Jackson Health System is one of the nation’s largest public health systems, with a mission of providing one standard of high-quality care to all Miami-Dade County residents, regardless of their ability to pay.

At Jackson, Charles Berberette, system director of clinical engineering, manages a team of 29 clinical engineers who maintain more than 45,100 pieces of medical equipment across four hospitals, multiple urgent care centers and care locations for corrections, rehabilitation, transplant, ambulatory and behavioral health.

The Public Health Trust Board of Trustees, established in 1973 by the Board of County Commissioners, is a group of volunteer citizens who set the policies for Jackson to assure the health system is responsive to community needs.

As a citizen body, this group provides leadership for joint planning between Jackson Health System, the University of Miami Miller School of Medicine, Miami-Dade County, and other private and community organizations.

THE PROBLEM

Berberette pinpointed three problems the organization faced regarding clinical decision support data technology:

1. Procurement of medical equipment parts.
2. Work order ticketing system through the computerized maintenance management system.
3. Enhanced cybersecurity oversight.

Procurement of medical equipment parts

Jackson previously had challenges with parts procurement and quality, two factors that influenced the decision to bring the clinical engineering team in-house in 2019 and create a new model for clinical engineering success.

"The health system wanted to work with a vendor that allowed us to achieve greater cost savings through multiple negotiations and stronger purchasing power," Berberette explained. "A system-wide parts and service procurement platform would drive standardization, enhance quality and improve cost savings and overall efficiencies.

"With more than 45,000 pieces of medical equipment to manage, we also needed data to analyze the effectiveness of the parts we used and associated cost and quality issues," he continued. "We didn’t have that information and knew our solution must provide the ability to make data-driven decisions."

Work order ticketing system through CMMS

Jackson didn’t have a viable CMMS system nor an effective way of creating a work order ticketing system. It needed a computer-based system to integrate time and financial systems and link to its CMMS to set up an automated work order system for all staff. The CE engineering staff and the staff served throughout the hospital.

"For example, someone would call the biomed shop and tell us about their equipment issue," Berberette said. "Then, our staff member would document the call and problem, and find the technician assigned to provide that information.

"Then the technician would manually create a work order in the system, address the situation, take care of the equipment and return to our department downstairs to close out the work order," he added.

Jackson did not have accountability from the perspective of true turnaround time. If a technician forgot to enter the work order when the call came in, then he might create it upon completion of the job.

Thus, when Berberette looked at the orders, it might appear the job was completed in one day, even though the clinical staff told us the equipment has been down for three weeks. The organization also did not have staffing to command the phones and assign work orders to technicians.

Enhanced cybersecurity oversight

Jackson did not have an effective patch management program for its internet of medical things systems. It wanted to address this challenge and find an AI-assisted program.

"This is always a priority for any health system because a cybersecurity incident can cost up to $10 million on average, data I always revisit when talking about this topic," Berberette noted. "Anytime you can prevent a disruption in the IT infrastructure, that’s big. And that’s what we wanted to do with an AI-assisted program."

PROPOSAL

Procurement

"Wasting money is my biggest pet peeve," Berberette stated. "With vendor PartsSource, Jackson streamlined its procurement process and worked with the one vendor to access many different products from multiple companies.

"PartsSource and Jackson aligned as well on the quality standards in place, which meant we could depend on receiving products ready to use and in working order," he continued. "The parts vendor also had completed Jackson’s vendor vetting process, a requirement we follow as a public health system."

Additionally, Jackson wanted to provide greater efficiency to the CE staff in procuring parts and managing its orders. The parts vendor's platform offered visibility at a detailed level that helped the technicians track and trace their parts orders, manage internal expectations on up-times, and track returns and core exchanges, which meant less time and money wasted in the organization.

"And ultimately, quality patient care is our primary goal at Jackson and within the clinical engineering department," Berberette said. "Knowing we had access to quality parts through the parts vendor's platform was vital to meeting clinical needs, as well."

Work order ticketing system

The CE team aligned with IT business partners and developed software that allowed Jackson to upload the database and asset information into the system. Each asset has a technician assigned to it. This was the first step in this process before implementing the system.

