BMETs and clinical engineers are a vital component of the imaging equipment acquisition process.

F02a.jpg (17332 bytes)As hospitals and care facilities work toward creating a better patient experience, today’s biomedical equipment repair technicians (BMETs) and clinical engineers are eager to join them. Actively participating in the decisions that directly impact quality of care—such as imaging equipment acquisitions—is a step in that direction. Unfortunately, BMETs and clinical engineers often meet resistance.

“At most hospitals, the medical director, hospital administrators, and purchasing leave out all the other people,” explains Salil Balar, clinical engineer, department of clinical engineering and technology management, Beaumont Services Co (Royal Oak, Mich). “It’s important to involve people from other departments, like biomed, clinical engineering, service-cost management, construction, and facility support.”

Working Together Improves Outcome
The new equipment purchasing process is relatively straightforward. A need arises and is assessed, quotes are received, and machines are purchased and installed. The level of biomed participation varies by location, but there are numerous advantages to making the imaging equipment acquisition process a team effort.

Navigating Negotiations

The process of acquiring new imaging equipment can be a lengthy one, but at some hospitals, too little time is spent on negotiating ongoing service agreements for the machine. This is an area where biomeds excel—as long as they’re given the chance.

“The key is for biomeds to get involved before a purchasing decision is made,” says Chris Leger, manager, service mode administration program, Beaumont Services Co (Royal Oak, Mich). “The biggest failure is waiting until the decision is made—then you’ve lost all leverage with the vendor.”

Before any purchasing decision is final, the biomed team should help evaluate the available contracts, ideally from two to three competing vendors. Initial meetings should cover the basic service options available.

Options vary by level of service provided, such as parts coverage and response time, as well as those combining vendor and in-house resources. It’s important that the roles of in-house BMETs are clearly defined, because the amount of responsibility placed on the biomed staff will gauge staffing and training.

More Than Just a Purchase Price
It’s also prudent to account for ongoing costs of ownership. For example, servicing software is not typically included, and in most cases accessing online service tools without it is impossible.

“Gaining this access should be a primary negotiating point for any after-warranty service agreement,” says Kenneth Bailey, radiology equipment technician, The Reading Hospital and Medical Center (West Reading, Penn). “Without the knowledge provided by diagnostics and documentation, service parts and technical support services pricing are secondary.”

In addition to scouring the contract and quizzing the vendor, learn more by conferring with each vendor’s existing customers. A little extra legwork can help guarantee that the service advertised is delivered. One way to make sure vendors follow through is to negotiate preacceptance procedures as part of the buying process.

“A preacceptance procedure is a series of tests,” Bailey says. These tests demonstrate that features, functions, specifications, and equipment delivered by the vendor performs as promised, he explains.

Breaking the Ice
For biomeds new to the negotiating table, here are a few questions to get the dialogue rolling:
• What special tools, software, or other test-type equipment is needed to repair and calibrate your machine?
• Do you have a biomed repair training course equal to the course for your staff available to us? How often is this training provided?
• Can we get a discount for parts? (For those planning to service equipment in-house.)
• What customer support do you offer? Is there a
number available for technicians or BMETs in need of help? How much does it cost to call?
• Are there any local service technicians trained on this equipment? If not, how long will it take to get a technician to our facility?
• What type of software is included to protect our
system against spyware and viruses? (For equipment that will be connected to a network.)
• Where is your closest parts source? If we have a failure at 10 pm, how will we get a part, and how long will
it take?
• Is there a recommended backup supply of some parts we should keep on hand? (Monitors and keyboards, for example, take up relatively little space, and having them available can keep a machine operating.)

Buy the Book
For BMET teams tasked with upkeep of the new equipment, another reason to contribute to the negotiation process is to secure necessary repair manuals.

“Vendors sell the product with the goal of selling a service contract,” says Scott R. Sovocool, director of biomedical engineering, Methodist Health Systems (Dallas). It’s rare for vendors to voluntarily hand over manuals or software, he adds. BMETs can even help secure free or discounted service training to take place before the contract expires.

“For most modalities, you can typically negotiate something far less than a full-blown contract,” Sovocool says. “The result can reduce costs considerably, yet still provide the coverage you need.”              —DH

In many cases, the primary decision-makers—clinicians, department managers, and hospital administrators—are not versed in medical-device issues, service considerations, facilities planning, or project implementation, according to Balar. Opportunities to update the decision-makers with relevant and crucial information about the medical devices results in better acquisition decisions involving medical devices, Balar adds.

