Patient monitoring devices have advanced over the years as new technology continues to extend the capabilities of these life-saving tools. TechNation contacted experts in the industry to gain their insights to patient monitors, including the latest advances, software updates and the benefits of purchasing new or refurbished equipment.
The panel of experts includes Pacific Medical Director of Technical Solutions Brian Barton, Gopher Medical Product Specialist Matt Bion, Sage Services Senior Integration Director Ed Decker, Bio-Medical Equipment Service Company (BMES) President and CEO Ed Evans, Southwestern Biomedical Electronics President Larry Neilson and Integrity Biomedical Services Service Manager Brad Sailsbury.
Q: What are the latest advances in patient monitors?
Barton: Remote patient monitors and alarm trends into a remote alarm that is reusable by nurses. Wireless alarms. Integration live patient monitoring equipment. It all gets out on the same main screen so you can have it all on one screen. For instance, you can be on Floor 3 and see Floor 4.
Bion: One product worth mentioning is wireless telemetry with Frequency Hoping Spread Spectrum (FHSS) technology. It works within a subchannel of Wireless Medical Telemetry Service (WMTS) bandwidth – it carries a strong signal and is known to be very reliable. This technology can be found in GE’s Apex Pro FH Telemetery System. Furthermore, the Apex Pro FH can transmit and receive information from 640 different channels. Using this advanced technology, the transmitter is capable of monitoring ECG, SP02, NIBP and Temperature and provides increased monitoring flexibility, more secure with less signal dropout problems.
Decker: We’re seeing more patient monitoring devices with color touch screens for ease of use and wireless capabilities allowing continuous connectivity to central monitoring and electronic medical records (EMR). Many of the devices are also being designed to be more portable/wearable offering patients the freedom to move around the hospital.
Evans: Patient monitors have come a long way in the last several years. Although not new, most patient monitors now have several ways of communicating information from the patient to the appropriate system within the hospital. Many monitors are already on a network backbone throughout the hospital using telemetry/transceivers. They use data management software that links them with the network that allows for off-site and on-site analyzation of patient data as needed.
Neilson: Many features that were additional options on patient monitoring systems a few years ago are now included at no additional cost. ETC02 is widely used and required in many sedation procedures and is typically an “add-on option,” but is available from nearly all manufacturers. New and/or improved audio/visual alarm variations are now engineered into monitors as alarm management is increasingly important. EMR interface is now a must. All new monitoring must interface to record gathering software. Diagnostic software is improving, such as arrhythmia or other cardiac activity.
Sailsbury: Patient monitoring at its core has not changed. The body is the same and we are measuring the same parameters. What has changed is the new way of looking at data, mainly with mobile devices. Due to advances in mobile technology we have access to complete data from wherever we are, which leads to better patient care.
Q: What are some important patient monitor tools/features HTM professionals should consider to assist with alarm management?
Barton: Logarithm now with alarms. How many times patients go from Level 1 to Level 3. Alarm trends for patient care. P02 Level 96 to Level 98 they will set it so they can maintain the patient much better. Makes for a happy patient. You can essentially have a reduced staff and save money with accurate alarm management.
Bion: I believe it comes down to staff training. For example, making sure all the clinical staff is adequately trained and fully understands all the alarm configurations and significance of each alarm. In addition, reviewing the monitor’s recorder history is helpful for establishing alarm patterns and identifying possible issues. Furthermore, it would be useful to collaborate with the manufacturer and other local hospitals for their input and solutions.
Evans: Alarm management is of course an important factor in the health care industry. There are tools available now that allow for better management and programming of patient monitors. For example, Philips uses the Mark2 tool which allows a variety of setups of profiles on monitors. Tools like this allow each monitor to be programmed according to the needs of each specific department in the hospital. Discussing these types of tools when purchasing equipment is always a good idea.
Neilson: Visual, audible, and staff notification techniques are all equally important. Most monitoring currently manufactured has color LEDs in various forms, bars, lights, etc. and these typically can be user changed to allow notification of a specific color/frequency/audible pitch for staff to immediately recognize.
Sailsbury: The features to combat this exist today, but staff needs to be educated on and empowered to use them. Alarm fatigue is a problem most facilities are facing. Educating staff to use the device settings specifically for their patient is one way to combat this. Patients are not all created the same, so expecting staff to use the same settings for each patient will create unnecessary alarms.
Q: How do you recommend the management of software updates for patient monitors?
Barton: When you purchase monitors, always negotiate software updates at the time of purchase.
Bion: The biomedical department needs to work closely with other departments within their institution and the manufacturer to learn more about the update. For example, is this a mandatory or optional suggested update by the OEM? How will this update affect other equipment? Once these questions are answered, the biomed department has some form of asset management program to track products and repairs within their system so information could be stored in a central location for status updates and scheduling purposes.
