Fronically, getting a look inside imaging equipment is sometimes more difficult than getting a look inside the human body. It is definitely as complex. Ionizing radiation devices—x-ray, computed tomography (CT), mammography, and fluoroscopy—create images of varying detail through the interaction of the body and radiation. X-ray exams, for instance, do not distinguish very well between soft tissues but can highlight fractures; 64-slice CT can perform cardiac imaging in a single breath hold. With such versatility and usefulness, this imaging equipment has become a routine part of care, and downtime can have a negative impact that is felt throughout an entire health care system, from scheduling and the waiting room to patient care and the bottom line.
However, the size and complexity of the equipment can be as intimidating to an untrained biomed as it is to an uneducated patient. And just as a physician can allay a patient’s unease with information, a biomed can handle diagnosing and, in some instances, even fixing, imaging equipment problems with proper training. If biomeds fill at least a first-response role, an institution can save significant dollars on maintenance, service, and repair.
Getting to a point where the in-house biomeds perform some type of service on imaging equipment takes planning. Tim Burke, CBET, biomed supervisor at Genesis Medical Center in Davenport, Iowa, shares that his team took about 1 year to implement the decision to bring imaging equipment services in-house. Training for staff began toward the end of that year and has been ongoing.
“You need to do a detailed analysis of your entire imaging inventory and look at what service options are available. You need to identify what training is needed and how to get the staff that training. You need to plan,” Burke says.
A Natural Progression to In-House
Genesis has four campuses with roughly 650 beds total. Its current inventory of imaging devices numbers 166 and includes radiology, ultrasound, mammography, nuclear medicine, and picture archiving and communications systems (PACS) modalities. Burke estimates the equipment was acquired from 33 manufacturers that range in size and scope. His biomed team is responsible for all of the maintenance on this equipment at the organization’s two largest facilities. “We are gradually getting involved at other sites as opportunities, training, and budgets allow,” Burke says.
Genesis’ decision to bring at least some portion of imaging equipment service in-house is one that has been made by many health care institutions. “Many start out with shared service contracts, which let the in-house team take a first look at the equipment. If they can fix it, they don’t have to wait for the manufacturer to come in,” says John Drew, technical training instructor with Radiological Service Training Institute (RSTI of Solon, Ohio).
The trend has followed the typical evolution of equipment servicing. “First, the manufacturer handles everything. Then, the independents appear. Then, it moves in-house. The natural progression is to service it yourself,” says Manny Roman, CRES, president of training institute DITEC Inc in Solon, Ohio.
Even so, some outside service is still typically needed for imaging equipment. Burke’s team does not handle all of Genesis’ imaging-service needs. “Our involvement is a blend of service plans that include total in-house support, shared service contracts with the original equipment manufacturer (OEM), shared service with a third party, and some full-service agreements. There are no one-size-fits-all solutions,” Burke says.
Full-service contracts, in which all maintenance and repair needs are handled by an outside company, tend to fall at the higher end of the price range, while in-house plans are usually the least expensive. To determine which solution will work best for a certain piece of equipment, Burke evaluates the system with several criteria in mind, asking:
• Can we get the necessary training and diagnostic service software from the OEM?
• Can we budget for adequate staff time to completely service in-house, or is a shared agreement better?
• Has the OEM priced the service agreement at a point where we estimate that we can save money by avoiding the agreement?
• Is software support bundled with the agreement? If so, this is considered when evaluating annual support costs.
The Price of Education
Obstacles to in-house service are usually defined by the OEM, Burke says, citing parts pricing for noncontract customers, shared contract pricing and conditions, software-support strategies, diagnostic service software access, and the availability of phone tech support.
Internal obstacles are typically related to either budget or staff, Burke notes. “With proper planning and communication, we can usually manage the budget issues,” he says.
Staff issues are managed with training. “It becomes a factor when dealing with highly specialized or unique technologies, where it is difficult for technicians to gain enough experience to service the system, even with training. In these cases, we will attempt to negotiate a shared service agreement,” Burke says.
Roman notes that a lot of savings can be realized without going to the extreme of training everyone on staff and dropping all service contracts. “You can reduce the contract, have demand service as a backup, buy block hours of support—there are many possibilities,” Roman says. He cautions facilities to maintain service contracts until their biomeds have been fully trained to assume the responsibilities.
With a relatively small investment, Roman suggests that biomeds can be trained as first-response individuals, saving the cost of a service call, in some instances, and reducing downtime. “A trained biomed can ensure the machine really is broken before calling somebody. He can fix mechanical issues right away, such as a burned-out bulb,” Roman says. “In-house calls save the outside service charge, which typically includes an hour of travel and an hour of fix-it time.”
