Endoscopy means to look inside something and usually refers to peering into a body for medical reasons such as diagnosis or treatment. Unlike the majority of medical imaging devices, endoscopes are inserted into an organ to view it. These medical devices can be used to investigate symptoms, confirm a diagnosis or provide treatment.
TechNation reached out to industry experts to find out the latest on flexible endoscopes. Philip Doyle, Director of Marketing, Gastroenterology, Olympus America Inc.; Charles Neff, Vice President of Operations with MedServ International Inc; and Jeff Maben, Flex Repair Division Manager at Mobile Instrument Service & Repair Inc. took time to share their insights.
Doyle: The introduction of a universal endoscopy platform has been considered a game-changer for endoscopy. The video processor and light source of the system can be used with both flexible and rigid endoscopes and camera heads, allowing a single platform to support multiple departments, from surgery to pulmonology to gastroenterology.
Maben: It’s an exciting time in the flexible endoscope industry with growing technological innovations promoting enhanced diagnosis and treatment methodologies. Advancing technology is enabling clinicians to gain greater access to the GI system which is facilitating increased disease detection capabilities. Expanding capabilities afford facilities the ability to improve infection control to decrease the number of healthcare-associated infection (HAI) occurrences which incidentally helps to contain rising healthcare costs. Additionally, there’s an immerging focus on flexible endoscope reprocessing technology with emphasis on continuing education on proper reprocessing procedures to also help improve infection control.
Neff: There is an ongoing advancement in imaging technologies that aims to improve visualization of the vascular network and surface texture of the mucosa and therefore are improving tissue characterization, differentiation, and diagnosis. These include technologies like chromoendoscopy, narrow band imaging, FICE and autofluorescence endoscopy and point enhancement or virtual histology technologies like endocytoscopy and confocal endomicroscopy. Additionally endoscope manufacturers are beginning to release high pixel count CMOS imaging sensors to replace higher cost CCD sensors.
Doyle: Universal endoscopy technology will play a key part in helping to address facilities’ efficiency goals and strategic spending because it meets the needs of several departments within a larger healthcare facility. The single-platform concept enables streamlined and flexible equipment deployment; simplified logistics, training, and biomed support; and backwards compatibility, together resulting in improved turnover time and reduced service expenses.
Maben: Across the nation, facilities are faced with rising healthcare cost concerns that are compounded by reduced government funding and facilities are looking to service providers to assist in reducing costs. A partnership between businesses and customers can offer the benefit of continuing education on proper scope care and handling procedures, proper scope reprocessing methods, and the implementation of routine preventive maintenance inspections to reduce user damage and help save on repair costs. Keeping existing equipment in peak condition will extend the life of the equipment saving capital budget dollars as well as provide repair cost containment. Ask any administrator or any clinician the best method to reduce infection or reduce repair costs and they will tell you it is prevention. I think we’ll see more aggressive preventive maintenance programs throughout the healthcare industry.
Neff: The overall impact of improved visualization is to enhance the diagnosis outcome. At the outpatient facility level, technologies like narrow band imaging and FICE will be readily available. At the specialist or cancer center level, most or all of the virtual histology technologies will be available. Since most of these technologies are built into the manufacturers’ video processor systems, and not into the endoscope, the overall cost of repair should not be significantly impacted.
Doyle: Manufacturers are always evolving endoscopy equipment to provide the most cutting-edge technology for diagnosis and therapy. Some Original Equipment Manufacturers (OEMs) may offer flexible leasing and financing options for customers to make even the most advanced equipment budget-friendly. To determine what initial investments to make, work with the manufacturer’s professional service team to develop an intelligent plan for upgrading your facility’s inventory based upon equipment usage and the number of years in service. This analysis can help establish a roadmap for which equipment to upgrade and when, based upon your allocated budget or other important factors.
