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ICE Magazine contacted imaging leaders for advice regarding imaging parts to better understand how to limit imaging device downtime and maintain an efficient workflow. Leaders who replied to share helpful information are The Ohio State University Wexner Medical Center Associate Director of Inpatient Imaging Services Lauren Bergstrom, UT Southwestern Medical Center Director of Outpatient Imaging Services Robin Eastland, San Francisco Department of Public Health Vice President of Support Services Nader A. Hammoud and St. Luke’s Health System Health Technology Management Imaging Service Team Manager Dean Skillicorn. Bergstrom was assisted by The Ohio State University Wexner Medical Center Director Amy Gallatin and Facilities Imaging Equipment Specialist Robert Hinton.
Q: What is your facility’s process for acquiring imaging parts for the maintenance and repair of imaging devices?
Bergstrom: We currently rely heavily on our clinical engineering department, who helps to manage and service over 42,000 pieces of equipment. When parts are needed, they primarily utilize PartsSource, a large marketplace supplier of medical supplies, equipment and repair services for the healthcare technology management (HTM) industry. We have multiple contracts with our vendors that we can leverage price of parts outside of warranty coverage. With our vendor agreements, we often qualify for significant discounts on OEM parts. Depending on the need and “hard to find” parts, we can request OEM or third-party through PartsSource and whenever possible we try to go with the OEM. There are times in which we cannot locate specialty parts or simply are not available fast enough. When this happens, we look to secondary third-party parts suppliers.
Eastland: We have two basic means to acquire imaging parts for maintenance and repair. Most of the major imaging equipment is on OEM service contract and parts are included with the service. For any parts that are not part of the service agreement or for the imaging equipment we allow our biomed department to handle the service and maintenance, the biomed department acquires the parts through the various OEM vendors and third-party vendors.
Hammoud: In general, it is part of a service agreement with the OEM. Outside of such an agreement, it would be mainly through third-party, issuing a requisition/PO for the needed part, with shipping speed identified ad hoc per the need.
Skillicorn: We have several methodologies for acquiring parts that depend on our relationship with the vendor. We have full-service contracts which have parts included. We have support level/risk sharing agreements that do not have parts covered; this option allows us to access parts with a negotiated discount with the vendor, or access parts through our own research. We have equipment that is not covered; these devices allow us to use our own research and parts vendors.
Q: What is your experience using OEM and/or third-party suppliers for imaging parts?
Bergstrom: A majority of the time we consider OEM and I would bet that most organizations also look to OEM parts. However, due to competitive availability of OEM and often elevated price points we do have to look to third-party suppliers. A majority of the time, there are not issues with third-party parts. We have had scenarios that there have been issues with both OEM and third-party. It’s only the ones that we have had issues with that everyone hears about and builds a bad reputation.
Eastland: We have had good experience with both OEM and third-party suppliers for imaging parts. Some of the third-party suppliers have provided even better pricing than the OEMs.
Hammoud: Most OEMs’ parts are extremely expensive compared to reliable third-party vendors. Some third-party vendors have extremely low-quality parts though, so it is an art of balancing the need of quality parts and price. It is worth noting that some OEMs have programs that would provide OEM parts cheaper than third-party markets.
Skillicorn: Interesting question, since COVID-19 derailed a lot of traditional parts ordering situations. The large vendors – such as GE, Philips and Siemens – all have multivendor parts programs that can assist in obtaining parts for any end-of-life system. Most third-party vendors have or are currently moving to ISO standards for quality to be in line with FDA standards. There are also vendors in the industry who do not use such practices. We use these processes to choose vendors for certain situations. Our experiences have been somewhat positive, specifically over the last year moving out of COVID-19 protocols where compromises to value chains for obtaining components caused a serious impact on availability and delivery time by OEMs and third-party parts vendors.
Q: What tips/advice can you share for an efficient process?
Bergstrom: There are all kinds of products out there which can make ordering the correct part difficult at times. One thing that has been important is to have an accurate inventory of our equipment with equipment identifiers including make, model, serial number and location within our imaging environments. As an example, you could have two identical ultrasound units, but one may be a slightly different model and require and slightly different part for the same function. In addition to special attention on specific model and parts identification, clinical engineering also has additional administration for issuing and tracking payment of parts so that the team is able to stay in the field helping to maintain and upkeep our imaging equipment. They also have dedicated staff for managing and maintaining our vendor agreements that we can quickly reference for warranty coverage.
Eastland: We have tried service agreements that were more “global” – meaning one vendor oversaw the service for all equipment regardless of vendor. This process did not work well for us. We switched back to more OEM-based service contracts and this has worked much better for us. While the immediate cost of the contract might seem more expensive, we have experienced less downtime and therefore it has been more financially responsible.
