By K. Richard Douglas
There’s something impressive about a contingent of 19 imaging service professionals dedicated to keeping 5,000 devices operational and fine-tuned. Those impressive numbers are even more notable when you consider that this imaging team, and their system manager, are part of a clinical engineering program that is 97 people strong.
Mark Newell is the system manager of imaging and the health system that his team supports is Advocate Health Care in Downers Grove, Illinois. Advocate’s clinical engineering department is made up of imaging and biomedical technicians, clinical engineers, business office staff and site managers, according to Newell.
“Operationally, we are part of the clinical engineering department, but are operated and managed as a system-based team versus a site-specific team when it comes to actual service and dispatching,” Newell says.
“We utilize an on-call process for imaging-only service, and have divided our sites amongst two primary service zones. Savings and turn-around on equipment has been very positive based upon the metrics we monitor. We track all repair and inspection work in one database, which in turn helps us to manage all costs and labor to the asset level and look for trends and opportunities,” Newell adds.
Advocate Health Care is the largest health system in the state of Illinois. The faith-based, not-for-profit system includes 12 acute-care hospitals and almost 400 sites of care. Last year, two of those hospitals were named among the Top 100 Hospitals by Truven Health Analytics.
“In perspective, $2.7 billion of our organization’s annual $6 billon patient care revenue is generated by the diagnostic imaging and radiation therapy equipment our team supports,” Newell says.
Newell says that the team supports 10 hospitals, one critical access facility, and two embedded children’s hospitals, along with about 60 offsite locations that offer some type of imaging service (radiology or cardiology).
He says that many of the hospitals are Level I trauma centers, so there is a higher acuity patient mix, and for clinical engineering labor impact – a higher count of equipment per bed than most hospitals.
“For a high-level count of larger equipment, we currently support 64 CT scanners, 33 MRI units, 35 cath labs, 18 IR labs, 600 ultrasound units, 42 nuclear cameras, 64 digital mammography units, 13 radiation oncology systems (Linacs, Tomo, Cyberknife), 169 dye injectors, 85 C-arms, 77 portable X-ray machines, 105 general rad units, 23 dental units, 9 cysto units, 6 PET, 10 SPECT and 15 digital specimen scanners,” Newell says.
He says that they still have about 100 CR units in use, but have purchased several dozen DR panels for converting many of the portables and fixed general rad rooms to full digital capability.
The team doesn’t yet support MRI, but is moving toward a shared-support model in the near future.
Training and In-house Savings
The group has proven that keeping imaging service in-house has resulted in substantial savings.
“Since 2014, we have insourced over 5,000 hours annually of vendor-billable labor. Between hiring and training staff, reassessing support strategies, aggressive second sourcing, use of competitive price-matching, and renegotiating service agreements, we have reduced our per-transaction and per-asset support costs, along with steadily raising the measured equipment reliability year over year. Net savings annualized is just over $3.4 million per year off prior per-asset run rates,” Newell says.
The team’s training needs are a mixed bag of OEM, third-party and on-the-job training.
“Between credits and outright purchases, we spent almost $200,000 last year on the imaging team for technical training. We normally average about $100,000 a year. All training justifications are based upon projected return-on-investment, the organization’s operational needs and current manpower capacity,” Newell explains.
“Our team participates at the local and system level for equipment planning, construction, and part of the pricing negotiations for capital. Our team is solely responsible for negotiating, holding, and paying for all service contracts and related repair costs,” Newell says.
He says that they also centrally manage negotiations for sourcing and price-matching with vendors for parts and labor.
“We do provide limited user training directly, and are part of the process to help identify when additional clinical user training may be required by the manufacturers,” he adds.
“From the equipment perspective, we have staff trained on nearly every item. Many members of the team have a mix of manufacturer and third-party work experience, military training, and formal service schools and degreed programs.”
Figuring It Out
In the problem-solving area, the imaging team has donned their detective hats more than once.
“We have worked with the clinical staff and the manufacturers to determine when an issue is actually the device — as an example, hardened beam quality contributing to a poor clinical image — versus the manufacturer assuming it was just the clinical users picking the wrong presets (which was also occurring and discovered when we monitored some cases),” Newell says.
“We have seen issues where new product is purchased that is similar to older product but must be used differently. An example was with a cardiac ultrasound unit – we had the manufacturer bring in a different trainer and directed them to approach it as if the clinical users never used the brand before…this helped resolve initial assumptions that were being made by both the trainer and the clinical customer.”
Newell remembers one challenge that was vexing at first. There was an issue where there were power problems with an off-site MRI in a leased building.
“The clinical users thought it was the MRI unit and the building’s maintenance supported the argument. What tipped us off that it was a bigger issue than just the MRI was that when we rounded with the customer we also talked with other people in the leased building – the other tenant’s lights were flickering and they were on a different circuit,” Newell says.
“We brought in an outside electrical contractor and found out the substation in the building had multiple connection problems. Our electrician addressed it with the building maintenance staff and the problems went away,” he adds
Away from work, the team has some staff who are members of the Clinical Engineering Association of Illinois as well as membership with AAMI and ECRI.
When it requires big resources to handle a lot of imaging equipment, and keeping an eye on the budget, the imaging services team at Advocate Health Care gets the job done every day.