Baryy Voss

Barry Voss

As biomeds, we all know the necessity of operator and service manuals. The Joint Commission, CMS, ACR, CAP, and all the other alphabet inspectors are also very interested in making sure they are in order.

This article considers the possibility of turning those paper manuals into the electronic version, and the cost/benefit of that conversion. In this case it will be a benefit/cost analysis because we all like to look at the benefits first. Note: These are the general use manuals—individual biomeds keep a copy of commonly used manuals in their own personal library. It is understood that some paper manuals need to be kept for convenience or possibly to avoid copyright infringement. Should you be concerned about copyright infringement? I don’t know, and apparently neither does the copyright office. It recommends you get permission from the author. In lieu of that, it recommendsw getting an attorney. We’ll assume it’s OK.

The Hypothetical Hospital

We’ll call it Barry’s hospital. It is a 600-bed hospital, there are 15,000 pieces of equipment to maintain, and 15 biomeds to take care of it. They have accumulated 3,000 manuals over the years in their library. The large number of manuals in the library takes up 150 square feet of space. The first thing to consider is: why are there 3,000 manuals for a hospital that services 15,000 pieces of equipment? That translates to one manual for every five medical devices. This seems excessive. The guess is there are obsolete manuals that need to be purged.

Now, back to the hypothetical hospital. The hospital is fully networked, so the electronic version of those technical manuals is available everywhere, all of the time. The number of times the library is accessed is roughly one time per month, per biomed, and turns out to be <1% of the time, so those paper manuals sit there taking up space over 99% of the time. The number of times a manual is missing or misfiled is one in 20, or 5% of the time.

The Real Benefits and Costs

A department has full access to manuals on the spot, it eliminates lost or misfiled manuals, it prepares for the future paperless workplace (that we’ve been talking about for the past 2 decades), and it impresses the inspectors.

It frees up valuable floor space. If the area of the technical library is 150 square feet at $24 per square foot (annually), then the savings is 150 x $24 = $ 3,600 per year.

If the average manual is 90 pages, and there are 3,000 manuals, then there is a total of (90 x 3,000) or 270,000 pages to be converted. At $.10 per page for conversion, the cost equals $27,000. The purchase of one TB of disk space to store the information (at hospital prices) equals $1,000. The cost from the hospital IS department to set up the database (index) equals: undetermined. I need to add a comment here: Adding notes that are usually handwritten in the paper manual needs to be addressed in the initial database setup and be easily accessible to the biomed. Notes in the ACME medical manual such as, “Mabel knows her stuff” are invaluable.

Other Things to Consider

What do you do with the old paper manuals? Recycle at $0. What do you do with the three-ring binders and shelving that once contained the manuals? Recycle/reuse (it’s the green thing to do, don’t you know). New electronic manuals are arriving at an increased rate. Prepare for them. Paper manuals are still coming in. Consider the value of a scanner and a designated librarian to convert them. Better yet, make it a condition in the original purchase of new equipment that electronic manuals are mandatory. And add the caveat that exceptions will be made at the hospital’s discretion. The manufacturers, distributors, etc can do the paper-to-electronic conversion. This saves the hospital time and money, and forces the smaller companies to get into the 21st century if they want to stay in business.

A quick recap. The savings is $3,600 per year (for floor space). The cost is $28,000 ($27,000 for conversion plus $1,000 for electronic storage). The break-even point is 7.8 years. This equates to: A Bad Idea. So why did you waste your time reading this? It’s just as important to know what not to do as it is to know what to do. Not all is lost. You may want to consider clearing out the obsolete manuals, converting a select few, and planning for the future. My recommendation is to do a review every February 29. Obviously, this is not a real cost/benefit analysis. It is something to think about so take a look around. Check with manufacturers to see if they have electronic versions of their technical manuals, and purge the paper ones. How many paper manuals do you have? Do they take up floor or shelf space? What is the value of that space? What is the cost of converting to the electronic version? What is the cost of accessing the electronic version? What is the value of instant reliable access to technical information? Go ahead and plug in real numbers. Clinical engineering departments don’t just fix “things,” they solve problems. If there is a problem, then fix it. If not, at least you can be content in the fact that you’ve looked into it.

Barry Voss has been a biomed since the 1970s. From Yale-New Haven Hospital to California to Saudi Arabia he has worked in biomed, nuclear medicine, ultrasound, and CT. He now works as a biomed in the US. For more information, contact .

What’s on Your Mind?

Got a gripe? A recommendation? Does someone or something deserve praise? Share your opinions and insights with your peers. Soapbox columns should be 850 to 900 words in length and can be e-mailed to .