As the healthcare sector becomes increasingly more technology-driven, the computerized maintenance management system (CMMS) segment is hotter than ever. Here, five CMMS industry experts—Joe Happ, CIO and EVP-East of Irvine, Calif.-based Renovo Solutions; Bryan Christiansen, founder and CEO of Lehi, Utah-based Limble CMMS; Matthew Baretich, PE, PhD, president of Fort Collins, Colo.-based Baretich Engineering, Inc.; Vishal Malhotra, CTO of Charlotte, N.C.-based EQ2, LLC; and Ben Mannisto, president of Southfield, Mich.-based Phoenix Data Systems—sit down with 24×7 Magazine to discuss advancements in CMMS technologies and what they mean for HTM departments around the country.
24×7: Why should hospitals and health systems consider purchasing CMMS software?
Ben Mannisto: With Joint Commission mandates on the rise—100% PM completion, following manufacturer PM procedures or implementing an AEM program—it would be virtually impractical, if not impossible, for any hospital to not use a CMMS.
The better question would be how a hospital chooses the best CMMS. It’s important that the CMMS used by hospitals include the ability to meet Joint Commission requirements, both now and in the future. It is equally important that they choose a CMMS that meets their needs now and in the future. The CMMS selected should be scalable—in order that the hospital can add as their needs increase—and should always be improving and evolving as requirements change.
Matthew Baretich: CMMS software is essential for HTM programs. Comprehensive CMMS software is essential for excellent HTM program management—[something I co-wrote about in HTM Levels Guide.]
Joe Happ: The return on investment in a CMMS has been proven for many years now. A CMMS greatly reduces the effort required for the timely collection and aggregation of service documentation. Having data in an electronic format improves the timeliness and accuracy of decision-making and allows analysis of the data that would otherwise not be possible.
Vishal Malhotra: To achieve the ever-present goals of increasing patient safety and customer satisfaction with limited staff and ever-shrinking budgets, hospital engineering departments now must use all available tools and technology to meet their goals. CMMS software is one of the best tools to help them do this. Good, hospital-experienced CMMS software providers have synthesized decades of operational experience with the latest software and network technology.
EQ2’s HEMS software, for instance, was developed by a hospital and has continued to evolve through three decades of use in hospitals. As a result, today’s version of HEMS has interactive dashboards, process automations (auto assignment, call escalation), assists with OEM and compliance and alternative equipment maintenance (AEM) processes, integrates with RTLS and IHE PCD, assists with cybersecurity risk assessment, [and more].
Bryan Christiansen: Hospitals and other health organizations have a critical mission that is often severely hindered by operational obstacles. When maintenance operations aren’t effectively managed, numerous undesirable results occur: Critical equipment and devices suffer more downtime; breakdowns are more frequent and severe; required spare parts may not be available when breakdowns occur; and labor hours are wasted manually distributing, inputting, and analyzing maintenance data. All these factors can contribute to skyrocketing costs and adverse patient outcomes.
An effective CMMS enables hospital maintenance and operations teams to counter these challenges in the following ways: communicating time-sensitive maintenance information seamlessly, tracking work histories for process improvements and legal risk management, managing equipment reliability, and maintaining lower costs. These benefits are accomplished through organizing maintenance tasks and assets, automating problem reporting and scheduled maintenance, assigning work, and evaluating maintenance reports.
24×7: How has the CMMS sector evolved in recent years, and how do you expect it to evolve even more in the future?
Christiansen: The number of CMMS offerings over the past several years has been growing, and these newer options have powerful mobile capabilities and other improved technologies at a much lower cost than traditional CMMS/EAM software products. IBM Maximo and SAP are still dominant and entrenched, but more and more organizations are taking advantages of the ease of use, flexibility, and reasonable pricing of the more modern, cloud-based, and mobile options.
I think that in the coming years, we can expect a continuation of this trend. Like how [some manufacturers have] missed the opportunity to embrace innovation and create a better product, these industry giants will lose their stranglehold as pricing contracts expire and maintenance professionals become aware of better options that are available.
Malhotra: Many corporate and hospital applications of CMMS operated in silos. Such applications were not only not connected to other applications, but often were not developed with an understanding of how to un-silo the data from different applications to derive further value. For example, instead of just documenting work orders, advanced CMMS applications began to use data for overall maintenance planning, parts and inventory management, and equipment end-of-life replacement budgeting.
Mannisto: Smart equipment troubleshooting will be inside the CMMS. This is critical because of the expected shortage of technician labor over the next five years. Also,
IoT substantially affects healthcare CMMS software. With medical device security risks on the rise, IoT integration has become the focal point of cybersecurity in hospitals. Cybersecurity issues of interconnected critical medical devices, such as heart monitors and IV pumps, must be managed in detail. And the best place for data on anything connected to medical equipment is the CMMS.
Happ: Recent merger and acquisition activities are creating multi-dimensional applications designed to accommodate the management requirements of the horizontal support providers in the healthcare vertical.
