If construction is part of the purchase, representatives from health care technology management, information technology and engineering should walk through the construction site frequently to ensure MEP and low-voltage infrastructure are installed according to plan.
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A well-organized medical equipment acquisition process can help hospitals and health care systems save precious financial resources.
Currently, there is no consistent equipment acquisition process that is recognized nationally or around the world. What’s more, equipment acquisition processes can vary across health care systems. This inconsistency can raise time, cost and performance issues. Too often, equipment is chosen by a lone clinician who has not engaged the correct multidisciplinary group of experts within the institution.
To ensure optimal procurement, collaboration and meticulous planning are needed among this multidisciplinary group of experts from the initial stages of equipment selection through to its go-live date.
The following process can be used for procuring a single device and scaled up for planning a major hospital renovation or construction project.
Health care technology purchases are driven by multiple factors. Institutions may want to keep up with other providers and offer the latest care options to patients. Changes in physician staff, including the recruitment and retention of the nation’s top talent, also drive changes in technology.
Many health care systems are also faced with aging fleets of equipment (e.g., beds, patient monitors, infusion pumps and ventilators) or aging standalone modalities (e.g., computed tomography [CT] scanners, general radiology rooms and linear accelerators). The inability of health care technology management (HTM) departments to find parts, combined with the device manufacturers considering these devices end of life (EOL) or end of service (EOS), also drives the need for equipment replacement.
Confusion often exists between EOL and EOS. Knowing the difference in the terms can help mold an organization’s capital replacement plan. EOL occurs when a model of a device is no longer being manufactured and, thus, can no longer be purchased new. However, the manufacturer will continue to make replacement parts and support the device. With EOS, a device manufacturer has stopped making replacement parts for a device and will no longer provide support or service for it. Ideally, a health care system should look at replacing a device or fleet of devices at EOL before EOS is reached.
Standardization of devices should also be considered when looking to purchase new health technology.
First and foremost, patient safety factors need to be considered. If clinicians are adept at using one brand of ECG carts and suddenly begin using another, they may be unfamiliar with how to operate the display or use the cart altogether. This concern becomes especially great when clinicians float throughout the hospital.
Another concern is the support of devices by the HTM and information technology (IT) departments. If biomedical equipment technicians are used to working on one brand, the amount of time it would take them to fix an off-brand piece of equipment might be substantially longer due to lack of familiarity.
The presence of a nonstandardized device or group of devices requires HTM departments to stock new parts, pay for additional service training and can diminish their opportunity for consolidated pricing for parts and service contracts. When equipment is standardized, hospitals can maximize discounts and benefit from consolidated pricing.
Additionally, if an off-brand device is purchased for a new clinic, it may not communicate in the same way across the hospital’s network as the standard brand. The standard brand already may have its own isolated IT network and infrastructure set up to send data to the electronic health record (EHR).
Servers and interfaces also may need to be purchased to ensure data communicates with the EHR. This could add considerable expense to the purchase and create a lot of unnecessary work for IT and HTM. Conflict also could result between clinicians and the IT and HTM support staffs because the clinical staff want equipment up and running as soon as it arrives. However, without the correct parts, accessories and infrastructure in place, this is not always feasible.
Engaging the vendors
Performing a proper market assessment is essential to ensuring a health care organization gets a fair and equitable price when purchasing equipment. This is especially important for fleet replacements and for high-cost and highly technical devices, such as CT scanners, magnetic resonance imaging scanners, positron emission tomography scanners and linear accelerators.
Most hospitals are members of a group purchasing organization that can negotiate better pricing on equipment than if the hospital purchases alone. Therefore, it is paramount that a hospital’s materials management or purchasing department be involved in up-front planning.
It also is important to perform premarket research, such as by consulting online resources offered by ECRI Institute, Plymouth Meeting, Penn., and MD Buyline, Dallas, to ensure the organization is getting the best pricing and is able to review the equipment prior to purchase.
After the market assessment phase, the next step is to request quotes or submit requests for information or requests for proposals to all vendors in contention. During this assessment phase, it is essential that the multidisciplinary team develop a list of requirements to which vendors must agree from the outset.
This list of requirements also is known as a “statement of work.” For instance, if HTM determines that having access to a service manual and the chief of radiology determines that having a stock of replacement parts on-site are essential for patient safety, this needs to be stated up front. If a potential vendor states that they cannot meet any requirements, the hospital can eliminate that vendor from consideration.
Once a multidisciplinary team (see sidebar, page 30) has determined which vendors will be considered, the vendor trials can begin. If a hospital is considering replacing a fleet of devices (e.g., infusion pumps), the hospital should coordinate a vendor day at the hospital where all competing vendors demonstrate their products.
