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David and Jahnke: Planning Medical Technology Management in a Hospital

touch.” All medical specialties depend to varying extent financial evaluations, which rely upon net present value
on technology for achieving their goals. Some specialties (NPV) and internal rate of return would consume an
more than others, use medical technology, be it in the enormous amount of a manager’s or director’s time and
fields of preventive medicine, diagnosis, therapeutic care, may in fact be questionable when put in their proper
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rehabilitation, administration or health-related education context. NPV is an important evaluation tool that needs
and training. Medical technology enables practitioners to to be integrated with a clinical engineering assessment
collaboratively and timely intervene together with other when evaluating new rather than existing demand-based
caregivers with patients in a cost-effective and efficient service lines of business or large program comparisons of
manner. Technology also enables integration and con- alternatives based on cost efficiencies. Examples include,
tinuum care in a way that improves the level of overall the proposed addition of a diagnostic imaging center or the
health indicators. Hospital and clinical administrators comparison of major system software packages. Examples
are faced with the expectation for return-on-investment of equipment not needing NPV analysis, existing assets
that meets accounting guidelines and financial pressures. include: defibrillators, infusion pumps, and anesthesia
Society’s expectations for quality care and for the machines. In this case, a typical health care organization
containment of the cost of care, as expressed in rela- may have an inventory encompassing thousands of indi-
tionship to the Gross National Product brought the need vidual pieces of equipment. However, in their attempt to
for even better integration and control into the public improve allocation of resources to medical equipment,
debate arena. The U.S. government, in 1983, attempted the majority of health care executives have been making
to contain runaway health care costs through Federal significant capital expenditure decisions with growing
regulation. These regulations established a new method involvement of clinical engineering expertise and cost-
of reimbursement, called the prospective payment system, of-ownership information. 3
which encouraged hospitals to manage their resources The concept of management of capital assets is a
more effectively. Reimbursement methodology continues far-reaching one that goes beyond merely acquiring or
to influence innovation, development, and adoption of maintaining medical equipment and generally includes
medical technologies. market-based demand forecasting as a method of estimating
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As a result, routine methods for delivering care are future demand for a health care organization’s services.
being replaced with alternatives, such as the growth of Changing payment methodology and existing inventory
outpatient clinics, ambulatory surgery and telemedicine. operations and maintenance costs are important factors
Conventional as well as alternative, sites of health care in planning the deployment of new equipment; these are
services are expected to meet a specific set of goals and management issues that merge together in the clinical
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objectives. These goals and objectives include adminis- environment. This paper describes the emerging process
trative, clinical, financial, and regulatory parameters that for managing medical technology in the hospital and the
influence how the integration of medical technological role that clinical engineers are fulfilling.
tools are planned for, funded, and executed. It also guides
how these tools are selected, installed, trained for, inte- THe TeCHnology MAnAgeMenT
grated, safely operated, serviced, upgraded, and retired PRogRAM – ACHIevIng goAlS
or replaced. These are essentially the phases of all tech- The health care delivery system is going through a
nology, including medical technology. The application of transition that is led by three major driving forces: cost,
knowledge about the optimal management of various technology, and social expectations. The impact of these
life cycle phases of capital assets will maximize system forces may change from time to time, as does their relative
utilization during each one of the phases. Capital assets significance. In addition, the human factor that interacts
management, one life cycle phase, the process of select- with these forces is not constant either, thus submitting
ing and acquiring medical technology, has not been well an important subject for public debate. Nevertheless, the
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coordinated in most hospitals until recently. In addition,

J Global Clinical Engineering Special Issue 1: 23-32; 2018 24