The Logic of Computerized Maintenance

True or false? All CEMS software is CMMS, but not all CMMS is CEMS software.

Not clear on the acronyms? CMMS—computerized maintenance management software—is not new, but CEMS—clinical equipment management systems—is a more recent development. CEMS software is computerized maintenance management software, or CMMS, designed expressly for biomeds.

“CMMS terminology originated with generic maintenance management-type software. Applications geared more specifically to biomeds, we call CEMS,” says Richard Overturf, BS, CBET, senior developer and owner of Harvest Data Systems in New Port Richey, Fla.

People may use different terminology for CEMS, but they speak similarly about its value. “Having CEMS software is essential for the operation of our biomed department. There is just way too much information to try to manage and report to be without a good software program,” says Cliff Ratke, biomedical department director, Redlands Community Hospital, Redlands, Calif.

Essentially, CEMS helps biomed professionals manage and document their medical equipment inventory, track corrective and preventive work orders, and create real-time documentation required for regulatory compliance. Some suggest that this is its only use, but the software often also creates more efficient workflow and greater data-mining capabilities.

These benefits, however, can be limited if a biomed department has the wrong software. Despite the fact that the acronyms are used interchangeably, all CMMS is not CEMS software. Mike Gross, manager of marketing for Four Rivers Software Systems Inc, Pittsburgh, thinks the abundance of generic applications on the market can be confusing. “There are literally hundreds of applications on the market that can be considered CMMS, but only a handful are dedicated to health care,” Gross says.

This specialization is one of the first things biomeds should look for when shopping for CEMS software, but it is not, of course, the only thing. Many biomeds consider a range of factors that include flexibility, scalability, support contracts, upgrades, ease of use, and reporting capabilities. Some features, such as work order dispatch, are more frequently standard, while other features, like wireless communication, may be add-ons.

Investments will range with needs; more features and greater complexity will require larger investments. Overturf, therefore, cautions biomeds not to spend money on features they do not need or will not use. “Avoid programs with too many bells and whistles, and avoid programs not made specifically for biomeds,” Overturf says.

Biomeds’ Little Helper

The right CEMS software will help biomeds improve their workflow by eliminating labor-intensive tasks. For instance, simply logging in a shipment of 100 new intravenous pumps can take hours if done manually. CEMS software can significantly reduce this time, particularly if it offers import capabilities from other programs, such as Microsoft Excel.

Some applications can automatically incorporate risk scores and preventive maintenance (PM) schedules for new inventory. The software may offer built-in device-ranking surveys that guide categorization of equipment or it may link PM information directly to specific instrument files included in its libraries.

Systems can generate work orders for equipment automatically, schedule the order with a particular biomed, and send the biomed notification. Notifications, such as approaching work order deadlines, can also be automatically sent to managers.

Inventory information can tie in to purchase data, such as cost, maintenance expenses, and life cycle. “The idea is to look at capital equipment replacement planning,” Overturf says. Similarly, repair costs can be tracked, providing data on parts, labor, downtime, response time, and costs.

“It’s possible to keep the inventory data, repair records, and planned maintenance work orders on paper, but if you have 5,000 pieces of equipment, that’s 5,000 folders. That’s a lot of paper to store and sort through,” Overturf says. CEMS stores the data for easy electronic access.

Digital storage of more data means data mining can provide more useful information, including reports on staff and workloads. “Our system helps us to keep track of workflow and workload. We can track the response time of technicians, how many work orders are open at once, what needs to be closed, and which equipment is a priority,” says Anthony Caruso, senior director of clinical engineering at Duke University Health System, Durham, NC.

Greg Johnson, CBET, CHFM, a founder of Southeastern Biomedical Association, Hudson, NC, finds CEMS software helpful with trending. “You can search your histories and locate equipment that has turned out to be a lemon,” Johnson says.

And of course, electronic storage and reporting also permits 24/7 compliance with The Joint Commission and other regulatory agency requirements. “CEMS can prove whether you’ve done the maintenance that The Joint Commision, the College of American Pathologists, or any other certification body requires,” Johnson says.

Necessary Extras?

Other components that most biomeds find helpful and often recommend include remote features: customer access and mobile functions. Some applications allow biomed customers to place work orders, most often through the Web. Gross estimates that approximately half of CEMS software offers this feature, many over the Web, some through the hospital network.

“Customer access streamlines the process. Customers can’t change work orders in our system, but they can open them to get their requests immediately entered,” Johnson says.

Customers also can check their order status directly without having to track down the biomed or require a callback. Gross suggests that such a feature can eliminate the need to have an employee dedicated to answering the phone or completing data entry.

Some applications achieve additional efficiency with the use of wireless communications. This function permits alerts to be sent to biomeds in the field through personal digital assistants.