With the continued cybersecurity issues presented with today’s medical devices, it will become imperative for the HTM CMMS to act as the configuration management database for the IT department and incorporate other best practices, such as change management, problem management, security management and project management. Providing a single application for HTM staff to document traditional service activity, along with the IT management facets, will enable an incredibly improved security risk profile.
Baretich: Almost all CMMS software can handle the basic functions: inventory, PM scheduling, and maintenance history. [But] the best CMMS software goes beyond the basics in two ways: First, the ability to integrate with other software systems—for example, financial and supply-chain systems, real-time location systems, IT service management software and change management database systems, and so on. Second, support for advanced analytics—related to AEM programs, for example—and automation of multi-parameter business rules.
24×7: What kind of impact are innovations such as cloud-computing, mobile access, and artificial intelligence and machine leaning having on the CMMS sector, and how do you see them impacting the field in the future?
Christiansen: Cloud computing and mobile access are becoming mainstream in the CMMS sector for many reasons. The advantages of cloud computing are straightforward, such as instant software updates, ability to access on mobile devices, and elimination of server and installation costs.
Additionally, mobile CMMS capabilities have revolutionized how maintenance work is performed by eliminating the need for paper work histories, empowering more seamless collaboration among maintenance teams, and automating work requests, among many other benefits.
I don’t think anyone yet knows how machine learning will impact the maintenance world, but we are seeing positive gains from the Industrial Internet of Things. When maintenance tasks are performed on critical equipment based on condition thresholds instead of schedules, a much more tailored approach can be taken to machine reliability. The application of this technology is also in its infant stages, but my guess is that we will use other technologies, including machine learning, to be even more precise in condition thresholds for maintenance, repairs, and replacements.
Mannisto: Cloud-based CMMS have provided hospitals with the ability to alleviate the expense required for an in-house environment. With a cloud-based CMMS, hospitals are relieved of the expense of upgrading hardware and software technology, as that is handled by the provider. Upgrades are scheduled at the convenience and necessity of the clinical engineering and facilities engineering departments, ensuring that critical updates and information are provided immediately. (Phoenix, for instance, recently introduced two new applications for our AIMS product that focus on mobility, operational efficiency, and cost containment.)
[Regarding artificial intelligence,] with a significant increase in AI abilities, it is only a short period of time before AI will be incorporated into a so-called ‘Smart CMMS.’ The probable outcome of this will be that the ‘Smart CMMS’ will concurrently announce many operating issues such as critical equipment-downs, out-of-standard KPIs, labor ineffectiveness, problem medical devices, poorly trained equipment users or clinicians, and more. With AI inside the CMMS, managers will receive critical information faster; thus, they can respond to critical issues more effectively.
Baretich: Cloud computing and mobile access have been here for a long time, but they are becoming more useful as Internet access is available almost everywhere and mobile devices are more powerful and easier to work with. AI and related technologies have not yet had a big impact on commercially available CMMS software, but will be here soon. Even sooner, we will see the integration of medical devices with the CMMS that will have major effects on HTM workflow.
Malhotra: At EQ2, we believe the future will be heavily driven by tools available from mobile computing. As hospitals continue to merge and form alliances, the further differentiation of facilities by specialty will be an important hospital cost and skills control-driver. But this increases the need for engineering services to provide multi-facility support.
Being able to effectively service equipment over a region requires a mobile service force. [After all,] a mobile service tech cannot function well without the resources available in his/her CMMS. And, with good mobile tools, there is no reason they can’t have all the CMMS tools they’d have at their bench. Further, the CMMS can provide engineering management with the visibility, metrics, and algorithms needed to help them run a distributed service center.
[Moreover,] as IoT has become more pervasive throughout healthcare, most new medical devices are becoming smart and connected, meaning a larger role for CMMS. Data will be analyzed in new ways automatically so that better decisions are made day to day and overall. In short, we believe AI will become an important process for future CMMS enhancement.
Happ: Artificial intelligence shows great potential for data analytics and predictive failures. We could see improved AEM recommendations and maintenance alerts from software predictions, reducing in-use failures once AI becomes more prevalent; however, the greater challenge is getting clean, accurate data into the CMMS. One of the first steps is leveraging cloud-computing and anywhere-access.
Enabling staff to interact with the CMMS on any device from anywhere has improved the quality and timeliness of service documentation. With these improvements, communication with the end-customer greatly increases while enabling HTM management to execute the appropriate service plans in real time.
24×7: Are there challenges of having to accommodate different sizes and types of hospitals within a health system—for example, a large academic medical center and a small community hospital?
Malhotra: Each type of hospital presents different needs for a CMMS to accommodate. Teaching hospitals or academic hospitals are generally larger than community-based health centers and often use cutting-edge technologies and processes. Specifically, academic hospitals have more needs and requirements for the automation of often-complex business processes and they need more powerful analytic reporting.
As they are larger, they have more data and, hence, require a better architecture of the database structure (OLTP, or online transaction processing), as well as the analytic application (OLAP, or online analytical processing) to provide them with quick response times and powerful reporting capabilities.
