The roadmap of our BEEMS is basically based on previous reported studies[1, 3, 4, 5, 6] and summarized in Figure 1. The system architecture is consisting of a central core module with intra-net and a mobile device application with the internet. With the combination of these two modules, the point-of-care software system become real-time and mobile for all users. The first step in establishment of this system is to update the equipment inventory database. We classified our equipment into multiple categories and update the basic information within the database. The device information is based on a property number and include the picture of medical device, the operation power current, the maintenance interval, contract duration, operating system and information security risk assessment, basic usage guideline and fast trouble shooting solving guideline. With the property number, we can connect the database with other system in the hospital through intranet (Figure1). Such as our property management system, equipment repairing system, Tableau system and budget management system.
Preventive maintenance (PM): We classified our PM into 1st degree and 2nd degree. First degree PM is inspected and is recorded by the user monthly, 2nd degree PM is carried out by biomedical engineers under a scheduled program. Our 2nd PM program scheduling is based the suggestion from WHO medical maintenance program. In brief, a risk-based biomedical equipment management number based on four domain (EM number #: Equipment function, physical risk associated with clinical application, maintenance requirements and incident history) is created. The inspection interval is determined by the EM number and automate scheduled by the BEEMS. If any out of order condition occurs, a notice message will be send to the management staff and responsible engineer.
Corrective maintenance (CM) and Repair: any failed device is reported by the users with the equipment repair reporting system to the BEEMS system, and a message will be send to the engineer. After transfer the message to the responsible engineer, who will restore function of the failed device and allow it to be put back into the service. If the failure equipment cannot be repaired, the engineers will mark the condition in the BEEMS and the message will be send to the users and budget management system. The clinical staff can prepare a renew planning in the future if necessary. Any warning information from product manufacture will be also recorded through the same pathway.
Medical Instrument Mobile Device Application (APP)
The most difficult part for this system is to recognize each equipment through the mobile devices application (APP). We attach a small QR code to most equipment; through the code, and the camera of mobile device, the APP can obtain the equipment identification property number and exchange information with the BEEMS. However, some equipment can’t be pasted a QR code sticker, such as the endoscopes, which need to be cleaned with disinfection liquid and sterilization in high temperature condition. Therefore, we attach water proof color coding SURG-I-BAND (Scanlan International, Inc. Minnesota, USA) on the instrument and developed a simple artificial intelligence system to read the color bandage and connect with the equipment identification property number (Figure 2). Finally, all of our medical equipment can be recognized through the APP with real-time mobile device.
Tableau system is our analytics platform; with the database connection, we can real-time trace the condition of each equipment and performance of staff.
System Satisfaction Survey
In order to clarify the satisfaction of our system, after the application more than one year, we conduct a questionnaire survey. We invite the system users in our hospital and use Google spread sheet with 5 point Likert scale anonymous questionnaire to survey the satisfaction of our BEEMS. The study is conducted according to the criteria set by the declaration of Helsinki and it is waived from written informed consent due to the anonymous design, but we still explain the design of this questionnaire survey to the system users. After the approval of the responders, they can fill out the survey. This study is approved by Research Ethics Review Committee, Far Eastern Memorial Hospital (IRB-109141-E). We classify the responder into management staff or not.
Category variables are expressed as the number and percentage and the difference is tested with Chi-square test with fisher exact correction.