Slide 1:Clinical Engineering Automation of Medical Equipment Information Prepared By Dr.Eng. Walid Tarawneh


Just to remained you :Just to remained you “The most meaningful way to differentiate your company from your competition ,the best way to put distance between you and the crowd ,is to do an outstanding job with information . How you gather, manage and use information will determine whether you win or lose” Bill Gates


1.Medical Equipment and Data :1.Medical Equipment and Data Too many data that need to be collected , managed , analyzed and to be used to serve and improve the purpose ,for which the medical equipment were provided for it


2.Data and Information :2.Data and Information just gathering data for medical equipment will not serve any purpose CE’s are swimming in data but they must know how to get information from it Data is the source for information's What to do with data Where to store data How to get information from it How to use the information in CE –practices DATA INFORMATION Knowledge Action


3.Computerization of Medical equipment data :3.Computerization of Medical equipment data The rapid development in information technology and in computer science offers many solutions, programs, systems to computerize the medical equipment data and information Some of these systems are the Computerized Maintenance Management System ( CMMS) ,and the Computerized Clinical Engineering System (CCES) CMMS deals with all issues regarding services provided to medical equipment CCES deals with all clinical engineering Issues related to medical equipment Both systems have evolved into a key tool in providing technology support The computerization of medical equipment data : can save time can save money can minimize the human errors One should be extremely cautious in deciding the type of CMMS / CCES to adopt because of the wide range and complex parameters involved In the market, there is a wide range of ready made software packages that are flexible enough for different clinical engineering management systems


4. CMMS and CCES :4. CMMS and CCES CCES Provide a way for health organization and CED to track medical equipment and related inventory assets electronically within its life cycle (from planning to de-commissioning ). It deal with all issues related to medical within its life span CMMS Provide a way for health organization and CED to track services provided to medical equipment and related inventory assets electronically within its utilization life cycle (from delivering to de-commissioning ) Both systems represent a valuable resource for CEs , BMEs ,BMETs and other health professionals who use computer technology to deliver support services The main purpose of both systems is to collect ,store and use data to improve the quality and the cost-effectiveness of equipment support activates ( selecting, maintaining , training, evaluating….etc)


CCES components related to medical equipment management :CCES components related to medical equipment management CCES Components PPM & IPM Management Management of Corrective maintenance Equipment inventory & bar-code Training receiving of new equipments Reports& analysais Warranty management Equipment specifications & tendering Equipment planning Warning & reminders Contract management Archiving management Purchasing Management centralization e- connections spare parts. Management Equipment scraping Test Equipment Management Document follow up Employees registration Risk management Inspection & quality control


5. CMMS/ CCES - Benefits :5. CMMS/ CCES - Benefits CMMS when designed and utilized correctly can provide technology management staff with a wealth of information to help manage many equipment support related functions: 5.1 Benefits Equipment performance function identification by model ,type ,location and to identify equipment requiring replacement and select vendors for new equipment Quantitative equipment reliability assessment can be made based on failure rate ,down time (DT) maintenance cost for similar equipment types and different manufacturer and be used for vendor selection information User training needs can be identified based on error problems Assessment of CE, BME, BMET,- performance based on time to repair ,repeated repairs , cost of repair …etc Planning of scheduled maintenance based on priority of servicing ,equipment risk category ,safety and the cost effectiveness of equipment Scheduled maintenance can be planned on the base of rate of problems and replaced parts Better manage of the work orders on base of DT, priority CED performance can be measured and monitored (financial performance ,productivity and quality ) Ability to Document of equipment history and to track the most frequently problems that occur in certain equipment.


Slide 9:Equipment Registration • Breakdown, Corrective and Preventive Maintenance Work Order (WO) • Preventive Maintenance Scheduling, WO Generation and Work Load Analysis • Equipment and Work Order Analysis • Failure Pattern Analysis • Engineer Performance Analysis Maintenance History and Cost Analysis • Multiple Breakdown Analysis • Preventive Maintenance Quality Analysis • MTTR and MTBF Analysis • Pending Work Order Report • Repair Turnaround Time Report • Warranty Management 5.2 Salient CMMS Benefits


Slide 10:Implementat -ion Analysis Inventory system Services Hardware Programm -ing Connecting &Down loading It Is not just a software and hardware , It must be a solution Starting with Inventory of equipment & Spare parts Data collection 6. Main stages in Building CMMS