Decker: We interact with HTM professionals regularly because of our service expertise across a wide range of OEMs and devices. We frequently receive tech support calls as a result of software incompatibility. Many facilities appear to stagger software updates by departments causing one department to have one revision of software on their equipment and another area of the hospital to have a later revision of software on their equipment. This can cause incompatibility issues if the equipment moves from department to department. So, a hospitalwide software update is a recommendation to eliminate any potential conflicts.
Evans: In today’s world of ever changing software and updates happening rapidly, management of updates can get confusing and very disorganized at times. As a result, I recommend that hospitals utilize some type of system to keep track of what revision is on each monitor at the time of each update. My suggestion would be to utilize a two-step process. First, make sure there is a physical label on each monitor of its current revision. Second, record that in some type of asset management system. This will allow for quick recall on revisions when needed.
Neilson: Some manufacturers today include software updates on their sales quotes. If they don’t, they should. It should be negotiated into the contract at the time of purchase. Updates can improve performance but they can also confuse the user. Staff may be so familiar with their equipment and soft key operation, a non-required update gets installed and “hey where is the remote view button” or any number of scenarios. Also if some devices get updates and one or two missed, then they are different. One should ask “Will this improve patient care?” or “Will this confuse staff and harm patient care?” And, “Is this update important?” In my opinion, it must be controlled by the HTM department.
Sailsbury: I suggest a very proactive process of reaching out to the device manufacturer on a regular basis. Schedule a time every three to six months to check for mandatory and voluntary updates. This approach will give the facility control in making sure everything is up to date.
Q: How can HTM professionals ensure service keys are provided without incurring additional costs?
Barton: Negotiate all service keys and service manuals when you purchase the units. The sales reps here will give it to you, whereas you have to purchase new to get it from the OEM.
Bion: Becoming more involved with the decision-making process when purchasing capital medical equipment. During the initial stages of the equipment negotiations, use the hospital’s buying power and negotiate that the software licenses will be provided for the lifespan of the equipment. When issuing the purchase order, be clear what keys are included and for how long is spelled out as a line item in the purchase contract. The ultimate goal is to keep costs down from the initial purchase for years to come.
Decker: HTM professionals need to be included in the decision-making process as hospital administrators and clinicians evaluate suppliers for any upcoming equipment purchases. HTM professionals understand the ongoing resources needed and costs associated with maintaining patient monitoring equipment during its lifecycle and can insist that training and that service keys are included in the purchase price.
Neilson: It’s got to be done at the negotiating table at the time of purchase, or at service contract signing time.
Sailsbury: The first step to this is to only buy from someone who is willing to train your staff. If necessary, be sure to work this into your contract at the time of purchase.
Q: Is it possible to keep up with the latest advances and improvements without buying brand new?
Barton: Work with your third-party vendors, as they can get you into a year old monitor instead of having to buy new. If you just need a bed system instead of a whole floor, you are able to buy at a cost savings.
Bion: Yes it is, by working with an established reputable vendor. Specializing in patient monitoring, we can offer current products with technical support services; along with buying options, new, demo and refurbished equipment. With a seasoned sales and support staff we offer customers more options and provide solutions. From building servers to selling monitors with the latest software, we understand the technical requirements needed. Selling current technology with the same warranty as the manufacturer, plus saving customers money, it makes financial sense to explore other options, such as refurbished equipment.
Decker: Yes, in many cases hospitals can. A large piece of our business is the sale of used/refurbished patient monitoring equipment. We have access to some of the newest equipment on the market providing our customers a price competitive and trusted alternative when purchasing new from an OEM is cost prohibitive.
Evans: It certainly is. The third-party market provides some fantastic opportunities in this area. In fact, I would suggest that the best value would actually be found in purchasing refurbished equipment. We have found that we can save hospitals a considerable amount of money by going this route. Many of the advancements that have been made these days are progressive in the sense that a series of small changes lead to big changes in technology. As a result, while refurbished may not be new, it provides a way to keep up with those progressive changes without killing the budget.
Neilson: In most cases it is. Many good and valuable improvements cannot be installed in older equipment. Health care facilities should consider their use of monitoring. Some older equipment still has a valuable place in many facilities.
Sailsbury: Yes, it is absolutely possible to have the latest and greatest without buying new. Many times third-party companies will have the latest model of preowned equipment. I suggest that facilities in search of equipment research all avenues before purchasing.
Q: What are the pros and cons of using OEM parts for repairs?
Bion: There are several advantages to using OEM parts for repair processes. First, the quality of parts and the reliability of the parts used are to be considered. Also you can be confident that the parts went through a quality-testing process and reliability testing. The only problem with using OEM parts in the repair process is the cost of parts is generally higher increasing the cost of repair.
