There is a big push by a number of large companies to make aggressive moves into the multi-vendor market. This is a manufacturer or large Independent Service Organization (ISO) taking over the imaging service of a hospital, health system or imaging group. For the manufacturer, it allows an inside track on big iron sales such as computed tomography, magnetic resonance imaging, catheterization laboratory and even general X-ray. For the ISO that specializes on clinical engineering (CE), it is more often a third-party solution to biomedical service as well as imaging service. The various equipment manufacturers also offer CE solutions. This is very big business that deals with multiple revenue streams.

There are a few primary considerations that come into play when the idea is put forth that perhaps an outside entity can save money on equipment service and repair costs compared to an in-house program. First, an efficient and well-run in-house program is most often the most cost-effective solution. There are, of course, exceptions. However, usually the in-house service, when operated properly, will be the most cost-effective option. Why then do hospitals or health systems choose the outside entity?

The reality is that most medical CEOs, COOs and CFOs do not understand how clinical engineering works or what they do. They have a vague notion, but no real understanding. They see numbers. With reductions in reimbursement, more regulation, and the size of the average repair budget. The numbers can become the focal point. Without an understanding of what level of service is being received, they assume all service will be maintained at the same or improved levels. This is typically not the case. A company has to come into the health system and make a profit. An in-house program does not make a profit. This is a fact that is often overlooked. The ways the numbers are calculated, the way the service is managed and the resulting quality must all be considered to ensure that the decision makers make an informed decision.

This requires the in-house program to consistently take a hard honest look at the program they are running. Is unnecessary cost being avoided? Is the quality of service maintained at the highest level? To run the best in-house system requires constant vigilance. Review of processes, documentation, and ensuring that sources for parts, tech support, training and service are reviewed and held to the highest standards. This is an ongoing process that is never finished.

For the individual field service engineer, this means the days of coasting into retirement are gone. The field service engineer needs to ensure that the lowest overall cost for quality service is being received by the health system up to the day they finally set the tool bag down for the last time. For the manager, this means constantly reviewing available sources for parts, service, tech support and training. The manager also has to keep everyone that reports to them accountable for the best service at the best price. For the CEO, COO and CFO it means hiring directors and managers who can get the lowest overall cost for the best quality service, and letting them do their job. ICE

John Garrett has 20 years experience in imaging service including general radiation, mammography, CT and nuclear medicine. He has worked for third-party service companies, manufacturers sales companies, and in house imaging teams. Currently, he is manager of clinical engineering at Catholic Health.