“Biomeds should be involved in imaging equipment acquisitions because the traditional decision-makers focus only on patient care and services—as it should be,” says Chris Leger, manager, service mode administration program, Beaumont Services Co. Leger believes a comprehensive approach ultimately benefits everyone—including the patient. “But without the involvement of technical experts, some very significant cost components are often missed.” Those cost components include additional installation and construction, increased utilities, and user and maintainer education—all of which can add up quickly. Money saved on such expenses would be better spent improving care in other areas.

Initial costs are not the only ones to consider. When equipment is purchased without input from biomedical/clinical engineering, ongoing maintenance expenses are often neglected.

“An original equipment manufacturer (OEM) tries to incorporate multi-year support agreements with the equipment sale, which include costs negotiated away during the equipment purchase,” explains Kenneth Bailey, radiology equipment technician, The Reading Hospital and Medical Center (Reading, Penn). “The biomed department understands these costs and can help minimize them.”

Saving money isn’t the only way biomeds contribute. Those outside the biomed department often don’t investigate safety implications such as hazard alerts and recalls, user-friendliness, or postwarranty service options and needs, Balar says. Clinical engineers, BMETs, and imaging specialists can compare vendors’ technology to help get past the “bells and whistles” being promoted to evaluate the system’s true worth; once the system is in place, they can also ensure that vendors deliver on their promises.

Breaking From the Status Quo
All the benefits of biomed involvement make it clear why the push to include them is catching on. And while there are few arguments against their involvement, the ones that exist have deep roots.

“Biomeds are often identified only as people who fix medical equipment,” says Scott R. Sovocool, director of biomedical engineering, Methodist Health Systems (Dallas). “Hospital administrators relate that to just monitors, respirators, and ventilators.” This mind-set often leads to the assumption that biomeds do not have any significant knowledge about imaging equipment—which is not true in most cases.

“Traditionally, biomed technicians were not viewed as qualified image ‘experts,’ but that is changing,” says Bailey, who credits the increased number of former OEM engineers becoming in-house staff technicians. “This expertise infusion has raised the bar.”

Others feel that biomeds are slowing the process or are involved simply to question the primary decision-makers. Again, nothing could be further from the truth, according to Leger.

“We are information providers here to support the decision-making process,” stresses Leger, who recommends that any biomed looking to be part of the equipment acquisition process adopt the same philosophy. “We help complete the picture.”

How To Get Involved
Biomeds interested in getting a foothold in the imaging equipment acquisition process should analyze the existing system, identify problems, and develop a comprehensive, efficient method incorporating potential solutions, Leger says. Be sure the presentation clearly identifies benefits biomeds provide, Leger adds, because without support from stakeholders, BMET involvement will be sporadic at best.

“We’re consistently being involved, if not always at the right time,” Leger says. “It really takes a mandate from the highest authority to make this involvement happen correctly.”

The importance of biomed involvement must also be promoted by the biomed group itself. Managers must communicate to administrators that the biomed staff has the appropriate knowledge to be part of the imaging equipment procurement process.

First Impressions First
As they say, there is only one chance to make a first impression. Biomeds zealously executing their duties are far more likely to be included in subsequent equipment acquisitions. Depending on the biomed’s area of expertise, this could mean additional homework.

“The first thing you need to do is study the modality they’re planning to purchase,” Sovocool says. As an active part of a buying committee, BMETs should educate themselves about the equipment choices currently available in the marketplace. Being familiar with different versions is only part of it, as biomeds must also know how all the devices interact and how they’re used to care for patients, he says. Networking with other facilities to determine a specific OEM’s long-term performance is another good idea.

Early Involvement
The ultimate goal for biomed departments is to be incorporated in the acquisition process as soon as the need for new equipment is identified—and to be part of every step, including all presentations, decision-making meetings, and any conversations discussing the product’s attributes and how they fit the needs of both hospital administrators and clinicians alike.

“Ideally, we would be involved in replacement planning years in advance of actual acquisitions, again at budget time, and then heavily involved prepurchase in vendor selection, clinical trials, and equipment selection,” Leger says. “Though our role is primarily as consultants, we should be leaders in the process because it brings everything together.”

Dana Hinesly is a contributing writer for 24×7.