"For example, if the clinical staff had a problem with a piece of equipment, we entered the information, asset number and department," Berberette explained. "The system automatically linked back into our CMMS to identify the technician assigned to either that department or piece of equipment.

"Then it cross-referenced to the time management system to see if that person was on the clock," he continued. "If that person is not on the clock, the system checks for the secondary staff member, meaning the system knew who was working at any given time."

Jackson also built in an escalation tree and set limits for critical and noncritical equipment to escalate the call to the next layer of management without human effort. It had an internal process to give out the work order without assigning it to someone to make sure the work got to someone.

The time stamp facilitated an internal process to send the work order to the technician without human interaction.

Cybersecurity

"We conducted a risk assessment as an organization and learned we needed an AI-powered solution linked to the medical equipment that could identify potential vulnerabilities," Berberette revealed. "We wanted a more effective tool to check for vulnerabilities, such as needed patches for equipment.

"Introducing an AI-based solution to address cybersecurity challenges was a first for Jackson," he continued. "Vendor Cynerio helped protect Jackson’s medical equipment against cybersecurity threats, including IoMT equipment."

MEETING THE CHALLENGE

Procurement

The entire health system and its thousands of patients depend on the CE team to maintain clinical availability for mission-critical medical equipment. Jackson staff knew any disruption in service that leads to significant equipment downtime was not an option.

"We introduced PartsSource Pro, their managed service model that combines cloud-based data analytics, best processes and logistical support to drive evidence-based decision making for parts and services procurement," Berberette explained.

"The vendor's system led to cost savings and helped drive process efficiency," he continued. "For example, the platform sends return and core exchange reminders automatically to the ordering technician and paperwork is self-serve directly from the website."

Work order ticketing system

Jackson built the in-house CMMS software to ensure regulatory compliance and operational efficiency from the onset of this new program.

For example, if a clinician had a problem with a piece of equipment, the staff entered that information, the asset number, or even the department, for an automatic link back into the CMMS system, to see who is assigned to either that department or that piece of equipment as a primary.

"Then it referenced to Kronos, our workforce management system, to see if that person is on the clock," Berberette explained. "If not, the system paged the on-call tech. If that person was not on the clock or was off that day, it checked for the secondary technician to see if they were on-call or off the clock."

That means the staff would know who was on-site at any given time, and the system would allow the staff to get the work order out to the right person efficiently. Jackson also set limits for critical equipment or noncritical equipment to automatically escalate the call to the next layer of management without human interaction. All orders have a time stamp and progress notes for easy access by technicians.

RESULTS

Jackson saved $1 million annually from 2019 through 2022 on parts procurement.

"The more efficient we are and the faster we turn around the equipment, the more equipment is available for the patient, which decreases length of stay and increases patient satisfaction," Berberette said. "Our savings during these four years is consistent based on the use of a data-driven decision-making platform from PartsSource.

"I always am looking for process improvements to drive the success of my team, knowing that all decisions impact Jackson as an organization," he continued. "The vendor monitors quality returns by tracking returns on all items from all vendors. The PartsSource current quality return rate is 0.48%. Our quality return rate goal is at 0.5%, which equates to a 99.5% quality acceptance rate."

By using the vendor for FY22 (October 2021-October 2022), Jackson's parts procurement spend would have been 46% greater had it purchased parts on its own. By using the parts vendor, it was able to save 34% off market price for parts purchases.

"Additionally, PartsSource managed 1,850 medical equipment orders on our behalf; this allowed us to consolidate 202 vendors, another example of efficient management based on our procurement model," Berberette noted.

ADVICE FOR OTHERS

"Start with a needs assessment and develop a scope of work that allows clinical engineering to function the way they need to within their organization," Berberette advised. "This includes a review of the technologies and partnerships that allow them to maximize their efficiency and financial stability.

"Then, review the needs for your organization and look for areas of opportunity that encourage growth," he continued. "Look at pain points and challenges in the past, and then try to develop solutions, especially computer-based, repeatable and self-sufficient solutions, to help grow your internal program."

With cybersecurity, it’s always most effective to select the best-option solution for the organization, but also continuously look for areas for improvement that could give the organization even greater efficiencies in that realm, he concluded.

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Email the writer: bsiwicki@himss.org
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