Bringing it all in-house: Intermountain Healthcare blazes the trail in Utah, Idaho

August 30, 2016
By John Schafer

Intermountain Healthcare is an independent delivery network with 22 hospitals and 185 clinics in Utah and Idaho. Clinical engineering is divided into four geographic regions, and there are 14 clinical engineering shops located throughout our facilities as well as a central service depot located at our supply chain center building.

Intermountain Healthcare began implementing in-house service on imaging devices four years ago. Before the transition, service for 100 percent of all imaging systems was outsourced. Today, we have 17 imaging engineers that service X-ray, ultrasound, nuclear medicine, CT and ancillary equipment. The move to in-house service for imaging has saved Intermountain Healthcare over $8 million in that four-year period.

The age-old standard for non-imaging clinical engineering service is to put all higher-end modality items under service contract, and the in-house CE technicians work on all lower modalities. We have been taking a hard look at the best way to reduce costs without sacrificing quality of service. The biggest return on our investment so far has revolved around reexamining the modalities normally under service contract and relocating them to in-house service with the proper training and credentialing for our CE technicians.

To be self-reliant, you will need training and credentialing for your CE technicians. So far in 2016, we have had training for lasers, phacoemulsifiers, the new Carefusion IV pumps we have transitioned to, laboratory and operating microscopes, Sonosite ultrasounds, and we are developing our own training program for A+ certification in a train-the-trainer format. You will also need to set up your support and logistics to have parts and technical support for the modalities that you take over service for. You may need an alternate source on parts, as parts not covered under agreement pricing may be more expensive. Next, analyze your support requirements before you send someone to school for training, and discontinue the service contracts for the units you are taking over. Also, make sure your technicians will have recognized training credentials in case you ever have to answer that dreaded question, “How do you know your people are qualified to work on this unit?”

We are using a hybrid service model of in-house and centralized support. Our hospital based CE technicians service equipment in their hospitals and support the smaller hospitals in their geographic regions. This equipment includes lab and operating microscopes, anesthesia units and phacoemulsifiers. The depot technicians provide loaners to the entire hospital system. These include lasers, bladder scanners, simulation labs, telemedicine, radiation detectors as well as Sonosite service with loaners. We will also be assuming service for the audiometers soon. The service depot began operations in March of 2015, and the savings from the centralized depot service during 2016 will exceed $1 million.

The central depot also services mobile medical devices such as IV pumps, sequential compression devices and syringe pumps. If one of our hospital-based CE technicians comes across a mobile medical device that will require more than 30 minutes to service, they will send it to the depot for repair and then can move on to another unit without wasting large amounts of time on a single unit. This gives our CE technicians the ability to complete more repairs in a single day in addition to putting more equipment back into the hands of our health care providers.

To support these hospital-based and depot operations, we have a central dispatching group and a centralized parts room at the supply chain building. The parts room has 715 CE parts line items and 273 imaging parts line items, including tubes. All parts being shipped to a hospital CE shop can “hitch a ride” on one of the 80 daily courier runs going from the supply depot to the hospital facilities. We can have parts to any of the CE shops within the Salt Lake City area in under three hours. Having a centralized parts inventory on hand allows us to utilize price breaks on high-use parts, cut shipping costs by using lower-cost, lower-priority shipping and maintain our parts inventory at needed par levels.

About the author: John Schafer, MBA, is the program manager, clinical engineering for the Intermountain Support Services/Supply Chain department. He invites you to contact him if you are interested in bringing more of your equipment service in-house.