Health Care Technology

Replacement Planning

PAHO/WHO Representation Office for Barbados and Eastern Caribbean Countries

20-24 October, 2008 Barbados

Tobey Clark
University of Vermont

Strategic Technology Cycle

Innovation

Adoption

Advanced 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 and
states the current technology is obsolete?
When the department manager complains my
equipment never works right at the capital budget
meeting?
When undergoing repair, it is found that parts and
support are no longer available?
Need a plan for technology replacement!

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

Why develop technology replacement plans?

Limited funds available

Removes subjective and anecdotal reasons for
replacement
Guidance when major repairs are needed
Use available data on safety, user problems,
reliability, support, costs, utilization, and age to
develop an ongoing, replacement plan
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

The Ideal Technology Replacement Planning

Tool
Facility-wide, all equipment analysis
Objective Criteria
Equipment management database

Prioritized
Urgent, Years 1-3, Advisory

Flexible
Add all quantitative and qualitative factors

Simple to administer
Advanced 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
Advanced 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
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

Individual Device Inventory

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

Manufacturer & Model

Specific Device Inventory

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

Equipment Database:
Maintenance Factors for Replacement
No Service Support
Parts, repair staff, service contracts, diagnostics no longer
available from the manufacturer
No Alternative Support
No service documentation or tools

Maintenance costs
Accumulated > 50% new cost or increasing?

Poor Reliability
Trend towards increased failures?
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Computations Used
Age factor
Current year Manufacturer date
Life expectancy

Reliability
Number of failures
Average number for equipment type/class

Maintenance costs
Maintenance cost
Purchase or replacement cost

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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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

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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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
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Weighting Replacement Factors

Heavy Weight
Unresolved Safety Issues
No Parts
Regulatory Prohibition
Moderate Weight
Opportunity for Income
Documented Poor Reliability
Does Not Meet Standard of Care
Lesser Weight
Anecdotal User Problems
Age
More advanced technology available

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Example Weighting System for Equipment Replacement Factors

FACTOR

VALUE
ASSESSMENT

RANGE

WEIGHT

Unresolved safety
issue

Expert evaluation

0-3

Support not
available

Expert evaluation or
in database

Absolute

Regulatory
Prohibition

Expert evaluation

Absolute

Reliability

Database analysis

0-3

Standard of care

Expert evaluation

0 or 3

Maintenance cost

Database analysis

0-3

Age

Database analysis

0-3

Standardization

Database analysis

0 or 3

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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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 and
category score
Add expert input

Generate draft list

Base list cut off on budget allocated to technology
replacement replacement costs equal $X
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Prioritizing Replacement

Urgent - immediate
Priority 1 - following fiscal year
Priority 2 -
Priority 3 -
Advisory
Product line changes, published end of
support, regulatory (e.g. medical
telemetry)

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Technology Replacement Report

Include options to direct replacement
Use in less critical application, do not replace - not
needed, change in technology
Options for disposal

Provide to department managers prior to their

budget submission or to capital equipment
committee after wish list received
Include replacement status in equipment
management database
Repair/ Replace decisions

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Technology Replacement Report

Control

Type

Manufacturer

Model

Serial

Year
Added

Justification

Replace
Year

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

2005

12566

OXIMETER,PULSE

OHMEDA

3700

FMAU01778

1992

2005

14445

OXIMETER,PULSE

OHMEDA

3700

FMAS01942

1991

2006

18950

OXIMETER,PULSE

OHMEDA

3700

FMAT01723

1991

2006

27951

VENTILATOR,VOLUME

SIEMENS MEDICAL SYSTEMS,PT

CARE

300

05242S11

1995

2006

24998

ECG INTERPRETIVE

NIHON KOHDEN AMERICA INC

ECG8350A

00062

1994

2007

27891

TREADMILL,STRESS
EXERCISE

MARQUETTE ELECTRONICS

T200

C5441880F

1995

2007

24753

OXIMETER,PULSE

OHMEDA

3700

FMAS01987

1993

2007

33434

PMS,EEG MODULE

BRAE

---

1997

2008

Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Completing the Technology

Replacement Process
Report serves as an objective starting point for
replacement decisions
Combine with non-technical factors and
hospital budget limitations to come up with a
rational plan for replacement
Ongoing use of report data to make repairreplace decisions and other technology
changes driven by external factors
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Reference for Equipment

Replacement Planning
A Practicum for Biomedical
Technology & Management
Issues
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
Advanced Clinical Engineering Workshop 20-24 October, 2008 Barbados

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Thank you
Questions?

Tobey.clark@uvm.edu
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