By Matt Skoufalos
The ubiquity of medical imaging systems in every aspect of the business of health care is a byproduct of both their nigh-endless utility in interventional medicine and their apex predator status at the top of the billing chain.
Maintaining both is the task of service engineers as much as it is clinical specialists, and the area of practice at which both intersect is the issue of connectivity. Imaging has long been a nighthawk game, thanks to remote support technologies, but in the field of device management, it’s a relative newcomer. Once leveraged, however, the value of big data to uptime, efficiency and overall equipment life becomes something close to indispensable. Mark Lothert, head of product in service business management for Siemens Healthineers North America, traces the foundations of Guardian, the company’s remote service solution for imaging modalities – including CT, MR, angiography, molecular imaging, and fixed X-ray to remote service offerings that began in the mid-1980s with telephone dial-up networks. Initially, Lothert said, remote service offerings took a reactive approach to the task and, even then, they mostly supported the break-fix work of an onsite engineer. In 2005, the company rolled out Guardian in response to the increasing complexity of the work done in technologically advancing imaging suites like interventional cardiology rooms and catheterization labs.
“Patient safety and criticality is extremely high in such environments, and that’s how Guardian started,” Lothert said.
Guardian began with data collection and analysis, measuring “changes in the systems that our users don’t even recognize,” Lothert said; analyzing patterns in equipment failure with high-level software that reveals “an indication that something might fail in the future.”
“That is basically what it is today,” he said. “The modalities or systems that we provide have sensors that give feedback all the time; based on that feedback we can identify changes and trends in system functional behavior and predict early breakdowns before the customers recognize them.”
Keeping equipment functioning to the best of its ability doesn’t only mean charting trends in opaque data sets. It also involves limiting table time for patients in the most vulnerable and critical of settings, while scheduling planned maintenance to preserve maximum uptime. After Siemens saw the value of enhanced analytics to its angiography and interventional lab systems, the company grew Guardian support to cover CT equipment, particularly in non-emergency settings. Such deployments gave the company an added install base for supporting its products as well as an opportunity to enrich the offerings of the solutions themselves. Guardian adds an average value of 10 percent to a service contract, Lothert said; he also suggests that the value of the added uptime could total hundreds of thousands of dollars annually, depending upon the procedures done.”
“Usually all systems nowadays come with a certain uptime guarantee around 95 percent,” he said. “That missing 5 percent could still be 10 to 12 days a year. If you increase uptime by 1 percent, you reduce the loss of revenue by about $100,000. Being predictive allows us to schedule planned downtime.
“We commit to a higher uptime where the customer can measure us,” Lothert said. “That means going from 95 to 98 or 99 percent. Customers can measure it from a confidence point of view, and are holding us accountable to it.”
Lothert believes the future of remote online service management will be both proactive and predictive, customized to the specific uses of a given facility, and maybe even the specific demands of individual departments. He likened it to the conventional wisdom around an oil change every 3,000 miles. Such planned changes don’t take into account specific considerations about your vehicle itself – whether you use the right gas, whether your commute is routinely short or long trips, how hard you drive the vehicle – that would either lengthen or shorten the amount of time needed between service appointments.
“That is the way it will go with monitoring,” Lothert said. “To show how the system is being used, where you have wear and tear, and whether it’s the right time to do preventive maintenance or replace parts.”
As vendors develop better ways to measure that wear and tear on medical equipment, and develop improved sensors that can report data from potentially affected components back to service banks, they’ll also be working to hone and automate the analytics that make sense of it, too.
“A lot of data means nothing,” Lothert said. “It’s just data; it’s not information, it’s not insight. You need something behind it that analyzes the data, recognizes patterns, and compares it to a normal database.”
Remote monitoring services can log and anticipate system failures and schedule preventive maintenance work; the precision of accompanying analytics software also mitigates the impact of the false positives and false negatives that can turn up. These solutions can also help calibrate and remotely update service and security protocols, saving technicians more time onsite as well.
“You can produce remote software versions much easier than having a service manager onsite loading CDs or DVDs to put software on,” Lothert said. “It’s extremely important for safety-relevant bug-fixes, where remote access makes it much easier and quicker. The big difference is the real-time monitoring, which requires people to sit at computer desks and look into error logs and alarms and alerts from all the systems that are installed.”
Gladys Correa, director of medical imaging and radiation oncology at Banner Desert Medical Center/Cardon Children’s Medical Center in Mesa, Arizona, said that when her facility was looking to upgrade its imaging equipment, working with a vendor that offered remote online service was a priority.
“We knew that we were going to an L1 trauma facility status,” Correa said. “Having a system in place that was allowing us to monitor the scanners from a remote area was of benefit to us.”