6.1 Data collection- over view :6.1 Data collection- over view The primary data to CMMS ( data which should be organized in such a manner so it can be developed to useful information ) are : Medical Equipment registration (for existing and new received equipments) Spare parts registration (existing ,used, ordered and new received parts) and purchasing details Repair requests and break down maintenance work orders and corrective maintenance details PPM &IPM scheduling ,procedures and working orders Maintenance contracts and sub-contracts details warranty and vendors maintenance warranty details Medical equipment Specifications and tendering details (for CCES ) Test equipment details and calibration schedules Technicians and Engineering staff details and skill management Operating and service manuals details Manufacturer, suppliers ,venders details User ,CE, BME ,and BMETs training locations and sub- locations details Quality control and routine inspection details Equipment de-commissioning details


6.2 Common data collection tables for medical equipment fig 1 :6.2 Common data collection tables for medical equipment fig 1


7.First step to build CMMS – INVENTORY & CODING7.1 equipment inventory and registration :7.First step to build CMMS – INVENTORY & CODING7.1 equipment inventory and registration The most critical step is the complete and accurate inventory and registration of all medical equipment - the existing within the organization equipment - the incoming equipment Inventory parameters Control number, type ,name ,location Model ,S/N ,Manufacturer, cost, agent Status , manuals, location, warranty Contract, installation, risk ,priority…etc with out accurate and complete inventory it is impossible to accurately track medical services and management functions related to medical equipment (maintenance, recalls, alerts, ) the control number : each equipment must have a unique control number assigned for it and labeled on the equipment Served by in-house CE Served by companies contract warranty


7.2 Elements of Euipment Inventory Management :7.2 Elements of Euipment Inventory Management  locating the equipment : Working equipment within the organization departments Stored equipment in the supply stores Standby equipment stored in medical department stores equipment shipped for maintenance (in house/out house)  Recording equipment parameter (see lecture 6)  Determining of equipment statues Working ( out of warranty, under warranty /contract ) Not working ( needs parts, out house support, parts orders Old /new received ( unit age ,installation date ) Working environment (water supply, electricity ,ventilation ,humidity ,noiseless…etc) recommendation for use and servicing (training of medical staff, technical staff ,consumables availability ,to be replaced ,to be consider as a standby, needs manuals- spare parts list…..etc ).


7.3 Registration of equipments (see lecture no 6) Each medical equipment in the organization should be registered .The registration should cover the following key fields: :7.3 Registration of equipments (see lecture no 6) Each medical equipment in the organization should be registered .The registration should cover the following key fields: Location / Facility name Device code –as per standard list Manufacturer - as per standard list Model number Serial number (S/N) Department - as per standard list Location code Purchase date Purchase price Warranty start and end date Vendor Registration card key fields Inventory list


7.4 Assigning The Control Number of Medical Equipment :7.4 Assigning The Control Number of Medical Equipment Is a unique code( usually alpha numeric) by which the device can be identified and traced by among the total quantity of medical devices within the organization. Reasons for creating the inventory ( control No) Different manufacturer Different models Different serial numbers ( S/N ) Different locations Cod of the Location Code of the Manufacturer Code of the Unit name Or type sequence Number Risk level priority The control number should be: Simple Include information Sequential automatically be obtained


7.5 Coding :7.5 Coding All key data related to medical equipment must be coded within the CMMS to avoid any sort errors. Some of the key data are: Equipment names Manufacturers Suppliers Equipment locations Models( if possible) Engineers / technicians Priorities, Risk level Spare parts Equipment groups Technical groups, workshops Test equipments stores for spare parts Medical departments & units Countries and towns Guide Lines for Encoding Don’t embed data in the code Codes can be numeric or alphanumeric or both No two or more codes should mean the same thing Use coding for faster access ,easier changes and for conservation of dick space Identify codes for user errors


Slide 19:7.6 The equipment class number The class number is a code assigned to every type of medical equipment Many different names for the same medical device ,which to select ??? Patient monitor : ECG - Monitor , Bed Side Monitor , vital sing monitor ,ICU monitor ,CCU monitor, ….etc Autoclave : central steam autoclave, steam sterilizer, central sterilizer The Universal Medical Device Nomenclature System“UMDNS” Equipment can also be coded according to risk and priority of servicing Equipment can be coded according to their application use (lab, diagnostic, therapeutic , imaging ….etc) 7.7 location & department coding – fig 2 Area code (Amman Irbed Zarqa Salt Karak) Health organization Code ( hospitals Medical center Blood bank Central lab) Facility name code Facility name code Facility name code Department name code Room code Room code Room code Room code Department name code Department name code


