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Working in the rapidly evolving medical device industry can make it difficult for biomedical equipment technicians (BMETs) and clinical engineers (CEs) to keep pace with the latest technologies. With ultrasound, the most recent advances put biomeds on the move.
“We’re seeing more of the portable systems; recent technology means there are a lot of good-quality products on the market,” says Hekmat Mdalal, vice president of technical development for Conquest Imaging, Stockton, Calif. “They see a lot of value in these little systems because they are reliable, relatively low in cost, and there is the ability to move them around.”
Until the last few years, clinicians were forced to choose: trading quality for portability. Those days are now over.
“The smaller laptop-type ultrasounds are really, really taking off. They have a lot of imaging capabilities, and a lot of them produce pretty good images,” says Joseph N. Stephens, imaging engineer in the clinical engineering department at Duke University Health System, Durham, NC. As a result, he adds, these units are starting to show up in places within the hospital where they previously did not have ultrasound. “Because it is affordable, now they are able to have small ultrasound units in more areas, like some of the intensive care units, the emergency department, even the physician’s office.”
Though convenient for physicians, the compact systems do present some unique challenges to biomeds. “The laptop-based ultrasound units are difficult to get into, to work on,” says Grant Smith, operations manager of imaging services, clinical engineering department, Duke University Health System, Durham, NC. At last tally, Duke’s portable ultrasounds numbered more than 60. “They are so small, you are basically limited as to what you can do, so it becomes almost like a depot repair, as opposed to a serviceable item. Primarily, you do swap-outs.”
Education Rules
Today, diverse offerings from the ultrasound OEMs and the frequent updates and improvements further complicate a biomed’s ability to stay current, making training an essential part of the equation.
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The concept of in-depth learning for multiple ultrasound systems can be daunting, so the most logical method is one of slow, steady progression. Diving into each manufacturer individually is one proven method.
“This approach helps the customer,” Mdalal says. “They’re not being overwhelmed with the tons of information that they need to comprehend and know how to use without making mistakes. It gives them time to get up to speed.”
Christopher Cone, president of Golden, Colo-based Echoserve Inc, echoes the sentiment. “The best way to do it is per platform,” he says. “You can’t just take an ultrasound tech who knows the Siemens ACUSON Sequoia or the Phillips HDI 5000 and assume they can handle the newer platforms,” he says. “You have to get advanced service training on each platform, because there are major differences between each of them. Ultrasound sort of straddles the world between being a biomed device—like an infusion pump or a patient monitor—and a diagnostic imaging device, which would classically be a CT/MR system.”
Cone adds that this results in a device with all the challenges that are unique to servicing diagnostic imaging equipment. “That includes image quality and modality functions. So there is a basic need to understand the device, from a clinical perspective. Above and beyond everything else is the image-quality piece of it.”
In addition to the above issues, biomeds face a special challenge in dealing with transducers, according to Cone. “It has its own unique standard for care and maintenance,” he says. “You have to understand transducers, transducer technology, how to test them, and how to clean them. Almost all systems have four or five transducers, they are handled all day, they get dropped and broken—they are a high-risk item that has to be managed distinctly from the asset itself.”
It is possible to gain this knowledge from a multitude of sources, including regional and nationwide third-party entities and the equipment’s manufacturer. Whatever route is taken, it is important that time be allowed for the proper vetting of schools or programs (see sidebar tips on identifying reputable educators).
Bring It Home
Motivated most often by the possibility of saving tens of thousands of dollars, more and more health care facilities are shedding service contracts and routinely placing the servicing of ultrasound systems into the hands of in-house biomeds.
However, as with any high-dollar investments, there are just as many risks as there are opportunities to shine. There is definitely not a one-size-fits-all solution to increasing responsibility for equipment: rush the move or make a misstep, and the quality of care can go down while the facility’s liability goes up.
If a facility is investigating the possibility of assuming the role of primary caretaker for ultrasound units, it is important to have a handle on the range of systems within the facility or throughout the health system. The only units that should be entered into the equation are those not currently under warranty, or systems either not under any kind of extended service contract or under a contract the hospital can break or cancel without penalty. The resulting list can serve as a guide.