Banner Desert Medical Center performed 65,000 CT scans in 2017, and since installing Siemens CT scanners with Guardian, “we’ve not been down for a prolonged time, except for maintenance and a preventive quick fix,” Correa said.
“If we’re down, it’s for a very short duration of time, as Siemens is diagnosing the problem from their remote monitoring center,” she said. “It allowed us the ability to detect the issue well before the facility even knew there was an issue. Siemens is well aware before even the technologists have had a chance to recognize a problem.”
“We have a very busy ER,” Correa said. “Where our CT scanners sit, we needed them running. That was a no-brainer for us.”
Correa said her in-house service engineers have also been trained from the ground up in remote online monitoring, which allows them to train with the equipment vendor directly, creating “a seamless operation.”
“We don’t even remember that the software is in place until there’s a problem,” she said.
That level of smooth integration is precisely what clients are looking for from their equipment vendors, said Josh Hanna, vice president of remote service technology for GE Healthcare Global Services: optimizing asset performance as well as clinical performance management.
“I think people are very familiar with how we should use the connectivity to improve uptime of your asset,” Hanna said. “Increasingly customers want to look at all of CT. How are those assets performing? Am I utilizing them right? You can give me the data that says, ‘I can redirect that patient outcome.’”
“By having a connection, hospitals can say, ‘Are we using the best protocol at the best time?’ We’re also on the cusp of learning to help radiologists be more accurate. We see this trend of leveraging technology for clinical optimization, as well,” he adds.
The biggest vendors in the imaging space all offer remote online service options for their equipment, and Hanna said that, increasingly, he encounters an “around-the-globe expectation of remote service” in every aspect of the space.
“We’ve got hundreds of thousands of systems connected all around the globe,” he said. “Those connections allow us to meet those uptime and productivity connections that our customers rely on for their convenience. This is not a new technology, nor a new expectation in the industry. You almost can’t differentiate yourself in the market through connectivity. For the big OEMs, if you’re not connected, you’re not competing.”
Each of the “big three” imaging equipment manufacturers supports its technology with a remote monitoring service: Siemens’ is called Guardian; GE’s is called OnWatch; Philips’ software is called OmniSphere. They all perform similar basic functions – advance warning of technological miscues, alerts for things that break, and scheduling warrantied service calls. Beyond those maintenance and upkeep functions, Hanna said the analytical components of the software can also defer maintenance by optimizing equipment usage. The simple act of warming up a CT tube – one of the most expensive, sophisticated and frequently changed-out components on the device – can add to its lifespan.
“Remote connectivity can tell you if that warm-up’s being done,” Hanna said. “It can tell you when certain parts are going to fail. We can’t cover everything, but we can cover lots of failure modes.”
“Every product we ship has connectivity,” he said. “The design for how you gather that data is predicated upon connection.”
Remote connectivity can also help simplify repairs by allowing technicians to download device information prior to making repairs, to identify replacement parts beforehand, and to coordinate and strategize around the maintenance process.
As Hanna puts it, “When the field engineer arrives at the same time as the part, that saves you quite a bit of time. The fact that we can download information might mean that we know what part you need replaced before you arrive onsite.”
Remote software also lets service technicians troubleshoot problems from a distance. GE imaging equipment makes use of iLink Systems software, which connects clinical staff with remote equipment support at the push of a button. Hanna said its remote technicians are veteran field service personnel whose expertise is still available on demand.
“Some of our best technical people are our remote engineers,” he said. “You’re getting someone who’s calling you with 30 years of experience, and that person is logged into your scanner, and is watching what you’re doing, and can also look at the very technical logs that you’ve got,” he said. “I can see if you’ve got a problem with your voltage; I can see if you’ve got a problem with your table.”
Hanna predicts that the added functionality of future remote optimization solutions won’t be limited to repairs; instead, he foresees it becoming another asset for clinical improvements. Aggregating anonymized data allows other insights to percolate while contributing to a generalized understanding of the technological landscape of the imaging space.
“I think the insights we’re going to gather on the clinical side is amazing,” Hanna said. “It would be very comforting to me to know the radiologist is looking at my scan along with an algorithm that’s comparing my scan with thousands of other scans in the world. How we use connection and data together, and the modern architecture of databases and the cloud, has enormous implications for clinical outcomes.”
By the same token, analytics can improve service offerings by delivering “fleet-wide” parametric data, he said. As vendors work to differentiate their offerings from one another, and to more tightly integrate their service delivery to specific contractual terms, Hanna anticipates “some bifurcation of offerings” along customer-defined lines.
“You’re going to see some break/fix, your basic uptime, contracts signed for operating,” he said, “but then I think there’s going to be a whole other piece: a partner that’s going to help me manage my assets. How these assets perform, how they’re used and maintained, leads to better clinical outcomes. On the slope, I think we’re in a time of improvement.”