Some applications may also work with other portable devices, such as the medTester from Fluke Biomedical, Everett, Wash, to communicate with biomeds in the field and/or permit electronic capture of maintenance and repair work. “The biomed often comes back at day’s end and uploads the information from their device into the main system. This avoids lost notes or manual keying of data,” Gross says.

It can also save biomeds literal steps. Electronic delivery of work orders and other information to portable devices means that biomeds do not have to return to the office to grab paperwork. An automatic generation of work orders can take into account the location of equipment and schedule repairs together for equipment located in the same area. “You can spend less time walking around the hospital looking for equipment,” Gross says.

Purchase Considerations

For some facilities, these remote features may be requirements rather than options, and biomeds should always have their current and future needs in mind when purchasing equipment or software. To realize the greatest benefit from CEMS, biomeds need to make sure they are using CEMS software and not a generic CMMS or one designed for another field, such as facility management.

Very often, hospitals buy database programs for the biomed department that were not made for biomeds. “The biomed department may be supervised by the facilities department, which has slightly different needs. But the biomeds are forced to use the same system, which is like trying to put a square peg in a round hole. In that case, the software can detract from workflow because the biomeds must try to adapt their process to the system,” Gross says.

Experts therefore generally agree that the first thing biomeds should look for in a system is that it is specifically intended for them. After that, biomeds value flexibility. “Every facility is different, and the software should be flexible so that it can be tailored to individual programs,” Johnson says. Flexibility can also incorporate scalability and upgradability. However, Johnson cautions against programs that are so flexible that they require someone with programming knowledge to use them.

“You want to look for something that is intuitive, easy to use, and quick to learn,” Overturf says. Training options vary with each vendor and range from online education to regional classes to on-site training.

“There are some systems that don’t have a lot of training. You buy the application, they send a CD, and you start up with a tutorial. And then there are others with week-long training courses,” Johnson says.

Vendor qualities are also important to consider. Biomeds in the market for CEMS software should talk to other biomeds, particularly those with similar situations, and check vendor references.

“Look for features that make your job easier: for example, software that anticipates your reporting needs and provides an easy and fast method to get your information in and out,” Ratke says.

Caruso suggests that health systems or biomed departments with multiple accounts look for applications with Web modules that permit remote access. “It’s easier to go into a Web browser to pull up work orders, reports, and the like,” Caruso says.

“All CMMS programs will generally have the same core functionality—recording assets, maintenance work orders, and tasks like that. When you have a system that works with you, you can automate much of that generic activity and improve workflow because there is much less time spent entering data into the system,” Gross says.

Cost Versus Return

Of course, cost is also a factor that needs to be considered. The more feature-rich a software program is, the more expensive it is likely to be. Gross estimates the programs can range from approximately $5,000 to $7,000 for CEMS software appropriate for a single department in a small hospital, to millions of dollars for a health care organization with 200 hospitals across the United States.

Ratke found many systems he looked at for his 172-bed acute-care facility fell between $5,000 and $7,000.

Overturf notes that Harvest Data Systems’ software falls within this price range. “We don’t normally charge for data conversion, and the first year of support, which includes all updates that come out during that time, is also included,” Overturf says.

Support options vary with each vendor and may or may not include upgrades. Caruso recommends that biomeds consider the service and support capabilities of a vendor before buying. He looks for free upgrades and responsiveness.

Support can impact the return on investment, which will vary for each facility according to functionality, use, and realized efficiencies. The capital investment can seem like an even greater value over time. Because manufacturers are constantly producing updates, the software can potentially have an endless life span.

“Software vendors handle updates differently,” Ratke says. Whether using e-mail, the Internet, or remote access, the important thing is to know that the vendor is always busy working on bug fixes and adding new features.”

Do It Yourself?

Most users of the software find they prefer commercial applications rather than homegrown versions. Although a homegrown program can very specifically meet an institution’s needs, it will require time, budget, and expertise. The software may become too reliant on one individual.

“It depends on the resources. If a lot of IT people are available to write the program for you, it can be a good thing, but it can also be time-consuming. It’s a continuous job requiring upgrades, and there can be issues when the programmers leave the facility,” Caruso says.

Commercial applications also have the benefit of focused development. “It would take years for me to learn about programming. The software vendor has the benefit of input from many hospital and independent service organization biomed customers from across the country, and can incorporate their input and ideas to benefit all of their customers,” Ratke says.

Vendors are also generally willing to work with their clients to build desired features into a program. “We get feedback from users as their needs change,” Overturf says, listing tab order, battery-replacement notifications, and The Joint Commission regulatory changes as examples.

And so CEMS software continues to meet the specific needs of biomeds, improving workflow, compliance, and ultimately, patient safety. “CEMS permits the efficient maintenance—preventive and corrective—of the medical devices the doctors, nurses, and patients rely on,” Gross says.

So back to the question: True or false? All CEMS software is CMMS, but not all CMMS is CEMS software.

Renee DiIulio is a contributing writer for  24×7. For more information, contact .