Healthcare Technology Management in Biomedical Engineering.ppt

Understand the managerial systems of the health system in Ghana. Appreciate the steps undertaken in the management of hospital equipment.
Understand the role of the biomedical equipment technician in the management of medical equipment

1. HEALTHCARE TECHNOLOGY
MANAGEMENT
Joseph Asamoah -Asare
Sunyani Technical University

2. Health System
Health System Organization of Ghana
Health care system of Ghana is managed by Ministry of
Health( MoH)
The functions of the MoHamong others is to;
-formulate health policy
-set standards for the delivery of health care in the country
-provide strategic direction for health delivery services
-monitor and evaluate the health service delivery by the Ghana Health
Service (GHS) and the Teaching Hospitals, other Agencies, Development
Partners and the Private sector
-source funding for service delivery through GOG, Health Insurance and
international community
-allocate resources to all health care delivery agencies under the Ministry

3. Health System
Health System Organization of Ghana
Organization of the Ministry of Health, Ghana
Ministry of Health
Colleges of Health Training/ Research
Institute /National Hospitals (Teaching
Hospitals
Regional and Zonal hospitals
District and Municipal Hospital/ Polyclinics/ Clinics/ District Health
Committees
Health Centres/ CHPS centres
Health Assistant, Staff Nurse, Auxiliary Health Workers, Auxiliary Nurse and
Midwives,
Community Health Volunteers
Village Development Committes(Intersectoral)
National Level
Region/Zone
District
Village
Village/Ward

4. Health System
Health System Organization of Ghana
Organizational structure of Ghana Health Service

5. Health System
Health System Organization of Ghana
Thehealthsystemisnowwidenedtoinclusionofprivatesector
suchas;
Non-governmental(NGO)care,careprovidedbymissionaries
suchasChristianHealthAssociationofGhana(CHAG), red
cross
Medicalpracticesbyprivatedoctors,nurses
Thelicensedpharmaceuticalseller
Thelargenon-biomedicalprofessionalizedhealingsystems
(Ayurvedic,Unani,homeopathicetc)

6. Health System
Organization of Technical Section
In the 1940s to 1990s, the maintenance units of KBTH and
KATH offered engineering services to all MoH facilities in
Ghana
However technology advanced tremendously and staff of
these hospitals could not cope
Most institutions relied on the basic skills of artisans to handle
complex electro-medical equipment and state of the
equipment was in total disrepair
There was no inventory/ records/ asset register and basic
equipment maintenance schedules were not available

7. Health System
Organization of Technical Section
In 1993, Biomedical Engineering Unit of the MoH was
established
By 1995, eight Regional Equipment management units were
functional
The Clinical Engineering Department was established in 2004
to support the Ghana Health Service
Currently all Regional Health Directorates, Regional Hospitals
and some selected District Hospitals have Clinical Engineering
Units whiles the Teaching Hospitals have established
Biomedical Engineering Units

8. Health System
Organization of Technical Section
TECHNICAL STAFF INFORMATION
The Biomedical Engineering Unit of the MoH and the Clinical
Engineering Department of the GHS are headed by Deputy
Directors of health
Regional level Clinical Engineering Units of GHS are headed by
Regional Equipment/Clinical Engineering Managers
Whiles District Hospitals Have Clinical Engineering Managers
as the heads of Clinical Engineering Units

9. Hospital Organization and management
Introduction
Hospitals are formal institutions developed by the
society for patient care
It is a place for the diagnosis and treatment of human
ailments and restoration of health and well-beings of
those temporarily deprived of these
Professionally & technically skilled people apply their
knowledge and skill with the help of complicated
equipment and appliances -to provide quality care for
the patient

10. Hospital Organization and management
Introduction cont.
Training
Medical
Research
Health
Education
Patient care
HOSPITAL
FUNCTIONS

11. Hospital Organization and management
Introduction cont.
A hospital is a multifaceted organization comprising
many committees, departments, types of personnel, and
services
It requires highly trained employees, efficient systems
and controls, necessary supplies, adequate equipment
and facilities, and, of course, physicians and patients
It is a business as well as a caring, people-oriented
institution and it has a similar structure and hierarchy of
authority as any large business

12. Hospital Organization and management
Introduction cont.
Every hospital, large or small, has an organizational
structure that allows for the efficient management of
departments
Organizational structure varies from hospital to hospital
Large hospitals have complex organizational
structures whiles smaller hospitals tend to have much
simpler organizational structures
The structure also helps one understand the hospital’s
chain of command

