clark replacement day 2 430
DESCRIPTION
sasaasasTRANSCRIPT
Health Care TechnologyReplacement Planning
Tobey Clark
University of Vermont
PAHO/WHO Representation Office for Barbados and Eastern Caribbean Countries20-24 October, 2008 – Barbados
2Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Strategic Technology Cycle
Innovation Adoption
3Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
When should technology be replaced?
• When it fails at a critical time?
• When the physician returns from a conference andstates the current technology is obsolete?
• When the department manager complains “myequipment never works right” at the capital budgetmeeting?
• When undergoing repair, it is found that parts andsupport are no longer available?
Need a plan for technology replacement!
4Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Why develop technology replacement plans?
• Limited funds available
• Removes subjective and anecdotal reasons forreplacement
• Guidance when major repairs are needed
Use available data on safety, user problems,reliability, support, costs, utilization, and age todevelop an ongoing, replacement plan
5Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
The Ideal Technology Replacement PlanningTool
• Facility-wide, all equipment analysis
• Objective CriteriaEquipment management database
• PrioritizedUrgent, Years 1-3, Advisory
• FlexibleAdd all quantitative and qualitative factors
• Simple to administer
6Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Equipment Database:Device Inventory
• Type
• Manufacturer
• Model
• Serial Number
• Date of Manufacture• Determine from purchase records or
hospital staff records
• Manufacturer customer service
• Sometimes, serial number
7Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Equipment Database:Life Expectancy• American Hospital Association
http://www.ahaonlinestore.com
Primarily financial/asset data
• U.S. Department of the Army
Document TB MED 7, appendix B
http://www.army.mil/usapa/med/
Included on CD for symposium
Older document based on engineering factors
• “Simple” retirement date =
Manufacture date plus Life Expectancy
8Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Individual Device Inventory
9Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Manufacturer & ModelSpecific Device Inventory
10Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Equipment Database:Maintenance Factors for Replacement
• No Service SupportParts, repair staff, service contracts, diagnostics no longer
available from the manufacturer
No Alternative Support
No service documentation or tools
• Maintenance costsAccumulated > 50% new cost or increasing?
• Poor ReliabilityTrend towards increased failures?
11Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Computations Used
• Age factorCurrent year – Manufacturer date
Life expectancy
• ReliabilityNumber of failuresAverage number for equipment type/class
• Maintenance costsMaintenance costPurchase or replacement cost
12Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Equipment Database:Safety Factors for Replacement
• Equipment-related incidents
• Recalls
Serious or unresolved
• User problems
User errors, no problem found…
• Regulatory prohibition
• Lack of essential safety features
13Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Equipment Database:Other Factors for Replacement
• Device function/risk
• Standardization
• Strategic Technology Plan
• Standards of Care
• Technology status• Obsolete
• Utilization
• Cost advantages of new technology• Consumable use, patient throughput, staff productivity…
14Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Weighting Replacement Factors
Heavy WeightUnresolved Safety Issues
No PartsRegulatory Prohibition
Moderate WeightOpportunity for Income
Documented Poor ReliabilityDoes Not Meet Standard of Care
Lesser WeightAnecdotal User Problems
AgeMore advanced technology available
15Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Example Weighting System for Equipment Replacement Factors
FACTOR VALUEASSESSMENT
RANGE WEIGHT
Unresolved safetyissue
Expert evaluation 0-3 5
Support notavailable
Expert evaluation orin database
Absolute
RegulatoryProhibition
Expert evaluation Absolute
Reliability Database analysis 0-3 4
Standard of care Expert evaluation 0 or 3 3
Maintenance cost Database analysis 0-3 3
Age Database analysis 0-3 2
Standardization Database analysis 0 or 3 2
16Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Evaluation of Database and Qualitative factors
• Put in Equipment Replacement Cost• Direct, upgrade or new technology
• Contact manufacturer, ECRI, etc. for cost
• Review and analyze each inventory item• Compute values according to algorithms and
determine total score based on weights andcategory score
• Add expert input
• Generate draft list• Base list cut off on budget allocated to technology
replacement – replacement costs equal $X
17Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Prioritizing Replacement
• Urgent - immediate
• Priority 1 - following fiscal year
• Priority 2 - “
• Priority 3 - “
• AdvisoryProduct line changes, published end of
support, regulatory (e.g. medicaltelemetry)
18Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Technology Replacement Report
Include options to direct replacement
• Use in less critical application, do not replace - notneeded, change in technology
• Options for disposal
Provide to department managers prior to theirbudget submission or to capital equipmentcommittee after “wish list” received
Include replacement status in equipmentmanagement database
• Repair/ Replace decisions
19Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
18912 ECG INTERPRETIVE NIHON KOHDEN AMERICA INC ECG 00639 1991 SR 2004
34851 OXIMETER,PULSE OHMEDA 3700 FMAV00018 1992 SR 2004
18951 OXIMETER,PULSE OHMEDA 3700 FMAS01959 1991 SR 2004
18949 OXIMETER,PULSE OHMEDA 3700 FMAQ03426 1991 SR 2005
27890 SCANNER,ECG,LONG TERM MARQUETTE ELECTRONICS CENTRA C5H90830F 1995 R 2005
12566 OXIMETER,PULSE OHMEDA 3700 FMAU01778 1992 S 2005
14445 OXIMETER,PULSE OHMEDA 3700 FMAS01942 1991 S 2006
18950 OXIMETER,PULSE OHMEDA 3700 FMAT01723 1991 S 2006
27951 VENTILATOR,VOLUMESIEMENS MEDICAL SYSTEMS,PT
CARE 300 05242S11 1995 R 2006
24998 ECG INTERPRETIVE NIHON KOHDEN AMERICA INC ECG8350A 00062 1994 R 2007
27891TREADMILL,STRESS
EXERCISE MARQUETTE ELECTRONICS T200 C5441880F 1995 R 2007
24753 OXIMETER,PULSE OHMEDA 3700 FMAS01987 1993 S 2007
33434 PMS,EEG MODULE BRAE I --- 1997 R 2008
Control Type Manufacturer Model SerialYear
Added JustificationReplace
Year
Technology Replacement Report
20Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Completing the TechnologyReplacement Process
• Report serves as an objective starting point forreplacement decisions
• Combine with non-technical factors andhospital budget limitations to come up with arational plan for replacement
• Ongoing use of report data to make repair-replace decisions and other technologychanges driven by external factors
21Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
• A Practicum for BiomedicalTechnology & ManagementIssues
Chapter 13 – Medical Equipment Replacement(Clark)
http://www.kendallhunt.com/samples/1530.pdf
ISBN # 978-0-7575-4890-1: Leslie R
Atles, Kendall-Hunt Publishing, Dubuque,IA, 2008
Format- Hard Cover, Approximately 800 Pages
• Included in handouts
Reference for EquipmentReplacement Planning
22Advanced Clinical Engineering Workshop – 20-24 October, 2008 – Barbados
Thank you
Questions?