By Jillyan Morano / Special to Healthcare Facilities Today

The new role of technology in healthcare delivery and hospital consolidation has created an evolution in clinical engineering. To get the most value from healthcare technology, innovative healthcare providers such as Care New England Health System are shifting strategies and implementing integrated clinical engineering solutions to reduce maintenance spend, streamline operations, and improve patient care enterprise-wide.

Driven by new legislation and regulations, financial pressures, and market dynamics, the healthcare industry has experienced dramatic change over the last decade. Patients have become more informed and empowered, there's a greater focus on quality and service, revenue demands are driving mergers and consolidation, and competition has increased.

Another big change that has transformed the healthcare delivery landscape is technology. Rapid advances in clinical information systems, robotics, imaging, genomics, telemedicine, and nanotechnologies have all helped improve the quality, timeliness, and effectiveness of patient care, increased patient and staff safety, and enhanced efficiency of business operations.

In a short amount of time, the industry has become heavily dependent on technology as a valuable member of the healthcare team. But, it's proven to be a double-edged sword. As advanced technologies have converged to form integrated clinical systems that are exponentially more capable, they have also become much more challenging to use and support.

Complexity and interdependency have introduced a lot of risk -- single points of failure and other vulnerabilities. If critical medical equipment and systems are not maintained properly, there can be dire consequences for many patients.

Trends affecting traditional clinical engineering

To ensure healthcare providers address the new technology support challenges, the Centers for Medicare and Medicaid Services (CMS), the Joint Commission (TJC), DNV Healthcare, and other accreditation agencies made significant updates to their standards for medical equipment maintenance in 2013. Under the new guidelines, hospitals must now maintain an inventory of all medical equipment (not just high-risk, critical technology) and strictly follow all manufacturer maintenance recommendations on all equipment.

For most hospitals, complying with the new standards is disruptive and costly. Thousands more pieces of equipment now require regularly scheduled maintenance two to four times per year. And the increased volume and frequency place a huge strain on already limited maintenance budgets and resources.

Additionally, the industry is experiencing an increase in mergers and acquisitions. Hospitals are consolidating to form larger healthcare networks that boost access to quality care and lower costs. While good for patients, it creates healthcare technology redundancies, inefficiencies, and disparate systems that add complications and cost to traditional clinical engineering (CE) efforts.

Evolving CE to an enterprise model to meet new challenges

While these industry trends have done much to improve patient care, they have drastically altered the face of traditional CE for most hospitals. Keeping up with the rapid rate of change and getting the most value out of technology today requires a holistic strategy that creates standardization, transparency, and collaboration across the entire healthcare enterprise.

Going well beyond break/fix and preventive mechanical maintenance, a system-wide model incorporates inventory auditing, capital and budget planning, procurement management, contract and vendor management, CE/IT integration, risk and failure assessment and analysis, user education and training, and other value-added elements.

CE/IT integration also increases awareness of medical device risk and ensures integrity, availability, and confidentiality of medical devices on the information technology network. This multi-disciplined collaboration makes CE and IT teams more proactive and innovative, which reduces downtime, and maximizes the full potential of medical technology.

Also, an enterprise program is more flexible and scalable. This allows growing healthcare systems to quickly and seamlessly bring new member hospitals online with minimal risk, cost, and complications.

Care New England Health System Embraces Enterprise CE to Save $290K and Improve Efficiency and Quality

Care New England (CNE) Health System is an example of a progressive healthcare group who understands today's complex healthcare technology landscape and has embraced a holistic clinical engineering strategy with some amazing results.

Comprised of four hospitals and other affiliates located in and around Providence, Rhode Island, CNE is focused on providing high-quality, cost-effective health and wellness services to all its constituents. CNE relies heavily on its healthcare technology to help provide world-class patient care, and is committed to complete healthcare technology management services of its combined inventory of more than 14,000 medical devices and assets.

