​The University of Pittsburgh Medical Center (Pittsburgh, PA) was selected as a finalist for ECRI Institute's 10th Health Devices Achievement Award for its objective, data-driven approach to planning for medical equipment replacement.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and four finalists for the 10th award in February 2016. For details about the other submissions that achieved recognition, see The Health Devices Achievement Award: Recognizing Exceptional Health Technology Management.

ECRI Institute congratulates the UPMC team: James Szilagy, Eileen Simmons, Patrick Flaherty, Keith Radakovich, Joseph Haduch, Donna Novak, and David Whiteman.

The Challenge

To develop a quantitative, objective means of evaluating the equipment in inventory across the UPMC health system to advance both clinical and financial goals. Desired outcomes include:

1. Identifying existing equipment that is at or near its expected end of life

2. Prioritizing equipment replacement based on quantitative metrics

3. Providing new equipment that offers enhanced technology

4. Reducing purchase costs through volume-based discounting

The Landscape

1. One critical challenge for hospital administrators is how to effectively and strategically replace their facilities' medical equipment. To make the best use of limited capital resources, administrators need an objective, evidence-based process for replacing equipment to help them fulfill the strategic mission of their institutions.

2. At UPMC, a health system incorporating more than 20 hospitals, strategic evaluation and replacement of medical equipment lacked focus and an objective process. As mergers and joint ventures flourished, equipment standardization and strategic capitalization across the health system suffered.

3. UPMC determined that data analysis and clinical review needed to be built into an objective process for evaluating its fleet of medical equipment.

4. In response to this need, UPMC worked with its healthcare technology management subsidiary BioTronics, which manages and services the devices in UPMC's inventory, to develop the "Fleet" program.

The Process

UPMC instituted its Fleet program to identify outdated, unsupported, or technologically deficient equipment in need of replacement across the enterprise. The program typically focuses on higher-volume capital equipment located at multiple facilities across the system. Key aspects of the program are outlined below.

1. Central to the UPMC Fleet process is the calculation of a Replacement Priority Value (RPV) for the equipment in its inventory.

a) The RPV allows comparisons to be made and priorities to be set based on a quantitative analysis.

b) The RPV is calculated through a weighted formula using data extracted from an in-house-developed computerized maintenance management system (CMMS).

(1) The system, known as Integrated Technology Solutions (ITS), was developed and is maintained by BioTronics.

(2) ITS analyzes over 165,000 pieces of medical equipment across the UPMC enterprise, facilitating evidence-based decision making using actual UPMC data.

2. To calculate the RPV:

a) Equipment is scored for the following metrics:

(1) Proximity to expected end of life

(2) Equipment age

(3) Risk level by device classification (e.g., life-support equipment, diagnostic device)

(4) American Hospital Association guideline for useful life

(5) Equipment lifetime maintenance cost

b) Each metric is scored on a 10-point scale, with higher numbers indicating a greater priority for replacement. For example, the proximity to expected end of life is scored as follows:

(1) At end of life: value = 10

(2) End of life within 1 year: value = 7

(3) End of life within 3 years: value = 4

(4) End of life >3 years: value = 1

c) Further, each metric is weighted to reflect a higher or lower priority. For instance, UPMC assigns the highest weight (40%) to equipment that is at or near its expected end of life.

d) The composite score is the RPV.

3. The Fleet analysis occurs in two iterations:

a) The entire equipment inventory is first analyzed by equipment type.

(1) RPVs are calculated for each category of equipment.

(2) Equipment types with the highest RPV receive first consideration for replacement.

b) Next, RPVs are calculated for each device within the equipment types that were found to be the highest priority.

c) The two-tiered process allows UPMC to:

(1) Identify the devices that need immediate replacement

(2) Develop a multiyear strategy for replacing the remainder of the system inventory

4. Equipment categories with RPVs above a cutoff value are vetted to determine which ones will be included as a fleet replacement project for the next fiscal year.

a) While much of the RPV process is data-driven, clinical input and review is nevertheless a key component of the program.

b) Evaluations are reviewed and vetted by:

(1) Various Value Analysis Teams (VATs), consisting of nurses, physicians, administrators, and other multidisciplinary staff

(2) Appointed clinical champions

c) Input from these sources helps:

(1) Preserve or improve the quality of patient care

(2) Identify opportunities for device standardization

5. For each equipment category on the final replacement list, a multidisciplinary project team is created to collect the information needed for equipment budgeting, approval, and purchasing processes. For example:

a) The BioTronics lead assembles information about the equipment in inventory, including the model number, quantities, and locations.

b) The clinical champion:

(1) Collaborates with clinical teams across the health system to determine the configuration, application, and technology requirements of a replacement device

(2) Identifies a manufacturer and model to drive toward becoming the system-wide standard

c) The strategic sourcing lead contacts the proposed replacement vendor and negotiates volume budgetary pricing.

The Results

1. Since its inception in 2010, when the program focused on only one equipment category (ventilators) and had an approved budget of $2.46 million, the program has grown to cover 24 equipment categories with an assigned budget of over $18.2 million for fiscal year 2015.

2. UPMC calculates that the capital and expense savings realized directly through the Fleet initiative total over $10.2 million in the five years since the program was initiated.

Key Takeaways

Additional benefits that UPMC ascribes to the Fleet program are that it has:

1. Allowed the organization to consolidate equipment demands and clinical requirements across the enterprise to facilitate the standardization of both equipment and operations.

2. Helped the organization identify, purchase, and deploy equipment that interfaces directly to the electronic medical record system, increasing user throughput and efficiency.

3. Facilitated quick responses to regulatory "recall" equipment and platform upgrades across the enterprise.

4. Created opportunities for reallocating existing resources—for example, taking devices that were being replaced at one facility (because of their RPV score in that environment) and shifting them to another facility that could still benefit from that technology.

Future benefits that might be achievable through the eventual use of predictive analytics include being able to anticipate the equipment needs of member facilities based on factors such as: departmental patient census trends, escalating equipment repair costs, or reimbursement rates for procedures utilizing technology purchased by fleet capital.