13. Hospital Organization and management
Organization of Hospital
Board
Administration
Therapeutic
Services
Information
Services
Diagnostic
Services
Support
Services
Admissions Billing, etc.
Med. Records Computer
Info. Health Ed. Human
Resour.
PT, OT Speech/Lang.
Resp. Therapy Pharmacy
Nursing Dietary
Med. Lab Radiology
Nuclear Med ER
Cardiology Neurology
Central Supply Biomedical
Housekeeping
Maintenance Dietary
Transportation
TRADITIONAL ORGANIZATIONAL CHART

14. Hospital Organization and management
Organization of Hospital
GOVERNING BODY
Most important body of a hospital is the Governing body/
Board of directors/ board of trustees
The governing body consists of various eminent personalities
in the field of medical education, research, administration,
politics, traditional rulers, etc.
The primary function of the board is to frame all major
policies, plans and programmes of the hospital
It also appoints a Hospital Administratorto get various
functions like clinical services, nursing, pharmacy performed

15. Hospital Organization and management
Organization of Hospital
Hospital departments are generally grouped according to
similarity of duties
Departments are also grouped together in order to promote
efficiency of the healthcare facility
Common Organizational Categories in the hospitals consist of;
-Administrative Services
-Informational Services
-Therapeutic Services
-Support Services

16. Hospital Organization and management
Organization of Hospital
ADMINISTRATIVE SERVICES
These are business people who run the hospital
Hospital Administrators;
-manage and oversee the operation of departments
-oversee budgeting and finance
-establish hospital policies and procedures
-perform public relation duties
They generally include Hospital CEOs, Administrators,
Accountants, Human Resource Officers, Administrative
Assistants, Department Heads, etc.

17. Hospital Organization and management
Organization of Hospital
INFORMATIONAL SERVICES
Mainly documentation and information processing
They are responsible for admissions and the first point of
contact for patients
They are responsible for billing patients for services
rendered
They are responsible for maintaining copies of all patient
records as well as maintaining the hospital’s computers and
network

18. Hospital Organization and management
Organization of Hospital
MEDICAL SERVICES
They are the diagnostic and therapeutic services
Therapeutic services include physical therapy, occupational
therapy, psychologist, dietetics, pharmacy and nursing
services amongst others
In some facilities, Nursing is a service in and of itself
Diagnostic services determines causes of illness or injury and
include medical laboratory and imaging services

19. Hospital Organization and management
Organization of Hospital
NURSING SERVICES
This the largest part of a hospital
They provide care for patients as directed by physicians
Nurses are assigned specific number of beds and have to give
personal attention to patients
Nurses are trained for prenatal care, observation, patient
comfort, etc.
A Nursing Director usually referred to as DDNS is the in-
charge of nursing services

20. Hospital Organization and management
Organization of Hospital
CENTRAL SUPPLY SERVICES
This includes stores which is responsible for ordering,
receiving, stocking and distributing all equipment and supplies
used by healthcare facility
Also is the Central Sterile Services Department (CSSD) Which
is responsible for the sterilization of instruments and supplies
Laundry services is also in charge of cleaning and maintaining
hospital linen and patient gowns

21. Hospital Organization and management
Organization of Hospital
TECHNICAL SERVICES
This includes biomedical engineering services who
-diagnose and repair defective equipment
-provide preventative maintenance to all hospital equipment
-pilot use of medical equipment to other hospital employees
Also included in technical services are artisans such as
electricians, carpenters, plumbers, mason, etc. who are
responsible with the day to day maintenance of equipment
and estate

22. Hospital Organization and management
Organization of the Technical Section
In many hospitals, administrators have established clinical
engineering departments to effectively manage all the
technological resources, especially those relating to medical
equipment

23. Hospital Organization and management
Structure of Clinical Engineering Dept. in Hospitals
The clinical engineering manager, by his or her education
and experience, acts as a manger and technical director of
the clinical engineering department
The clinical engineering manager works with nursing and
medical staff to analyze new medical equipment needs and
participates in both the prepurchaseplanning process and
the incoming testing process
The major functions of a clinical engineering department in
a hospital is technology management, risk management,
technology assessment, training, research and
development

24. Hospital Organization and management
Structure of Clinical Engineering Dept. in Hospitals
In the Ghana Health Service, the Clinical Engineering Unit
is under the Health Administration And Support Services
Department
At the regional level, the Clinical Engineering Unit is
headed by the Regional Equipment Manager who reports to
the Regional Administrator of Health Services
Clinical Engineering units at the regional, municipal and
district hospitals are headed by Clinical Engineering
Managers who work under hospital administrators

25. Introduction to Medical Equipment management
Introduction
Medical devices are essential components of the health care
system and are crucial in the prevention, diagnosis and
treatment of disease and in rehabilitation
Appropriate management of equipment is vital as it ensures
that medical equipment remains safe for its intended use,
equipment life is maximized and total lifetime costs are
minimized
The key objective in the study of medical equipment
management is
-to reduce the risk of injury or adverse impact on patient care
-to decrease equipment life cycle costs
-to comply with codes, standards, and regulations