“Before you begin, you need to think through the entire process from A to Z, and it needs to be planned very well,” Mdalal says. He recommends first asking if the existing staff of biomeds is sufficient to take over all of the machines on the list. “If the answer is yes, the next questions are: ‘Who am I going to use to get my biomedical engineers up to speed in ultrasound technology and troubleshooting? How am I going to be able to get the parts that will fix the system after I troubleshoot the failure?’ “
Facilities that maintain service contracts on ultrasound systems should be equally aware of the warranty status of their units. The answer lies in building alliances with established vendors. Biomed teams “should have relationships with both the original vendor and third parties,” Cone says. This is particularly important if taking on all service tasks. “To believe you will never have to deal with the manufacturer for their equipment is probably a false approach; you want to have a relationship there, if and when you need it. Putting all of your eggs in one basket for third-party support is not advisable.”
He suggests finding two or three qualified independent service providers capable of consistently providing quality products and service.
This approach has served Duke well. “One of the tools we have really established is making some key alliances with third-party vendors,” Smith says. “We knew there was a tremendous amount of pro-repair and parts that would be required to support our health system. We essentially told the third-party vendors, we are going to require technical support for some of these mainline products. We give them the business when opportunity presents and, in return, they offer us technical support that really helps in our efficiencies for uptime.”
It also is important to note that the list of in-house systems may contain only one modality, but the lack of diversity usually ends there.
“One of the challenges [we had when bringing service in-house] is that we have at least eight different manufacturers of ultrasound equipment,” Stephens says. “To stay up to speed with each different system is challenging, because some units you only see once a year, or once every 6 months, and you have to become familiar with it all over again when you are addressing its issues.” All ultrasound systems have been the responsibility of in-house techs since February 2007. Along with his staff of biomeds, Stephens oversees more than 170 individual units. “The only way that we could accomplish this is by working as a team. We do cross training, and we also use all of our resources.”
Once again, those resources include manufacturers and trusted third-party vendors, both of which play an important supporting role.
Get Smart(er)
If there is any one way to guarantee failure when transitioning to in-house ultrasound service, it is to underestimate the value of proper training. With an ever-expanding list of options and capabilities—such as Doppler, 3D/4D imaging, volumetric imaging, and network connectivity—ultrasound systems present unique repair challenges for biomeds.
“Training is key for any hospital thinking about bringing those services internal,” Mdalal says. He gives the example of how improperly performed preventive maintenance (PM) can have a substantial impact on the hospital’s budget. “With DICOM, there is a string of code that actually enables DICOM on that system. When techs do PMs they need to create a backup and print those encryptions, so if the system fails at some point down the road they can recover those options without going to the OEM or having to purchase them again.
“It’s very important to actually select a good company to provide training, because everything is dependent on training those biomeds and providing them with the tools and the knowledge that will allow them to be successful,” Mdalal says. “If the training is not up to speed, if they are not getting all of the troubleshooting skills and techniques they need, the facility is risking a lot of money. If the techs can’t deliver, the hospital is taking a couple of steps backward.”
For facilities looking toward in-house service, making use of first-call contracts also is a good idea, according to Stephens. “If they are considering taking the units off contracts, definitely go to first-call contract first,” he says. “Doing so means that, number one, you can build your confidence with the machines, because you are involved with assessing problems. Also, with a lot of manufacturers, before you can do first call, you have to go to some type of service training or service school.” This provides biomeds the opportunity to learn which aspects of which units they are able to handle, and which are better left to the vendor’s tech. “You’ll get a decent idea of what types of problems you are having with the machine during the first year or two,” Stephens says. “If you have a machine that is having a lot of issues, it is not cost-effective to take that out of warranty or off of contract.”
Find Savings Where Possible
Not every health care system can or wants to bring ultrasound maintenance in-house. In such cases, working closely with a vendor can provide the ongoing support that is required without draining the biomed budget.
“Approach it in a dynamic way,” Mdalal advises. For example, if a hospital has only two biomeds and a lot of equipment, “it’s risky to put all that workload on the shoulders of a couple of people. Realistically, they really can’t achieve it and maintain good quality.”
However, there are other ways to save money with third-party vendors, which can sometimes help lighten the load.
“Independent service providers offer 40% to 50% savings on the cost of parts, and labor and travel are probably 40% less than what the OEM charges,” Mdalal says. “This means facilities can use a mix. Maybe the plan is for the biomeds only to take the PMs, which will reduce their costs without overburdening the techs.”
In addition to cutting costs, such compromises provide another type of return on investment: improved care and internal service.
Dana Hinesly is a contributing writer for 24×7. For more information, contact .
