Photo courtesy of United Imaging Healthcare

What OEMs want you to know before signing a CT service agreement

August 08, 2023
by John R. Fischer, Senior Reporter
Maintaining a CT scanner throughout its lifetime is more than just diagnosing problems and deploying the right staff and tools to address them. Any service professional will tell you; medical equipment is no longer a “break-fix” industry, successful practices are preventing problems from happening in the first place.

For example, the failure of a CT tube can put a scanner out of commission for days or weeks until the part can be replaced. The cost of that downtime to a facility’s bottom line can be enormous. Today, investment in technologies like remote monitoring, combined with advancements in logistics, is allowing service providers to detect a tube failure before it happens.

While some hospitals and health systems perform CT scans all day, every day, others have downtime baked into the schedule, and still others may rarely use them but require they be ready in emergencies. An effective servicing plan will take into account utilization patterns, as well as other unique factors. HCB News sat down with four major CT original equipment manufacturers (OEMs) to discuss those key service considerations, and how providers can get the right plan for their needs.

Choosing the right service provider
Unsurprisingly, financial margins are a key factor influencing an organization’s decision on the type of service they seek for CT maintenance. For instance, while large, academic healthcare facilities often have the means to hire the manufacturer to oversee scanner maintenance, rural and small providers may be more inclined to go with independent service organizations, many of which can provide dependable services at lower costs, (we will look at independent servicing more closely in an upcoming article). Additionally, providers with well-trained HTM teams may prefer to keep certain aspects of CT service in-house that others could not.

Providers need to remember that certain servicing needs can sometimes best be handled by the OEM, according to Hani Chohan, vice president for service growth for the U.S. and Canada region at GE HealthCare. Therefore, it’s critical to consider not just the costs of service but also the quality and impact it will have on patient care long-term.

“Let's say a former healthcare employee went to work with some of these ISOs but their training on that GE HealthCare CT equipment was 10 or 15 years ago, he said. “Customers have the right to choose who they want to work with, and are encouraged to work with ISOs that have the right training and right access to compliant OEM parts.”

Some engineers may only be familiar with a small number of specific modalities, while others may be trained on numerous, which can affect the quality of service they provide. For that reason, healthcare providers should ask for examples of qualifications, training, and certifications.

Most OEMs now offer customized service packages at different costs, giving facilities more control over what services to choose from, depending on their individual needs. Philips, for instance, now offers packages that involve strictly remote monitoring, or ones where it oversees both remote and physical servicing needs.

“It really depends on the desire of the hospital as well as the capability and capacity that they have within the hospital engineering team,” said Maarten Leertouwer, services and solutions deliverability leader in CT at Philips. “But we can tailor that exactly to the needs of the hospital.”

OEMs also can train those in-house biomed teams on maintaining new equipment. What this training entails varies among service providers and should be a matter of discussion in negotiations. For instance, United Imaging Healthcare (UIH) trains in-house HTM teams at its international training facility in Houston alongside the company’s service engineers, and has a program called BioMed Training for Life where hospitals pay only once for a biomed to receive training. The engineer can then come back for refresher courses on specific CT scanners and other modalities without paying an extra fee.

“We treat those in-house or biomed teams like our own,” said Jeff Bundy, CEO of UIH. “They come to the same classes as our teams. They have the same access to our support infrastructure, tools, remote diagnostic tools, and more. The idea is, we're very flexible.”

Photo courtesy of Siemens Healthineers

Having access to quality parts
All service providers typically have warehouses and stocking ports of spare parts, such as tubes or brush rings, to replace faulty components in CT systems. According to Dr. Mark Lothert, head of product management for customer service for Siemens Healthineers, it is the quality of these parts that determines when the same repair will need to be repeated and affects the long-term productivity and maintenance costs for a CT scanner.

“Are they using OEM parts? Are they using refurbished parts? Are they using used parts?” he asked.

Providers should also inquire about the logistics of shipping and flying in parts and other forms of transport. They should also ask about a service provider’s network of field engineers. If nearby and able to access the part needed, these personnel can speed up replacement jobs.

Additionally, service agreements for replacements can be intricate and should be evaluated thoroughly to determine if the provider is getting the best quality and benefits for their buck. In UIH’s agreements, tube replacements are unlimited for CT.

“We try to take the pressure off capital budgets by having this operational expense built into what we provide on the service side so that our customers can just focus on their patients,” said Bundy.

Stopping a problem before it starts
In the past, hospitals would alert their service provider about a CT scanner breaking down, and the company would often dispatch an engineer once to diagnose the problem and again to fix it. Engineers would often come back a third time or more to ensure the issue was resolved.

The introduction of remote monitoring has transformed this break-and-fix dynamic into a proactive and predictive one, in which service providers detect signs of trouble and schedule a visit to fix the problem before it occurs. They can also deploy the right engineer with the right specializations, training, and tools to address the issue the first and only time around.

Photo courtesy of Philips

GE HealthCare, for instance, offers Tube Watch, a program that utilizes predictive algorithms to determine the risk of tube failure in advance. The AI technology creates a virtual digital twin representation of the scanner that simulates real-world situations to identify potential failures for proactive parts delivery and service scheduling.

“It's a constant evolution of making sure that we continue to drive a better experience for our customers,” said GE HealthCare’s Chohan.

The timing of services, whether they be reactive, proactive, or predictive, is also essential to consider, as scheduled visits during working hours, no matter how much time it saves the provider in the event of a system failure or decommissioned scanner, still create unplanned downtime.

In its CentriCare package, Siemens Healthineers asks providers when they are working so that they can schedule their maintenance services at times that won’t disrupt patient throughput.

“When the system is not available is when we do planned maintenance efforts,” said Lothert. “In addition, updates and upgrades are part of our non-obsolescence approach. All those things that we do without the system really being broken could take away hours from the operational day to day.”

Certain services, such as those involving software issues, no longer require on-site visits and can be fixed remotely via system configurations, upgrades, log file reboots, and patches. Service providers can even instruct in-house biomed and IT teams remotely on how to address these and other issues. “As you can imagine, we're saving so many hours of engineers flying over the world or traveling,” said Philips’ Leertouwer.

Like with parts replacement, healthcare providers should inquire about the intricate details of these services, and how a service provider’s offerings can meet their specific needs within their budgets. UIH, for example, offers software upgrades for life.

Ultimately, an effective preventive maintenance plan comes down to how well providers know their CT systems, including what procedures they are primarily used for and how often. While all should conduct preventive maintenance checks at least once a year, those that rely on their scanners frequently and for complex procedures should invest in a service agreement that includes two or more maintenance checks, along with resources like remote monitoring for those that play a highly critical role in their operations.

It is this criticality that is the deciding factor in the specific servicing needs a healthcare system requires, and which service provider is best matched to meet those needs, according to Jeff Bundy.

“The key to everything about service is really to understand at the end of it that there's a patient, and that's the mentality we have; and all the things that we put in place are to make sure that the patients can get scanned as soon as possible and then their lives are not disrupted,” he said.