Slide 20:Each equipment type is classified according technical responsibility ,priority of service type& time of periodic maintenance and the estimated working load * REQUIRED TIME “RT”: time interval over which the user requires the equipment to be in a condition to perform a required function


7.8 CED-Personnel coding :Each employee should have a code which identify his name , job and job location The first digit should represents the type of the employee 1- engineers 2- technicians 3- store keepers 4 - administrative 7.8 CED-Personnel coding 7.9 Spare parts coding A spare part inventory also must be completed accurately to determine the available spare parts Two main category of spare parts : - stock spare parts ( common used ,for future use) - non stock spare parts ( for certain use , purchased when required ) Many way to code spare parts the easiest way is to connect coding to equipment type and the field of use Spare part code = AA /BB / CCC AA : represents the store location (store code) BB : represents the equipment group( x-ray, sterilizer, dental, suction …etc) CCC : represents the serial number of part in the equipment group 7.10 Manufacturers and Suppliers coding The manufacturer Coding should shows the local agent of the company in the country


Slide 25: Both screens shows the name ,address, tel ,fax, email address and P.O.BOX  The manuf. Coding screen shows the local agent of the company in Jordan


8. CMMS/ CCES MODULES :8. CMMS/ CCES MODULES 8.1 core module Fig - 3 shows the Core Modules 1. Equipment Management module Should have a data entry screens to capture essential information of an equipment. Equipment Registration screen Equipment Category Equipment Register Equipment Status Manufacturer Vendor Department Employees Hospital Region / Zone Warranty period


Slide 27:2. Work Order Management module should have a data entry screens to capture maintenance activities of an equipment. Order request Entry CM Work Order Entry PM Work Order Entry Breakdown Cause Entry Problem Entry 3. Preventive Maintenance Module Should suite any type of Scheduling Requirement. PM Scheduling PM Schedule Update PM Load Analysis PM Work Order Generation PM Frequency Update PM Quality Update


Slide 28:4. Spare Parts & Logistics Management module should fulfill the requirement of inventory process of Maintenance Service. fig 4 shows the spare parts & Logistics Process Flow Warehouse Inventory Details Stock Details Material Request Material Delivery Material Return Material Receipt Stock Adjustments Material discharge Fig. 4 Material Request Entry Delivery Entry


Slide 29:5. Analysis and Reports module Analysis and reports should be forceful with user friendly interface. Complex queries, analysis and reports should be created immediately. Equipment Analysis Work Order Analysis Cause and Problem Analysis Engineer Performance Analysis Maintenance Cost Analysis Multiple Breakdown Analysis PM Quality Analysis MTTR & MTBF Analysis Equipment History WO Turnaround time report WO Aging Report 6. Executive Information Sys. Module The system should be able to Communicate with other information systems within the health organization (HIS ,RIS and PACs ) including PDAs Pagers, mobile phone communication


Slide 30:Maintenance Management – Data Collection, Tracking, Reports & Analysis CLIENT HELP DESK SERVICE PROVIDER Work Order Mgmt, Inventory Mgmt, Dispatching & Reporting 8.2 CMMS Process Flow


9. Analyzing the CE work flow procedures :9. Analyzing the CE work flow procedures 9.1 Equipment data generic work flow Analyzing all the process , procedures and data related to the medical equipment such as :


According to [ 19 ]the CMMS the Equipment History represent the source of all data and activates :According to [ 19 ]the CMMS the Equipment History represent the source of all data and activates [19] AAMI ,Computerized maintenance management system for clinical engineering 2003 edition


Equipment history :Equipment history All critical data from in-house work orders and outside vender work orders should be produced /transferred automatically to equipment history record This integral history record should contain information for : All necessary basic equipment inventory data All corrective maintenance activities ( WO- number, request order date, final job date , repair time ,transport time, service provider name (employee / vender) PPM activities and time Cost of servicing: parts and parts cost ,labor cost, total cost


Equipment history screen :Equipment history screen


9.2 CE-Generic work flow :9.2 CE-Generic work flow Analyzing all the CE –activities and responsibilities related to the medical equipment and building the CE –working procedures and forms


9.3 breaking down the CE - flow procedures :9.3 breaking down the CE - flow procedures Procedure / operation : Any activities that convert the input action to out put results Main element of any operation : Resources Procedures Activities Measurements Services Process Module (ISO- Module ) Activity Resource Procedure Measurement Service CHECK ACT DO PLAN P D C A


