by K. Richard Douglas
If you live in the Midlands of South Carolina, you have access to a 414-bed medical center with a network of more than 600 physicians. Lexington Medical Center (LMC) opened its doors in 1971 as the Lexington County Hospital. Today, the medical center employs nearly 6,000 people from West Columbia, S.C., and the surrounding area.
Affiliated with Duke Medicine for cardiac care and cancer care, the center’s doctors are able to consult with their counterparts at Duke. The affiliation provides Lexington Medical’s patients with access to clinical trials at Duke.
Biomedical Services at Lexington is an in-house shop and always has been; dating back to 1978. The 14-person department is led by Facilities Director Dale Thompson and Facilities Assistant Director Paul Wise, CHFM. The department’s manager is Joe Howe, CBET.
Other department members include Jackie Bottomley, CBET; James Newton, CBET; Michael Chisholm, BMET; Hayward Goodwin, BMET; Lester Gornto, CBET; Wayne Hallman, CBET; Gene Alveshire, CBET; John Levels, BMET; Bryan Pettis, BMET; Bob Brock, BMET and Candice Howard, administrative assistant.
In addition to supporting the medical center’s main campus, the department supports six community medical centers, an occupational health center and about 100 affiliated physician practices. Those facilities contain about 15,000 active assets that are part of the department’s inventory.
The department is working on achieving certification.
“We completed our scheduled Det Norske Veritas (DNV) survey in 2013 with a recommendation that we receive ISO 9001 certification. We are waiting to learn if we have earned this prestigious certification. LMC has DNV accreditation,” Howe says.
EPIC was Epic
Networking and electronic health records have impacted the department. Michael Chisholm is the team’s networking go-to guy.
“Years and years ago, they took us from a single switch up in the ceiling into their network closet, so once we entered their network closet, it became a little different how we install networks,” he says. “Over the years, we’ve seen how we have to integrate into the IT world and build our networks as solid as the hospital networks.”
“We have 18 servers that we handle in Spacelabs, so we do a lot of work with them as far as building our networks,” Howe adds. “Every day, there’s something going on with the capsule interfacing, or if we’re looking at adding a piece of equipment, we have to work with IT to see how it’s going to impact our build practices.”
“Our department has integrated about 700 medical devices with our new electronic health records system — EPIC EHR — to enable the digital capture of vital signs and other diagnostic information seamlessly,” he adds.
The project took three months with an additional month for testing.
“This project required a tremendous amount of teamwork between departments including information services, biomed, engineering, nursing and environmental services. Tasks included installation of hundreds of new work stations, thin clients and 120 capsule neuron data captor devices,” Howe explains. “We also up-fitted the new hardware with network drops, emergency power, new cabinet work and a wide variety of mounting options. Incredible teamwork ensured that we completed the project on time.”
The department learned that the EPIC go-live would be an educational experience. The rep from EPIC made a prediction that proved to be prophetic.
“This is going to shine a bright light on your process weaknesses,” Howe recalls the rep proclaiming. “It did.”
One example arose from the fact that EPIC only pulls the pulse rate from EKG. It only sends the heart rate. It looks strictly at EKG. Dried out EKG electrodes don’t work well. A more strategic process of electrode use and the move to go to smaller packaging, improved the EKG signal quality quite a bit.
Because the department brought up the whole hospital at once with EPIC, the challenge was more than it would have been with a piecemeal approach. They also had to re-educate the monitor tech department, which includes three monitor tech rooms, monitoring over 200 channels. After the go-live, biomed provided 24-hour coverage for two or three weeks, along with the EPIC team who was on-site.
Equipment Management Experience
A couple of years ago, the department took on a project that required expensive training, while the hospital took on an important clinical offering.
“We started a whole new open heart program here,” Chisholm says. “We spent many months getting equipment in, setting up the room, working with profusion team, the cardiac team. We worked one-on-one with the doctors, (including) the CV anesthesiologist. It’s not often that you get a CV anesthesiologist who will want to sit with you and learn all about Spacelab monitor(s). How to make everything run silent. We spent two or three days with the CV anesthesiologist, working with him.”
“It involved a lot of people in our department,” he adds. “We got specialized training on the heart-lung equipment; just a whole new approach to what we do.”
The team closely monitors service contact costs as well.
“All service contracts for medical equipment are centrally managed by the biomed manager. We always run an MD Buyline analysis before executing and we generally frown on service contracts,” Howe says. “We prefer to negotiate the training needed to support new technology with the purchase of the new technology and maintain as much as we can without contracts using in-house expertise.”
The MD Buyline service has proven to be an asset.
“They track history on what it costs to maintain the equipment through the years,” Hallman says. “With a new piece, they may not have a lot, but something that has been out there four or five years, they will be able to track service history and basically find out what the cost of ownership is two or three years down the road.”
The effort to keep the number of service contracts to a minimum has been achieved through training. Howe says that they have been careful to negotiate training at the point of purchase. He says that the one caveat is to time the training to be a year or more out based on the warranty length.
“It’s always easier to get it up front than later,” he says. “It’s all about risk. How much risk you are willing to take doing stuff in-house. I’ve found over the years, it’s almost always cheaper to do things in-house.”
The department is willing to use independent providers who have ISO certification.
“Data collection is done using the Four Rivers TMS system,” Howe says. “We track and trend multiple types of work orders and use the data gathered to help find devices that are more prone to use errors, damage (or) battery failures. We can then target our performance improvement (PI) activities toward error prone devices or other problem areas.”
Away from the shop, members of management and the technicians are active with the Healthcare Technology Management Association of South Carolina (HTMA-SC).