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This is the second part of the Computerized Medical Equipment Management System or CMEMS. In this part we'll have a practical example to demonstrate what is a Computerized Medical Equipment Management System, and the example will be about HEMS system, which is developed by the EQ2. And, we will cover these points. Then, we'll talk about the planning for a new Computerized Medical Equipment Management Systems, and the points, which we should consider during the planning of such system, and how to implement this system. Now, I'll start with this practical example. These systems have evolved over time. After the IBM PC introduction in mid-1980, systems based on PC-databases started to appear. An example of Computerized Medical Equipment Management System, which was developed by the University of Vermont. This system is called "Hospital Engineering Management System or HEMS. It was founded in 1985. We can see here, a screenshot for the main page, which had been used from 1985 till 2010. In this slide, we see the new software for the HEMS in 2017. This is a screenshot for the main page. As we can see, we have different modules. We have work orders, generate schedule, assign work orders, equipment inventory, equipment types, equipment models, schedules, procedures, parts, reports, and so on. The HEMS system consists of data on the medical equipment inventory on work information, or what's also known as work orders, can be separated into scheduled and unscheduled. And, also, we have other information. All combined to create a complete history for each medical device. As we'll see in the next slide. So, firstly we have two types of maintenance. We have in-house maintenance or clinical engineering services / hospital clinical engineering services inside the hospital. And, we have out house services or vendor services. The work orders are for the in-house services will be generated. We have two types of the work orders. We have unscheduled work orders due to unscheduled work requests. And, we have pending scheduled work orders generated by the PM scheduler of the computerized medical equipment management systems. So, we have different inputs, as we can see here, for the work order control. We have from the pending scheduled work orders, and unscheduled work requests. We have input also from parts, and equipment inventory. The output of the work order control will be for medical equipment history. Also, the medical equipment history have different inputs. One of them is a work order control, which is generated by the in-house staff. Whereas, we also have work orders or vendor service information, which is considered as out-house services. We have the equipment inventory. So, the medical equipment history will be the second step. And based on this medical equipment history, reports will be generated, which is the essential point behind this computerized medical equipment management system, which has helped us to reduce cost, to improve the quality of the care, to perform a lot of tasks, which we'll talk about in the next slides. Now, we will watch a short video about the HEMS system. HEMS is an acronym for Hospital Engineering Management System. We have different staff, who helps to generate (create) such computerized medical equipment management system. And, also, the report generated by such system will be useful for different types of the staff, as we can see here, starting with the vice-president and ending with the clinicians. So, one of the features is being secured and real-time. So, we can update data in a real-time. Also, we will see important features of the HEMS system, which include: first integrations with the HIS (Hospital Information System) system. This is very important and essential the integration or interoperability with medical devices based on IHE, which is the International Healthcare Enterprise. Also, another feature of the HEMS system is the RTLS, which is an acronym for the real-time location system. The network information, the electronic patient health information (ePHI) checks, also the connection directly to the the electronic medical record (EMR) of a patient or a electronic patient record. Also, one of the feature of the HEMS system is the ability to connect with electrical safety analyzer or biomedical equipment testing. And, also another feature, which is very important concerning HEMS system and we will see this later, it can work either as offline or online. As we said before, usually most of the commercial computerized medical equipment management either can be offline or online. The HEMS has the capability of being installed as offline and online, so cloud or hospital server. So, this is a short brief about the HEMS system. Now, we'll talk about the different parts of this HEMS system. We will talk firstly about the medical equipment import inventory. Then, we will talk about the maintenance information. Then, we will talk about reports generated by such computerized system. So, now, we will start with the medical equipment inventory. There are different types of data, which are related to the medical equipment inventory. This can be classified as either essential data, additional data or network connectivity. Essential data: can be unique identification number, device type, manufacturer, model, serial number, and so on. Additional data could be a photo, which is taken for this device, the life expectancy, the service contract data, software version, the MAC address and IP address, purchase order number and PDF, and so on. The network connectivity becomes now essential due to the connectivity