Slide 38:Determine major process to be computerized Determine input and output data of each process( used forms and results reports) Determine the flow sequence of each process Determine responsibilities within each process Determine relation between processes and sub –processes Identify sources of data ( CE ,technicians , users ,venders) and type of data ( paper ,electronically stored )and ported data Determine available data ( equipment inventory, PPM –plan, procedures, materials ..etc) Determine data which is essentially but not available Readjust procedures ,forms if required Determine common data ( locations, manufacturer ,venders, employees ,equipment types….etc) Determine primary and secondary key data Draw a relation data chart for each process and between processes


Slide 39:Work request & break down procedure Medical staff HELP DESK break down service request Working order generating WO Service Provider Problem Fixed? Closing working order Parts Required ? Acquire Support Manuf / Loc.Agnt Parts Available ? Part delivery Purchasing Process Store yes no no no yes yes Maintenance ,Purchasing & Parts Management – Data Collection, Tracking, Reports & Analysis


10. Software :10. Software Use SQL ( Standard query language) and RDBS (Relation data base system ) to build the required CMMS /CCES Software should be based on common used OS (operating system- window, Unix ,luninx) Software should be power full Software should sport client- server technology ( LAN- Local area network) and web based technology (WAN- wide area network) Software should be with multi language capabilities Software to have application service provider (ASP)


Some additional requirements when design CMMS :Some additional requirements when design CMMS When designing a CMMS /CCES ,certain concern should be paid for : Easy use of data entry screens System should have help menu System should generate of error massages/screens System should have on-line indicators that shows which fields can or can’t be edited System should generate some sub screens and massages to help the user for quick ,correct , better usage of the system The help massages should be obtained when a certain sequence is needed , some fields are not allowed to be used by some users , certain format of data is needed ,information about some fields….etc “Pop-up” : display of commonly used references and indexed tables that indicate the available selection for a field


11.CMMS REPORTS :11.CMMS REPORTS All data ,information ,activities should be used to obtain certain reports useful for CEs,BMEs,BMETs,CED ,head of clinical departments ,users , venders and patients . Three types of reports can be generated : 1. predefined or standard reports : - customer reports :for example monthly service reports with cost - data list reports : for example equipment list per location / department / model / manufacture - quality improvement reports : for example cost analysis - productivity reports : for example A%, DT%, MTBF,MTTR and PPM compliance - equipment reports : for example equipment problems ,PPM - PLAN Ad hoc reports : for example DT% for equipment from one model and certain manufacturer customer reports : for example LCC- reports ,maintenance cost of certain equipment model ,type to equipment cost . such reports depends on customer needs


Some reports examples :Some reports examples


12. Data collection to CMMS :12. Data collection to CMMS Data entry by key board Data entry by lab top Data entry test equipment Data entry by photo media Data entry by scanners Data entry by PDA “personal digital assistance” Data entry by medical equipment


Benefits of data entry using lab top or PDA :Benefits of data entry using lab top or PDA A lot of maintenance occurs in the fields. the use of lab top or PDA can help to record information during actual maintenance .At the end of the day CE’s can transfer all recorded data to CMMS Easy Can be carried to the field In field communications and interfaces with CMMS data server via net work ,wireless or internet or telephone service providers to synchronize data and data collection Lab top can be used with testing equipment to store and analyze technical equipment data Reduces of paper work and data entry Improve productivity of CE’s on field On field generation of work orders Downloads open work orders from the CMMS


13. CMMS Net Configuration :13. CMMS Net Configuration 13.1 Local net configuration


13.2 wide net configuration :13.2 wide net configuration


Slide 49:Disadvantages : All disadvantages are related to grantee very high levels of protection and security


Slide 50: AL BASHER.H Pr.Bassma H ZARQA H KARAK .H Peripherals Work shops at Internet www.dbe.gov.jo Application & Data base Server Help desk Central Work shop Dep't Contract Dep't QC Dep't Stores Dep't CED LapTop or PC From any where INC LAN Server Web Server Combined CMMS Configurations Firewall Cover s all dep’ts & workshops in the country , . ADSL Router Routers No more paper to collect and view information's about Medical Equipment JTC


14. Implementation of CMMS14.1 Implementation Plan :14. Implementation of CMMS14.1 Implementation Plan


14.2 Reasons for failure :14.2 Reasons for failure


14.3 steps for successful implementation :14.3 steps for successful implementation


15. In- House & Commercially Developed CMMS :15. In- House & Commercially Developed CMMS 15.1


Slide 55:15.2


Slide 56:15.3


Slide 57:15.4