Managing Medical Equipment

Read through for the best strategy in purchasing medical equipment for a hospital. K Deepalakshmi finds out what factors drive medical equipment management in major hospitals

A survey reveals that of the total cost of a hospital project, nearly 60 per cent involves hospital equipment. Nearly half of this resource is used in the purchase of medical equipment. With the advent of newer technologies, medical equipment has come a long way in assisting healthcare professionals in diagnosis and treatment. Hence, the purchase, maintenance and replacement of medical equipment are an essential and integral part of hospital management.

Prior to the purchase of equipment, a hospital carefully analyses its decision, taking into account several factors like the necessity, utility, pricing and so on. The decision is taken in consultation with various people including the end users, biomedical engineers, medical professionals, top management officials and so on. This process is called equipment planning.

Equipment Planning

"When it comes to training, we expect the vendor or manufacturer to assist our technicians" - G Narotham Reddy Vice President-Materials Apollo Hospitals Group

"There are multiple advantages in opting for the services of consultancies in equipment planning" - Harshita Narwekar Consultant HOSPIC

"If we have to purchase medical equipment for an existing setup, we analyse the usage of the existing equipment and then order extra, if needed" - Binu John Manager- Biomedical Engineering Wockhardt Hospitals, Bangalore

Equipment planning is done in two situations—at the time of establishing a new hospital and in an existing hospital setup.

"Equipment planning for a new project starts prior to the project," says G Narotham Reddy, Vice President, Materials, Apollo Hospitals Group. The selection of equipment is based on the scale of the hospital and its demands.

The need for medical equipment varies with specialities and topography. For instance, high-end equipment required in a tertiary care hospital is not necessary for a primary or secondary care hospital. Similarly, it is unnecessary to procure medical equipment for a super speciality in a rural setup or in a primary health centre.

"If we have to purchase medical equipment for an existing setup, we analyse the usage of the existing equipment and then order extra, if needed," says Binu John, Manager, Biomedical Engineering, Wockhardt Hospitals, Bangalore. "We decide to buy a new machine if the existing technology becomes outdated," he adds.

The Need

Be it a new project or an existing one, need drives the purchase of medical equipment. "Necessity is the highest order of priority in equipment purchase," says Reddy. The need is known from the medical practitioners, the end users of the equipment. Depending on the patient flow, the demand for the equipment increases, which in turn creates a necessity for the equipment.

The Technology

The second main driver in the purchase of equipment is the technology. In recent years, the healthcare industry is witnessing rapid growth, especially in research and development. Newer equipment is regularly introduced in the market with additional features and better technology. When existing technology becomes outdated, or new technology scores over the existing one, the decision to buy new equipment is taken.

"Sometimes, the same equipment can be upgraded to the new technology by adding additional software, for example. We consider this aspect too before buying the new equipment," says BK Bhaskar, Deputy General Manager, Biomedical Engineering, Apollo Hospitals Group.

"We get feedback from existing users about the product and its usage," says G Shivaprakash, in charge of Purchase, Capital, KLES Dr Prabhakar Kore Hospital & MRC, Belgaum. The biomedical department of hospitals generally takes care of analysing the technological upgrading.

The Service

The next important aspect is the service rendered by manufacturers and vendors, both within the warranty period and afterwards. "We check if the company gives a minimum of two years warranty," says Shivaprakash. John goes one step further and says, "We check the service of the regional service centre. The quality of service may vary from region to region." The accessibility of the service centre is also taken into account. Generally, all brands would have their service centres in metros and major cities. If the hospital is in a town or rural area, the proximity to the service centre should be considered. It's good to check if the company provides onsite warranty, and the delay in attending a call. "We would prefer the call to be attended within 24 hours and in the case of critical equipment within 8-10 hours," says John. "If on AMC, the first call is taken within four hours by the companies," Bhaskar assures.