Maben: Facilities must invest wisely to get the best value out of declining repair dollars without sacrificing quality. The investment must be pertinent to the medical mission to meet healthcare treatment needs. While purchasing new equipment has advantages of obtaining the latest technology it also carries a significant price tag. Make those dollars work for you by investing in technology that improves continuity of care and reduces infection control risks. One of the best ways to stretch your budget dollar is to prevent equipment damage through ongoing care and handling training with follow up on monitoring of processes to ensure lasting cost-savings results. The implementation of routine business reviews will help both the facility and service provider to assess optimal budgetary spend efficacy is achieved.
Neff: Base systems for all major endoscope manufactures come with a full featured technology set. At a minimum, a system should be equipped with some type of narrow band imaging either mechanical (Olympus) or electronic (FujiFilm, Pentax) in functionality.
Doyle: Buying certified pre-owned from a Food and Drug Administration OEM is significantly different from purchasing a pre-owned endoscope from an Independent Service Organization (ISO). When purchasing a certified pre-owned(CPO) endoscope from an OEM, the refurbishments completed will bring the tool back to its original “like-new” specifications, using original manufacturer parts and components. ISOs are not regulated by the FDA, and are only responsible for returning the refurbished item to “within a reasonable approximation of the manufacturer’s specifications.” It is important to note that many OEMs do not sell the proprietary parts that enable endoscopes to function the way they were designed and FDA-approved to function – which is why many Automated Endoscope Reprocessor(AER) manufacturers will not guarantee the results of their reprocessors when used with endoscopes refurbished by ISOs. It’s always recommended that endoscopes in need of repair be returned to the OEM for servicing. Many OEMs offer service contracts to keep repair costs down and loaner equipment to reduce downtime.
Maben: The heightened financial burden smacking healthcare facilities in the face is forcing facilities to review how every dollar is being spent. In my opinion, a reputable third-party company holds the best overall value to meet or exceed purchasing or service needs. Ensure your service provider has the ability to customize service agreements to meet the facility’s needs and expectations, help implement proactive onsite continuing education on care and handling training, and monitoring of ongoing preventive maintenance programs. When considering purchases, ensure you are working with reputable vendor that utilizes USP Class VI medical grade parts and materials that are compatible with modern reprocessing methods.
Neff: It is important to understand your needs and requirements. It is easy to purchase new equipment that has no technological difference from your current equipment. You must be knowledgeable about your current equipment’s capabilities to properly evaluate purchasing the “latest and greatest” that may or may not change your patient outcomes.
Doyle: How the endoscope is refurbished plays a vital role in how the endoscope is reprocessed. Many OEMs do not sell the proprietary parts that enable endoscopes to function the way they were designed and FDA-approved to function. Should a piece of the endoscope not work properly and there is no manufacturer replacement part for purchase, the ISO would likely substitute some other part for the part the OEM spent years perfecting, which may pose a risk to patient safety. While OEM CPO endoscopes are validated by the majority of AER manufacturers, AER manufacturers appear to be uncomfortable with guaranteeing the results of their reprocessors when used with endoscopes refurbished by ISOs. Before purchasing an ISO-refurbished endoscope, facilities should check with their AER manufacturer about whether the endoscope will be validated to minimize risk in the event of a lawsuit.
Maben: Third-party companies can save on repair spend by as much as 30 to 60 percent annually. Most facilities’ scope inventory consist of multiple manufacturers but OEMs are usually limited to service contracts for their name brand, whereas an established third-party company has the ability to repair many product lines without bias or conflict of interest. Another benefit of a reputable third-party company is that it can have the technical expertise to provide dependable high-quality durable repairs for all OR services. Ask your repair vendor if you can tour their facilities and speak directly with their technicians to see how the repairs are being done; seeing is believing.
Neff: When choosing to use a reputable third-party it is important to understand their capabilities. Regardless of what they say no third-party can do everything the manufacturer does and knowing these limits upfront set expectations properly for all parties. Knowing what parts are new and what parts or recovered/remanufactured allows you to understand what you are paying for. A reputable third-party should always communicate clearly and stand behind the work performed and be available to reply to any quality concerns in a timely manner.
