How healthcare technology management professionals are playing key roles in procuring the equipment hospitals need
By Chris Hayhurst
When you work for one of the top-10 largest nonprofit health systems in the United States, you get a certain amount of leeway, spending-wise, when it comes to purchasing medical equipment. Still, says Steve Vanderzee, CBET, vice president of healthcare technology management with Advocate Aurora Health in Chicago, $60,000 is not exactly chump change—especially in today’s fiscal environment. The price tag in question, Vanderzee explains, came attached to the repairs that were needed on a recently broken portable x-ray unit.
“It was a very old machine with a newer detector panel that had been installed to make it digital,” he says. “And it was kind of a one-off—we had nothing else like it on that unit, and it wasn’t even aligned with our current standard” for such devices. Vanderzee, who in addition to overseeing Advocate Aurora’s clinical engineering program manages the organization’s capital equipment purchasing process, decided it was time to shop around.
“We could have paid for that repair through our contingent-capital process,” which allots a certain amount of money for urgent purchases, “but instead we went out on the used market to see what we could find.” Before long, he recalls, they found a nearly new unit that also matched their standard, “and it cost about the same as it would have cost us to repair the old one.”
Even better, Vanderzee adds, because of the capital equipment purchasing program that Advocate Aurora has in place (they have a devoted “equipment planning and procurement” or “EPP” team), they could access the funds they needed immediately. “We were able to make a quick decision and move forward and get it in. You always hear about these struggles around waiting for capital to get approved, where you have to run it up to whoever it is and it takes weeks or even longer to get the money you need.”
That’s not the way it works at Advocate Aurora, he says. “I don’t think we’re unique. We don’t have the capital capacity to address everything, and we’re always having to draw the line somewhere. But we do have a process that allows us to make good decisions and that helps us save money and time overall.”
HTM’s Place at the Table
Strong capital equipment purchasing programs are critical to the success of any hospitalor health system. It’s only been relatively recently, however, that most organizations have come around to involving their HTM teams in the procurement process. “Historically,” Vanderzee notes, “you’d have supply chain doing the buying and clinical engineering would be maintaining. It wasn’t unusual, even a couple years ago, to have equipment show up at the dock and that would be the first time clinical engineering had heard about it.”
Whenever that happened, the results were predictable: “We’d be scratching our heads like, ‘Why did we get this? We don’t even have this model here.’ Or you’d find out that they didn’t negotiate to get the service manual—that they didn’t even think about things like that.” Fortunately, stories like that are becoming less common as hospital executives see the value HTM can bring to purchasing.
“We bring a lot to the table,” says Mike Busdicker, MBA, CHTM, system director with the clinical engineering department at Intermountain Healthcare, an integrated delivery network in Utah with 23 hospitals and around 185 clinics. Intermountain relies on a centralized supply chain to provide facilities with equipment from a distribution warehouse in Salt Lake City, Busdicker explains.
“We have specialty committees that determine what we’re going to spend and standardize on as an organization, and clinical engineering has a voice on those committees. We’re involved throughout the entire process, from the earliest stages of equipment evaluation to the final selection of the suppliers that we use.” Each department or group represented on a given committee has a weighted vote in the selection process, Busdicker explains. “We carry a little more weight than some voting members, and a little less weight than others.”
Clinical engineering, for its part, typically looks at a range of potential issues to determine which purchases might be the best fit. “As we talk to our suppliers, we’re asking them: ‘Is support going to be a collaborative effort, where we can work on the equipment as we need to? What are we looking at in terms of parts availability, or training availability?’ And then we work hand in hand with the IT/IS department on things like integration and data flow into the EMR.”
Beyond that, Busdicker says, important considerations include cybersecurity and device usability. “It’s much more than just, ‘Can we service it?’ We want to know if it will make processes easier so the clinical staff can spend more time with patients at the bedside.” Likewise, Busdicker says, he and others on the capital equipment committee are always “looking ahead three, five, 10 years into the future,” doing their best to predict how long certain equipment might last before it needs to be replaced.
“We might put things on a cyclical replacement cycle, or sometimes, if we have items that we want to upgrade but they still meet our standards, we’ll remove the older devices from service in one facility and redeploy them to one of our other sites.” This hand-me-down process, he explains, “can sometimes give us a bigger window for the capital cycle on those devices,” which in turn frees up money the organization can spend elsewhere.
The ‘Subject Matter Experts’
Another organization with an exemplary capital equipment purchasing program is VA Portland Health Care System (VAPORHCS) in Oregon. With its main 300-bed facility and a sister hospital in nearby Vancouver, Wash., as well as 10 smaller community-based outpatient clinics, VAPORHCS serves veterans scattered across rural areas of the Pacific Northwest. And VA Portland has included HTM professionals on its capital equipment committee “for as long as I can remember,” says Chris Winson, systems planner in the biomedical engineering department.