RSTI’s Drew uses the same calculations, noting that costs have increased over the past few years. “If we are looking at $300 an hour, with 1 hour travel each way and 1 hour of service, a facility can easily spend $1,000 on one call. In-house service can save 80% to 90% of that cost,” Drew says. Comparing the cost to training, he adds, “The cost of one preventive maintenance on a piece of equipment will pretty much cover the cost of a class.”
The Proper Order
“When we started our in-house imaging service program, we had to add the training to our department’s expense budget,” Burke recalls. Now, as new systems are purchased, Burke works closely with in-house customers and the purchasing department to negotiate training and service options. “Or at least get the costs for these items included with the capital purchase,” he says.
Coursework can include both comprehensive and system- specific training. Often, it is best to start with an overall basics course. This was the approach taken by Burke, who took classes along with his staff.
“You can’t just jump into a specific product without the fundamentals, so there is a path. But it all depends on what the organization determines it should do,” Roman says.
“Although training should be situation specific, in general a multi-vendor course works best when learning the basics. A high percentage of our students handle it this way. There aren’t many hospitals that are vendor specific anymore,” Drew concurs.
Fortunately, there are a number of system-specific courses available, from third-party training institutions, such as DITEC and RSTI, as well as the OEMs. Many factors influence whether coursework is offered on a specific system. “The complexity of the system, the installed base, the availability of parts, the perception of the departments—there are a lot of things that play into whether or not a course will be available,” Roman says. “It takes us 10 weeks to develop a 1-week course, so before we can expend that time there has to be an installed base of machines, a willingness to come to training, and available parts. If you can’t get parts for the machine, then the class doesn’t matter.”
OEM training seminars will often provide more information than their third-party counterparts, according to Burke. And though they tend to be system specific, they can have their own prerequisites. “You will typically get more in-depth information from the OEM than you may be able to get from a third-party simply because they are the only ones with the resources. The OEM will have all of the service software and technical information needed,” Burke says.
He also notes that some manufacturers will provide this material at reasonable costs while others will charge very high fees. In those instances where the manufacturer has priced materials so that the cost of in-house service is equal to or greater than that of a service agreement, Burke’s team will use the manufacturer service option.
RSTI’s Drew thinks it’s difficult to cut the manufacturer out entirely in any case. “It’s not possible to perform 100% of this service in-house. Even manufacturers have backups. But it’s realistic to say that 80% to 90% of the work can be brought in,” he says.
The problems encountered with imaging equipment cover a wide range of issues. Burke cites image quality and mechanical problems, and with facilities where PACS has been fully implemented, software and data communication issues as well. He approaches all service calls with the same troubleshooting process: discuss the issues with the customer, diagnose the problem, and repair.
“Many problems are of a routine nature. Certainly there are some very deep problems, but those are fewer and fewer. More often, they are minor and can be resolved by in-house technicians. Even if our techs don’t have the same skills as the OEM, simply due to lack of exposure, there is a lot they can do,” Burke says, noting that some systems require more vendor involvement than others.
Common problems, according to Drew, originate with glassware, such as image intensifiers, x-ray and camera tubes, and equipment that biomeds are already used to seeing: breakers, switches, interlocks, etc. “Repairing these items in-house can save a substantial amount of money,” Drew says.
Training is key for even these basics. “A lot of times, the biomed may know the breakers are the problem, but doesn’t know where they are located. Glassware often does not break but degrades over time, and there is nothing you can do but replace it. A biomed will need to know how to calibrate the machine after making the repair,” Drew says.
Newer systems will naturally require less service than their older counterparts. “The older machines, of course, have more repair problems. But the newer machines are designed with greater reliability so that service does not involve as much repair of the equipment as tweaking of image quality and ensuring compliance,” Roman says.
The Savings and Involvement Correlation
Maintenance is another area where biomed involvement can help an organization with its bottom line. Burke’s team handles calibration checks and mechanical inspections, especially on larger systems. Drew estimates that routine maintenance on a machine for which no problems have been reported can cost roughly $2,000. “Biomeds can save significant money by performing planned maintenance without calling in the manufacturer,” Drew says.
They can also save significant time. If a manufacturer comes in to perform maintenance, the service provider will run through a checklist. If something on the list needs further attention, it is typically handled during another sales call. An in-house team can be equipped to handle both in the same session.
“The bulk of maintenance work involves electrical mechanical checks, such as ensuring the switches work. There are a lot of mechanical issues, because there are many moving parts,” Roman says. Parts such as stress cabling should be checked; image quality should be monitored; and routine compliance steps should be documented.
Of course, the biomed technicians can only be as involved as their organizations want them involved. Burke notes that for many years, Genesis had its imaging equipment service handled by outside providers. But financial pressures, difficulties with the outside service provider, and a change in imaging management presented an opportunity to bring the service inside. Says Burke, “Converting to full in-house imaging equipment management requires more of a hospital’s management and clerical time as well as the biomed’s. And it is definitely a commitment, but a worthy one.”
Renee DiIulio is a contributing writer for 24×7.