Happ: Although documentation and management requirements are similar for each, resource availability is the biggest challenge. While large health systems may have specialized tools for different service activities, staff at smaller hospitals have a greater need for a robust CMMS that supports the various service management tools that they may otherwise not have access to. By providing a centrally managed device classification system, parts procurement tools, change management and configuration management, we can overcome those resource challenges.
Mannisto: Large medical centers typically include off-campus healthcare facilities, so it’s important that their data is inside the CMMS used by the main hospital. Data is kept separate for reporting and other purposes using individual facility codes. Data in individual facility codes can be rolled up to provide hospital system-wide information and can also be analyzed on a facility-by-facility basis. Implementation for these smaller hospitals is completed at the same time as that of the hospital system to ensure validity of data across facilities.
When choosing a CMMS, it’s important to select a vendor that offers scalability with respect to users, components, and new technology. The CMMS should be able to meet current needs while offering the ability to add to the system as needs increase.
Christiansen: There are certainly differences and challenges for each. A smaller hospital typically doesn’t have the sort of financial and human resources of a larger one, so they would need a CMMS implementation that is easy on the budget and extremely easy to learn.
Baretich: In my experience, a well-designed CMMS is applicable to HTM programs of all sizes. However, the initial and ongoing cost of a comprehensive CMMS can seem overwhelming for a small, standalone hospital. Smaller facilities will continue to be served by simple, basic CMMS software, but their numbers are dwindling. The value of comprehensive CMMS software will be greatest for complex, integrated health systems.
On the other hand, larger hospitals often have numerous bureaucratic hurdles to jump within the organization for approval and implementation, as well as IT requirements such as fully integrated capabilities with ERP, HRMS, CRM, and other software systems. These considerations, among others, should be made in evaluating CMMS options.
24×7: What else should 24×7 readers know about the CMMS sector?
Baretich: If you are thinking about changing CMMS software, start with an open mind about what a good CMMS can do for your HTM program. Then, follow a careful process to identify the right vendor.
Malhotra: Before you select which CMMS to purchase, make sure that it can be configured for your hospital’s policies, can assist you with meeting those policies, and can provide visibility of compliance to those policies via dashboards with real-time data. Also, make sure that it can work with the devices that you are planning to use, like smartphones, tablets, laptops and desktops.
Also, evaluate the strength and standing of the vendor in the market by looking at how long the product and the vendor have been serving healthcare and how the product has evolved over time. Consider the future vision of the vendor’s products and see if it matches with your vision. The combination of expertise in serving healthcare while supporting the latest technological tools and advancements give peace of mind that you are getting a solution that means a greater chance of success for your hospital.
Mannisto: In the future, all access to CMMS data will be available by mobile devices. This gives technicians the ability to enter all their work in real time, while also [enabling] customers to immediately request corrective maintenance for critical repairs.
Also, I believe a closer relationship between IT and engineering departments [will occur in the future.] As more and more medical equipment becomes technology-related, these departments will work closer together. In the past, IT changes and updates were carefully planned and scheduled over extended periods of time—but with critical equipment, issues must be resolved quicker. As these departments become more cohesive, efficiencies in both corrective and preventive maintenance will become greater.
Christiansen: With the flexibility and power of today’s CMMS options, almost every organization can achieve a very quick return on their investment in maintenance software. Additionally, many CMMS software options offer a free trial to make sure what you see is what you really get. Now is a fantastic opportunity to enjoy fewer breakdowns, less downtime, increased productivity, and lower repair costs.
Happ: Consolidation in the CMMS sector with application providers in the healthcare vertical will enable integration of information and tools horizontally. This integration will present significant improvements for all service providers.
To Me, the single most important aspect of CMMS is to be integrated with the hospital’s order entry system for accessing HTM services. For example, the caregivers order labs, xrays, diets, meds etc all out of order entry. having Biomed, IT and facilities as just another category in order entry is how it should work. That way reporting technology issues is a standard part of the clinical workflow. The call is tagged to the caregiver, cost center, room, procedure and case. The caregiver enters the asset# just like a MRN#, your asset list is just another data source OE pulls from, no stories, no missing data, its 100% accountable and closed loop. After the caregiver hits send, the provider gets the work order for action, the system knows the GL code for the dept and caregiver requesting service thru general ledger and accounting. The BMET’s time is charged against it along with parts and labor. The manager gets timely reporting, the C-suite gets cost accountability. Risk management gets good QA data. as the BMET closes the WO and codes his actions. I had such a system running on meditech in the 90’s and 2000’s. I had a fully customized Biomed order entry form in the clinical order entry system. I didn’t get phone calls or pages, the work orders just popped up on the laser printer in the Biomed shop. it worked ! In todays world, I would have had it texting the WOs to my cell phone. Then closed them on it as well. Why don’t all commercial CMMS software systems work this way ? in 2018 shouldn’t CMMS be fully integrated into HIS and not stand alone?
and BTW for hospital’s that use 3rd party Biomed services. Even more important to own the CMMS yourself and control and QA the data. comments on this?