Doyle: Manufacturers are always evolving endoscopy technology to improve diagnostic and therapeutic capabilities for the benefit of physicians and their patients. This makes new equipment more appealing. Some newer imaging technologies include high definition (HDTV), Dual Focus (optimizes imaging system on-demand for better close-up viewing of tissue), Narrow Band Imaging technology (now brighter and twice the viewable distance to enhance the visibility of vessels and other tissue for more accurate biopsies) and wide-angle view capability. Other improvements include wider working channels for therapeutic applications and advancements in flexibility and control for maneuvering more easily throughout the digestive tract. While new endoscopes offer the most advanced technology on the market, when budgets won’t allow the purchase of new endoscopes through leasing or financing options, CPO endoscopes can offer access to previous-generation technology for purchase at a fair price.
Maben: With a little effort, it is possible to keep up with technical advancements without buying brand new equipment. There are several outlets that have the ability to locate newer equipment and sell it as refurbished. This allows hospitals to gain access to the latest technologies while avoiding OEM pricing. Also keep in mind that most new endoscopes are compatible with older model video equipment and this backwards compatible equipment can help facilities upgrade scopes while waiting for more funding to afford the latest video processor. You may not have access to all the new technologies until you get that new processor but at least you can spread out the damage to your budget without losing any of your current capabilities.
Neff: For some time now the base systems for all major endoscope manufactures come with a full featured technology set including some type of narrow band imaging either mechanical (Olympus) or electronic (FujiFilm, Pentax) in functionality. In some cases it is as simple as adding a compatible scope to your existing system to gain this functionality.
Doyle: Before making an endoscope purchase, one can start by uncovering the specific diagnostic and therapeutic needs the current equipment is not meeting, and also evaluate which capabilities the facility is looking to improve upon. This research will help determine what investments the facility should prioritize. Also, it is important to consider what benefits and service the manufacturer will offer throughout the entire life of your equipment – not just at the point of sale. The initial attraction of a low price or single novel feature can be tempting, but the on-site training, education and support necessary to learn and maintain the equipment can be costly afterthoughts if not included with the purchase.
Maben: Make sure any investment in technology lives up to its advertisements. Ask around, talk to doctors or staff that have had experience with the new equipment. Look for technology that is designed for efficiency or damage prevention during reprocessing. When you do get that new equipment, don’t stop with the information provided by the sales rep. Check online, ask your repair rep (not the guy that sold you the equipment) and talk to other industry experts to ensure you get all the education necessary to handle and reprocess your new equipment.
Neff: Purchasers should always look to the manufactures website, both locally and internationally, to better understand the equipment they are considering. In many cases the literature can be requested on the website. The local manufacturer representative is a good source of information. Training should come from each unique equipment manufacturer’s personnel to assure compliance with the OEM’s standards. Training records should be provided to the account as a permanent document.
Doyle: When it comes to making a purchase decision, education will prove invaluable. Research the manufacturer’s track record, the durability of the equipment and the manufacturer’s post-sale support. The investment should go beyond just the purchase of the equipment – the manufacturer should be a partner in ensuring staff is properly trained and the equipment is well maintained.
Maben: The most important thing to remember is that all companies (third-party and OEM) have different strengths and weaknesses. Some companies will have better quality, some with better pricing, some better education and so on. This is important not only because of the services for which you are seeking but also when determining educational needs, maintenance programs, and cost savings. Just because someone can offer the best price doesn’t necessarily mean they offer the best service or combination of services.
Neff: It is important for biomeds to be involved with the installation and setup process of the new equipment. By working with the OEM installation team, the biomed can better understand how the systems are configured, wired and made ready to go into service. Biomeds should also attend all initial “OEM in-service” training to understand the pre-procedure setup, the post-procedure scope pre-cleaning, leak testing, washing, disinfecting and post-disinfection drying. These basic skills will better prepare the biomed for troubleshooting issues should they occur.
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