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Roundtable Discussion: Anesthesia Equipment

This month, TechNation consults the experts about servicing anesthesia equipment in 2011 and beyond.

Thu Mar 03 2011By Lanier Norville, TechNation Magazine

This month, TechNation consults the experts about servicing anesthesia equipment in 2011 and beyond. Scott Long, Vice President of CE-Tech; David Karchner, Director of Marketing for Perioperative Care at Dräger Medical, Inc. and Tom Green, President of Paragon Service, all share their insights.

TechNation: What are the biggest trends currently affecting the servicing of anesthesia equipment?

Scott Long: Technology-wise, electronic medical records (EMRs) are a big push, and the technology and sales are moving in that direction. Continuous patient data on a common network is a goal for most facilities. Everything from recordkeeping, alarm management, gas/agent monitoring and miscellaneous patient data is being captured.

            Operationally, OEMs are discontinuing older, but perfectly functional, devices to ensure future sales. We have also experienced a steady increase in parts to maintain and repair today’s devices. And all of this is happening during a time of economic recession. Because of these trends, we are now seeing more third-party repair options available. Multivendor third-party and in-house technicians are positioning themselves to accommodate the need for anesthesia maintenance. Other vendors are also offering alternatives to the more popular brands in the way of pre-owned and quality refurbished equipment. Furthermore, other less-known manufacturers are providing new products to compete with the large majority-market OEMs.

Tom Green: Anesthesia ventilators are incorporating much-needed modes from the ICU, such as PSV, SIMV and SMMV. Also, manufacturers are integrating patient monitors into the anesthesia system. Lastly, systems are being manufactured with EMRs in mind. For the most part, anesthesia systems are similar to those manufactured in 1986 – just add a few features and alter the packaging.

TechNation: How has the servicing of anesthesia equipment evolved in recent years? How do you think it will change in the future?

Long: Gas monitoring is now being incorporated into the anesthesia machine itself. Electronic flow meters are getting more prevalent and pressure support ventilation and synchronized intermittent mandatory ventilation are becoming standard ventilation modes. Also, service intervals are being reduced to once a year, depending on local and state codes.

            Electronic medical recordkeeping will continue to be the future – just more of it. Any data that can be captured will be captured. Anesthesia machines will have integrated hemodynamics built in with the ability to push all information to a recordkeeping device or an EMR. Also, alarm management will be advanced enough to notify users and correct some issues before an adverse condition places a patient in jeopardy. Alarm events will be recorded for study and improvement.

David Karchner:While you can certainly look at the advancements in ventilation capabilities from the traditional anesthesia units to what we have in today's anesthesia units (e.g., pressure control, pressure support and SIMV) in order to support the “difficult to ventilate patients,” we are also seeing the anesthesia market evolve from the traditional “anesthesia box” to anesthesia workstations, including the anesthesia machine, patient monitor and anesthesia information management system (AIMS). You will continue to see this migration in the future in order to consolidate information, enabling anesthesiologists and certified registered nurse anesthetists to make more informed decisions.

Green: I think we will see two things: First, a “closed loop” anesthesia system where the system makes the changes based upon monitors automatically. The anesthetist will control the beginning and the end of the case. I’m not saying that I’m a proponent of this – I just see it going in that direction. Secondly, we will see less inhalation anesthesia. In the future, an anesthesia system may be a ventilator, syringe pumps and monitors.

TechNation: What are some of the biggest challenges of servicing anesthesia equipment?

Long: Machines are getting more sophisticated with more built-in electronics. Of course, this typically increases the expense for service as well. With that being said, having experienced, well-trained technicians across the various types of manufacturers’ product lines is getting increasingly more difficult. After all, training is expensive. If there are a limited number of techs, you have to prioritize what schools would have the most impact for the facility and the possible return on investment.

Karchner:As stated above, we are beginning to see a migration from traditional anesthesia machines to anesthesia workstations, where the anesthesia machine, patient monitor and AIMS are all working in unison. Hospital biomedical professionals, who at one time may have “specialized” in one of these three areas, are now challenged to be proficient in two and sometimes all three of them in order to support their clinicians. 

Green: Manufacturers, in general, do not want competition from independent service organizations. They must dance a fine line between the federal laws and selling more equipment.

TechNation: What advice would you give biomeds regarding software issues in the anesthesia equipment industry?

Long: Be aware that different levels of software do exist for the same equipment. Upgrading requires chip replacement, and it can be expensive. What’s more, not all software upgrades are needed or required. Also, all safety-related software should be free.

Karchner: One of the greatest software concerns that customers have when purchasing anesthesia workstations is how to integrate the anesthesia machine with the patient monitor and AIMS. While many healthcare organizations have implemented a sole-source strategy as their solution for integration, many are still utilizing the “best of breed” strategy where the anesthesia machine, patient monitor and AIMS could come from three different vendors.

            First, it is very important to understand your facility’s strategy (e.g., sole source vs. best of breed). If best of breed, it is very important to work with your vendors to make sure that they understand your strategy and are willing to work with the other vendors at your healthcare organization. Handling these types of questions at the beginning of the sales cycle is crucial.

Green: They need to know thatEMR mandates from the federal government are a nightmare. There are a million codes and languages available, and they will be required to communicate with each other. In fact, some hospitals purchase EMR systems that lock them into a brand of monitors/machines.

TechNation: Do you have any insider tips for hospital biomeds servicing anesthesia equipment?

Long: Evaluate the types of equipment your facility purchases. Be ahead of the purchase and plan for service after the sale. Prioritize training opportunities to ensure the biggest bang for your buck. Also, make sure you take into account specialized tools and test equipment. Train anesthesia techs on the essentials so that they can perform quick, first-call triage. Stay abreast of new technology and forecast where the hospital needs to be to properly maintain the equipment. 

Karchner: Build a strong relationship with your anesthesia equipment vendor’s local sales, local service and “back office” tech support representatives. Also, be sure to take advantage of your vendor’s biomedical courses and online clinical tutorials in order to maximize both your technical and clinical knowledge about your anesthesia workstation. After all, the stronger the communication bond between the vendor, the hospital biomedical professional and the clinician, the greater the opportunity that the anesthesia workstation is utilized to its fullest capacity.

Green: My advice is tonegotiate free service seminars and parts pricing upon any purchase.

TechNation: Any final words for TechNation readers?

Long: Anesthesia machines last longer then OEMs imply. Reputable third-party companies can provide the same level of service at much more affordable pricing. Often, secondhand devices can be used to fit the need for a facility with less capital dollars expended. Anesthesia equipment can be managed, serviced and supported just like every other life-support device in your facility. Remember: Lifecycle costs can be reasonably managed.

Karchner: Anesthesia vendors recognize hospital biomedical professionals as important resources when collecting requirements for current and future product lines. Dräger’s Remote Service Link, which enables data to be transferred quickly and easily from hospital to Dräger’s experienced Triage Center staff, could not have been developed without the help of our existing hospital biomedical teams. This is just the most recent of many examples of how hospital biomedical personnel have influenced the development of Dräger product lines.

 

Originally published in TechNation, Jan. 2011.

 

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