needed with the medical devices, and with hospital information system (HIS). So, such information or data will include the IP and the MAC address, the host, the gateway, the mask, antivirus, duplex and other information. As we can see, this is an example of the type of data. This is a screenshot, which has been taken for of the inventory information. It includes some of the essential data, and as well as some of the other data. We can see here an example of the connectivity data. As we said before, the IP address, the MAC address, the DHCP server, the port number, and so on. Also, important point concerning the medical equipment inventory is to have a standardized format. Concerning the standardized format, we should talk about the FDA initiative, and nomenclature, which has been used based on the requirement of the FDA initiative. It's essential that the data fields to be input in a standardized format using a systemic approach according to the nomenclature. Why this is important, because in case we have a recall device, and we should search for it in our medical equipment inventory, this will be even missed or very difficult, in case we don't have a standardized format. So, in 2013, the FDA put forth the final rule related requirement for a unique device identifier (UDI) for medical devices, which also known as UDI. The identifier contains unique device and production data. This rule mandates companies to use the UDI system in stages. The first stage started in September 24, 2014. And, this will be ended in September 24, 2020. This is an example of the UDI, which is proposed by the FDA, or which has been initiated by the FDA. Now, we'll talk about the second part of the HEMS system. So, the first step will be the medical equipment inventory, the establishment of such medical equipment inventory. The next step will be the maintenance information generated related to this medical equipment inventory. This information can be separated into two parts: scheduled maintenance and unscheduled maintenance information. The scheduled one will be separated into routine inspections, or known as IPM inspection and preventive maintenance procedures, and a special inspection procedures. The scheduled maintenance is at the core of the computerized medical equipment management system usage due to the cost and resource factors. A key part of the maintenance is to automate this. To automate the preventive maintenance and inspection program due to the large number or the quantity of medical devices and the differing requirements for intervals and tasks. As an example in the case of a hospital or even a medical center with a large number of medical devices in its medical inventory, this task will be very difficult to make a preventive maintenance schedule, and to assign this task to a staff in our clinical engineering department. So, having a computerized medical equipment management system will automate this process, and will make easier for the staff, and will save a lot of time and cost. So, as we said, this maintenance information will be separated into scheduled and unscheduled one. The schedule and also will be separated into routine and specialized. The information or the element, which we are needed in addition to the to the procedure schedule and the equipment, will be the parts required, the spare parts required in the IPM or the inspection and preventive maintenance, the biomedical testing equipment or testing equipment in general, also staff skilled required, and finally the results. The tasks included in routine inspection of procedures will be a general physical check up, an electrical safety, also check up based on standards such as IEC 60601-1. Also, the tasks such as filter cleaning, visual inspection, and so on. This is an example of the routine tasks, which are performed in routine scheduled maintenance procedures. In addition to the routine, we have the special inspection procedure, which some devices may have: custom self-tests to be administrated, uncommon measurement procedures, or even a specialized parts replacement. In this case, this is considered as specialized or special inspection procedure. and this is a part of the scheduled maintenance information. Now, we'll talk about the second part of the maintenance information, which will be the "unscheduled maintenance". The unscheduled maintenance work includes: repairs, incoming inspection in case of a new equipment has been delivered for the hospital, recalls, updates for the equipment, and a modification of some equipment, installations and other work that is not scheduled. So, the unscheduled work will include repairs, incoming inspections of new equipment, recalls, updates, modifications, and installations and other work that is not scheduled. Repairs will be the majority of typical medical device life cycle maintenance cost. So, the repairs will represent the most of the cost concerning a typical medical device life cycle maintenance cost. For this, we should consider this cost concerning the labor parts and shipping. Another point is the failure rate associated with the repairs. It is also important reliability measure. So, the problem type and resolution need to be documented, typically with a code for searching and test description to show the specification related to this problem. Why is this important? This will be important in the generating of the reports, and the analysis of reports in order to take actions. Here is an example of some maintenance code,example for common problems, such as random failures. This is a code in case if we have a random failures maintenance related and battery replacement may be