26. Introduction to Medical Equipment management
Healthcare Technology Management Life Cycle

27. Medical Equipment Inventory
Introduction
Medical equipment inventory is a list of the technology
on hand at the hospital, including details of the type and
quantity of equipment and the current operating status
Medical equipment inventory is an essential part of an
effective health-care technology management system
and may be used to:
•Develop budgets for maintenance and running costs
•Build and support an effective clinical engineering department
•Support a medical equipment management programme
•Plan the stock of spare parts and consumables
•Support equipment needs assessment

28. Medical Equipment Inventory
Data Included in an Inventory
Inventory identification number
Type of equipment/item
Brief description of item
Manufacturer
Date of manufacturing
Model/part number
Serial number
Physical location within facility
Condition/operating status
Power requirements
Maintenance service provider
Purchase supplier

29. Medical Equipment Inventory
Inventory Identification Number
The clinical engineering department determines the
identification numbering and labelling system to be used
within the organization
To assist in this decision-making process, three possible
numbering systems are described here
•Sequential numbering: starting with 1, 2, 3 and continuing
sequentially
•Coded numbering: a code is used to identify unique features
about the equipment, with different parts of the code identifying
different features of the equipment (Eg. 01-XXX-02)
•Barcodes: barcode stickers can be used to label each piece of
equipment. With this more advanced system, a barcode reader is
necessary to read the inventory identification number

30. Medical Equipment Inventory
InventoryIdentification Number
Hospitals under the Ghana Health Service as well as the
teaching hospitals have their own unique way of identifying
their equipment.
Teaching hospitals usually have an identification number
indicating that they are under the MOH (Eg.
MOH/KBTH/AE/SUC/003)
Hospitals under the Ghana Health Service also have a similar
identification (Eg. GHS/SMH/AE/SUC/003)
In recent times, a number of teaching hospitals as well as
regional hospitals have adopted barcodes in their
identification of assets

31. Medical Equipment Inventory
InventoryIdentification Number

32. Medical Equipment Inventory
Computerized Systems for Inventory Management
Although using a paper-based system for inventory is
perfectly acceptable, a computer-based inventory system can
ease inventory management, especially for larger inventories
The inventory may be integrated into a Computerized
Maintenance Management System (CMMS), which generally
combines inventory, repair and maintenance history, and
work-order control into one system
Other information as needed may also be included in a CMMS
Computerized maintenance management systems are
commercially available or may be customized

33. Medical Equipment Maintenance
Types of Maintenance

34. Medical Equipment Maintenance
Types of Maintenance
Medical equipment maintenance can be divided into two major
categories:
•Inspection and preventive maintenance (IPM)
•Corrective maintenance (CM)
IPM includes all scheduled activities that ensure equipment
functionality and prevent breakdowns or failures
Performance and safety inspections are straightforward
procedures that verify proper functionality and safe use of a
device
Preventive maintenance (PM) refers to scheduled activities
performed to extend the life of a device and prevent failure (i.e.
by calibration, part replacement, lubrication, cleaning, etc)

35. Medical Equipment Maintenance
Types of Maintenance
Preventive maintenance (PM) refers to scheduled activities
performed to extend the life of a device and prevent failure
(i.e. by calibration, part replacement, lubrication, cleaning,
etc.
Planned !

36. Medical Equipment Maintenance
Troubleshooting Techniques

37. Medical Equipment Maintenance
Troubleshooting Techniques

38. Medical Equipment Maintenance
Troubleshooting Techniques

39. Medical Equipment Maintenance
Troubleshooting Techniques

40. Medical Equipment Maintenance
Troubleshooting Techniques

41. Medical Equipment Maintenance
Troubleshooting Techniques

42. Medical Equipment Maintenance
Troubleshooting Techniques
Identify test equipment for specific medical equipment,
such as:
•ECG simulator
•Defibrillator tester
•Oxygen analyser
•Surgical machine tester
•X-ray phantom tester
•Electric safety tester
Use test equipment correctly

43. Medical Equipment Maintenance
Preparing and keeping records of works
A Maintenance Record System helps the health service to
keep track of the maintenance and repair work done. It
provides the health service with important information
regarding:
how many jobs are being done at any one time
how many jobs are still waiting to be started
how the jobs are allocated to HTM Team members, and therefore
who is overworked
the details of the work done on each machine, and therefore what
the history of the machine is
what spare parts and materials are used, and therefore which stocks
need to be replaced
when a job is completed

