Anesthesia Roundtable

This month, TechNation asks the experts about buying and maintaining anesthesia equipment. Responders include Ashish Dhamman, regional sales director of Soma Technology, Inc.; David Karchner, director of marketing for perioperative care atDräger; Scott Long, vice president of CE-Tech and Jeff Rhinehart, president of Metropolitan Medical Services.

TechNation: What are the biggest trends right now in the anesthesia equipment market?

Dhamman: Over the last decade, anesthesia companies have introduced machines with advanced ventilators, additional and newer modes of ventilation and the concept of low flow anesthesia. Most of the ventilators today are electronic and software driven. Software options as upgrades in most of them to have additional ventilation modes, color screen, trends, etc. While low flow anesthesia is pretty much a standard on all new anesthesia machines being made in the market today, advanced ventilation options like SIMV, PSV, PCV, VG, etc., still remain an option to the customer, and in many machines can be updated or purchased on an as-needed basis.

Also, in the last few years some of the most popular models of anesthesia machines, such as the Excel 210, Modulus, Narkomed’s, etc., have reached the end of their life in terms of support from the manufacturers. This has further increased the sale of newer anesthesia equipment in the health care industry. Of late we have also seen some new entrants in the American market with companies like Penlon, Datascope/Mindray and Spacelabs.

Karchner: Low flow anesthesia. Customers are very much focused on driving down the cost of anesthesia delivery. Because volatile anesthetics tend to be one of the biggest cost drivers in anesthesia delivery, the desire to have a uniform practice of  “low flow anesthesia” across the clinical team of CRNAs and anesthesiologists is a goal of many health care institutions. To assist our customers, Dräger has incorporated a “Low Flow Wizard” into our Apollo anesthesia machine that informs the clinician if they are using too much, too little, or just the right amount of fresh gas flow. The result is a better opportunity to uniformly practice “low flow anesthesia” across your health system. The results can be dramatic. One customer’s “Letter to the Editor” in Anesthesiology News stated that they saved $8,800 per month (or $105,600 per year) using the Apollo’s Low Flow Wizard. This is significant savings, and I expect other institutions to follow in this trend.

Long: EMR and Device Integration. Anesthesia equipment must be able to integrate real time data into the patient’s electronic medical record in order to improve clinical documentation, patient safety, efficiency, regulatory compliance and billing effectiveness. Accurate clinical data allows health care providers to monitor the level of care and track the quality of patient outcomes. By incorporating performance measurement into industry risk assessments, there can be more precise performance evaluation of hospitals and provid­ers, resulting in greater support for payment models tied to performance. The aim is to provide less expensive health care while ensuring the delivery of safe, high-quality care with security and privacy. The industry has called on manufacturers to reduce vertical market development and concentrate on developing horizontally by integrating devices from existing proprietary or segregated monitoring networks to much larger, more complex hospital IT networks. This is a significant challenge, and anesthesia is right in the middle of it.

Rhinehart: Significant growth and availability of advanced technology, including EMR, IT integration and anesthetic gas recycling will be the key factor in market growth within the anesthesia equipment industry over the next five to 10 years.Challenges to this growth will include decreases in governmental reimbursements for medical equipment, mergers and acquisitions within the market driving price wars and increased availability of aftermarket service that prolongs the life of a facility's existing equipment.There are also multiple companies entering the anesthesia marketplace with their “latest and greatest” anesthesia machine.

TechNation: How will the market for anesthesia equipment evolve in the next five years? How will that affect service of the equipment?

Dhamman: While it is not expected of the manufacturers to introduce new equipment in the market, there will be a strong push to move to the newer generation of equipment that is currently in the market in the next five years, especially for surgery centers and hospitals that are using obsolete equipment. Parts and service for older equipment are becoming increasingly hard to find. The concept of complete anesthesia solution is gaining market share in larger hospitals.

Service for obsolete equipment is being stopped by OEMs; third party service companies are the only source for the service and availability of parts for such equipment. Newer and current anesthesia service and extended warranty is available from the manufacturers, and now an increasing number of third party service providers are completely trained and have parts available to repair and perform preventative maintenance on most if not all new and old anesthesia machines.

Karchner: The anesthesia machine market is quickly evolving from what was previously a stand-alone “non-networked” anesthesia machine to what is now more of a “networked” anesthesia workstation, including the anesthesia machine, the anesthesia monitor and the anesthesia information system (AIMS).

Long: I believe there will be an increased amount of equipment entering the marketplace from outside the U.S. How it will affect the quality of devices and the serviceability is uncertain. However, it is sure to decrease the price of anesthesia delivery systems and impact the market share of longtime industry leaders. What was once a specialty area dependent on OEM service may become more open for third-party vendors and in-house BMETs. Unfortunately, training expenses will continue to increase, making it less cost-effective to attain OEM factory training. Perhaps this will make way for alternative training programs at more favorable prices from the more entrepreneurial vendors. Either way, more devices in the mainstream will lend to service opportunities on various OEM equipment.

Rhinehart: We will see the largest evolution in anesthetic IT integration. With the inclusion of EMR in the perioperative environment, medical professionals will be able to provide better patient care and improve financial efficiency. Driven by this demand for better technology, the market will likely increase for anesthesia equipment that can provide the best IT solutions for each facility. A competitive advantage will be given to the equipment that better integrates with the facility's existing IT network.

More companies are delving into sales and manufacturing of anesthesia equipment. Where in the past there were typically two major manufacturers in the U.S., I think we could see three or four viable anesthesia machine solutions. In addition to those, there will likely be three or four more that will try and fail. Service support for some of these new companies who have decided to “try” anesthesia is very concerning. We are already seeing support issues with some of these machines that were sold only four or five years ago. Examples would be training schools that are limited or unavailable, parts costs that are unacceptable and inadequate tech support.

