Clinical equipment management systems (CEMS) offer more than a paperless and painless method for tracking service, vendors, staff, and inventory—though these are often the reasons used to justify their purchase. But even more value can be found when data collected by the system is used to improve service rather than just document it.
Many biomeds have been using equipment management software to meet and document regulatory requirements for years. “It’s hard to think about life without it,” says Paul Gudenau, CBET, corporate program manager of clinical engineering services at Mount Clemens and Pontiac Regional Medical Centers, a McLaren Health Care service in Flint, Mich.
But CEMS also helps to organize, store, and analyze data in ways that can result in better service for customers, not just in internal efficiencies. “Everything is improved by reliable data,” says Steve Kehrberg, CBET, vice president of the supply chain clinical engineering group of Catholic Health Initiatives (CHI) in Tacoma, Wash. “Because of that data and the ability to slice and dice it, we have been able to go into other nontraditional clinical engineering operations, like capital procurement.” CHI has been able to leverage its data to accomplish goals by sharing it among departments. Everyone can see the same information, which means better communication and greater ability for improvement. Trends are noticed in real time, and changes are implemented as needed. All customers—which for some means clinicians, administrators, and vendors—benefit, and ultimately, and perhaps most importantly, so does the patient.
Work Orders Improve Performance
Smart users of CEMS use the system to allow the equipment inventory to drive clinical service, not functional service. But tracking work is a major function of CEMS. “Accurate maintenance records empower the management of the service cycle at every level, whether it’s dispatch or response,” says Phil Englert, director of technology for CHI.
Most systems permit customers to place work orders, which are then automatically forwarded to technicians and tracked so progress is visible to all interested parties. “A transparent service tracking system can be used to adjust customer expectations and narrow the communication gap. Having good information available to people responding lets them make smarter decisions,” Englert says.
It also ensures that every stakeholder such as the nurse on the next shift or the department supervisor has the necessary information. Childrens Hospital Los Angeles has a system that automatically forwards relevant work orders to department heads so they are always aware of what is happening with the equipment, according to George Panyarachun, MS, BME, GNG, manager of the facility’s biomedical engineering department.
|Biomed departments can mine CEMS data to produce useful reports for capital planning.|
The ability to track factors such as user error or physical abuse damage, or an inability to duplicate the problem and produce analytical reports, allows biomeds to notice trends earlier and act on them, often saving money. For instance, increased user error of a particular device may mean it is time for an in-service training to address and eliminate, or at least reduce, those errors.
“We consistently pull data and work with customers to identify trends for operator errors,” Gudenau says. “We are not looking to be punitive, but if one floor is continuously dropping an infusion pump, we’ll use that data to try to resolve the situation.”
Similarly, customers also can suggest areas for improvement. CHI gauges customer service with an annual customer survey managed through its CEMS. The predefined questions are sent to all end users, including nurses, physicians, and department heads; and responses are collected over the Internet. “We ask subjective questions, but we also ask what we could do better,” Kehrberg says.
The surveys have revealed more than simple tracking of response time and other service data. “At first, we were very gung ho to track response time and downtime and things like that, and what we found is that our customer surveys provide better insights,” Englert says.
Benchmarks, Metrics, and Goals
Most systems track response time, downtime, and priorities as well as individual performance, which biomeds use to set goals targeting better customer service. “We can use the system to identify quantifiable targets and remove the subjectivity,” Gudenau says.
CHI uses its system to drive improvements. “The most important thing we do with our CEMS is set benchmarks and metrics,” Kehrberg says. Whatever those numbers are, the organization will push to improve them. One key metric is the repair expense-to-inventory value. The total cost of equipment—training and education, contracts, parts, service—is compared to its price—the actual price that was paid and not the list price, which is often higher since the organization frequently gets volume discounts.
|CEMS also ensures that every stakeholder such as the nurse on the next shift or the department supervisor has the necessary information.|
“We take the complete inventory of a biomed shop and look at the entire repair expense required to support that shop and its equipment over a period of time, and we ask that everyone maintain a repair expense-to-inventory value of 5% or less of the overall costs,” Kehrberg says.
Kehrberg compares this to the 10% to 12% a vendor might offer, and the 7% to 9% typical of third-party providers. Currently, the institution boasts an overall value of 4.8%. The ratio is always changing, and some CHI facilities do approach a value of 6%. By using CEMS, the organization as a whole can identify what has worked in other facilities and create best practices to help individual biomed departments hit their numbers. The data also can be used in staff evaluations, answering questions such as: What is an average response time? What is the average time to fix a problem? What is the average work order open time? How effective is the staff in closing an assigned PM? Is their average work order expense out of line with what is typical in the institution? How much time is devoted to each department?
