By K. Richard Douglas
In the course of profiling many HTM departments around the country, TechNation has encountered every size from one-person operations to those surpassing 100 technicians. Banner Health, which operates 29 core facilities spanning seven states, has a contingent of HTM professionals that might take the cake.
Spread over four separate divisions; Clinical Technology Assessment and Planning, Diagnostic Imaging Service, Clinical Engineering Service and ENTECH, the Banner Health Technology Management Department includes 250 personnel. Their purpose is to facilitate a comprehensive medical equipment life cycle program. That goal supports Banner Health’s mission statement; “We exist to make a difference in people’s lives through excellent patient care.”
Steering this big ship is a leadership team that includes Vice President of Technology Management Tim Riehm, Senior Director of Clinical Engineering Frank Cabrera, Senior Director of Diagnostic Imaging Services Steve Letourneau, Senior Director of Clinical Technology Assessment and Planning Perry Kirwan and Senior Director of ENTECH Shane Gilman.
The 29 facilities that the department handles include 5,500 beds and 220 operating rooms. They range from 25-bed rural access facilities to 700-bed academic/trauma centers, according to Cabrera. The four divisions within the Technology Management department are important components of making it all work.
Headquartered in Phoenix, Banner Health is a nonprofit that operates 25 hospitals and other healthcare facilities in seven states. The health system celebrated its 15-year anniversary last year. The healthcare system’s Technology Management Department has embraced the unifying name for the profession as its official title.
Divisions Make it Work
“Diagnostic Imaging Service is a corporate-based department that provides in-house service support for all imaging equipment across the entire Banner Health network of facilities,” Cabrera says. “In addition, Imaging Services provides the development and implementation of all service delivery strategies for each location and device type. This includes the creation and development of standardized vendor contract features designed to provide long-term cost containment across all Banner Health facilities.”
“Our goal is to create and maintain superb vendor partnerships that work seamlessly and collaboratively toward our collective goal of achieving optimal service delivery and quality patient care on a 24/7 basis,” he says.
The department is also comprised of the anchor Clinical Engineering Service, which provides support for technology refreshes and departmental expansion and renovation to new facility builds, along with most traditional services.
With the potential for real purchasing power, the Clinical Technology Assessment and Planning (CTAP) division can rely on atypical leverage in negotiating deals. The department has some impressive results that have been achieved since its implementation.
“The infrastructure is built, in place, and leverages a Computerized Maintenance Management System, financial and operational data,” Cabrera says. “Scoring matrices are developed for imaging and non-imaging clinical technologies and are embedded into the Banner Health’s capital prioritization processes.”
Cabrera says that CTAP standardization processes are fully operationalized and have saved $58.75 million since their inception in 2009.
“These savings are on top of the results that we receive through the ECRI quote analysis services,” he says.
“New technology processes are fully operationalized. ECRI’s Select Plus, HTAIS, and Market Intelligence reports play a vital role in the outcomes of this process,” Cabrera explains.
“Banner Health CTAP has taken a large, complex organization that serves many markets across a large, geographical area and developed processes that have enabled clinical and business stakeholders to work together to support a common mission,” he adds.
The ENTECH division is an independent service organization that supports over 400 contracted customers.
“All medical equipment service agreements are centrally managed through the Technology Management Department,” Cabrera says. “This provides opportunities to leverage geography, as well as economies of scale, with respect to vendor relationships.”
The legal portion of the agreements have been hashed out using a comprehensive service-focused boilerplate developed by the health system’s legal department.
“In parallel of the legal process, the operational service component — payment schedules, discount structures — are also being negotiated,” Cabrera explains.
“In my opinion, this single program has assisted greatly in maintaining a relatively flat annual service budget for the past several years,” he says.
“This is even more impactful when we look at the overall incremental service growth over the past three years as Banner Health has added greater than $250 million in equipment in support of the following initiatives: Thunderbird South Tower expansion (150 bed), Estrella tower expansion (100 bed), Good Samaritan OR renovation (15 additional ORs) as well as the building of new facilities at Ironwood (40 bed), Gold Field (25 bed) and MD Anderson Cancer Center.”
Major Initiatives
It may come as no surprise that a big department can take on big projects. The Banner HTM department has addressed some of the leading-edge challenges in HTM with measurable success. One of those has been the implementation of telemedicine.
Cabrera says that translating the available technology used for video conferencing to telemedicine has been a “tricky proposition.” He points to achieving the technical aspects of the service while maintaining HIPAA compliance as one example.
“But, also more practical ones, like finding the right use cases and even the right tools to do the job at hand,” he says. “Also at odds with the adoption, the high cost and almost dedicated nature of the solutions available on the market today.”
“Banner Health asked Technology Management’s CTAP/Telematics team to develop low-cost systems for telemedicine,” Cabrera explains. “Of all of the barriers that Banner experienced regarding adoption, cost was the largest one. The cost of dedicated carts prohibited both access and, just as important, the ability to iterate the design of the delivery systems to best suit the clinical use cases.”
He says that the Telematics team defined the clinical, technical and business requirements, analyzed the market for potential suppliers that met those requirements and vetted the suppliers and made recommendations for products. After much work and review, the result was a “framework of products that could be adapted to fit the unique requirements of each telemedicine use case.”
“The team has developed six unique fixed and mobile designs that enable the following clinical services – tele-psychiatry, tele-stroke, tele-neurology, tele-pediatrics, eSNF (eskilled nursing facilities) and patient-centered medical home. Each one of these systems is designed around a specific set of tasks that achieve objectives such as time to diagnose, prevention of transfers, patient safety and ongoing patient monitoring,” Cabrera adds.
The team at Banner also tackled bringing surgical instrument services in-house.
“The goal of this 18-month journey was to reduce outsourced service expense for hand-held surgical instruments; rigid endoscopes, flexible endoscopes and surgical power tools,” Cabrera says. “Historically, the service for this product line has been decentralized through individual departments: Supply Chain, Endoscopy, Central Sterile Processing and Perioperative.”
“This program has exceeded expectations by delivering greater than 20 percent expense reductions as well as leveraging Original Equipment Manufacturer (OEM) relationships to greater levels. As a direct result, Stryker Surgical has facilitated a very aggressive service offering with value adds exceeding $1 million,” he says.
Banner Health Technology Management has been heavily involved with the Arizona Medical Instrumentation Association (AZMIA). Tim Riehm, the department’s vice president, is the current president of the AZMIA. The department also has members who make up several leadership positions in the association.
The department moves forward with an unremitting mandate for managing a lot of technical expertise along with a massive amount of equipment.