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

Dhamman: The latest technology does not come low-priced, even some of the most basic configurations of the latest equipment can cost a fortune. Budgeting for high-end machines may have to be done over a several fiscal year period due to the cost associated with it. Many health care organizations, clinics, outpatient surgery centers, etc., are looking towards refurbished options for their purchases. Soma Technology, Inc. is an example of such a company that can provide complete anesthesia solutions to health care organizations, including service and monitoring options. Third-party service providers have more than doubled in the last decade, and this speaks volumes about the heavy costs involved in service contracts from OEMs.

Karchner: As these older anesthesia machines migrate to networked anesthesia workstations (including anesthesia machines, anesthesia monitors and AIMS), coordination between the hospital biomedical team and the hospital’s information technology group is important. Today’s anesthesia workstations not only combine anesthesia machine, anesthesia monitor and AIMS, but also have the ability access a patient’s electronic medical record (including PACS images). While this is extremely beneficial to the clinical team and the patient, it may initially add some complexity in understanding  “who supports what” within the biomed and IT teams.

Long: Make no mistake about it: Data integration will be a very marketable tool for the manufacturer to persuade customers to buy more expensive systems. With EMRs come larger, more complex networking and computer applications. Technicians will need to be IS-savvy and continue that trend for the long term.

The ability to maintain the obsolete models will continue to be a challenge due to the lack of parts. Parts availability and pricing will push end users into decisions to replace older equipment even if it continues to be very operable. Again, this may lay the groundwork for aftermarket parts sources for those entrepreneur types.

As with any major purchase decision, ROI has to be at or near the top of the decision-making process. However, we can’t overlook patient safety and the possible affect it has on the bottom line. As systems become more integrated and software-dependent, the need for specialized training and service tools should be factored into the technical assessment. Pre-purchase planning for service happens at the point of negotiation for purchase and well before the warranty expires.

Rhinehart: One of the biggest challenges is the increased sophistication and technology of the machines. Not only does it require better knowledge of the machines, but a better understanding of how these technologies translate into effective solutions for the facility and the patient.

Another challenge to consider is if the company you're buying from is just “trying their hand at anesthesia,” or if they are truly committed to the anesthesia marketplace. Do they have a long-term vision?

TechNation: Please share your advice for people in hospitals that are faced with these challenges.

Dhamman: It is necessary for hospitals to evaluate their equipment needs and carefully consider their budgetary options before they make a decision on expensive equipment. Newer equipment is not only an expensive purchase but in some cases the upkeep can be draining on associated service costs. Please consider operational costs of equipment and the vaporizers that are compatible with it. In some cases older vaporizers can be used on newer equipment, allowing savings on some of the requirements.

            Higher cost doesn’t mean that equipment is the best option for you! Some basic configurations for equipment may be best suitable for your facility. Save the money by opting out of advanced and expensive add-on options and apply the savings towards other critical equipment needs. Wherever and whenever possible, consider refurbished medical equipment. You will be surprised; some of the newest equipment is available from refurbished vendors like Soma Technology.

            If purchasing a refurbished machine, please make sure the company is reputable and has service contracts and extended warranty options available. It helps if the vendor has local support technicians within a few hours’ reach to the facility in case of emergency service requirements. Please ask for references from the refurbished vendor and make sure they follow OEM set standards for refurbishing equipment and performing PMs.

Karchner: It’s important to understand that vendors are here to help! Our Dräger Sales and Service teams are experts in the field of anesthesiology and are available to assist you as you as you make your migration. As this technology continues to become more integrated, consulting your salesperson is more important than ever before.

Long: Do the math! Don’t wait for an invite because it may never come. Know the numbers behind servicing anesthesia equipment and apply the right maintenance strategy based on operational and financial risk as well as patient safety factors.

Budget and plan ahead, and get involved with capital purchases. Be a part of the multi-disciplinary team of clinical, financial and technical professionals to ensure the appropriate planning takes place relative to medical device purchases. A governance committee consisting of clinical engineering, information services and plant operations can play a large part in the successful implementation and long-term support of new technology in the health care environment. Invest in your training and education. If it is not available through your employer, take it upon yourself to get it on your own. Be prepared for tomorrow before tomorrow comes!

Rhinehart: Evaluate the short and long-term benefits of the equipment you are looking to purchase. Above cost considerations, technology, upgradability and design are important considerations that can now provide distinct advantages to a facility in a competitive market. Perform a service and parts analysis on the major parts and yearly PM costs for each machine being considered.

TechNation: What else do you want TechNation readers to know about purchasing and servicing anesthesia equipment?

Dhamman: The above question and answers give you a good idea of some of the latest trends. Monitoring options are plenty for anesthesia machines, and remember it is not necessary to upgrade monitoring when you upgrade anesthesia machines. If the money is limited, you can always upgrade monitors in the next fiscal year. Always do your research on purchase and service options, and do not hesitate to contact other vendors apart from OEM for new, refurbished and demo equipment. All the best!

Long: We on the more technical side of the house must be a bigger part of the positive changes impacting the health care industry. We have to stay abreast of not only the technical changes, but also the environmental and climatic changes (healthcare laws, regulations, the FDA, population/demographic shifts, etc). Device integration will force the medical/health care environment to evolve and get faster, smaller, safer, cheaper and more efficient. A by-product will be a more skilled, well-rounded BMET: One that is comfortable working with anesthesia and information systems and clinical, administrative and technical staff, as well as a multitude of different anesthesia systems all in a timely, professional and cost-effective manner.

Rhinehart: Consider the past history and the long-term future commitment of each company and product being evaluated for purchase. Utilize research and networking to ask other customers their experience with the company and the product.

Originally published in the January 2012 issue of TechNation Magzine.