This latter question can be valuable not only for biomedical/ clinical engineering departments, but also for administration, finance, and human resources. “We can analyze the cost of operations and the hours we provide to each department,” Panyarachun says. Departments can be compared against one another, and value can be identified. Gudenau notes that the CFO can use labor breakdowns to complete CMS reports. In some instances, the information can be used to justify biomed activity.
Equipment Data Impacts Capital Planning
CEMS also can be used to justify technology purchases. Many biomed departments are able to mine the data to produce useful reports for capital planning, particularly acquisition needs. “We assess all of our existing clinical equipment against a set of objective criteria that allows us to score that equipment on where it is in its life cycle and use it as a guide for capital planning,” Kehrberg says.
The objectivity means the evaluations are completed fairly and without bias. “So while a CT scanner will generate a lot of revenue, its replacement index score could be the same as that of a stretcher,” Kehrberg says. Factors can include current use and condition, historical reliability, the estimated end of service support (manufacturer and/or third-party), and technological obsolescence potential.
Panyarachun has developed a technology scale for use at Childrens Hospital Los Angeles that uses hardware and software features. He incorporates factors that include the equipment’s level of sophistication, risk score, and potential obsolescence.
How to Manage CEMS
So It Manages Services
A clinical equipment management system (CEMS) can help to improve service, but only if it’s managed properly. We spoke to a few biomeds who offered some tips on managing the CEMS:
Tracking everything—from cradle to grave—ensures whatever data you need is there.
Be sure to enter the data. If it is not there to mine, then mining is useless. Portable devices may help, since they permit users to complete their data entry at the point of delivery.
Regular audits can identify inaccuracies—for instance, the improper coding of equipment.
Additional software, such as Crystal Reports (a report-sharing service that lets you distribute your reports over the Web in place of e-mail or by hard copy), can expand reporting capabilities beyond what is inherent to a system.
Sharing data among departments provides leverage and eases communication.
CEMS’ greatest value is the data it holds, making it one of the biomed’s strongest tools. “Trust in God, but everyone else bring data,” says Steve Kehrberg, CBET, vice president of the supply chain clinical engineering group for Catholic Health Initiatives in Tacoma, Wash.
Using this type of information, clinical/biomedical engineering departments can produce a list of items that should be top priorities, so the administration can put high-risk or high-cost items on its radar. “The department manager shouldn’t have to look at the equipment to know when to replace it. My system should tell them it’s time,” Panyarachun says.
Another useful consideration is actual equipment utilization. “We know anecdotally how much equipment is truly utilized or not utilized, so if we can tap into other systems within the health care enterprise to see where the equipment is and whether it is being used for billing, we can manage equipment and the purchase cycle even better,” Englert says. A hospital could therefore buy the exact number of infusion pumps that it needs, for example, and not spend money on a “few extra that will be thrown in a closet,” Englert says.
Biomeds who do participate in capital planning often complete annual reports that identify what equipment will likely need to be replaced at what time: 1, 3, 5, 8, and 10 years are popular benchmarks. Administration can not only plan acquisitions and budgets, but also justify them.
Gudenau is using CEMS to pull data that will justify the move to a completely digital imaging environment. “Right now, we have some digital imaging through PACS, but we still support film,” Gudenau says. The data he is producing will highlight the costs, including operation, repair, and replacement, associated with the related equipment—such as film processors—and illustrate how they will go away in a full digital environment. “Ideally, administration uses this information when building their capital and strategic planning,” Gudenau says.
Vendor Management Improves Accountability
CEMS does not help only when a device must be purchased, however. It also helps manage that equipment and the vendor afterward. Many systems can be used to track contracts, warranties, PMs, repairs, and history.
Work orders provide a way to integrate in-house work with vendor work. “If it’s billable or under contract, we track it like we would an in-house order so we are better able to look at the real service history, hours, and downtime,” Gudenau says.
Panyarachun’s system (like many others) features a service contract module. “It’s hard to keep up with service contracts, but having everything stored electronically keeps it just a click away,” Panyarachun says. The system reminds him when a contract needs to be renewed and stores copies of the documents that have been scanned in. “The information can be shared with purchasing so everyone sees the same data,” he says.
When mining the CEMS data, biomeds can get a good feel for a vendor and its equipment. “You can go back and review particular issues related to a vendor,” Kehrberg says. He then asks: Are they maintaining equipment appropriately? What are their uptime guarantees? Have they met them? What is the mean time between failures? “These become very important from the vendor management side of things,” he says. Vendors can be held accountable, and information can be managed to drive expectations and make smart business decisions. “By tracking data, we can get a feeling for what we need to do to support customers,” Kehrberg says. So CEMS, by documenting service, helps to improve it.
Renee Diiulio is a contributing writer for 24×7. For more information, contact .