Experiencing growing CE challenges

However, after CMS and TJC changed medical equipment maintenance and management requirements in 2013, CNE needed to revise its current policies and practices to align with the new standards. They enlisted the help of long-time partner ABM Healthcare who revamped the CE program and set them on the right path to timely and cost-effective compliance. ABM is one of the leading healthcare support service providers in the nation, specializing in clinical engineering and healthcare technologies.

At around the same time, CNE also added another hospital to its growing network. But, now each member hospital managed clinical engineering differently -- some outsourced while others handled it in-house.

With disparate CE departments, each hospital was in charge of its own staff, budgets, and contracts. Information was siloed, so they had no visibility into the true scope and spend of clinical engineering across the system.

Embracing an enterprise CE solution

To better meet the growing needs of all its members, keep up with technology advances, and reduce costs, CNE wanted to unify CE operations and implement a single solution for clinical engineering enterprise-wide.

To do this most effectively they turned, once again, to ABM. Working together, CNE and ABM developed a customized enterprise business solution to more strategically and efficiently manage healthcare technology across all CNE member hospitals. The program included the implementation of:

• A system-wide labor infrastructure

• Professional technology leadership and management

• Automated, web-based enterprise technology management system

• Standardized operations and system delivery

• Quality, productivity, and cost performance metrics

ABM guided CNE to form a leadership task force that included representatives of all member hospitals. This collaborative process allowed them to establish organization-wide best practices; initiate metrics and analytics; create auditable controls; and implement new policies, procedures, and protocols.

The enterprise management system centralized, streamlined, and automated clinical engineering operations, allowing CNE to better manage assets and contracts, schedule and track maintenance requests and work orders, access and share data, and automate reporting.

Web-based, the system also speeds maintenance activities, increases productivity, and reduces delays and downtime. Technicians receive alerts and other information on their phones, and the system also provides real-time client feedback, increasing user satisfaction.

To help complete its enterprise transformation, CNE increased collaboration and communication between its clinical engineering and information technology services. This has allowed them to work together more efficiently and more adequately meet the needs of its complex technology environment.

Because of the large scope of the project, the solution was deployed in phases. This minimized disruption and maximized savings opportunities while ensuring employees were successfully adopting and using the solution.

Driving savings, standardization and service delivery excellence

CNE's enterprise strategy provides more comprehensive service to member hospitals and helped drive standardization, quality, and best practices for clinical engineering and associated systems. The initiative has also provided CNE with transparency and accountability of all CE projects, inventory, and capital procurement.

Now that there is complete insight into total medical equipment maintenance operations, CNE has been able to reduce CE spend by more than $130,000 in 2015. And CNE is on track to save more than $250,000 in 2016.

Once dependent on outside labor, CNE has leveraged the efficiencies and economies of scale created by the enterprise system to simplify and convert most service contracts to self-performance. Now work for all hospitals is done in-house with a seasoned team of clinical and biomedical engineering technicians managed by ABM.

The new system has also allowed the CE team to be more proactive in identifying and solving healthcare technology management issues. An example of this was a temperature monitoring system that was not being used to its full potential. Because of integration, the CE and IT teams worked closely together to redefine how to support the system, streamline the troubleshooting process, and resolve the problem.

The CE team's efforts were recognized by the Association for Advancement of Medical Instrumentation (AAMI), who praised the "collaborative, silo-breaking" approach and presented them with its 2016 Bright Ideas award. The national award recognizes organizations for tackling tough healthcare technology management challenges with innovative solutions.

CNE's new enterprise approach is a perfect illustration of the evolution of healthcare technology in the industry. The journey has taken CNE from providing disparate and commoditized basic services to allowing them to offer comprehensive, integrated healthcare technology management that incorporates compliance, biomedical, and clinical engineering support for all member hospitals.

"Working with a professional consultant and trusted partner like ABM was critical to our success. Leveraging their experience and expertise, we were able to avoid costly and time-consuming pitfalls, minimize risks and disruptions, and speed implementation and time to benefit," said Steve Silva, vice president of supply chain for Care New England Health System.

Jillyan Morano is Director of Clinical Engineering for ABM’s healthcare support services.