Bringing high-cost and highly technical devices to the hospital is not always possible. In these scenarios, the vendor may set up a site visit at a local hospital that has the device. Members of the multidisciplinary team and other stakeholders then are able to trial the devices, ask questions, and evaluate and rate each vendor. It is important that the devices be evaluated from the perspectives of infection control and cleaning, accessories, supply, clinical training, technical training and serviceability as well as from a clinical usability and patient safety standpoint.
The multidisciplinary team must come to a consensus regarding which selection criteria are considered deal breakers, potentially resulting in the elimination of certain vendors.
The team should not hesitate to ask for references and consult with other hospitals that have purchased the equipment.
Placing the order
After the team has agreed on the vendor, it is essential to solidify all quotes and options with the manufacturer. Quotes should be reviewed extensively by engineering, HTM, IT, materials management and clinical staff to ensure that all verbal agreements made by the vendor are included. Having a proper quote with all expectations and agreements in writing is the hospital’s only way of holding the vendor accountable.
If the purchase involves construction, this is also the time to review all architectural and mechanical, electrical and plumbing (MEP) documents. It is much easier and less expensive to add an outlet to the document than it is to tear open a wall later or find that the existing breaker or circuit cannot handle the new load.
Once an official purchase order is sent to the vendor, it is time to start managing the project and planning in advance to ensure the go-live date goes as smoothly as possible. If construction is part of the purchase, HTM, IT and engineering should walk through the construction site frequently to ensure MEP and low-voltage infrastructure (e.g., technology wire runs and nurse call systems) are installed according to plan. HTM and IT should coordinate whether the device is going to be placed on the hospital’s network and if it requires servers to transmit data.
After the device’s arrival, IT will often create a test and development environment to ensure data messages are being sent and received properly. All servers, as well as any additional switches, ports, interfaces and Wi-Fi or hardwired networks, should be configured in advance. In all of these examples, the hospital’s HTM, engineering and IT departments should be working directly with the vendor’s project management team to identify problems, ask questions and submit change orders.
Other disciplines that should be engaged prior to go-live include supply room and materials management to ensure that any new disposables and accessories are stocked and ordered and any supplies and disposables that are no longer needed are not ordered. It is also essential that any old supplies are removed from units and supply rooms so they are not accidently used.
Environmental services (EVS) and equipment distribution also should be engaged because a new fleet of equipment may require a different cleaning process. If applicable, EVS also will need to plan to conduct a deep clean of the construction site prior to go-live to ensure patient safety.
Finally, nursing education is vital to ensuring that all clinical staff who will be using the new equipment are trained. HTM also will need to ensure that the necessary replacement parts and test equipment are available following the go-live date.
After the equipment arrives on-site, it will either be installed into the construction site or, in the case of a fleet replacement, installed throughout the hospital. For equipment fleet replacements, the equipment will typically go to the HTM department, where it will be unboxed and set up.
Each medical device will receive a unique identifying tag with a hospital asset number. After the device is tagged, it is then entered into the hospital’s computerized maintenance management system (CMMS). In most cases, the vendor’s field engineer will be on-site to help the HTM department set up the equipment. After setup, each device will receive an incoming inspection, which is documented in the CMMS, to ensure it is working properly and was not damaged upon receipt. At that time, the device is also scheduled for preventive maintenance (PM).
Equipment that is being installed on a construction site will still need to receive an asset tag, be checked into the CMMS and scheduled for PM. However, the manufacturer or construction company subcontracted by the manufacturer will physically install the device. It is important that the delivery date is coordinated so that members from the hospital’s HTM, engineering and IT teams are available and on-site to assist and help manage the installation.
Coordinating the go-live date is especially important, as all support services need to be available to immediately troubleshoot issues. Clinical educators need to be available to help staff, and if the go-live requires additional staffing, it needs to be scheduled in advance. For a fleet installation, go-live dates often are scheduled by unit.
A “big bang” approach is not the safest decision in this scenario. If the hospital rolls out equipment on one unit and the deployment does not work as planned, it is much easier to halt all subsequent go-live dates rather than have the entire hospital experience issues. This also allows support staff and educators to dedicate their time and attention to one unit.
If the equipment acquisition involves construction and one device, the support staff will test the device with the clinical staff to ensure it is working properly. The outcome of this testing will drive the go-live date.
An effective process
Meticulous attention to detail is vital for an effective equipment acquisition process. The more planning that is done up front, the easier and smoother the go-live date will be.
Danielle C. McGeary, CHTM, PMP, is vice president for health care technology management at the Association for the Advancement of Medical Instrumentation, Arlington, Va. She can be reached at DMcGeary@aami.org.