The Price

The equipment with best price is ultimately bought. "Best price doesn't mean the lowest price," John clarifies. "We analyse the price based on various factors like software and hardware package, technical specifications, after sales support, warranty and so on," he adds.

Shivaprakash endorses this view. "Cost alone cannot be seen as critical for purchase. The quality of the product should meet our standards," he says.

"Apollo being a large healthcare group, the quantity of equipment is also high. So we usually get the best deal," says Reddy. "We also analyse the period of return of investment, but the priority of this is after need and technology," he adds.

Thus price, while significant, does not dominate the quality of the product.

Training

To keep oneself abreast of the latest technology is very important. To have excellent equipment but no skilled manpower to utilise it is as good as not procuring at all. "When it comes to training, we expect the vendor or manufacturer to assist our technicians," says Reddy. He insists that both doctors and technicians who use it should be given proper training before installing equipment.

Reddy explains the training programme as a 'three-step process'. The end users from the hospitals are sent to the 'beta-sites', where the equipment is already in use, and given on-site training by the manufacturing company.

In the next step, the equipment is installed in the hospital and the technicians give training to those who use it there.

The last step in training happens after the equipment is open for the public in the hospital. The application trainers from the manufacturers oversee the users and clarify their doubts. "This way, we ensure that the equipment is utilised completely," says Reddy.

Comparison and Brand value

There are a handful of major players in medical equipment manufacturing. They have earned a good brand value over the years. It is obvious that these brands have earned the trust of Indian hospitals. John explains, "These brands have earned international compliance and they abide by all major international guidelines."

Besides, there are minute differences in the technical specifications and features offered by these brands, in products in the same category. The best equipment is selected after carefully analysis and comparing the features and technical specification of various brands. "We get at least three to four quotations and our purchase committee analyses the technical valuation, financial negotiation and other terms and conditions," explains Shivaprakash.

Equipment Maintenance

Medical equipment needs to be maintained, checked for natural wear and tear of parts, any operation errors and troubles. The biomedical department of hospitals takes care of the day-to-day maintenance and periodic inspection of all the medical instruments. "The biomedical department is capable of doing troubleshooting for minor to slightly major faults," says John. In addition to this, hospitals do take some measures for better maintenance.

If the equipment is new or within the warranty period, the vendors attend to the complaints and troubleshooting is done free-of-cost. After warranty, hospitals choose annual maintenance contracts (AMC) with service centres. "Under our AMC, the companies do a periodic service of the equipment and it covers any replacements too," says Bhaskar.

AMCs are of two forms, labour AMC and comprehensive AMC. In labour AMCs, the company doesn't charge for service but any replacement of parts will be charged. Under comprehensive AMCs, both labour and spares are covered but consumables are charged. "We choose both kinds of AMC depending on the equipment," says John. Comprehensive AMCs are preferred in equipment with bigger capital investment. In some cases, the companies do not give the option of comprehensive AMC if the equipment is obsolete.

"We do conduct preventive maintenance checks, especially for high-end equipment for its smooth functioning," says Bhaskar. These preventive maintenance checks are conducted once in every six months or as suggested by the manufacturers.

Equipment Sharing

In order to reduce the investment on equipment and for effective utilisation of life saving equipment, hospitals opt for equipment sharing, that is, many departments using the same equipment. "The utilisation of some equipment like ventilators, machine warmers, syringe pumps is about 50 per cent," says John. For effective usage of such equipment, a central pool is created, where the instrument can be used in various departments when needed.

There are some hospitals that do not share equipment. Apollo, for instance, has exclusive equipment for all departments. "Though a common pool can reduce the investment in equipment, there are chances of non-availability of equipment at times," feels Bhaskar.

Equipment Replacement

All medical equipment has an average lifespan. When this lifespan is crossed, it starts showing symptoms of malfunction, and repeated breakdown foreshadowing a replacement. "The need for a replacement comes from the end-user. The report is submitted to the screening committee of our hospital, who decide the fate of the equipment," says Shivaprakash.