Hammoud: Most challenges in this domain are the availability and timeliness of parts. Sometimes internal processes can be the biggest hurdle an organization must overcome to have timely deliveries. So, identifying a special budget/risk pool with unrestricted access to healthcare technology or imaging engineers is a must-have process to ensure a part is ordered when a part is needed, and not 3 days later.
Skillicorn: First and foremost, you must understand the requirements that FDA has in place for being an OEM, a remarketer, a remanufacturer and selling parts without doing rework on them. The differences are critical and need understanding to monitor vendors appropriately. Second, have processes around vetting and monitoring vendor performance for pricing, parts failures upon receipt (i.e. defective when received for installation), time to order to receipt, etc. Also, is the vendor ISO certified? What quality measures do they have? How are they with issues around parts ordering and delays? Are their processes simplistic or complicated? Use of this information will allow you to have a quality program around your vendor selection and prioritize the selection of parts from appropriate vendors.
Q: What is the budgeting process for imaging parts?
Bergstrom: We have an extensive capital planning process for our organization in which we build capital requests over the course of the year and prioritize based on specific need. Our clinical engineering department has a dedicated focus on existing and future equipment planning. They are able to recognize service-related needs and help provide our administrators with equipment history and service data to make an informed decision on capital projections. Specifically pertaining to parts, the clinical engineering team also uses their own data to weigh cost analysis for their capital projections and are represented yearly in our organizational capital planning process.
Eastland: We budget for the service contracts which include most parts. Beyond that, we use historical information for the cost of parts that fell outside the contract adding a given percentage to match inflation.
Hammoud: Historical last 12 rolling months.
Skillicorn: Our process includes an annual target for expenditures that is based upon the past performance of equipment. To lower our contract outlay and future expenses, we also utilize methods to move costs from contract to in-house based; these decisions are based upon risk-sharing contracts. This approach is a more recent one we have implemented as we move forward with plans to train in-house staff to assume services on currently contracted equipment cost to avoid expenses in the future.
Q: Which departments are involved in the process of acquiring imaging parts?
Bergstrom: Radiology and imaging administration, operational leaders, clinical engineering, IT, quality lead technologists, data analytics, modality managers, radiology chair and specific clinical modality physicians.
Eastland: Biomed and imaging services are involved in the process for acquiring imaging parts.
Hammoud: Healthcare technology/imaging engineers are the ones who would place the orders. Yet the imaging departments are usually the ones paying it out of their budget, so it will require their approval, then the purchasing department must create and submit the PO to the vendor.
Skillicorn: There are four departments involved in our processes. We have an internal administrative team that assists with tracking parts acquisition and costs for efforts in cost reduction. Our team members fill out all PO requests and submit them to their manager for approval. These requests are then routed through our purchasing department for a PO to be assigned and a PO returned to the ordering service personnel for ordering. Once our parts are ordered, shipping and receiving will deliver them to our sites upon receipt from shipping vendors. Lastly, all of the cost information is tracked and documented in our financial system for budget review and financial analysis.
Q: What else should ICE Magazine readers know about imaging parts?
Bergstrom: That parts are always more expensive than they seem and the recent COVID pandemic has made them hard to find and often takes longer to get, but this has been improving this year. And that we would not be able to acquire our imaging parts without the partnership with our clinical engineering department.
Eastland: We have found keeping options open with both the OEM and third-party vendors helps to keep pricing competitive and to increase the availability of parts. We are fortunate to operate near a major international airport, but for more rural areas, working with the vendors to keep certain key parts close to the facility to help expedite repairs can also prove beneficial.
Hammoud: For an immature in-house program for imaging maintenance, there will be trial and error to find the best vendor to use for parts (or even service), until you establish a well-defined, agreed-upon SLA with whoever your main parts provider is. Never settle on an exclusive source, keeping your options open will ensure you get the best deal every single time.
Skillicorn: There are several areas to be very critical of when ordering and using used parts, specifically end-of-life products. Used tube and detector, imaging intensifier acquisitions should be done with the utmost care and research. Age will be critical in either of these components. Specifically, with regards to detectors and image intensifiers, image quality will be key to determining how long these components will survive in use. Understanding how long a used tube has been on the shelf could make a difference in how long that tube lasts, and the processes involved in installation, degassing, and calibration of such tubes. Be certain that any used components in this area are vetted appropriately before ordering them. •
This month’s article is sponsored by Avante Health Solutions. For more information on this company, visit avantehs.com.