44. Medical Equipment Maintenance
Preparing and keeping records of works
JOB REQUEST FORMS
This is usually completed by the user giving details of the
fault

45. Medical Equipment Maintenance
Preparing and keeping records of works
JOB CARDS
Record when the equipment comes to the workshop
Record fault as reported by the user
Record the time taken to repair/do the work
Record the work done on equipment
Record spare parts used on equipment
Record consumables used on equipment
Record the maintenance staff who worked of equipment
Record the verifying officer on completion of work

46. Medical Equipment Maintenance
Preparing and keeping records of works

47. Medical Equipment Maintenance
Medical Equipment Maintenance Styles
IN-HOUSE STYLE
Staff engineer and/or technician are in charge of
maintenance of all equipment.
Advantage: Immediate availability of service technicians to
troubleshoot and repair equipment
Disadvantage: Relative costs associated with operating an in-
house clinical engineering service

48. Medical Equipment Maintenance
Medical Equipment Maintenance Styles
OUTSOURCING
This style is to contract maintenance work with an outsourcer
and the maintenance work is carried out by outsourced people
Contract patterns can be divided into the following 3 patterns:
•On call contract –When service is required, contracted engineer
and technician is called to visit and work at the facility for
maintenance work. The range of work should be based on
contract.
•Resident contract –Contracted engineer and technician stay in
the facility permanently and work for medical equipment
maintenance work
•Contract for selected equipment -Make maintenance contract on
selected equipment. On call or periodical visit will be made by
the contractor

49. Medical Equipment Maintenance
Medical Equipment Maintenance Styles
MIXED STYLES
In-house style + on call contract –In-house
engineer/technician takes overall responsibility of
medical equipment maintenance. If necessary, they can
obtain technical assistance from the outsourcer.
In-house style + residence contract –One or few
engineer/technicians work with in-house
engineer/technician. They can work for medical
equipment management as one team

50. Medical Equipment Decommissioning and Disposal
Introduction
All medical equipment will, at some point, reach the end
of its useful life.
An organization then has the problem of what to do with
it.
Decommissioning is removal of a medical device from
service in a health care facility after a decision to
disinvest in the device itself or in a service in which it is
used.

51. Medical Equipment Decommissioning and Disposal
Introduction
WHEN TO DECOMMISSION A MEDICAL EQUIPMENT
it is broken down beyond repairs
it does not perform its function
it is unreliable or unsafe
spare parts are no longer available
it is no longer economical to repair
it is clinically or technically obsolete
it is not needed/used any more

52. Medical Equipment Decommissioning and Disposal
Equipment Lifetime
Expected life time, typical:
ECG monitor 5 years
pulse oximeter 7 years
autoclave 10 years
suction pump 10 years
operating table 15 years
electricity generator 20 years
Actual life time depends on:
the rate of use
how the equipment is
handled
how well the equipment
is cared for/cleaned
how well the equipment
is serviced
the initial quality
the environment and
climate

53. Medical Equipment Decommissioning and Disposal
Decommissioning Pathway

54. Legal aspect in Hospital Management, Regulatory
Requirement and Health Care Codes
Medico-Legal Cases
Any case of injury or ailment where some criminality is
involved is called as MLC
Criminality in a case may be Non Cognizable(Police has
no authority to arrest without warrant) or cognizable
(police can arrest without warrant)

55. Legal aspect in Hospital Management, Regulatory
Requirement and Health Care Codes
Bill of Rights
Respectful care
Complete information regarding diagnosis, treatment
and prognosis
Patient has right to information from doctor before he
gives consent
Right to refuse treatment to the extent permitted by law
and to be informed of medical consequences
Right to privacy, all communication and records be
treated as confidential
Right to refuse to participate in research
Right to examine and receive explanation of bill
Right to hospital rules

56. Legal aspect in Hospital Management, Regulatory
Requirement and Health Care Codes
Code of Ethics

57. Legal aspect in Hospital Management, Regulatory
Requirement and Health Care Codes
Professional Licensing
To work as a clinical engineer one needs a degree or
diploma in electrical engineering, electronic engineering,
mechanical engineering, biomedical science/engineering
physics
In Ghana Clinical Engineering licensure is largely
optional and practice is not mandated by law
Some Clinical Engineers have license from the
Engineering Council through the Ghana Institution of
Engineers (GhIE) and the Institute of Engineering
Technologists (IET)

58. Legal aspect in Hospital Management, Regulatory
Requirement and Health Care Codes
Professional Association
The Ghana Society for Biomedical Engineering (GSBE) is
a professional association for Clinical Engineers and
Biomedical Engineers
Clinical Engineers fall under the Health Services Workers
Union of the Trades Union Congress

59. Healthcare Technology Management
END