Decker: In many cases the OEMs don’t offer a complete parts inventory for their patient monitors making it difficult for HTM professionals trying to service their equipment onsite. Also, many of the OEM parts sold are priced excessively high making onsite repairs cost prohibitive.
Evans: There has been a general belief that OEM parts are best for many years now. However there are challenges that come with OEM parts and the customer experience when getting parts. Premium price points, slow delivery time, shorter warranty periods, backorders, and lengthy processes to get parts returned when there is a problem are just a few of those challenges. With that said, we utilize OEM parts in many of the patient monitors we repair and refurbish. The pros of using OEM parts are pretty straight forward as well. You know the part will be designed correctly. You can also know that you will not have to hunt a part down with multiple vendors to find it. With that said, this is why we stock a variety of parts to be able to meet our customers’ needs promptly and with a high-quality part.
Neilson: Pros are that you should receive the part that works and is recommended by the manufacturer, however I know that some, not all, parts change at the manufacturer. An example is a NEC display that may no longer be available so the manufacturer has to change to whatever is available. So just because you purchase OEM parts, it may not be the same as what you are replacing. Cons are typically price. We purchase our parts from the same manufacturer of the component that failed. The electronics industry changes very quickly these days and manufacturers often have to send out a “kit” to fit a part/assembly that they no longer can purchase.
Sailsbury: Sometimes the OEM may provide a new part or a part that is a new rev level or software version. However, the newest model may be an insignificant change and with a refurbished part you may get a longer warranty and the equipment will continue working exactly as it should. Cost is certainly another aspect to explore, many times OEM parts have a significantly higher price point.
Q: What are the pros and cons of using remanufactured parts for repairs?
Bion: The only advantage to using OEM remanufactured parts is the cost is generally lower than OEM parts. Parts might not be of the same quality, and testing might not be as detailed as the OEM processes. But the cost is reduced and may be more affordable to the consumer.
Decker: HTM professionals should feel confident in buying refurbished parts as long as it’s a trusted source with industry expertise and knowledge. These parts typically come with warranties that match or exceed OEM offerings and are sold at a fraction of the cost. HTM professionals can expect savings of 25 to 50 percent or more depending on the part.
Evans: There are many variables with this question, however there are two main drivers from my perspective. First, its important to make sure that any part used that is not OEM is tested out well before being put into use. In today’s world of so many third-party compatible part options it is critical to make sure the part was manufactured well and is fully compatible regarding form, fit and function. It’s not enough to just check function anymore from my perspective. We put a lot of focus in this area to ensure that all parts used meet our standards of form, fit and function. Second, well-made parts are well-made parts. Ask yourself this question, “Where is the best value going to be long-term for the health care facility using this part?” Often non-OEM parts can provide a better value than OEM parts when it comes to the budget constraints being faced today. While at the same time providing a high-quality part.
Neilson: Pros are hopefully price and warranty may also be better than the OEM. Also, in our services, we provide a better part and I believe that is the case in many ISOs. Again, an organization that provides a remanufactured part must be better in many areas for repeat business. Cons are receiving a lesser quality and/or used part and that depends on the provider.
Sailsbury: Our customers typically enjoy reduced costs and a longer warranty on high-quality products. Additionally, we continue to provide parts for aging equipment that the manufacturer will no longer support. The part may not be new but we provide a longer warranty than the manufacturer to combat this.
Q: What else would you like to add or do you think is important for HTM professionals to know about patient monitors?
Bion: When purchasing equipment or sending your products in for repair, do not base your decision solely on the lowest bid – look at the whole picture. For example, look at the quality of the product, turnaround times, product knowledge, integrity and values. You will benefit in the long run by doing so. There is a lot of truth in the saying, “You get what you pay for.”
Evans: When replacing or adding patient monitors to existing networks in the hospital, remember to include all software and hardware options that are needed. This will speed up the process for you and get the equipment on site much faster. If you are unsure of what options you need that’s a great discussion to have on the front end of getting a quote. That’s why one of the first questions we ask customers when they inquire about patient monitors is, “What options do you need your monitor to have?”
Neilson: Cost containment has always been a high priority and in our experience this is more important than ever since the enactment of the Affordable Care Act. HTM professionals should at least investigate the independent companies that can help them with prolonging the life of their patient monitoring devices. There are many good ISOs out there and finding one with experience and staying power (longevity) can be a tremendous asset to their department.
Sailsbury: Patient monitoring is a first-line defense for staff and having monitors that work accurately is non-negotiable. It is invaluable for HTM professionals to have a trusted source for both education and support. In selecting an equipment manufacturer or service provider, look for a well-educated team that provides quality products and reacts quickly to your support questions and parts needs.
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