also used. This is an example of unscheduled work order in the HEMS system. In addition to the information related to scheduled and unscheduled maintenance information, we have non maintenance information. Such information will include: the asset data on purchase cost, depreciation, and parts; risk management data on the user errors, incidents and recalls; data to support the purchasing function, such as the parts data for ordering inventories to assess future purchases; and finally functional information for example major medical equipment items for state agencies. So, we have started with the establishment of the medical equipment inventory. Then, we talked about the maintenance information related to during the life cycle of these medical devices, which is the maintenance information. Now, we will talk about the last point, which will be related to the maintenance information as well as the medical equipment inventory. It will be the analysis, and the reports which is the idea behind the computerized medical equipment management system. We have different types of reports, which will be used in by different type of staff or healthcare staff. For example, we have reports generated by the computerized maintenance management system will be related to the administration. We have other type of reports will be related to the clinical staff / risk management, facilities management, regulatory compliance officers. For example in the case of the administration, we have reports related to the medical equipment replacement, the downtime, the cost of labor, and charges to the department's for hospitals that use a chargeback system, and so on. For the clinical staff and risk management, we have reports related to the user use errors, or no problem found and incidents, damage / abuse, and so on. In the case of the facilities management, we have reports related to the maintenance schedules and procedures interactions with support departments related to the work reliability and finally device histories. Concerning the reports for regulatory compliance officers, we have the results related to the accreditation requirements. Such requirement are needed by regulatory compliance and Joint Commission. Now, we will see some examples of these generated reports. The first type of the reports, the first example will be about the medical equipment downtime results. Downtime can be related or has an impact on the patient care. For example, in the case of a physiological monitor or defibrillator, so it will compromise the patient care. Other results or impact of the equipment downtime or the medical equipment downtime will be the cost that are lost or the income lost. The lost income, this cost can be varied based on the equipment. We have the essential equipment of the hospital, which are found in the laboratory and imaging. As well as, we have the complex system such as a robotic surgical system. The down time for such the system will mean that the loss of big income, and this has impact on the balance sheet for the hospital. For example, in the case of the laboratory equipment exams are low in cost, but high numbers will make the cost higher. For example, the test will be around ten dollars or seven dollars, but we have large number of tests will be performed in the laboratory equipment. If we take the example of the imaging exams or tests are higher individual cost ranging from the hundred to thousand dollars. And, the cost will be even much higher in the expensive system or medical device systems such as robotic surgical system, this will be cost of 10 of thousands of the dollars. So, this is an example of the cost of the test in the laboratory services, in the radiology, in MRI, CT scan, PET scan. As we can see, this is the cost and this is a cost for the charge of the hospital. This will be the charge for the professional physicians (radiologists and laboratory physicians or doctors), and this will be the total charge loss in case of we have medical equipment downtime. So, downtime, as we said before, means money. This exam chart data has been taken from the University of North Carolina hospitals. So, the second type of our reports, which is generated by computerized medical equipment management system will be the workload balancing. So, another advantage of the CMEMS is the analytics included to perform tasks, such as distributing the workload associated with PM inspection program. As we said before, it's very difficult to make a preventive maintenance schedule for a hospital or a Medical Center with a large number of medical devices. And, what will be more even difficult, it will be the assigning of these tasks generated by this PM schedule with staff available in the clinical engineering department. For the thousand of devices with differing schedules and requirements, the resources must be balanced between the staff and between even the available testing equipment, PM schedules, and so on. These resources include the medical equipment safety and performance testing equipment, as we said, and, most importantly the staff work time. So, we have three elements. We have the medical devices in the PM schedule. We have the medical testing equipment, which are also limited. We have also the limited number of staff, who should make this matching. Trying to make this matching manually, this will take a lot of time, and this will cost a lot of loss, or will be expensive concerning the cost for the clinical engineering department. Having a computerized medical equipment management system, all these tasks will be done more fast, more efficient, and will save a lot of money. Another type of generated