and responsibly.
Overeem: Make sure everyone is on board with the removal and get appropriate signatures documenting that fact. Remove patient data if any. If the equipment is being replaced, get trade-in values if any. Get multiple offers when you try to sell an item, don’t just take the first offer. Have the buyer sign a document stating the terms of the sale, that makes sure everyone knows what to expect.
Violette: A lot of the steps required are also listed as answers in Question No. 2, but an additional item to factor is to have the HTM professionals prepared and trained to service the new/replacement equipment as well as the staff prepared to use the new equipment.
Grimes: Organizations considering donations of their used medical equipment to charities should proceed with some caution. There have been some significant criminal activities associated with organization staff facilitating the “donation” to those claiming to represent “charities.” Before deciding to donate, organizations should research to verify the legitimacy of the charity. Consider the World Health Organization (WHO) or the American College of Surgeons (ACS) websites. Be sure to have a signed agreement that releases the donating organization of liability, stating the equipment is provided “as is” and the equipment recipient assumes sole responsibility for the equipment’s removal, transport, safety, operation and maintenance.
Humes: What many do not know is that charitable organizations do not usually have HTM staff that can repair the medical equipment that is being donated, so it is very important to only donate equipment that is in good working condition. Also, be sure to vet the charitable partner to ensure they are providing the equipment to where it is needed most. Unfortunately, there are some charities that think sending equipment to developing countries in crates is the best solution but if the country has no need for that specific equipment, there is no training on how to use it, or they don’t have supplies to use the equipment, it ends up creating a landfill of unutilized equipment.
Overeem: Here at ProHealth, we have several charities that we work with. If we have something that we cannot redeploy and cannot sell but is still functional, we contact the charities with the equipment list to ask if they have need for any of the items on the list. If they do, we make the required arrangements and do the paperwork needed to process the donation and arrange for a pick-up.
Violette: There are many charitable organizations that will give your old medical equipment a new home, sometimes in a less privileged country or region. For-profit hospitals may benefit more as they can utilize the donations as a tax deduction.
Grimes: Radiology and imaging systems continue to represent the largest investment most health care providers make in medical technology. Through 2024, a recent P&S Intelligence report predicts imaging equipment maintenance services will see a 10.1% compound annual growth rate (CAGR) due to high cost of equipment and increasing adoption of various imaging modalities. To better exercise control over the timeliness, quality, safety and cost of services, health care providers will need to have access to more service options. Some major imaging manufacturers have been making it increasingly difficult for in-house and third-party servicers to provide maintenance servicers on their products. Many suspect these manufacturers are attempting to protect their service revenue streams. Right-to-repair will continue to be an issue until all stakeholders can collaborate and achieve an acceptable compromise.
Overeem: There are a few things to remember, including:
These really apply not only to radiology but also to any imaging modality or any equipment that requires outside de-installation.
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