In their case, Winson explains, “we’re very involved at an early point in the equipment-purchasing process.” Among other things, he and the two other members of his department who sit on the capital equipment committee help review and evaluate all equipment requests before they are sent to contracting. “We’re the subject matter experts. We’re vetting each and every system before anyone does anything to make sure that it is right for the hospital as a whole.”
Recently, Winson says, a request came in from the surgical department for a new endoscopy tower. “In that area of the hospital, we’re standardized to a particular vendor,” but this equipment was from another company. “So we kind of had to put up a temporary roadblock to say, ‘OK, we understand you want this, but we need to make sure it meets our technical requirements and there has to be a very strong reason for breaking that standardization.’”
The clinicians weren’t happy at first, “but once they realized that it’s our job to make sure that we’re purchasing the right stuff, they were able to provide us with much better clinical and technical justifications for why that equipment was necessary.” In the end, Winson recalls, the purchase went through because he and his team had a “full can of ammo” they could bring to the committee to say, “‘Yes, this is different than the standard, but it’s OK because of X, Y, and Z.’”
Ideally, notes Winson’s colleague Chris Arciga, a staff engineer and fellow member of the committee, biomedical engineering is consulted even before an official request for equipment is submitted. “In that case, all of the issues we ran into could have been avoided if we were brought in a little earlier and asked to provide input,” he says. “We’re working on that—letting them know they should talk to us—but it doesn’t always happen, which can lead to trouble down the road.”
One place where biomed has been involved from the start is in collaborating with the organization’s facilities management team as it draws up plans for new clinical areas and remodeling projects. “That’s the way we like it to work, where we’re talking with the architects and project engineers about the equipment needs for a space before it’s even built,” Arciga says.
Another crucial aspect of the committee’s work involves ensuring prospective purchases comply with VA standards, especially in the area of network security. “We definitely deal with hurdles there,” he says. “Vendors have to show they take security seriously” if they are going to make the cut.
Improving All the Time
Despite the success of VA Portland’s capital equipment purchasing program, Winson says they still have “lots of room to streamline.” It can be tough, he notes, to get the various stakeholders—from IT, to information security, to clinicians and everyone else—to come together on the same page. But by holding committee meetings on a regular basis, and ensuring representatives from each of those groups have the chance to contribute insight based on their professional perspectives, “we’re improving and becoming more efficient each year, basically fine-tuning how we go about the process.”
Similarly, Vanderzee says, the EPP team at Advocate Aurora, as it collaborates with departments like clinical engineering, is constantly honing its approach to capital spending. The team was formed in 2016, he notes, when it became clear that outsourcing equipment planning was no longer in the organization’s best interest. “We were building new towers, new clinical space, and that planning work was being handled by somebody else. We’d wind up with generic equipment lists that weren’t aligned with our standards.”
In other cases, projects would take years to get started, at which point they’d need to make changes to the plans. The other reason they brought the process in-house was to gain better control over the discretionary capital they allocated to their sites. “Each facility was operating autonomously in terms of the medical equipment they were buying when they needed replacements,” Vanderzee explains.
That had led to variations in their inventory that in turn led to challenges around maintenance and support. “When you have four different anesthesia vendors and six different ultrasound vendors, and all these different platforms within the same facility—that’s a problem from the technologists’ perspective.”
With the new EPP team, he says, they could centrally manage that discretionary capital, drive standardization compliance, and improve utilization by looking at potential purchases more critically. “You know, if we have three of something, do we really need another, or could we even just get by with two? Or, if we’re looking at purchasing 30 anesthesia machines, now we could negotiate with the manufacturer of choice on a multiyear replacement strategy. We gained a lot of leverage we didn’t have before.”
When the EPP group was launched, Vanderzee says, they made sure they “had the right tools” for the equipment planning process, like the software they now use for working with construction teams, and the application they run with their computerized maintenance management system (CMMS) to help them determine when equipment should be replaced. That program, he explains, is customer-facing, so clinicians see the same data the EPP team uses in the decision-making process.
“It can help when you have to make hard decisions, like when someone asks for something they feel really strongly about, but maybe it’s not the right time for that purchase.” Two years after they created the EPP team, some within Advocate Aurora have expressed their reservations about the new capital equipment purchasing process, especially in regards to that loss of autonomy.
Vanderzee, though, sees it for its positives: It’s a transparent system that ensures money is spent responsibly and that decisions are made not just ‘in the moment,’ but with the long-term health of the organization in mind. “We did a big-bed project recently,” he recalls, “and when we looked at it objectively, we discovered that some of the features we were buying on our current beds were no longer required from a clinical perspective.”
They decided the replacements they would buy would only include exactly what was necessary. “We wound up saving more than $7 million just by aligning the technology with our clinical needs.” In his opinion, Vanderzee says, “you don’t just initiate something like this and expect everything to work out overnight.” Capital equipment purchasing is a difficult business, he says. “It takes a lot of work to get it right.”
Chris Hayhurst is a contributing writer for 24×7 Magazine. For more information, contact chief editor Keri Forsythe-Stephens at [email protected].
Capital spending might also be a good time to insist on the provision of the necessary service and repair manuals.