reports by computerized medical equipment management system is the safety committee quality groups. Now, we'll see two types of the report generated to the Safety Committee or quality groups. The first one will be general concerning the work order generated, the reason behind it, and analysis during four-month period. Then, we'll have another report, which generates the number of the work orders generated based on specific devices, which will be more useful. This one will have will help the clinical engineering department to take general actions. Whereas, the second type of the report, which we will see in the next slides, will help us to take actions on concerning specific devices on the hospital or a medical center. So, as we can see, these are the numbers of the work orders generated in a four-month period. The reason behind these work orders can be either maintenance, use error, damage, or no problem found. As we can see here, in this chart that the higher number of work orders was the result of "no problem found". So, we should take actions based on the reason behind these work orders. This is another type of reports generated for the Safety Committee. This is based on the work orders generated based on a specific device, and what is percent percentage available. So, user error and no problem found work orders by device type. As we can see different types, we see ventilators, fetal monitors, patient's lift, anesthesia machine, and so on. As we can see, it's recommended that the percentage of the work order based on the user error or no problem found shouldn't exceed 10%. As we can see in these work orders chart based on a specific devices, most of the devices are below this percentage, which means the performance for this department is good. So, this data is more specific than the previous trend graph, which shows the work orders in four month period because it focuses on device types, as we see on a fetal monitor, or a ventilator, or anesthesia machine, and so on. The criterion, as we said, shouldn't exceed ten percent. As we have seen that, all the devices have have not exceeded this percentage. If the devices types were over this limit, which will be the ten percent, than either staff training, reviewing techniques, or human factors aspects of the device should be considered. So, after we have a practical example for computerized medical equipment management system, which was the HEMS, now, we will talk about the planning and the implementing a computerized medical equipment system for a new department, or for new users, or new clinical engineering users. If you have a clinical engineer, who has never had a computerized medical equipment management system to help run their clinical engineering department or having using the basic tools, such as the spreadsheet like Excel sheets, then this person should learn about the system to be able to plan the acquisition of the computerized medical equipment mentioned management system, and to implement it effectively. Also, we should analyze the the current practices of of this engineer, and engineering department, and see if they fit with computerized medical equipment management system. What are the factors, which we should consider when we are planning for the acquisition of a computerized medical equipment management systems? Some of the factors include: the ease of use especially speed and accuracy of data entry. Another points will be the functions and the features, the number of facilities and departments that can be supported, support of for the system, update history, web-based capabilities, interface capabilities with the hospital information system, as we said before the data format the SQL output. This is important especially, if we have a limitation in the type of the reports generated by this computerized medical equipment management system. Then the reporting the handheld netbook capabilities for the mobile leads in case we have different sides or multi-site case of hospital or from medical center, test devices interfaces. All these points, we have talked about and with the HEMS, we should have. As we have seen before, that HEMS has the capabilities for the connection with the HIS system, with medical devices, with the testing medical equipment, with the ePHI or the electronic patient health information, and so on. So, these points should be considered when we are talking about the planning for the acquisition of a new computerized medical equipment management system. Also, in the third part, I will talk about the computerized medical equipment management system and my proposal concerning the application of Big Data and artificial intelligence (AI) for the computerized medical equipment management system, and how this will help to enhance the healthcare technology industry. Finally, we'll talk now about the implementation advices for this computerized medical equipment system. In general, the hardware should not only be the limitation for such system, we should consider, as we said, software, workflow, processes procedures, and reporting also should be considered when we are talking about the acquisition or the planning for a new CMEMS system. Also, great expectations are not achieved if the system is not planned for or implemented correctly. Finally, the implementation phase can be daunting in case we have a large number of the medical devices for starting up system in a new hospital or a medical system. We have for example data conversion, training to of staff, hardware needs, interfacing, and so on. This will be very very very difficult and daunting for a large Hospital starting up system. Finally, thank you.