There are cases where the equipment is overused. In such cases, the breakdown is much earlier than the usual lifespan. "If the technology is out-dated, in order to upgrade, we need to replace the existing one," says Reddy.

Usually, a buyback scheme is followed in hospitals. Through this, the manufacturing company takes the defective or old equipment and gives a rebate on the purchase of new equipment. This buyback policy is generally verified at the time of purchase of the equipment.

"If the equipment is too outdated and not fit to serve the purpose anymore, it is considered as scrap," says John. This is when the equipment dies a natural death.

Manufacturers usually develop methods by which existing equipment can be upgraded to new technology. "Only if the chance of upgrading the existing equipment is very weak, do the manufacturers declare it obsolete," says Bhaskar. Even in such cases, the spares for this equipment will be available in the market for a period of seven years.

Equipment Audit

The scientific means of calculating the efficiency of medical equipment is known as equipment audit. Equipment audit is undertaken at regular intervals by the biomedical department. It is during these audits that the condition of the equipment is reviewed and the decision on preventive maintenance, upgrading and replacement is taken. "Equipment audit is an in-house process done once in every two years in our hospital," says Shivaprakash. Wockhardt Hospitals conducts a utilisation audit every year.

Apollo Hospitals, on the other hand, performs equipment audit, but the periodicity varies by equipment. "Equipment audit unlike energy audit does not require to be done simultaneously for all equipment," says Bhaskar and adds, "All equipment is unique and purchased at various points of time, and hence audit is done at regular intervals at different times for different equipment."

Equipment Planning Assistance

While some hospitals take care of their equipment related needs in-house, there are healthcare consultancies, which assist hospitals in equipment planning and audit. HOSPIC is one such healthcare consultancy firm, which has provided equipment planning solutions to some of the major names in the healthcare sector like Health Care Foundation of North East, Guwahati, Bhagwan Mahaveer Cancer Hospital, Jaipur, and Allied Hospitals, Kerala.

Harshita Narwekar, Consultant, HOSPIC, enumerates, "We offer equipment planning as a detailed project report. This includes a detailed analysis of the specialities and diagnostic services the proposed hospital should provide. Then in consultation with our team, which includes biomedical engineers, we come up with the type, quantity and estimated cost of the equipment."

For a proposed hospital, a consultancy offers services such as determining the exact requirements of equipment, instruments and apparatus during various stages, providing technical and financial analysis to assist the purchase, assistance in price negotiation, payment terms, preparing contracts and taking care of installation, stabilising and trial operations.

Narwekar says there are advantages in opting for the services of consultancies in equipment planning. "We have a large existing database of vendors with whom we share a relationship. The client can leverage these relationships," she points out and adds, "We do not favour any client based on our relationship. Rather we provide a detailed financial and technical analysis and the decision to go with a certain vendor rests with the clients."

Guidelines Required

Medical equipment manufacturers adhere to internationally accepted guidelines prescribed by various countries in equipment production on quality and consistency. USFDA is one governing body that prescribes guidelines on equipment manufacturing. These guidelines are widely accepted in most countries including India. Other widely accepted certifications are ISO (International Organisation for Standards), IEC (International Electro technical Committee) and CE certification from European Union. "These certifications speak for the quality of the equipment," says John.

But the Indian Government is yet to prescribe any guidelines on medical equipment manufacturing or import. "While some guidelines are laid down by the Government under PNDT Act on the purchase of ultrasound machines, there are no other prescribed regulations," complains Shivaprakash.

Given the growth in the Indian healthcare industry, medical equipment manufacturing and retailing have the potential to boom. It is essential for the Government to prescribe and properly execute the guidelines in order to ensure quality.

Medical equipment planning involves people from purchase, bio-medical engineering, medical practitioners and technical staff. The selection and procurement of the right equipment handled by trained professionals is sure to make a difference in quality healthcare.

k.deepalakshmi@expressindia.com